Mechanisms of Behavioral and Affective Treatment Outcomes in a Cognitive Behavioral Intervention for Boys

Abstract

Evidence for effective treatment for behavioral problems continues to grow, yet evidence about the effective mechanisms underlying those interventions has lagged behind. The Stop Now and Plan (SNAP) program is a multicomponent intervention for boys between 6 and 11. This study tested putative treatment mechanisms using data from 252 boys in a randomized controlled trial of SNAP versus treatment as usual. SNAP includes a 3 month group treatment period followed by individualized intervention, which persisted through the 15 month study period. Measures were administered in four waves: at baseline and at 3, 9 and 15 months after baseline. A hierarchical linear modeling strategy was used. SNAP was associated with improved problem-solving skills, prosocial behavior, emotion regulation skills, and reduced parental stress. Prosocial behavior, emotion regulation skills and reduced parental stress partially mediated improvements in child aggression. Improved emotion regulation skills partially mediated treatment-related child anxious-depressed outcomes. Improvements in parenting behaviors did not differ between treatment conditions. The results suggest that independent processes may drive affective and behavioral outcomes, with some specificity regarding the mechanisms related to differing treatment outcomes.

CBT-Enhanced Emotion Regulation as a Mechanism of Improvement for Childhood Irritability

“…Compared to children receiving standard community care, children in SNAP displayed greater reductions of internalizing and externalizing problem behaviors, as well as symptom counts of ADHD, ODD, anxiety, and depression (Burke & Loeber, 2015). Unlike other hypothesized mechanisms for SNAP treatment effectiveness, including increased problem-solving ability and reduced parental distress, only enhanced ER skills mediated reductions in both aggressive behavior and anxiety-depression scores on the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2001; Burke & Loeber, 2016). …”

“…The SCS has demonstrated concurrent validity with other measures of ER capacities: high social competence scores corresponded to high ER on the Emotion Regulation Checklist (Shields & Cicchetti, 1997; Gouley et al, 2008). Burke and Loeber (2016) demonstrated that anxiety and depression symptom improvement among children with behavioral problems were linked to the ER skills subscale specifically.…”

“…The study recruitment procedures, random assignment to treatment conditions, and assessment protocols have been reviewed in prior publications (Burke & Loeber, 2015, 2016). In brief, of 481 parents who inquired about treatment at one of two agencies providing SNAP services and received information about the study, 337 were interested in screening for enrollment.…”

“…However, empirical tests using a three-level modeling approach demonstrated a lack of systematic influence on observations due to treatment group participation. Further details regarding specific aspects of treatment participation, its relevance to outcomes, and the evaluation of the effect of partial nesting can be found in Burke and Loeber (2015, 2016). …”

“…Though SNAP was specifically designed for children referred for severe conduct problems, initial investigations of SNAP treatment outcomes demonstrated significant improvements not only for conduct symptoms and rates of police contact, but across both behavioral and affective symptom domains (Burke & Loeber, 2015, 2016). Compared to children receiving standard community care, children in SNAP displayed greater reductions of internalizing and externalizing problem behaviors, as well as symptom counts of ADHD, ODD, anxiety, and depression (Burke & Loeber, 2015).…”