Patterns of sub-optimal change following CBT for childhood anxiety

Lizel-Antoinette Bertie^{1

2

3}, Kristian Arendt⁴, Jonathan R I Coleman⁵, Peter Cooper⁶, Cathy Creswell^{6

7

8}, Thalia C Eley⁵, Catharina Hartman⁹, Einar R Heiervang¹⁰, Tina In-Albon¹¹, Karen Krause¹², Kathryn J Lester¹³, Carla E Marin¹⁴, Maaike Nauta⁹, Ronald M Rapee², Silvia Schneider¹², Carolyn Schniering², Wendy K Silverman¹⁴, Mikael Thastum⁴, Kerstin Thirlwall⁶, Polly Waite^{6

7

8}, Gro Janne Wergeland¹⁰, Jennifer L Hudson^{1

2

3}

Affiliations

¹ School of Psychology, UNSW, Sydney, NSW, Australia.
² Department of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
³ Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
⁴ Department of Psychology, University of Aarhus, Aarhus, Denmark.
⁵ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, & King's College London, London, UK.
⁶ School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
⁷ Department of Psychiatry, University of Oxford, Oxford, UK.
⁸ Department of Experimental Psychology, University of Oxford, Oxford, UK.
⁹ Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
¹⁰ Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
¹¹ Clinical Child and Adolescent Psychology and Psychotherapy, Department of Psychology, University of Koblenz-Landau, Landau, Germany.
¹² Mental Health Research and Treatment Center, Ruhr-Universtät Bochum, Bochum, Germany.
¹³ School of Psychology, University of Sussex, Brighton, UK.
¹⁴ Yale University, Child Study Center, New Haven, CT, USA.

PMID: 38817012
PMCID: PMC11563922 (available on 2025-12-01)
DOI: 10.1111/jcpp.14009

Multicenter Study

Patterns of sub-optimal change following CBT for childhood anxiety

Lizel-Antoinette Bertie et al. J Child Psychol Psychiatry. 2024 Dec.

. 2024 Dec;65(12):1612-1623.

doi: 10.1111/jcpp.14009. Epub 2024 May 30.

Authors

Affiliations

¹ School of Psychology, UNSW, Sydney, NSW, Australia.
² Department of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia.
³ Black Dog Institute, University of New South Wales, Sydney, NSW, Australia.
⁴ Department of Psychology, University of Aarhus, Aarhus, Denmark.
⁵ Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, & King's College London, London, UK.
⁶ School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK.
⁷ Department of Psychiatry, University of Oxford, Oxford, UK.
⁸ Department of Experimental Psychology, University of Oxford, Oxford, UK.
⁹ Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
¹⁰ Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway.
¹¹ Clinical Child and Adolescent Psychology and Psychotherapy, Department of Psychology, University of Koblenz-Landau, Landau, Germany.
¹² Mental Health Research and Treatment Center, Ruhr-Universtät Bochum, Bochum, Germany.
¹³ School of Psychology, University of Sussex, Brighton, UK.
¹⁴ Yale University, Child Study Center, New Haven, CT, USA.

PMID: 38817012
PMCID: PMC11563922 (available on 2025-12-01)
DOI: 10.1111/jcpp.14009

Abstract

Background: Children and adolescents demonstrate diverse patterns of symptom change and disorder remission following cognitive behavioural therapy (CBT) for anxiety disorders. To better understand children who respond sub-optimally to CBT, this study investigated youths (N = 1,483) who continued to meet criteria for one or more clinical anxiety diagnosis immediately following treatment or at any point during the 12 months following treatment.

Methods: Data were collected from 10 clinical sites with assessments at pre-and post-treatment and at least once more at 3, 6 or 12-month follow-up. Participants were assigned to one of three groups based on diagnostic status for youths who: (a) retained an anxiety diagnosis from post to end point (minimal responders); (b) remitted anxiety diagnoses at post but relapsed by end point (relapsed responders); and (c) retained a diagnosis at post but remitted to be diagnosis free at end point (delayed responders). Growth curve models assessed patterns of change over time for the three groups and examined predictors associated with these patterns including demographic, clinical and parental factors, as well as treatment factors.

Results: Higher primary disorder severity, being older, having a greater number of anxiety disorders, having social anxiety disorder, as well as higher maternal psychopathology differentiated the minimal responders from the delayed and relapsed responders at the baseline. Results from the growth curve models showed that severity of the primary disorder and treatment modality differentiated patterns of linear change only. Higher severity was associated with significantly less improvement over time for the minimal and relapsed response groups, as was receiving group CBT, when compared to the delayed response group.

Conclusions: Sub-optimal response patterns can be partially differentiated using variables assessed at pre-treatment. Increased understanding of different patterns of change following treatment may provide direction for clinical decision-making and for tailoring treatments to specific groups of clinically anxious youth. Future research may benefit from assessing progress during treatment to detect emerging response patterns earlier.

Keywords: Anxiety; childhood; cognitive behavioural therapy; response patterns; sub‐optimal response.

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Conflict of interest statement

Conflict of interest statement: No conflicts declared.

References

1. Aebi M, Kuhn C, Metzke CW, Stringaris A, Goodman R, & Steinhausen H-C (2012). The use of the development and well-being assessment (DAWBA) in clinical practice: a randomized trial. European Child & Adolescent Psychiatry, 21(10), 559–567. - PMC - PubMed
1. Bai S, Rolon-Arroyo B, Walkup JT, Kendall PC, Ginsburg GS, Keeton CP, et al. (2023). Anxiety symptom trajectories from treatment to 5-to 12-year follow-up across childhood and adolescence. Journal of Child Psychology and Psychiatry. - PubMed
1. Byrne SP, Lebowitz ER, Ollendick TH, & Silverman WK (2018). Anxiety Disorders in Children and Adolescents. In Hunsley J& Mash EJ (Eds.), A guide to assessments that work (pp. 217–241).
1. Chu BC, Skriner LC, & Zandberg LJ (2013). Shape of Change in Cognitive Behavioral Therapy for Youth Anxiety: Symptom Trajectory and Predictors of Change. Journal of Consulting and Clinical Psychology, 81(4), 573–587. - PubMed
1. Coleman JR, Lester KJ, Keers R, Roberts S, Curtis C, Arendt K, et al. (2016). Genome-wide Association Study of Response to Cognitive Behavioural Therapy in Children with Anxiety Disorders. British Journal of Psychiatry, 209(3), 236–243. - PMC - PubMed

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Patterns of sub-optimal change following CBT for childhood anxiety

Affiliations

Patterns of sub-optimal change following CBT for childhood anxiety

Authors

Affiliations

Abstract

Conflict of interest statement

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical