Trajectories of change in youth anxiety during cognitive—behavior therapy.

Abstract

Objective To evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks. Methods 488 youths ages 7–17 years (50% female; 74% ≤ 12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children’s Global Assessment Scale (CGAS; Schaffer et al., 1983) and every four weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; Rupp Study Group, 2002). Youths in SRT and PBO were included as controls. Results Longitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior). Conclusions Findings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed.

Testing the Habituation-Based Model of Exposures for Child and Adolescent Anxiety

“…cognitive restructuring, relaxation, psychoeducation). However, we note that research has found that early introduction of exposures is associated with positive outcomes (Gryczkowski et al, 2013) and the entry of exposure into typical CBT has shown to be followed by a significant acceleration in the rate of progress in treatment (even after other treatment techniques are introduced; Peris et al, 2015). In other words, exposure has evidenced unique contributions to outcome (Voort et al, 2010).…”

“…Although particular aspects of CBT for various anxiety disorders in youth vary by treatment manual, exposure is a core element across specific interventions. Exposure is perhaps the most integral component of CBT, influencing the trajectory of improvement (Peris et al, 2015), predictive of treatment outcome (e.g., Voort, Svecova, Jacobsen, & Whiteside, 2010), and showing comparable performance when conducted in isolation and compared to more comprehensive CBT interventions (e.g., Deacon & Abramowitz, 2004). Additionally, exposure as a therapeutic tool is strengthened by its versatility, capable of being conducted across varied settings and tailored to individual presentations (Peterman, Read, Wei, & Kendall, 2014).…”

Constructive and Unproductive Processing of Traumatic Experiences in Trauma-Focused Cognitive-Behavioral Therapy for Youth

“…Such research can include more frequent assessment and more sophisticated and dynamic modeling (e.g. Peris et al, 2015) of factors that hinder and facilitate emotional processing. It will be especially important to map the temporal sequencing of components of unproductive and productive processing over time and to identify the factors that predict change in PTSD-specific symptoms.…”

Predictors of clinician use of exposure therapy in community mental health settings

“…Cognitive-behavioral therapy (CBT) is a proven and efficacious treatment for anxiety demonstrating durable effects over time (Benjamin, Harrison, Settipani, Brodman, & Kendall, 2013; Ginsburg et al, 2014; Higa-McMillan, Francis, Rith-Najarian, & Chorpita, 2016). Use of exposure, or confronting fear stimuli within the context of CBT, is the key ingredient of intervention leading to improved outcomes (Kendall et al, 2006; Peris et al, 2015). Despite scientific recognition that exposure is critical to the success of CBT for anxiety, recent estimates suggest that only 10–30 percent of clinicians endorse using exposure therapy in routine clinical care (Becker, Zayfert, & Anderson, 2004; Borntrager, Chorpita, Higa-McMillan, Daleiden, & Starace, 2013; Trask, Fawley-King, Garland, & Aarons, 2016; Whiteside, Deacon, Benito, & Stewart, 2016; Wolitzky-Taylor, Zimmermann, Arch, De Guzman, & Lagomasino, 2015).…”