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Behav Res Ther. 2016 Jan;76:1-12. doi: 10.1016/j.brat.2015.11.001. Epub 2015 Nov 5.

Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders.

Author information

1
Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway. Electronic address: gjwergeland@gmail.com.
2
Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Frambu Resource Centre for Rare Disorders, Siggerud, Norway.
3
Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
4
Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway.
5
Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.
6
Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, University of Stockholm, Stockholm, Sweden.
7
Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
8
Anxiety Research Network, Haukeland University Hospital, Bergen, Norway.
9
Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
10
Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.

Abstract

A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8-15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.

KEYWORDS:

Anxiety; Children; Cognitive behavior therapy; Effectiveness; Predictors

PMID:
26583954
DOI:
10.1016/j.brat.2015.11.001
[Indexed for MEDLINE]
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