In-person mental health treatment more successful for young patients
March 19, 2025
MSU researcher finds human connection can make the difference in therapy results particularly for children with chronic medical conditions
A recent study found that psychological therapies may help reduce anxiety in children with chronic medical conditions. If the therapy includes support from a live provider (whether in person or virtual), this has a significant impact on anxiety symptoms, the study led by researchers from Michigan State University and DePaul University found.
The use of self-management approaches, including computer apps, videos and self-guided websites, showed no improvement in anxiety, said the study’s senior author, Natoshia Cunningham, PhD, an associate professor of family medicine and licensed clinical psychologist in the MSU College of Human Medicine.
“I strongly believe part of what defines psychological therapy is the human connection,” Cunningham said. “It can be complemented with but not replaced by technology. This is something I’ve been shouting from the rooftops for years.”
Cunningham collaborated on the study with Susan Tran, PhD, a licensed clinical psychologist and associate professor at the DePaul University College of Science and Health, along with seven other researchers.
Their study was an invited systematic review and meta-analysis, which appears in a special Nov. 28 edition of the Journal of Pediatric Psychology. The journal editors approached Cunningham because of her expertise in developing and testing psychological therapies to manage anxiety in youth with chronic medical conditions and asked her to build a team of experts to conduct the review. Cunningham asked Tran to help lead the project, given her expertise in pediatric psychology and meta-analytic methods.
This study is important because more than 40 percent of children are affected by chronic medical conditions. Anxiety is also a common issue affecting youth.
“The rates of anxiety disorders are much higher for children and youths with chronic medical conditions than those without,” Tran said.
Cunningham and Tran began by screening 6,262 published studies, eventually narrowing them to 33 randomized clinical trials relevant to this project. Children and youth in those studies suffered a variety of chronic medical conditions, including cancer, type 1 diabetes, asthma, juvenile arthritis, headaches, and mixed chronic pain conditions.
With the ever-growing creation of apps and online support tools to manage mental health concerns, children and their families have more options than ever, but it can be overwhelming to know where to begin and what might work best. Understanding the long-term impacts of such care will also be important, as this project focused on symptom changes in the short term.
Prior research has shown that the most effective therapies for child anxiety use cognitive behavioral strategies, and the majority of studies in this meta-analysis used that approach. This study adds that care with a live provider is also important for addressing anxiety, particularly if a child has a chronic medical condition.
“If anxiety is getting in the way of life, psychological therapy can help with that,” Cunningham said. “Constant stress is not good for our health.”
Tran said further research is needed to identify the best type of therapy for each patient. “I think we can develop different types of interventions for different kinds of chronic conditions,” she said.
To that end, Cunningham is working on developing and testing tailored psychological treatment approaches to support youth with different chronic medical conditions (such as abdominal pain disorders and lupus).
The team also noted that there might still be a place for using self-management, online support tools in certain cases, such as in areas where trained therapists are unavailable, although more work is needed to ensure such approaches can be used consistently and effectively.
Another option Cunningham is testing is training other professionals who work with children, such as school nurses, in using cognitive behavioral strategies to manage symptoms. When possible, working with an appropriately trained provider may be the key ingredient for optimal care.
By Pat Shellenbarger