Predictors of school-based cognitive behavior therapy outcome for youth with anxiety

Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents’ credibility and expectancy of interventions should be targeted to optimize school-based CBT.publishedVersio

Treatment motivation in child anxiety treatment – Factor structure and associations with outcomes

Motivation is associated with cognitive behavioral treatment (CBT) outcomes. We examined the factor structure of a motivation measure, and if motivation factors were differentially associated with CBT outcomes for children with anxiety. The sample comprised 179 children aged 8–15 years (M age = 11.5 years, SD = 2.1; 53.0% girls) with anxiety disorders who received CBT in a randomized controlled community clinic trial. Participants completed the Nijmegen Motivation List – child version (NML-C) at treatment onset. Outcomes were diagnostic recovery, anxiety/depression symptom and clinical severity change from pre-treatment to post-treatment, one-, and 3.9-years follow-up, and treatment dropout. Principal component analysis showed that the NML-C comprised two factors, preparedness (beliefs that CBT is useful and willingness to engage in treatment; 36.4% explained variance) and distress (discomfort from symptoms and perceived urgency to be helped; 12.7% explained variance). Higher preparedness predicted larger clinical severity reduction at post-treatment, alongside pre-treatment clinical severity. Higher distress predicted larger depression reduction at one-year follow-up, alongside pre-treatment depression. Higher preparedness predicted lower dropout. In conclusion, the NML-C comprises two factors that are differentially associated with CBT outcomes, but not above the effects of pre-treatment symptoms. Clinicians' focus on children's distress and preparedness could enhance CBT outcomes and reduce dropout