The Impact of Treatment Expectations on Exposure Process and Treatment Outcome in Childhood Anxiety Disorders

Monica S. Wu*, Nicole E. Caporino, Tara S. Peris, Jocelyn Pérez, Hardian Thamrin, Anne Marie Albano, Philip C. Kendall, John Timothy Walkup, Boris Birmaher, Scott N. Compton, John Piacentini

*Corresponding author for this work

Research output: Contribution to journalArticle

Abstract

This study examined the relationship between caregivers’ and youths’ treatment expectations and characteristics of exposure tasks (quantity, mastery, compliance) in cognitive-behavioral therapy (CBT) for childhood anxiety. Additionally, compliance with exposure tasks was tested as a mediator of the relationship between treatment expectations and symptom improvement. Data were from youth (N = 279; 7–17 years old) enrolled in the Child/Adolescent Anxiety Multimodal Study (CAMS) and randomized to cognitive-behavioral therapy (CBT) or the combination of CBT and sertraline for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. Caregivers and youth independently reported treatment expectations prior to randomization, anxiety was assessed pre- and post-treatment by independent evaluators blind to treatment condition, and exposure characteristics were recorded by the cognitive-behavioral therapists following each session. For both caregivers and youths, more positive expectations that anxiety would improve with treatment were associated with greater compliance with exposure tasks, and compliance mediated the relationship between treatment expectations and change in anxiety symptoms following treatment. Additionally, more positive parent treatment expectations were related to a greater number and percentage of sessions with exposure. More positive youth treatment expectations were associated with greater mastery during sessions focused on exposure. Findings underscore the importance of addressing parents’ and youths’ treatment expectations at the outset of therapy to facilitate engagement in exposure and maximize therapeutic gains.

Original languageEnglish (US)
JournalJournal of Abnormal Child Psychology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Anxiety Disorders
Therapeutics
Anxiety
Cognitive Therapy
Caregivers
Compliance
Separation Anxiety
Sertraline
Random Allocation

Keywords

  • Anxiety
  • Expectations
  • Exposure
  • Outcome
  • Treatment

ASJC Scopus subject areas

  • Developmental and Educational Psychology
  • Psychiatry and Mental health

Cite this

Wu, Monica S. ; Caporino, Nicole E. ; Peris, Tara S. ; Pérez, Jocelyn ; Thamrin, Hardian ; Albano, Anne Marie ; Kendall, Philip C. ; Walkup, John Timothy ; Birmaher, Boris ; Compton, Scott N. ; Piacentini, John. / The Impact of Treatment Expectations on Exposure Process and Treatment Outcome in Childhood Anxiety Disorders. In: Journal of Abnormal Child Psychology. 2019.
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abstract = "This study examined the relationship between caregivers’ and youths’ treatment expectations and characteristics of exposure tasks (quantity, mastery, compliance) in cognitive-behavioral therapy (CBT) for childhood anxiety. Additionally, compliance with exposure tasks was tested as a mediator of the relationship between treatment expectations and symptom improvement. Data were from youth (N = 279; 7–17 years old) enrolled in the Child/Adolescent Anxiety Multimodal Study (CAMS) and randomized to cognitive-behavioral therapy (CBT) or the combination of CBT and sertraline for the treatment of separation anxiety disorder, generalized anxiety disorder, and social phobia. Caregivers and youth independently reported treatment expectations prior to randomization, anxiety was assessed pre- and post-treatment by independent evaluators blind to treatment condition, and exposure characteristics were recorded by the cognitive-behavioral therapists following each session. For both caregivers and youths, more positive expectations that anxiety would improve with treatment were associated with greater compliance with exposure tasks, and compliance mediated the relationship between treatment expectations and change in anxiety symptoms following treatment. Additionally, more positive parent treatment expectations were related to a greater number and percentage of sessions with exposure. More positive youth treatment expectations were associated with greater mastery during sessions focused on exposure. Findings underscore the importance of addressing parents’ and youths’ treatment expectations at the outset of therapy to facilitate engagement in exposure and maximize therapeutic gains.",
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Wu, MS, Caporino, NE, Peris, TS, Pérez, J, Thamrin, H, Albano, AM, Kendall, PC, Walkup, JT, Birmaher, B, Compton, SN & Piacentini, J 2019, 'The Impact of Treatment Expectations on Exposure Process and Treatment Outcome in Childhood Anxiety Disorders', Journal of Abnormal Child Psychology. https://doi.org/10.1007/s10802-019-00574-x

The Impact of Treatment Expectations on Exposure Process and Treatment Outcome in Childhood Anxiety Disorders. / Wu, Monica S.; Caporino, Nicole E.; Peris, Tara S.; Pérez, Jocelyn; Thamrin, Hardian; Albano, Anne Marie; Kendall, Philip C.; Walkup, John Timothy; Birmaher, Boris; Compton, Scott N.; Piacentini, John.

In: Journal of Abnormal Child Psychology, 01.01.2019.

Research output: Contribution to journalArticle

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