In-Session Involvement in Anxious Youth Receiving CBT with/without Medication

Erika A. Chiappini; Elizabeth Gosch; Scott N. Compton; Thomas M. Olino; Boris Birmaher; Dara Sakolsky; Tara S. Peris; John Piacentini; Anne Marie Albano; Courtney P. Keeton; John T. Walkup; Golda Ginsburg; Philip C. Kendall

doi:10.1007/s10862-020-09810-x

In-Session Involvement in Anxious Youth Receiving CBT with/without Medication

Erika A. Chiappini, Elizabeth Gosch, Scott N. Compton, Thomas M. Olino, Boris Birmaher, Dara Sakolsky, Tara S. Peris, John Piacentini, Anne Marie Albano, Courtney P. Keeton, John T. Walkup, Golda Ginsburg, Philip C. Kendall^*

^*Corresponding author for this work

Psychiatry and Behavioral Sciences

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Although in-session factors of CBT for youth anxiety (e.g., youth involvement; therapist behaviors) have demonstrated significant associations with treatment outcomes, no study has examined the role of concurrent selective-serotonin reuptake inhibitors (SSRI) on in-session behavior affecting youth outcomes. The combination of SSRI and CBT have demonstrated robust outcomes over either treatment alone. Research has also neglected to examine in-session behavior based on treatment phase (i.e., psychoeducation, exposure) and the association between in-session factors and treatment outcome. Youth (N = 190) were participants in the Children/Adolescent Anxiety Multimodal Study (Walkup et al. New England Journal of Medicine, 359, 2753-2766, 2008) who completed CBT; of these, n = 94 received concurrent sertraline. Tapes of psychoeducation/skill-building (first half) and exposure sessions (second half) were rated by reliable coders for positive youth involvement (e.g., participation, understanding), negative youth involvement (e.g., safety-behaviors, negative affect), and therapist behaviors. Youth and therapist in-session behaviors were examined as predictors of the trajectory of anxiety outcomes using multilevel modeling. Medication (sertraline) was examined as a moderator. Results indicated that positive and negative youth involvement in CBT was significantly associated with outcomes. Positive youth involvement during psychoeducation and exposure sessions predicted better outcomes, and negative youth involvement during psychoeducation sessions predicted less favorable outcomes. Sertraline did not moderate these findings. Therapist behaviors were not significantly associated with outcomes, likely due to limited variability and low frequency of observed behaviors. Youth in-sessions behaviors are associated with treatment outcomes in anxiety treatment. However, medication does not appear to have a differential impact on youth in-session behaviors.

Original language	English (US)
Pages (from-to)	615-626
Number of pages	12
Journal	Journal of Psychopathology and Behavioral Assessment
Volume	42
Issue number	4
DOIs	https://doi.org/10.1007/s10862-020-09810-x
State	Published - Dec 1 2020

Funding

Dr. Kendall has received honoraria from professional societies for speaking at conventions. He receives royalties from the sales of materials related to the treatment of anxiety in youth, from Guildford Press, Ericsson, Workbook Publishing (his spouse’s employment), and Oxford University Press. Dr. Birmaher has or will receive royalties from Random House, Inc., Lippincott Williams & Wilkins, and UpToDate. Dr. Sakolsky serves as an editorial board member of Child & Adolescent Psychopharmacology News and specialty consultant for the Prescriber’s Letter. She has received consulting fee from LEK consulting in 2015. Dr. Piacentini has received research support from Pfizer Pharmaceuticals through the Duke University Clinical Research Institute. Dr. Walkup has past research support for federally funded studies including free drug and placebo from Pfizer’s pharmaceuticals in 2007 to support the Child Adolescent Anxiety Multimodal study; free medication from Abbott pharmaceuticals in 2005 for the Treatment of the Early Age Media study; free drug and placebo from Eli Lilly in 2003 for the Treatment of Adolescents with Depression study. He currently receives research support from the Tourette’s Association of America and the Hartwell Foundation. He also receives royalties from Guilford Press and Oxford Press for multi-author books published about Tourette syndrome and royalties from Wolters Kluwer for CME activity on childhood anxiety. Dr. Walkup has received honoraria and has had travel expenses covered for speaking engagements and meetings sponsored by the Tourette Association of America. Drs. Chiappini, Gosch, Olino, Peris, and Ginsburg do not report any conflicts of interest. Parts of this project were supported by NIMH grants (MH063747 to Kendall; MH64003 to Birmaher; MH64003 to Compton; MH64088 to Piacentini; MH64089 to Walkup; MH64092 to Albano). Acknowledgements

Keywords

Anxious youth
CBT
Involvement
Medication

ASJC Scopus subject areas

Clinical Psychology

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10.1007/s10862-020-09810-x

Cite this

Chiappini, E. A., Gosch, E., Compton, S. N., Olino, T. M., Birmaher, B., Sakolsky, D., Peris, T. S., Piacentini, J., Albano, A. M., Keeton, C. P., Walkup, J. T., Ginsburg, G., & Kendall, P. C. (2020). In-Session Involvement in Anxious Youth Receiving CBT with/without Medication. Journal of Psychopathology and Behavioral Assessment, 42(4), 615-626. https://doi.org/10.1007/s10862-020-09810-x

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title = "In-Session Involvement in Anxious Youth Receiving CBT with/without Medication",

abstract = "Although in-session factors of CBT for youth anxiety (e.g., youth involvement; therapist behaviors) have demonstrated significant associations with treatment outcomes, no study has examined the role of concurrent selective-serotonin reuptake inhibitors (SSRI) on in-session behavior affecting youth outcomes. The combination of SSRI and CBT have demonstrated robust outcomes over either treatment alone. Research has also neglected to examine in-session behavior based on treatment phase (i.e., psychoeducation, exposure) and the association between in-session factors and treatment outcome. Youth (N = 190) were participants in the Children/Adolescent Anxiety Multimodal Study (Walkup et al. New England Journal of Medicine, 359, 2753-2766, 2008) who completed CBT; of these, n = 94 received concurrent sertraline. Tapes of psychoeducation/skill-building (first half) and exposure sessions (second half) were rated by reliable coders for positive youth involvement (e.g., participation, understanding), negative youth involvement (e.g., safety-behaviors, negative affect), and therapist behaviors. Youth and therapist in-session behaviors were examined as predictors of the trajectory of anxiety outcomes using multilevel modeling. Medication (sertraline) was examined as a moderator. Results indicated that positive and negative youth involvement in CBT was significantly associated with outcomes. Positive youth involvement during psychoeducation and exposure sessions predicted better outcomes, and negative youth involvement during psychoeducation sessions predicted less favorable outcomes. Sertraline did not moderate these findings. Therapist behaviors were not significantly associated with outcomes, likely due to limited variability and low frequency of observed behaviors. Youth in-sessions behaviors are associated with treatment outcomes in anxiety treatment. However, medication does not appear to have a differential impact on youth in-session behaviors.",

keywords = "Anxious youth, CBT, Involvement, Medication",

author = "Chiappini, {Erika A.} and Elizabeth Gosch and Compton, {Scott N.} and Olino, {Thomas M.} and Boris Birmaher and Dara Sakolsky and Peris, {Tara S.} and John Piacentini and Albano, {Anne Marie} and Keeton, {Courtney P.} and Walkup, {John T.} and Golda Ginsburg and Kendall, {Philip C.}",

note = "Funding Information: Dr. Kendall has received honoraria from professional societies for speaking at conventions. He receives royalties from the sales of materials related to the treatment of anxiety in youth, from Guildford Press, Ericsson, Workbook Publishing (his spouse{\textquoteright}s employment), and Oxford University Press. Dr. Birmaher has or will receive royalties from Random House, Inc., Lippincott Williams & Wilkins, and UpToDate. Dr. Sakolsky serves as an editorial board member of Child & Adolescent Psychopharmacology News and specialty consultant for the Prescriber{\textquoteright}s Letter. She has received consulting fee from LEK consulting in 2015. Dr. Piacentini has received research support from Pfizer Pharmaceuticals through the Duke University Clinical Research Institute. Dr. Walkup has past research support for federally funded studies including free drug and placebo from Pfizer{\textquoteright}s pharmaceuticals in 2007 to support the Child Adolescent Anxiety Multimodal study; free medication from Abbott pharmaceuticals in 2005 for the Treatment of the Early Age Media study; free drug and placebo from Eli Lilly in 2003 for the Treatment of Adolescents with Depression study. He currently receives research support from the Tourette{\textquoteright}s Association of America and the Hartwell Foundation. He also receives royalties from Guilford Press and Oxford Press for multi-author books published about Tourette syndrome and royalties from Wolters Kluwer for CME activity on childhood anxiety. Dr. Walkup has received honoraria and has had travel expenses covered for speaking engagements and meetings sponsored by the Tourette Association of America. Drs. Chiappini, Gosch, Olino, Peris, and Ginsburg do not report any conflicts of interest. Funding Information: Parts of this project were supported by NIMH grants (MH063747 to Kendall; MH64003 to Birmaher; MH64003 to Compton; MH64088 to Piacentini; MH64089 to Walkup; MH64092 to Albano). Acknowledgements Publisher Copyright: {\textcopyright} 2020, Springer Science+Business Media, LLC, part of Springer Nature.",

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doi = "10.1007/s10862-020-09810-x",

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Chiappini, EA, Gosch, E, Compton, SN, Olino, TM, Birmaher, B, Sakolsky, D, Peris, TS, Piacentini, J, Albano, AM, Keeton, CP, Walkup, JT, Ginsburg, G & Kendall, PC 2020, 'In-Session Involvement in Anxious Youth Receiving CBT with/without Medication', Journal of Psychopathology and Behavioral Assessment, vol. 42, no. 4, pp. 615-626. https://doi.org/10.1007/s10862-020-09810-x

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AU - Chiappini, Erika A.

AU - Gosch, Elizabeth

AU - Compton, Scott N.

AU - Olino, Thomas M.

AU - Birmaher, Boris

AU - Sakolsky, Dara

AU - Peris, Tara S.

AU - Piacentini, John

AU - Albano, Anne Marie

AU - Keeton, Courtney P.

AU - Walkup, John T.

AU - Ginsburg, Golda

AU - Kendall, Philip C.

N1 - Funding Information: Dr. Kendall has received honoraria from professional societies for speaking at conventions. He receives royalties from the sales of materials related to the treatment of anxiety in youth, from Guildford Press, Ericsson, Workbook Publishing (his spouse’s employment), and Oxford University Press. Dr. Birmaher has or will receive royalties from Random House, Inc., Lippincott Williams & Wilkins, and UpToDate. Dr. Sakolsky serves as an editorial board member of Child & Adolescent Psychopharmacology News and specialty consultant for the Prescriber’s Letter. She has received consulting fee from LEK consulting in 2015. Dr. Piacentini has received research support from Pfizer Pharmaceuticals through the Duke University Clinical Research Institute. Dr. Walkup has past research support for federally funded studies including free drug and placebo from Pfizer’s pharmaceuticals in 2007 to support the Child Adolescent Anxiety Multimodal study; free medication from Abbott pharmaceuticals in 2005 for the Treatment of the Early Age Media study; free drug and placebo from Eli Lilly in 2003 for the Treatment of Adolescents with Depression study. He currently receives research support from the Tourette’s Association of America and the Hartwell Foundation. He also receives royalties from Guilford Press and Oxford Press for multi-author books published about Tourette syndrome and royalties from Wolters Kluwer for CME activity on childhood anxiety. Dr. Walkup has received honoraria and has had travel expenses covered for speaking engagements and meetings sponsored by the Tourette Association of America. Drs. Chiappini, Gosch, Olino, Peris, and Ginsburg do not report any conflicts of interest. Funding Information: Parts of this project were supported by NIMH grants (MH063747 to Kendall; MH64003 to Birmaher; MH64003 to Compton; MH64088 to Piacentini; MH64089 to Walkup; MH64092 to Albano). Acknowledgements Publisher Copyright: © 2020, Springer Science+Business Media, LLC, part of Springer Nature.

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N2 - Although in-session factors of CBT for youth anxiety (e.g., youth involvement; therapist behaviors) have demonstrated significant associations with treatment outcomes, no study has examined the role of concurrent selective-serotonin reuptake inhibitors (SSRI) on in-session behavior affecting youth outcomes. The combination of SSRI and CBT have demonstrated robust outcomes over either treatment alone. Research has also neglected to examine in-session behavior based on treatment phase (i.e., psychoeducation, exposure) and the association between in-session factors and treatment outcome. Youth (N = 190) were participants in the Children/Adolescent Anxiety Multimodal Study (Walkup et al. New England Journal of Medicine, 359, 2753-2766, 2008) who completed CBT; of these, n = 94 received concurrent sertraline. Tapes of psychoeducation/skill-building (first half) and exposure sessions (second half) were rated by reliable coders for positive youth involvement (e.g., participation, understanding), negative youth involvement (e.g., safety-behaviors, negative affect), and therapist behaviors. Youth and therapist in-session behaviors were examined as predictors of the trajectory of anxiety outcomes using multilevel modeling. Medication (sertraline) was examined as a moderator. Results indicated that positive and negative youth involvement in CBT was significantly associated with outcomes. Positive youth involvement during psychoeducation and exposure sessions predicted better outcomes, and negative youth involvement during psychoeducation sessions predicted less favorable outcomes. Sertraline did not moderate these findings. Therapist behaviors were not significantly associated with outcomes, likely due to limited variability and low frequency of observed behaviors. Youth in-sessions behaviors are associated with treatment outcomes in anxiety treatment. However, medication does not appear to have a differential impact on youth in-session behaviors.

AB - Although in-session factors of CBT for youth anxiety (e.g., youth involvement; therapist behaviors) have demonstrated significant associations with treatment outcomes, no study has examined the role of concurrent selective-serotonin reuptake inhibitors (SSRI) on in-session behavior affecting youth outcomes. The combination of SSRI and CBT have demonstrated robust outcomes over either treatment alone. Research has also neglected to examine in-session behavior based on treatment phase (i.e., psychoeducation, exposure) and the association between in-session factors and treatment outcome. Youth (N = 190) were participants in the Children/Adolescent Anxiety Multimodal Study (Walkup et al. New England Journal of Medicine, 359, 2753-2766, 2008) who completed CBT; of these, n = 94 received concurrent sertraline. Tapes of psychoeducation/skill-building (first half) and exposure sessions (second half) were rated by reliable coders for positive youth involvement (e.g., participation, understanding), negative youth involvement (e.g., safety-behaviors, negative affect), and therapist behaviors. Youth and therapist in-session behaviors were examined as predictors of the trajectory of anxiety outcomes using multilevel modeling. Medication (sertraline) was examined as a moderator. Results indicated that positive and negative youth involvement in CBT was significantly associated with outcomes. Positive youth involvement during psychoeducation and exposure sessions predicted better outcomes, and negative youth involvement during psychoeducation sessions predicted less favorable outcomes. Sertraline did not moderate these findings. Therapist behaviors were not significantly associated with outcomes, likely due to limited variability and low frequency of observed behaviors. Youth in-sessions behaviors are associated with treatment outcomes in anxiety treatment. However, medication does not appear to have a differential impact on youth in-session behaviors.

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In-Session Involvement in Anxious Youth Receiving CBT with/without Medication

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