Category: Child / Adolescent - Anxiety
Cognitive and behavioral components of treatment are increasingly being studied as mechanisms of symptom reduction for youth anxiety, but research is needed to assess how these factors relate to longer-term outcomes of treatment. To address this gap, we tested changes in (a) perceived coping efficacy, (b) negative self-statements, and (c) interpretive biases to threat as potential mediators of the relationship between treatment condition and long-term follow-up (average of 6.5 years after intervention). Participants included 301 youth who had participated in the Child/Adolescent Multimodal Study (CAMS) and subsequently opted to participate in a naturalistic follow-up study beginning an average of 6.5 years after the end of the acute treatment phase. In the intervention phase, participants (ages 7 to 17) were randomized to cognitive behavioral therapy (CBT), pharmacotherapy (sertraline), combined CBT and sertraline, or pill placebo. Putative mediators were measured at 4 time-points over the course of the intervention phase. The follow-up study consisted of five annual assessment visits that included ratings of current anxiety based on an interview by an independent evaluator who was blind to the randomization of participants. Reductions on a measure of interpretive biases to threat over the course of the combined intervention condition mediated anxiety outcomes at the first follow-up visit, which took place an average of 6.5 years after treatment (-1.243, 95% confidence interval [-7.139, -0.023]). No other significant mediated effects were found for any of the putative mediators. The findings suggest that interpretive biases to threat, an often elevated characteristic of anxious youth, may be an important component to address as part of the treatment of anxiety in order to maintain reductions in anxiety in the years following treatment. The specificity of this finding to the combined CBT and sertraline condition offers support for the synergistic effect of CBT and sertraline when implemented in tandem to reduce anxiety-related cognitive factors with long-term implications.
Distinguished University Professor and Laura H. Carnell Professor of Psychology