title: The role of day-to-day emotions, sleep, and social interactions in pediatric anxiety treatment.
abstract: Do day-to-day emotions, social interactions, and sleep play a role in determining which anxious youth respond to supportive child-centered therapy (CCT) versus cognitive behavioral therapy (CBT)? We explored whether measures of day-to-day functioning (captured through ecological momentary assessment, sleep diary, and actigraphy), along with clinical and demographic measures, were predictors or moderators of treatment outcome in 114 anxious youth randomized to CCT or CBT. We statistically combined individual moderators into a single, optimal composite moderator to characterize subgroups for which CCT or CBT may be preferable. The strongest predictors of better outcome included: (a) experiencing higher positive affect when with one's mother and (b) fewer self-reported problems with sleep duration. The composite moderator indicated that youth for whom CBT was indicated had: (a) more day-to-day sleep problems related to sleep quality, efficiency, and waking, (b) day-to-day negative events related to interpersonal concerns, (c) more DSM-IV anxiety diagnoses, and (d) college-educated parents. These findings illustrate the value of both day-to-day functioning characteristics and more traditional sociodemographic and clinical characteristics in identifying optimal anxiety treatment assignment. Future studies will need to enhance the practicality of real-time measures for use in clinical decision making and evaluate additional anxiety treatments.
authors.affiliation: Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA; Department of Statistics, University of Pittsburgh, 230 South Bouquet Street, Pittsburgh, PA 15260, USA. Electronic address: lotzmj@upmc.edu.
authors.forename: Meredith L
authors.initials: ML
authors.lastname: Wallace
authors.affiliation: Department of Psychology, Florida International University, 11200 S. W. 8th Street, Miami, FL 33199, USA. Electronic address: dmcmakin@fiu.edu.
authors.forename: Dana L
authors.initials: DL
authors.lastname: McMakin
authors.affiliation: Department of Psychiatry, University of California, 757 Westwood Plaza, Los Angeles, CA 90095, USA. Electronic address: pztan@mednet.ucla.edu.
authors.forename: Patricia Z
authors.initials: PZ
authors.lastname: Tan
authors.affiliation: Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA. Electronic address: dkr19@pitt.edu.
authors.forename: Dana
authors.initials: D
authors.lastname: Rosen
authors.affiliation: Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA. Electronic address: forbese@upmc.edu.
authors.forename: Erika E
authors.initials: EE
authors.lastname: Forbes
authors.affiliation: Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA. Electronic address: ladouceurcd@upmc.edu.
authors.forename: Cecile D
authors.initials: CD
authors.lastname: Ladouceur
authors.affiliation: Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA. Electronic address: ryannd@upmc.edu.
authors.forename: Neal D
authors.initials: ND
authors.lastname: Ryan
authors.affiliation: Department of Psychiatry, University of Pittsburgh, 3811 O'Hara Street, Pittsburgh, PA 15260, USA. Electronic address: gsiegle@pitt.edu.
authors.forename: Greg J
authors.initials: GJ
authors.lastname: Siegle
authors.affiliation: School of Public Health, University of California, 50 University Hall, Berkeley, CA 94720, USA. Electronic address: rondahl@berkeley.edu.
authors.forename: Ronald E
authors.initials: RE
authors.lastname: Dahl
authors.affiliation: Department of Psychology, Temple University, 1701 North 13th Street, Philadelphia, PA 19122, USA. Electronic address: pkendall@temple.edu.
authors.forename: Philip C
authors.initials: PC
authors.lastname: Kendall
authors.affiliation: Allegheny General Hospital, Four Allegheny Center, Pittsburgh, PA 15212, USA. Electronic address: amannari@wpahs.org.
authors.forename: Anthony
authors.initials: A
authors.lastname: Mannarino
authors.affiliation: Department of Psychology, University of Pittsburgh, 210 South Bouquet Street, Pittsburgh, PA 15260, USA. Electronic address: jss4@pitt.edu.
authors.forename: Jennifer S
authors.initials: JS
authors.lastname: Silk
mesh_terms: D056044:Actigraphy; D000293:Adolescent; D001008:Anxiety Disorders / Q000523:psychology / Q000628:therapy*; D002648:Child; D015928:Cognitive Behavioral Therapy; D000072860:Ecological Momentary Assessment; D004644:Emotions; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D008499:Medical Records; D011613:Psychotherapy; D012890:Sleep; D016896:Treatment Outcome
keywords: Actigraphy; Client-centered therapy; Cognitive behavioral therapy; Ecological momentary assessment; Optimal combined moderator; Sleep diary