title: Trajectories of change in youth anxiety during cognitive-behavior therapy.
abstract: OBJECTIVE
  To evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks.
  
  
  METHODS
  Four hundred eighty-eight youths ages 7-17 years (50% female; 74% ≤ 12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls.
  
  
  RESULTS
  Longitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior).
  
  
  CONCLUSIONS
  Findings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed. (PsycINFO Database Record
authors.affiliation: Semel Institute for Neuroscience and Human Behavior University of California, Los Angeles.
authors.forename: Tara S
authors.initials: TS
authors.lastname: Peris
authors.affiliation: Department of Psychology and Behavioral Sciences, Duke University Medical Center.
authors.forename: Scott N
authors.initials: SN
authors.lastname: Compton
authors.affiliation: Department of Psychology, Temple University.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Kendall
authors.affiliation: Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.affiliation: Division of Services and Intervention Research, National Institute of Mental Health.
authors.forename: Joel
authors.initials: J
authors.lastname: Sherrill
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University Medical Center.
authors.forename: John
authors.initials: J
authors.lastname: March
authors.affiliation: Department of Psychology, Philadelphia College of Osteopathic Medicine.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gosch
authors.affiliation: Division of Child and Adolescent Psychiatry, Johns Hopkins Medical Institutions.
authors.forename: Golda
authors.initials: G
authors.lastname: Ginsburg
authors.affiliation: New York State Psychiatric Institute-Columbia University Medical Center.
authors.forename: Moira
authors.initials: M
authors.lastname: Rynn
authors.affiliation: Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
authors.forename: James T
authors.initials: JT
authors.lastname: McCracken
authors.affiliation: Division of Child and Adolescent Psychiatry, Johns Hopkins Medical Institutions.
authors.forename: Courtney P
authors.initials: CP
authors.lastname: Keeton
authors.affiliation: Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center.
authors.forename: Dara
authors.initials: D
authors.lastname: Sakolsky
authors.affiliation: Department of Psychology, University of Georgia.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Suveg
authors.affiliation: New York State Psychiatric Institute-Columbia University Medical Center.
authors.forename: Sasha
authors.initials: S
authors.lastname: Aschenbrand
authors.affiliation: Institute for Social Research, University of Michigan.
authors.forename: Daniel
authors.initials: D
authors.lastname: Almirall
authors.affiliation: Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center.
authors.forename: Satish
authors.initials: S
authors.lastname: Iyengar
authors.affiliation: Division of Child and Adolescent Psychiatry, Weill Cornell Medical College.
authors.forename: John T
authors.initials: JT
authors.lastname: Walkup
authors.affiliation: New York State Psychiatric Institute-Columbia University Medical Center.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Albano
authors.affiliation: Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles.
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
mesh_terms: D000293:Adolescent; D014151:Anti-Anxiety Agents / Q000627:therapeutic use*; D001008:Anxiety Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D012064:Relaxation Therapy; D020280:Sertraline / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D014151:Anti-Anxiety Agents; D020280:Sertraline