Elsevier

Behaviour Research and Therapy

Volume 76, January 2016, Pages 1-12
Behaviour Research and Therapy

Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders

https://doi.org/10.1016/j.brat.2015.11.001Get rights and content

Highlights

  • Knowledge of predictors of outcome is important for adapting CBT in community clinics.

  • Anxiety symptom severity and impairment predicted poorer outcome.

  • A primary social phobia or separation anxiety disorder predicted poorer outcome.

  • Parent internalizing symptoms predicted poorer outcome.

  • Children with these characteristics may need adapted CBT treatment.

Abstract

A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8–15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.

Section snippets

Methods

This study was part of a randomized waitlist-controlled effectiveness trial of CBT for children with anxiety disorders. The main aims of the trial were to investigate the effectiveness of CBT in community clinics and to compare the relative effectiveness of individual CBT (ICBT) and group CBT (GCBT) for children with anxiety disorders. The procedures for recruitment of participants, training of therapists and assessors, and randomization have been reported elsewhere (Wergeland et al., 2014)

Results

At post-treatment, 22.7% of the children was free from all inclusion anxiety disorders, and 35.2% was free from their principal anxiety disorder. At 1-year follow-up, the corresponding numbers were 36.5 and 45.9%. The observed mean change in child-rated anxiety symptoms at post-treatment was −8.51 (SD 14.40) and at 1-year follow-up, it was −11.89 (SD 14.39). For parent-rated child anxiety symptoms, the corresponding means were −8.16 (SD 12.08) and −11.19 (SD 13.22), respectively. Child- and

Discussion

The present study examined potential predictors of CBT outcome in children with anxiety disorders who were treated in community clinics with a manualized CBT program. Treatment outcomes were evaluated across different methods focusing on different aspects of outcome. The most consistent findings were that higher child anxiety levels, higher functional impairment, higher levels of parent internalizing symptoms at baseline, and primary diagnoses of social phobia or separation anxiety were

Conflicts of interest

Wergeland, Gro Janne H. reports no conflicts of interest.

Fjermestad, Krister W. reports no conflicts of interest.

Marin, Carla E. reports no conflicts of interest.

Bjelland, Ingvar reports no conflicts of interest.

Haugland, Bente Storm-Mowatt reports no conflicts of interest.

Silverman, Wendy K. reports no conflicts of interest.

Öst, Lars-Göran reports no conflicts of interest.

Bjaastad, Jon Fauskanger reports no conflicts of interest.

Oeding, Kristin reports no conflicts of interest.

Havik, Odd E.

Acknowledgments

The study received support from the Western Norway Regional Health Authority through project numbers 911366 and 911253. The study received additional financial support from the Meltzer Research Foundation at the University of Bergen, Norway; Josef and Haldis Andresen Foundation, Solveig and Johan P. Sommer Foundation for promotion of research on clinical psychiatry, Gidske and Petter Jacob Sørensen Foundation, and Risteigen Foundation. The authors are grateful to Professor Paula Barrett for

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