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Dysregulation in Youth with Anxiety Disorders: Relationship to Acute and 7- to 19- Year Follow-Up Outcomes of Cognitive-Behavioral Therapy

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Abstract

This study evaluated the impact of dysregulation across cognitive, affective, and behavioral domains on acute and 7- to 19-year follow-up outcomes of cognitive-behavioral therapy (CBT) for anxiety, and explored dysregulation as a predictor of psychopathology and impairment in young adulthood among individuals who received anxiety treatment as youth. Participants (N = 64; 50 % female, 83 % non-Hispanic White) from two randomized clinical trials completed a follow-up assessment 7–19 years later. Latent profile analysis identified dysregulation based on Anxious/Depressed, Attention Problems, and Aggressive Behavior scores on the Child Behavior Checklist. Although pretreatment dysregulation was not related to acute or follow-up outcomes for anxiety diagnoses that were the focus of treatment, dysregulation predicted an array of non-targeted psychopathology at follow-up. Among youth with a principal anxiety disorder, the effects of CBT (Coping Cat) appear to be robust against broad impairments in self-regulation. However, youth with a pretreatment dysregulation profile likely need follow-up to monitor for the emergence of other disorders.

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Notes

  1. This profile has been referred to as the CBCL Dysregulation Profile [89], the CBCL Juvenile Bipolar Disorder Profile [90], the CBCL Pediatric Bipolar Profile [21], the CBCL Mania Proxy [91], and Deficient Emotional Self-Regulation [19]. Operational definitions have varied irrespective of the profile name used.

  2. In Benjamin et al. [42] N = 66 at 7- to 19-year follow-up. For the current analysis, N = 64 as a result of dropping 2 participants for whom pretreatment CBCL data were missing.

  3. CSRs for participants in Kendall et al. [47] were based on the 0-4 scale in use at that time. CSRs for participants in Kendall et al. [48] were based on a 0-8 scale. For consistency, the senior author reviewed posttreatment diagnostic reports for participants in Kendall et al. [48] and recoded CSRs using the 0–4 scale.

  4. Separation anxiety disorder, generalized anxiety disorder, and social phobia have been conceptualized as sharing an underlying construct [92], are highly comorbid [93], and have been studied jointly in the context of treatment [47].

  5. See Benjamin et al. [42] for a description of how additional treatment ratings were computed for this sample.

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Acknowledgments

This research was facilitated by Grants (MH086954 and MH103955 to Dr. Benjamin Wolk; MH063747 and MH086438 to Dr. Kendall) from the National Institute of Mental Health.

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Authors and Affiliations

  1. Department of Psychology, Georgia State University, P.O. Box 5010, Atlanta, GA, 30302-5010, USA

    Nicole E. Caporino

  2. Department of Couple and Family Therapy, Drexel University, Philadelphia, Pennsylvania

    Joanna Herres

  3. Department of Psychology, Temple University, Philadelphia, Pennsylvania

    Philip C. Kendall

  4. Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania

    Courtney Benjamin Wolk

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  1. Nicole E. Caporino
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Caporino, N.E., Herres, J., Kendall, P.C. et al. Dysregulation in Youth with Anxiety Disorders: Relationship to Acute and 7- to 19- Year Follow-Up Outcomes of Cognitive-Behavioral Therapy. Child Psychiatry Hum Dev 47, 539–547 (2016). https://doi.org/10.1007/s10578-015-0587-2

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