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

Philip C. Kendall*, Colleen M. Cummings, Marianne A. Villabø, Martina K. Narayanan, Kimberli Treadwell, Boris Birmaher, Scott Compton, John Piacentini, Joel Sherrill, John Walkup, Elizabeth Gosch, Courtney Keeton, Golda Ginsburg, Cindy Suveg

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1-14
Number of pages14
JournalJournal of Consulting and Clinical Psychology
Volume84
Issue number1
DOIs
StatePublished - Jan 1 2016

Keywords

  • anxiety
  • anxious self-talk
  • coping
  • mediators
  • youth

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health

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