Mediators of Change in the Child/Adolescent Anxiety Multimodal Treatment Study

• Published in: Journal of consulting and clinical psychology Vol. 84; no. 1; pp. 1 - 14
• Main Authors: Kendall, Philip C., Cummings, Colleen M., Villabø, Marianne A., Narayanan, Martina K., Treadwell, Kimberli, Birmaher, Boris, Compton, Scott, Piacentini, John, Sherrill, Joel, Walkup, John, Gosch, Elizabeth, Keeton, Courtney, Ginsburg, Golda, Suveg, Cindy, Albano, Anne Marie
• Format: Journal Article
• Language: English
• Published: United States American Psychological Association 01-01-2016
• Subjects: Adaptation, Psychological; Adjustment; Adolescent; Adolescent Psychotherapy; Adolescents; Anxiety; Anxiety disorders; Anxiety Disorders - diagnosis; Anxiety Disorders - psychology; Anxiety Disorders - therapy; Anxiety, Separation - diagnosis; Anxiety, Separation - psychology; Anxiety, Separation - therapy; Attention Deficit Disorder with Hyperactivity; Behavior modification; Child; Child Psychotherapy; Cognitive Behavior Therapy; Cognitive behavioral therapy; Cognitive Behavioral Therapy - methods; Cognitive therapy; Cognitive-behavioral factors; Combined Modality Therapy; Conditions; Coping; Coping Behavior; Diagnostic and Statistical Manual; Drug therapy; Efficacy; Female; Generalized Anxiety Disorder; Human; Humans; Male; Mental disorders; Multimodal Treatment Approach; Negative emotions; Pharmacology; Phobic Disorders - diagnosis; Phobic Disorders - psychology; Phobic Disorders - therapy; Questionnaires; Selective Serotonin Reuptake Inhibitors - therapeutic use; Self-Talk; Selftalk; Separation anxiety; Sertraline; Sertraline - therapeutic use; Social anxiety; Surveys and Questionnaires; Test anxiety; Treatment Outcome; anxiety; mediators; youth; coping; anxious self-talk
• ISSN: 0022-006X; 1939-2117; 1939-2117
• DOI: 10.1037/a0039773

Objective: Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). Method: Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. Results: Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. Conclusions: The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator.
What is the public health significance of this article?
These findings suggest that, within empirically supported treatments for anxiety in youth, the youth's self-perceived ability to manage anxiety provoking situations plays a role in beneficial change.