The relative impact of exposure and cognitive extensiveness in session-by-session and post-treatment CBT outcomes for youth anxiety

Although Cognitive Behavioral Therapy (CBT) represents the gold standard treatment for pediatric anxiety disorders, research has indicated opportunities to further advance its effectiveness and efficacy. Studies identifying the core active CBT ingredients and moderators of treatment outcome can facilitate such advancement. The current study utilized an observational coding measure to evaluate the relative strength of therapist Exposure and Cognitive Extensiveness associated with session-by-session and post-treatment outcomes. Participants (aged 8-17) were 73 youth with a principal anxiety disorder diagnosis who completed a manual-based CBT protocol (Coping Cat; Kendall & Hedtke, 2006). Video recordings of two exposure sessions per participant was observed and coded for Exposure and Cognitive Extensiveness. Anxiety symptoms were rated by clinicians at pre- and post-treatment, as well as by children and parents prior to each session and at post-treatment. Session-by-session multiple regression analysis indicated a trend for Exposure Extensiveness to be associated with increased child and parent-reported symptom severity in the first half of exposure sessions (Sessions 9-12), and statistically significant child-reported improvement in the second half of exposure sessions (Session 13-16). Although Cognitive Extensiveness was not associated with outcomes when analyzing the sample as a whole, age and frequency of negative automatic thoughts significantly moderated the relationship between average Cognitive Extensiveness and post-treatment clinician-rated outcomes.Psy.D.Includes bibliographical referencesby Mina Yadega