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J Consult Clin Psychol. 2016 Jan;84(1):1-14. doi: 10.1037/a0039773. Epub 2015 Oct 12.

Mediators of change in the Child/Adolescent Anxiety Multimodal Treatment Study.

Author information

1
Department of Psychology, Temple University.
2
Department of Psychology, Center for Child and Adolescent Mental Health.
3
Department of Psychology, The Norwegian Center for Child Behavioral Development.
4
Department of Psychology, University of Connecticut.
5
Department of Psychiatry, University of Pittsburgh.
6
Department of Psychiatry and Behavioral Sciences, Duke University.
7
Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles.
8
Child and Adolescent Mental Health, National Institute of Mental Health.
9
Department of Child and Adolescent Psychiatry, Cornell University.
10
Department of Psychology, Philadelphia College of Osteopathic Medicine.
11
Department of Child and Adolescent Psychiatry, Johns Hopkins University.
12
Department of Psychology, University of Georgia.
13
Department of Child and Adolescent Psychiatry, Columbia University.

Abstract

OBJECTIVE:

Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS).

METHOD:

Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up.

RESULTS:

Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms.

CONCLUSIONS:

The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator.

PMID:
26460572
PMCID:
PMC4695375
DOI:
10.1037/a0039773
[Indexed for MEDLINE]
Free PMC Article

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