Category: Child / Adolescent - Anxiety
Anxiety is a serious condition, affecting 10-20% of all children and adolescents (Kessler, Berglund, Demler, Jin, & Walters, 2005). Cognitive Behavioral therapy (CBT) is a well-established treatment for anxiety in youth (Hollon & Beck, 2013) and has demonstrated good response rates, with 60% of youth rated as responders following a course of treatment in randomized clinical trials (RCTs; Kendall, Hudson, Gosch, Flannery-Schroeder, & Suveg, 2008; Walkup et al., 2008). However, about one third of youth do not demonstrate significant improvement after the typical 16 weeks, and nearly half remain symptomatic (Compton et al., 2004). Given the prevalence of and the impairments associated with youth anxiety disorders, there is public health importance in maximizing the efficacy of current treatments.
It is common in many settings for therapists to extend treatment beyond the 16 weeks typical of many manual-based treatments. However, most research is conducted in the context of formal RCTs, where methodology caps treatment at 16 weeks. No research to date has explored the benefits of these additional weeks of treatment.
The current study examines the clinical characteristics of youth who chose to extend therapy beyond the standard 16 weeks. Participants were youth ages 7-17 meeting diagnostic criteria for a principal anxiety disorder who were part of a larger study examining the mechanisms of change in CBT for child anxiety (F31MH105104). Anxiety was assessed at baseline and following session 16 by independent evaluators (IEs) using the Anxiety Diagnostic Interview Schedule, Fifth Edition (ADIS-5; Albano & Silverman, in press) and with parent and child self-report on the Multidimensional Anxiety Scale for Children (MASC; March et al, 1997). IEs additionally completed the Clinical Global Impressions Scale-Improvement (CGI-I; Guy, 1976) at the 16-week assessment. Therapists also completed an informal questionnaire describing the decision to end or extend treatment after 16 weeks (e.g. what were the reasons, who made this decision, etc.).
Data collection is ongoing, with an expected sample of 60 youth. Analyses will examine pre-treatment characteristics that are associated with the decision to extend treatment beyond 16 weeks. Logistic regressions will examine whether pre-treatment factors including anxiety severity (as measured on the ADIS and MASC), principal diagnosis (as identified on the ADIS), and number of diagnoses (as identified on the ADIS) are associated with the decision to extend treatment. Additional analyses will explore the associations between the decision to extend treatment and several factors assessed at week 16, including anxiety severity (as measured on the ADIS and MASC), remission of principal diagnosis (as identified by the ADIS), number of remaining clinical diagnoses (as identified by the ADIS), and overall improvement (as measured by the CGI-I). Finally, descriptive statistics will be presented regarding therapist-reported reasons treatment was extended or terminated. These results will provide important information about the decision to extend manual-based treatment for anxious youth. Implications for assessment and intervention will be discussed.
Elana Kagan– Graduate Student, Temple University, Philadelphia, Pennsylvania
Mathew Carper– Graduate Student, Temple University
Philip Kendall– Distinguished University Professor and Laura H. Carnell Professor of Psychology, Temple University, Philadelphia, Pennsylvania