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Randomized Controlled Trial
. 2023 Sep;64(9):1336-1345.
doi: 10.1111/jcpp.13796. Epub 2023 Apr 2.

Anxiety symptom trajectories from treatment to 5- to 12-year follow-up across childhood and adolescence

Sunhye Bai  1 , Benjamin Rolon-Arroyo  2 , John T Walkup  3 , Philip C Kendall  4 , Golda S Ginsburg  5 , Courtney P Keeton  6 , Anne Marie Albano  7 , Scott N Compton  8 , Dara Sakolsky  9 , John Piacentini  10 , Tara S Peris  10
Affiliations
Randomized Controlled Trial

Anxiety symptom trajectories from treatment to 5- to 12-year follow-up across childhood and adolescence

Sunhye Bai et al. J Child Psychol Psychiatry. 2023 Sep.

Abstract

Objective: The current study examined trajectories of anxiety during (a) acute treatment and (b) extended follow-up to better characterize the long-term symptom trajectories of youth who received evidence-based intervention for anxiety disorders using a person-centered approach.

Method: Participants were 319 youth (age 7-17 years at enrollment), who participated in a multicenter randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study, and a 4-year naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study, an average of 6.5 years later. Using growth mixture modeling, the study identified distinct trajectories of anxiety across acute treatment (Weeks 0-12), posttreatment (Weeks 12-36), and the 4-year-long follow-up, and identified baseline predictors of these trajectories.

Results: Three nonlinear anxiety trajectories emerged: "short-term responders" who showed rapid treatment response but had higher levels of anxiety during the extended follow-up; "durable responders" who sustained treatment gains; and "delayed remitters" who did not show an initial response to treatment, but showed low levels of anxiety during the maintenance and extended follow-up periods. Worse anxiety severity and better family functioning at baseline predicted membership in the delayed remitters group. Caregiver strain differentiated short-term responders from durable responders.

Conclusions: Findings suggest that initial response to treatment does not guarantee sustained treatment gains over time for some youth. Future follow-up studies that track treated youth across key developmental transitions and in the context of changing social environments are needed to inform best practices for the long-term management of anxiety.

Keywords: Anxiety; adolescents; children; growth mixture modeling; treatment; treatment relapse.

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