Anxiety symptom trajectories from treatment to 5- to 12-year follow-up across childhood and adolescence

Sunhye Bai*, Benjamin Rolon-Arroyo, John T. Walkup, Philip C. Kendall, Golda S. Ginsburg, Courtney P. Keeton, Anne Marie Albano, Scott N. Compton, Dara Sakolsky, John Piacentini, Tara S. Peris

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Objective: The current study examined trajectories of anxiety during (a) acute treatment and (b) extended follow-up to better characterize the long-term symptom trajectories of youth who received evidence-based intervention for anxiety disorders using a person-centered approach. Method: Participants were 319 youth (age 7–17 years at enrollment), who participated in a multicenter randomized controlled trial for the treatment of pediatric anxiety disorders, Child/Adolescent Anxiety Multimodal Study, and a 4-year naturalistic follow-up, Child/Adolescent Anxiety Multimodal Extended Long-term Study, an average of 6.5 years later. Using growth mixture modeling, the study identified distinct trajectories of anxiety across acute treatment (Weeks 0–12), posttreatment (Weeks 12–36), and the 4-year-long follow-up, and identified baseline predictors of these trajectories. Results: Three nonlinear anxiety trajectories emerged: “short-term responders” who showed rapid treatment response but had higher levels of anxiety during the extended follow-up; “durable responders” who sustained treatment gains; and “delayed remitters” who did not show an initial response to treatment, but showed low levels of anxiety during the maintenance and extended follow-up periods. Worse anxiety severity and better family functioning at baseline predicted membership in the delayed remitters group. Caregiver strain differentiated short-term responders from durable responders. Conclusions: Findings suggest that initial response to treatment does not guarantee sustained treatment gains over time for some youth. Future follow-up studies that track treated youth across key developmental transitions and in the context of changing social environments are needed to inform best practices for the long-term management of anxiety.

Original languageEnglish (US)
Pages (from-to)1336-1345
Number of pages10
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number9
StatePublished - Sep 2023


  • Anxiety
  • adolescents
  • children
  • growth mixture modeling
  • treatment
  • treatment relapse

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Developmental and Educational Psychology
  • Pediatrics, Perinatology, and Child Health


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