Category: Child / Adolescent - Anxiety
Anxiety disorders are among the most common mental health conditions of childhood and adolescence, and are associated with persistent difficulties and long-term impairment across multiple domains of functioning. Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder (SAD), and Social Anxiety Disorder (SOC) (also known as Social Phobia) are among the most common anxiety disorders in youth. GAD is characterized by persistent, uncontrollable worry about a variety of themes, while SAD involves specific fears of separating from a loved one, and SOC involves fears that focus specifically on social evaluation. The big three disorders highly comorbid in youth and are often researched together and treated similarly.
Cognitive Behavioral Therapy (CBT) has been shown to be an effective treatment across the anxiety disorders; however, evidence suggests not all youth respond equally well to treatment. Youth with SOC tend to have poorer outcomes after CBT treatment relative to their anxious peers, while youth with GAD tend to demonstrate more treatment gains. Though their existence is well documented in individual and group CBT, there is less research on the existence of these disparities in CBT with a manualized parent training component (CBT-PT). Furthermore, the reasons for these outcome disparities remain unclear. Emerging recent research suggests family accommodation is important in the development and maintenance of childhood anxiety disorders. Accommodation may include facilitating children's anxiety-related avoidance, adhering to rigid child-assigned rules related to anxiety, modifying family routines around a child’s anxiety, and providing excessive reassurance. Accommodation behaviors are thought to be in direct conflict of the goals of CBT, though little research has been conducted around how accommodation is associated with the specific anxiety disorders, and how these associations may differentially influence treatment gains.
This study uses a clinical sample of (N~80) youth ages 7-17 with a primary diagnosis of SOC, GAD, or SAD, as determined by the ADIS-IV. The youth participated in 12 weeks of CBT using the Coping Cat manual, and at least one parent participated in a 12-week manualized training to target accommodation. Regression will be used to examine the comparative efficacy of a 12-week CBT-PT intervention for youth with SOC, GAD, and SAD, respectively. The data will be examined for differences in levels of accommodation before and after treatment across the three groups. Finally, we will use a mixed model analysis to test if the relation between primary diagnosis and accommodation is significantly related to treatment outcomes. Contrary to expectations from individual and group CBT studies, preliminary evidence suggests CBT-PT may be equally effective for youth across the big three primary diagnoses. Findings and treatment implications will be discussed.
Stephanie Young– University of Texas at Austin, Austin, Texas
Eli Rolfes– The University of Texas at Austin
Travis Kozak– University of Texas Austin
Morgan Engelmann– University of Texas at Austin
Arielle Gammon– University of Texas Austin
Kevin Stark– Professor, The University of Texas at Austin, Austin, Texas