title: Mediators of exposure therapy for youth obsessive-compulsive disorder: specificity and temporal sequence of client and treatment factors.
abstract: OBJECTIVE
  Behavioral engagement and cognitive coping have been hypothesized to mediate effectiveness of exposure-based therapies. Identifying which specific child factors mediate successful therapy and which therapist factors facilitate change can help make our evidence-based treatments more efficient and robust. The current study examines the specificity and temporal sequence of relations among hypothesized client and therapist mediators in exposure therapy for pediatric Obsessive Compulsive Disorder (OCD).
  
  
  METHODS
  Youth coping (cognitive, behavioral), youth safety behaviors (avoidance, escape, compulsive behaviors), therapist interventions (cognitive, exposure extensiveness), and youth anxiety were rated via observational ratings of therapy sessions of OCD youth (N=43; ages=8 - 17; 62.8% male) who had received Exposure and Response Prevention (ERP). Regression analysis using Generalized Estimation Equations and cross-lagged panel analysis (CLPA) were conducted to model anxiety change within and across sessions, to determine formal mediators of anxiety change, and to establish sequence of effects.
  
  
  RESULTS
  Anxiety ratings decreased linearly across exposures within sessions. Youth coping and therapist interventions significantly mediated anxiety change across exposures, and youth-interfering behavior mediated anxiety change at the trend level. In CLPA, youth-interfering behaviors predicted, and were predicted by, changes in anxiety. Youth coping was predicted by prior anxiety change.
  
  
  CONCLUSIONS
  The study provides a preliminary examination of specificity and temporal sequence among child and therapist behaviors in predicting youth anxiety. Results suggest that therapists should educate clients in the natural rebound effects of anxiety between sessions and should be aware of the negatively reinforcing properties of avoidance during exposure.
authors.affiliation: Rutgers, The State University of New Jersey. Electronic address: BrianChu@rci.Rutgers.edu.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Chu
authors.affiliation: Kean University.
authors.forename: Daniela B
authors.initials: DB
authors.lastname: Colognori
authors.affiliation: Data Insight Analytics, D&B.
authors.forename: Guang
authors.initials: G
authors.lastname: Yang
authors.affiliation: Rutgers, The State University of New Jersey.
authors.forename: Min-ge
authors.initials: MG
authors.lastname: Xie
authors.affiliation: UCLA Semel Institute for Neuroscience and Human Behavior.
authors.forename: R
authors.initials: R
authors.lastname: Lindsey Bergman
authors.affiliation: UCLA Semel Institute for Neuroscience and Human Behavior.
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001007:Anxiety / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003192:Compulsive Behavior / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000523:psychology / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Obsessive Compulsive Disorder; child and adolescent; exposure and response prevention; mediators of change