Future Directions for the Examination of Mediators of Treatment Outcomes in Youth.

How do psychological therapies work? How can we enhance treatment to improve outcomes? Questions of mediation lie at the heart of these inquiries. However, within the child and adolescent treatment literature, studies of mediation often rely on methodological and statistical approaches that limit the inferences that can be drawn from study findings. This future directions review delineates some of these issues and suggests improvements through two interrelated paths. We propose that mediation studies in the youth treatment literature will be enhanced (a) by adopting best practices in nomothetic (group-based) methodologies for assessing putative mediating variables and conducting appropriate statistical analyses and (b) by increasing the use of idiographic (individual-focused) approaches to youth outcome research through mediation studies that use innovative designs, data collection techniques, and analytic methods. We discuss the applicability of findings using these approaches to the treatment of youth in particular.

A Multi-Informant Examination of Maternal Symptoms and Autonomy Granting in Youth Anxiety.

Evidence suggests the important role of (a) parenting behaviors and (b) parental psychopathology in the development and maintenance of youth anxiety. Using a multi-informant approach, the current study examined the association of maternal autonomy granting and maternal symptoms (i.e., anxiety and depression) with youth anxiety among mothers and 88 youth (ages of 6-17) diagnosed with a principal anxiety disorder. Results from the generalized estimating equations (GEE) analyses indicated that mothers reported higher youth anxiety symptoms compared to youth self-reports. Youth-perceived maternal autonomy granting was inversely associated with youth anxiety, and maternal self-reported anxiety and depressive symptoms significantly moderated this relationship: As mothers reported higher anxiety and depressive symptoms, the inverse association between parental autonomy granting and youth anxiety weakened. The interaction between parenting behavior and parental psychopathology significantly influenced youth anxiety symptoms, which presents important clinical implications to integrate into parenting work in the treatment of youth anxiety disorders.

Interpersonal psychotherapy-adolescent skills training: anxiety outcomes and impact of comorbidity.

Given the frequent comorbidity of anxiety and depression, it is important to study the effects of depression interventions on anxiety and the impact of comorbid anxiety on depression outcomes. This article reports on pooled anxiety and depression data from two randomized trials of Interpersonal Psychotherapy-Adolescent Skills Training (IPT-AST), a depression prevention program. Ninety-eight adolescents were randomized to receive IPT-AST or school counseling (SC). Outcome and predictor analyses were performed utilizing hierarchical linear models. IPT-AST adolescents had significantly greater reductions in anxiety and depressive symptoms than SC adolescents during the intervention. Baseline anxiety symptoms predicted change in depressive symptoms for adolescents in both intervention conditions, with adolescents low in baseline anxiety demonstrating more rapid change in depressive symptoms than adolescents high in baseline anxiety. These findings indicate that IPT-AST is effective at decreasing both depressive and anxiety symptoms. For adolescents with comorbid symptoms of anxiety, there may be slower rates of change in depressive symptoms following prevention programs.

Mediators of youth anxiety outcomes 3 to 12 years after treatment.

OBJECTIVE: Test changes in perceived coping efficacy, negative self-statements, and interpretive biases to threat during treatment as potential mediators of the relationship between randomly assigned treatment conditions and long-term anxiety follow-ups. Age at randomization was also tested as a moderator of mediational relationships. METHOD: Participants included 319 youth (ages 7-17) from the Child/Adolescent Multimodal Study (CAMS) who participated in a naturalistic follow-up beginning an average of 6.5 years after the end of the CAMS intervention. The intervention conditions included cognitive behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), combined CBT and sertraline, and pill placebo. Putative mediators were measured four times during the intervention phase. Follow-up consisted of four annual assessments of current anxiety. RESULTS: Reductions on a measure of interpretive bias to threat over the course of the combined condition intervention, as compared to the placebo condition, mediated anxiety outcomes at the first follow-up visit. This mediated effect was not significant for the CBT-only or sertraline-only conditions when compared to the placebo condition. No other significant mediated effects were found for putative mediators. Age did not significantly moderate any mediated effects. CONCLUSION: Changes in youth-reported interpretive biases to threat over the course of combined youth anxiety interventions, as compared to a placebo intervention, may be associated with lower anxiety an average of 6.5 years following treatment.