title: Mediators of change in the Child/Adolescent Anxiety Multimodal Treatment Study.
abstract: OBJECTIVE
  Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS).
  
  
  METHODS
  Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up.
  
  
  RESULTS
  Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms.
  
  
  CONCLUSIONS
  The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator.
authors.affiliation: Department of Psychology, Temple University.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Kendall
authors.affiliation: Department of Psychology, Temple University.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Cummings
authors.affiliation: Department of Psychology, Center for Child and Adolescent Mental Health.
authors.forename: Marianne A
authors.initials: MA
authors.lastname: Villabø
authors.affiliation: Department of Psychology, The Norwegian Center for Child Behavioral Development.
authors.forename: Martina K
authors.initials: MK
authors.lastname: Narayanan
authors.affiliation: Department of Psychology, University of Connecticut.
authors.forename: Kimberli
authors.initials: K
authors.lastname: Treadwell
authors.affiliation: Department of Psychiatry, University of Pittsburgh.
authors.forename: Boris
authors.initials: B
authors.lastname: Birmaher
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Duke University.
authors.forename: Scott
authors.initials: S
authors.lastname: Compton
authors.affiliation: Department of Psychiatry and Behavioral Sciences, University of California, Los Angeles.
authors.forename: John
authors.initials: J
authors.lastname: Piacentini
authors.affiliation: Child and Adolescent Mental Health, National Institute of Mental Health.
authors.forename: Joel
authors.initials: J
authors.lastname: Sherrill
authors.affiliation: Department of Child and Adolescent Psychiatry, Cornell University.
authors.forename: John
authors.initials: J
authors.lastname: Walkup
authors.affiliation: Department of Psychology, Philadelphia College of Osteopathic Medicine.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Gosch
authors.affiliation: Department of Child and Adolescent Psychiatry, Johns Hopkins University.
authors.forename: Courtney
authors.initials: C
authors.lastname: Keeton
authors.affiliation: Department of Child and Adolescent Psychiatry, Johns Hopkins University.
authors.forename: Golda
authors.initials: G
authors.lastname: Ginsburg
authors.affiliation: Department of Psychology, University of Georgia.
authors.forename: Cindy
authors.initials: C
authors.lastname: Suveg
authors.affiliation: Department of Child and Adolescent Psychiatry, Columbia University.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Albano
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D001008:Anxiety Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D001010:Anxiety, Separation / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*; D020280:Sertraline / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D017367:Selective Serotonin Reuptake Inhibitors; D020280:Sertraline