Do clinical experience, formal cognitive behavioural therapy training, adherence, and competence predict outcome in cognitive behavioural therapy for anxiety disorders in youth?

OBJECTIVE: The aim was to investigate whether clinical experience, formal cognitive behavioural therapy (CBT) training, adherence, and competence predict outcome in CBT for anxiety disorders in youth. METHOD: Videotapes (N = 181) from the sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014, Behaviour Research and Therapy, 57, 1-12) comprising youth (N = 182, M age = 11.5 years) with mixed anxiety disorders were assessed for treatment adherence and competence using the Competence and Adherence Scale for CBT for anxiety disorders in youth (Bjaastad et al., 2016, Psychological Assessment, 28, 908-916). Therapists' (N = 17) clinical experience and educational background were assessed. Participants completed a diagnostic interview (Anxiety Disorders Interview Schedule, child and parent versions) and an anxiety symptom measure (Spence Children's Anxiety Scale, child and parent versions) at pretreatment, posttreatment, and 1-year follow-up. RESULTS: Higher therapist adherence was related to better treatment outcomes, whereas number of years of clinical experience and competence was related to worse outcomes. However, these findings were not consistent across informants and the time points for the assessments. Interaction effects suggested that competence among therapists with formal CBT training was related to better patient outcomes. CONCLUSIONS: Therapist adherence, competence, and clinical experience are associated with outcomes of manualized CBT for youth anxiety disorders, but mixed findings indicate the need for more research in this area.

Parental internalizing symptoms as predictors of anxiety symptoms in clinic-referred children.

BACKGROUND: Mothers' and fathers' internalizing symptoms may influence children's anxiety symptoms differently. OBJECTIVE: To explore the relationship between parental internalizing symptoms and children's anxiety symptoms in a clinical sample of children with anxiety disorders. METHOD: The sample was recruited through community mental health clinics for a randomized controlled anxiety treatment trial. At pre-intervention, children (n = 182), mothers (n = 165), and fathers (n = 72) reported children's anxiety symptoms. Mothers and fathers also reported their own internalizing symptoms. The children were aged 8 to 15 years (M age = 11.5 years, SD = 2.1, 52.2% girls) and all had a diagnosis of separation anxiety, social phobia, and/or generalized anxiety disorder. We examined parental internalizing symptoms as predictors of child anxiety symptoms in multiple regression models. RESULTS: Both mother and father rated internalizing symptoms predicted children's self-rated anxiety levels (adj. R 2 = 22.0%). Mother-rated internalizing symptoms predicted mother-rated anxiety symptoms in children (adj. R 2 = 7.0%). Father-rated internalizing symptoms did not predict father-rated anxiety in children. CONCLUSIONS: Clinicians should incorporate parental level of internalizing symptoms in their case conceptualizations.

Relationship factors and outcome in child anxiety treatment studies.

This study reviews 19 randomized controlled trials examining the association between three relationship factors - participation, treatment involvement, and therapeutic relationship - and outcome of cognitive-behavioral anxiety treatments for children and adolescents. In 12 studies, parent participation was considered as an independent variable compared to child-only participation. In three studies, parental involvement was measured. Child involvement was measured in one study. The child's perception of the therapeutic relationship was considered in three studies. Six studies found a significant positive effect of parent participation on diagnostic status, symptom level, or global functioning outcome measures. One study found a significant effect of parental involvement on global outcome measures. Another study found a significant positive association between child involvement and symptom measures and global functioning measures. No association was found between the quality of the child's perception of the therapeutic relationship and treatment outcome. Clinical implications are discussed.