Characterizing the Implementation of CBT for Youth Anxiety

Abstract

CHARACTERIZING THE IMPLEMENTATION OF CBT FOR YOUTH ANXIETY By Meghan M. Smith, B.A. A thesis submitted in partial fulfillment of the requirements for the degree of Master of Science at Virginia Commonwealth University. Virginia Commonwealth University, 2013 Major Director: Bryce D. McLeod, Associate Professor, Psychology Department Although evidence-based treatments (EBTs) often perform well in research settings, when EBTs are delivered in practice settings they sometimes fail to outperform usual care (UC). One reason for this could be that therapists in practice settings may not follow the EBT protocol as closely or may deliver more therapeutic interventions that align with other treatment domains. I tested this possibility in the context of cognitive-behavioral treatment (CBT) for youth anxiety by comparing how CBT was delivered in practice (i.e., community-based clinics) and research (i.e., lab) settings. A diverse sample of youth (aged 7-15) received one of two treatments to address primary presenting problems of anxiety: CBT in a lab (N = 51), CBT in clinics (N = 18), or UC in clinics (N = 22). The extensiveness of therapeutic interventions delivered was measured using the Therapy Process Observational Coding System for Child Psychotherapy – Strategies Scale (McLeod & Weisz, 2010). Two coders independently coded the same available sessions. Analyses investigated mean-level differences in interventions session-by-session, over time between the three groups. Results indicated that CBT delivery differed across groups, over time. Future researchers should use this characterization to further implementation and processoutcome research, and eventually either enhance quality control efforts or alter aspects of EBT protocols (Garland, Hulbert, & Hawley, 2006).