title: Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders.
abstract: A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8-15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.
authors.affiliation: Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway. Electronic address: gjwergeland@gmail.com.
authors.forename: Gro Janne H
authors.initials: GJ
authors.lastname: Wergeland
authors.affiliation: Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Frambu Resource Centre for Rare Disorders, Siggerud, Norway.
authors.forename: Krister W
authors.initials: KW
authors.lastname: Fjermestad
authors.affiliation: Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Carla E
authors.initials: CE
authors.lastname: Marin
authors.affiliation: Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Norway.
authors.forename: Ingvar
authors.initials: I
authors.lastname: Bjelland
authors.affiliation: Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.
authors.forename: Bente Storm Mowatt
authors.initials: BS
authors.lastname: Haugland
authors.affiliation: Child Study Center, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Wendy K
authors.initials: WK
authors.lastname: Silverman
authors.affiliation: Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychology, University of Stockholm, Stockholm, Sweden.
authors.forename: Lars-Göran
authors.initials: LG
authors.lastname: Öst
authors.affiliation: Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
authors.forename: Jon Fauskanger
authors.initials: JF
authors.lastname: Bjaastad
authors.affiliation: Anxiety Research Network, Haukeland University Hospital, Bergen, Norway.
authors.forename: Kristin
authors.initials: K
authors.lastname: Oeding
authors.affiliation: Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
authors.forename: Odd E
authors.initials: OE
authors.lastname: Havik
authors.affiliation: Anxiety Research Network, Haukeland University Hospital, Bergen, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
authors.forename: Einar R
authors.initials: ER
authors.lastname: Heiervang
mesh_terms: D000293:Adolescent; D001007:Anxiety / Q000628:therapy; D001008:Anxiety Disorders / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology; D011237:Predictive Value of Tests; D011379:Prognosis; D011615:Psychotherapy, Group; D016896:Treatment Outcome
keywords: Anxiety; Children; Cognitive behavior therapy; Effectiveness; Predictors