Differential Sequencing of Cognitive-Behavioral Techniques for Reducing Child and Adolescent Anxiety

Treatment outcome research has rarely allowed investigators to declare how or why thera-peutic techniques work. As an initial step to understand such change processes, the current study investigated the timing of positive changes typically achieved during a course of cognitive-behavioral therapy for anxiety reduction. Using an interaction element multiple-baseline design across four children ( N = 4) diagnosed with selected anxiety disorders, anxiety levels, cognitive errors, and treatment outcome were repeatedly assessed as children progressed through four a priori determined treatment sequences. Results varied across reporters, dependent variables, and the order in which each treatment technique was deliv-ered. Child-reported trends were slightly clearer than those reported by parents and sug-gested that exposure was a key element for triggering some (but not all) positive changes after completing self-monitoring and psychoeducation techniques