Modular Cognitive Behavioral Therapy for Youth with Anxiety Disorders: A Closer Look at the Use of Specific Modules and their Relation to Treatment Process and Response

Abstract

Recent data have emerged suggesting the benefits of a modular rather than manualized approach to treating anxiety disorders, particularly in school settings. However, little is known about the use of specific modules or their relation to treatment process or response. Using data from a modular cognitive behavioral treatment for anxiety disorders delivered by school clinicians, this study examined (a) the frequency of module use (e.g., exposure, cognitive restructuring), (b) whether therapy session process variables (e.g., therapeutic relationship) varied by module, and (c) the relation between specific module use and treatment response. Data from 124 therapy sessions were used to address these questions. Therapy sessions were delivered by 11 school-based clinicians to a sample of 16 volunteer youth (mean age 11.1 years; 68.8 % female, 87.5 % African-American) as part of a randomized controlled trial (Ginsburg et al. in Child Youth Care Forum 41:1–19, 2011). After each therapy session, clinicians identified the module used and rated various process variables. Treatment response was assessed by blind evaluators who conducted diagnostic interviews with children and parents post-intervention and at a 1-month follow-up. The most frequently used modules were exposure (47 % of sessions), psychoeducation (20 % of sessions), and cognitive restructuring (18 % of sessions). Session process variables (e.g., child involvement, therapeutic relationship) varied by module. No individual module predicted treatment response. Findings suggest that newly trained clinicians do not use CBT modules with equal frequency and type of module does not appear to affect key treatment variables. Future studies are needed to explore the reasons clinicians select specific modules as well as the quality of implementation.