Abstract
To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work. Exposure to feared situations is an effective CBT component. However, there is little observation-based empirical research on how exposure relates to outcomes and other clinical variables. In a randomized controlled community clinic trial for youth with anxiety disorders, observers reliably rated exposure quality for 68 youths aged 8 to 15 years based on 118 videotaped sessions. The treatment program was the manual-based FRIENDS program. Three exposure quality elements (preparation, post-processing, and parent contribution to exposure) were examined in relation to pre-treatment demographic and clinical variables, outcomes, and youth- and therapist-rated alliance using multilevel hierarchical regression models. The outcomes were diagnostic recovery, clinical severity and anxiety symptoms change from pre- to post-treatment and one-year follow-up, and treatment dropout. The results showed that parent contribution to exposure was higher for boys and younger children. Parent contribution to exposure, but no other exposure element, was associated with a larger likelihood of diagnostic recovery and larger clinical severity reduction at one-year follow-up. Exposure quality was unrelated to outcomes at post-treatment, dropout, or alliance. We conclude that enhancing parent contribution to exposure during treatment could improve long-term outcomes after CBT for youth anxiety disorders. Exposure elements should be observed in larger samples to further examine their potential role for CBT outcomes.
Highlights
The current study aimed to examine therapists’ use of exposure elements when cognitive behavioral therapy (CBT) was delivered in community clinics for youth with anxiety disorders
To further extend the field’s knowledge about the exposure component when CBT is delivered outside university clinics, we examined exposure quality beyond potential associations with outcomes
Intent-to-treat analyses of participants in the individual CBT (ICBT) arm showed that 35.2% had lost their primary anxiety disorder at posttreatment, which had increased to 46.2% at one-year followup (Wergeland et al, 2014)
Summary
The current study aimed to examine therapists’ use of exposure elements when cognitive behavioral therapy (CBT) was delivered in community clinics for youth with anxiety disorders. This initial evidence provides the field with some direction about how to tailor exposure tasks to optimize CBT outcomes This evidence-base is limited by few studies, all of which have been based on the Coping Cat program (Hedtke et al, 2009; Peris et al, 2017; Peterman et al, 2016; Tiwari et al, 2013) and conducted in efficacy settings (i.e., university-led intervention sites with specialized therapists).
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