@article{98c619d81374444599cacee2c86a79a5,
title = "Therapist-Reported Features of Exposure Tasks That Predict Differential Treatment Outcomes for Youth With Anxiety",
abstract = "Objective Exposure tasks are recognized widely as a key component of cognitive-behavioral therapy (CBT) for child and adolescent anxiety. However, little research has examined specific exposure characteristics that predict outcomes for youth with anxiety and that may guide its application in therapy. Method This study draws on a sample of 279 children and adolescents (48.4% male; 79.6% white) with a principal anxiety disorder who received 14 sessions of CBT, either alone or in combination with medication, through the Child/adolescent Anxiety Multimodal treatment Study (CAMS). The present study examines therapist-reported quantity, difficulty level, compliance, and mastery of exposure tasks as they related to CBT response (i.e., Clinical Global Impressions−Improvement ratings). Secondary treatment outcomes included reduction in anxiety symptom severity on the Pediatric Anxiety Rating Scale, global impairment measured via the Children's Global Assessment Scale, and parent-report of anxiety-specific functional impairment on the Child Anxiety Impairment Scale. Results Regression analyses indicated a dose–response relationship between therapist-reported quantity of exposure and independent evaluations of treatment outcome, with more time devoted to exposure linked to better outcomes. Similarly, greater time spent on more difficult (rather than mild or moderate) exposure tasks predicted better outcomes, as did therapist ratings of child compliance and mastery. Conclusion The present findings highlight the importance of challenging children and adolescents with difficult exposure tasks and of collaborating to ensure compliance and mastery.",
keywords = "CBT, anxiety, exposure, treatment",
author = "Peris, {Tara S.} and Caporino, {Nicole E.} and Sarah O'Rourke and Kendall, {Philip C.} and Walkup, {John T.} and Albano, {Anne Marie} and Bergman, {R. Lindsey} and McCracken, {James T.} and Boris Birmaher and Ginsburg, {Golda S.} and Dara Sakolsky and John Piacentini and Compton, {Scott N.}",
note = "Funding Information: This research was supported by grants from the National Institute of Mental Health (U01 MH064089 to Dr. Walkup; U01 MH64092 to Dr. Albano; U01 MH64003 to Dr. Birmaher; U01 MH63747 to Dr. Kendall; U01 MH64107 to Dr. March; U01 MH64088 to Dr. Piacentini; and U01 MH064003 to Dr. Compton). Sertraline and matching placebo were supplied free of charge by Pfizer. Funding Information: Disclosure: Dr. Peris has received research funding from the National Institute of Mental Health and the Society of Clinical Child and Adolescent Psychology and book royalties from Oxford University Press. Dr. O{\textquoteright}Rourke has received funding from Mursion Inc., the National Institute of Mental Health, NC GlaxoSmithKline Foundation, and the North Carolina Sickle Cell Syndrome Program. Dr. Kendall has received research support from the National Institute of Mental Health. He has received honoraria from professional societies for speaking at conventions. He has received royalties from Guildford Press, Ericsson, Workbook Publishing (his spouse{\textquoteright}s employment), and Oxford University Press. Dr. Walkup has received past research support from the National Institute of Mental Health for federally funded studies including free drug and placebo from Pfizer in 2007 to support the Child Adolescent Anxiety Multimodal study; free medication from Abbott in 2005 for the Treatment of the Early Age Media study; free drug and placebo from Eli Lilly and Co. in 2003 for the Treatment of Adolescents with Depression study. He currently receives research support from the Tourette Association of America and The Hartwell Foundation. He has served as an unpaid advisor to the Anxiety Disorders Association of America and the Trichotillomania Learning Center. He has received honoraria and travel expenses for speaking engagements and meetings sponsored by the Tourette Association of America. He has received royalties from Guilford Press and Oxford University Press for multi-author books published about Tourette syndrome and from Wolters Kluwer for CME activity on childhood anxiety. He has served as a paid speaker for the Tourette Syndrome− Center for Disease Control and Prevention outreach educational programs, the American Academy of Child and Adolescent Psychiatry, and the American Psychiatric Association. Dr. Albano has received royalties from Oxford University Press, including use of the ADIS. However, the ADIS was provided at no cost for this study and CAMS. She has received honoraria from the American Psychological Association. Dr. McCracken has served as a consultant to Think Now and Alcobra. He has received a research contract with Psyadon, and his spouse has received a grant from the Merck Foundation. Dr. Birmaher has received research support from the National Institute of Mental Health. He has or will receive royalties from Random House, Inc., Lippincott Williams and Wilkins, and UpToDate. Dr. Sakolsky has received research funding from the National Institute of Mental Health and the National Alliance for Research on Schizophrenia and Depression. She has received consulting fees from LEK Consulting in 2015. Dr. Piacentini has received grant or research support from the National Institute of Mental Health, the Petit Family Foundation, the Tourette Association of America, the TLC Foundation for Body-Focused Repetitive Behaviors, and Pfizer Pharmaceuticals. He is a co-author of the Child OCD Impact Scale−Revised (COIS-R), the Child Anxiety Impact Scale−Revised (CAIS-R), the Parent Tic Questionnaire (PTQ), and the Premonitory Urge for Tics Scale (PUTS) assessment tools, all of which are in the public domain therefore no royalties are received. He has served as a consultant for an NIMH R01 grant at the University of Michigan. He has received honoraria and travel support for lectures at academic institutions and from the Tourette Association of America and the International Obsessive Compulsive Disorder Foundation for behavior therapy trainings. He has received royalties from Guilford Press and Oxford University Press. Dr. Compton has received research support from the National Institute of Mental Health, NC GlaxoSmithKline Foundation, Pfizer, and Mursion, Inc. He has served as a consultant for Shire and Mursion, Inc. He has received honoraria from the Journal of Consulting and Clinical Psychology, Nordic Long-Term OCD Treatment Study Research Group, and the Centre for Child and Adolescent Mental Health, Eastern and Southern Norway. He has served on the scientific advisory board of Tourette{\textquoteright}s Association of American and Mursion, Inc. He has given expert testimony for Duke University. Drs. Caporino, Bergman, and Ginsburg report no biomedical financial interests or potential conflicts of interest. Publisher Copyright: {\textcopyright} 2017 American Academy of Child and Adolescent Psychiatry Copyright: Copyright 2017 Elsevier B.V., All rights reserved.",
year = "2017",
month = dec,
doi = "10.1016/j.jaac.2017.10.001",
language = "English (US)",
volume = "56",
pages = "1043--1052",
journal = "Journal of the American Academy of Child and Adolescent Psychiatry",
issn = "0890-8567",
publisher = "Elsevier Limited",
number = "12",
}
