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Randomized Controlled Trial
. 2017 Dec;56(12):1043-1052.
doi: 10.1016/j.jaac.2017.10.001. Epub 2017 Oct 9.

Therapist-Reported Features of Exposure Tasks That Predict Differential Treatment Outcomes for Youth With Anxiety

Tara S Peris  1 , Nicole E Caporino  2 , Sarah O'Rourke  3 , Philip C Kendall  4 , John T Walkup  5 , Anne Marie Albano  6 , R Lindsey Bergman  7 , James T McCracken  7 , Boris Birmaher  8 , Golda S Ginsburg  9 , Dara Sakolsky  8 , John Piacentini  7 , Scott N Compton  3
Affiliations
Randomized Controlled Trial

Therapist-Reported Features of Exposure Tasks That Predict Differential Treatment Outcomes for Youth With Anxiety

Tara S Peris et al. J Am Acad Child Adolesc Psychiatry. 2017 Dec.

Abstract

Objective: Exposure tasks are recognized widely as a key component of cognitive-behavioral therapy (CBT) for child and adolescent anxiety. However, little research has examined specific exposure characteristics that predict outcomes for youth with anxiety and that may guide its application in therapy.

Method: This study draws on a sample of 279 children and adolescents (48.4% male; 79.6% white) with a principal anxiety disorder who received 14 sessions of CBT, either alone or in combination with medication, through the Child/adolescent Anxiety Multimodal treatment Study (CAMS). The present study examines therapist-reported quantity, difficulty level, compliance, and mastery of exposure tasks as they related to CBT response (i.e., Clinical Global Impressions-Improvement ratings). Secondary treatment outcomes included reduction in anxiety symptom severity on the Pediatric Anxiety Rating Scale, global impairment measured via the Children's Global Assessment Scale, and parent-report of anxiety-specific functional impairment on the Child Anxiety Impairment Scale.

Results: Regression analyses indicated a dose-response relationship between therapist-reported quantity of exposure and independent evaluations of treatment outcome, with more time devoted to exposure linked to better outcomes. Similarly, greater time spent on more difficult (rather than mild or moderate) exposure tasks predicted better outcomes, as did therapist ratings of child compliance and mastery.

Conclusion: The present findings highlight the importance of challenging children and adolescents with difficult exposure tasks and of collaborating to ensure compliance and mastery.

Keywords: CBT; anxiety; exposure; treatment.

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Figures

Figure 1.
Figure 1.
Interaction between percentage of sessions containing exposure and age. Note: CAIS-P = Child Anxiety Impact Scale-Parent.
Figure 2.
Figure 2.
Interaction between percentage of exposure sessions containing difficult exposure and treatment condition. Note: CBT = cognitive-behavioral therapy; CGAS = Children’s Global Assessment Scale; COMB = combination of medication and CBT.
Figure 3.
Figure 3.
Interaction between therapist-rated mastery during exposure and treatment arm. Note: CAIS-P = Child Anxiety Impact Scale-Parent; CBT = cognitive-behavioral therapy; COMB = combination of medication and CBT.
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