Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety

Predictors and Associations With Outcomes

Phyllis Lee*, Asima Zehgeer, Golda S. Ginsburg, James McCracken, Courtney Keeton, Philip C. Kendall, Boris Birmaher, Dara Sakolsky, John Walkup, Tara Peris, Anne Marie Albano, Scott Compton

*Corresponding author for this work

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7–17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.

Original languageEnglish (US)
Pages (from-to)S215-S226
JournalJournal of Clinical Child and Adolescent Psychology
Volume48
Issue numbersup1
DOIs
StatePublished - Mar 29 2019

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Cognitive Therapy
Anxiety
Anxiety Disorders
Separation Anxiety
Therapeutics
Family Therapy
Diagnostic and Statistical Manual of Mental Disorders
African Americans
Compliance
Parents
Demography

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Clinical Psychology

Cite this

Lee, Phyllis ; Zehgeer, Asima ; Ginsburg, Golda S. ; McCracken, James ; Keeton, Courtney ; Kendall, Philip C. ; Birmaher, Boris ; Sakolsky, Dara ; Walkup, John ; Peris, Tara ; Albano, Anne Marie ; Compton, Scott. / Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety : Predictors and Associations With Outcomes. In: Journal of Clinical Child and Adolescent Psychology. 2019 ; Vol. 48, No. sup1. pp. S215-S226.
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abstract = "Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7–17 years of age, 51.6{\%} female; 79.6{\%} White, 9{\%} African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adherence. The most robust predictors of greater adherence were living with both parents and fewer youth comorbid externalizing disorders. With respect to outcomes, therapist ratings of higher youth compliance with CBT predicted several indices of favorable outcome: lower anxiety severity, higher global functioning, and treatment responder status after 12 weeks of CBT. Number of sessions attended and homework completion did not predict treatment outcomes. Findings provide information about risks for youth nonadherence, which can inform treatment and highlight the importance of youth compliance with participating in therapy activities, rather than just attending sessions or completing homework assignments.",
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Lee, P, Zehgeer, A, Ginsburg, GS, McCracken, J, Keeton, C, Kendall, PC, Birmaher, B, Sakolsky, D, Walkup, J, Peris, T, Albano, AM & Compton, S 2019, 'Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety: Predictors and Associations With Outcomes', Journal of Clinical Child and Adolescent Psychology, vol. 48, no. sup1, pp. S215-S226. https://doi.org/10.1080/15374416.2017.1310046

Child and Adolescent Adherence With Cognitive Behavioral Therapy for Anxiety : Predictors and Associations With Outcomes. / Lee, Phyllis; Zehgeer, Asima; Ginsburg, Golda S.; McCracken, James; Keeton, Courtney; Kendall, Philip C.; Birmaher, Boris; Sakolsky, Dara; Walkup, John; Peris, Tara; Albano, Anne Marie; Compton, Scott.

In: Journal of Clinical Child and Adolescent Psychology, Vol. 48, No. sup1, 29.03.2019, p. S215-S226.

Research output: Contribution to journalArticle

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AU - Lee, Phyllis

AU - Zehgeer, Asima

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AU - McCracken, James

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