title: Cognitive mediation of cognitive-behavioural therapy outcomes for anxiety-based school refusal.
abstract: BACKGROUND
  Cognitive-behavioural therapy (CBT) has proven to be effective for anxiety-based school refusal, but it is still unknown how CBT for school refusal works, or through which mechanisms.
  
  
  OBJECTIVE
  Innovative statistical approaches for analyzing small uncontrolled samples were used to investigate the role of self-efficacy in mediating CBT outcomes for anxiety-based school refusal.
  
  
  METHODS
  Participants were 19 adolescents (12 to 17 years) who completed a manual-based cognitive-behavioural treatment. Primary outcomes (school attendance; school-related fear; anxiety) and secondary outcomes (depression; internalizing problems) were assessed at post-treatment and 2-month follow-up.
  
  
  RESULTS
  Post-treatment increases in school attendance and decreases in fear about attending school the next day were found to be mediated by self-efficacy. Mediating effects were not observed at 2-month follow-up.
  
  
  CONCLUSIONS
  These findings provide partial support for the role of self-efficacy in mediating the outcome of CBT for school refusal. They contribute to a small body of literature suggesting that cognitive change enhances CBT outcomes for young people with internalizing problems. Regarding methodology, the product of coefficient test appears to be a valuable way to study mediation in outcome studies involving small samples.
authors.affiliation: Leiden University Institute of Psychology, the Netherlands.
authors.forename: Marija
authors.initials: M
authors.lastname: Maric
authors.forename: David A
authors.initials: DA
authors.lastname: Heyne
authors.forename: David P
authors.initials: DP
authors.lastname: MacKinnon
authors.forename: Brigit M
authors.initials: BM
authors.lastname: van Widenfelt
authors.forename: P Michiel
authors.initials: PM
authors.lastname: Westenberg
mesh_terms: D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000193:education / Q000379:methods*; D003469:Culture; D005239:Fear; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007318:Inservice Training; D008297:Male; D009426:Netherlands; D010552:Personality Assessment; D010698:Phobic Disorders / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D020377:Self Efficacy