Do changes in coping and the therapeutic alliance in CBT for youth anxiety disorders precede and predict subsequent symptom improvement

Abstract

The study investigated the temporal pattern of change between engagement and disengagement coping, the therapeutic alliance and symptoms in cognitive behavioral therapy (CBT) for youth with anxiety disorders. Data from an ongoing sixteen-week CBT program for youth with anxiety disorders were analyzed in this study. Paired sample t-tests showed that anxiety symptoms, coping and alliance changed significantly over treatment. Hierarchical regression analyses revealed that reductions in disengagement coping and anxiety were associated over the first half of treatment (by both parent and child report). Changes in engagement coping over the first half of therapy were inconsistently related to symptom change. Changes in the therapeutic alliance by midtreatment did not predict symptoms at any time point. If trends continue, they could indicate that disengagement coping is more important to long-term symptom improvement than engagement coping.