Trajectories of change in youth anxiety during cognitive-behavior therapy

Abstract

Objective: To evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks.

Method: Four hundred eighty-eight youths ages 7-17 years (50% female; 74% ≤ 12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls.

Results: Longitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior).

Conclusions: Findings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed. (PsycINFO Database Record

Figure 1

Estimated population mean CGI-S growth curve trajectories by CAMS treatment condition following the start of CBT cognitive restructuring and exposure exercises. Note: Onset COG = onset of cognitive restructuring component of CBT; Onset EXP = onset of exposure exercises component of CBT.

Figure 2

Estimated population mean CGI-S growth curve trajectories for COMB and CBT by participant age following the start of CBT exposure exercises. Note: Onset COG = onset of cognitive restructuring component of CBT; Onset EXP = onset of exposure exercises component of CBT.

Figure 3

Estimated population mean CGAS growth curve trajectory by CAMS treatment condition following the start of CBT cognitive restructuring and exposure exercises. Note: Onset COG = onset of cognitive restructuring component of CBT; Onset EXP = onset of exposure exercises component of CBT.

Figure 4

Estimated NASSQ population mean growth curve trajectories by CAMS treatment condition following the start of cognitive restructuring. Note: Onset COG = onset of cognitive restructuring component of CBT.

Figure 5

Estimated NASSQ population mean growth curve trajectories for COMB and CBT by participant age. Note: Onset COG = onset of cognitive restructuring component of CBT.