Anxious Children and Adolescents Non‐responding to CBT: Clinical Predictors and Families' Experiences of Therapy
Abstract
The purpose of the study was to examine clinical predictors of non‐response to manualized cognitive behaviour therapy (CBT) among youths (children and adolescents) with anxiety disorders, and to explore families' perspective on therapy, using a mixed methods approach. Non‐response to manualized group CBT was determined among 106 youths of Danish ethnicity (7–17 years old) with a primary anxiety disorder, identified with the Clinical Global Impression of Improvement Scale at the 3‐month follow‐up. Twenty‐four youths (22.6 %) had not responded to treatment, and a logistic regression analysis revealed that youths with a primary diagnosis of social phobia were seven times more likely not to respond, whereas youths with a comorbid mood disorder were almost four times more likely. Families of non‐responding youths with primary social phobia and/or a comorbid mood disorder (n = 15) were interviewed, and data were analysed through interpretative phenomenological analysis. Two superordinate themes emerged: youths were not involved in therapy work, and manualized group format posed challenges to families. The mixed methods approach provided new perspectives on the difficulties that may be encountered by families of non‐responding youths with a primary social phobia diagnosis and youths with a comorbid mood disorder during manualized group CBT. Clinical implications related to youths' clinical characteristics, and families' experience and suggestions are drawn. Copyright © 2015 John Wiley & Sons, Ltd. Key Practitioner Messages: Youths with an anxiety disorder, who had a primary social phobia diagnosis and those, who had a comorbid mood disorder, were more likely not to respond to manualized group CBT. Parents of those non‐responding youths often considered them as motivated to overcome their difficulties, but due to their symptomatology, they were unreceptive, reluctant and ambivalent and therefore not actively involved in therapy. The non‐responding youths with social phobia felt evaluated and nervous of what others thought of them in the group. The parents of the non‐responding youths with a comorbid mood disorder felt the group format placed restraints on therapists' ability to focus on their individual needs.
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Group-based CBT for broad anxiety may not be optimal for all children, particularly those with certain anxiety subtypes or comorbidities.
“However, group-based CBT for broad anxiety may not be optimal for all children, particularly those with certain anxiety subtypes or comorbidities.”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [43]
Parents of children with a comorbid mood disorder reported that the group format limited the ability to address their family's individual needs.
“Parents of children with a comorbid mood disorder reported that the group format limited the ability to address their family´s individual needs.”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [43]
A study on non-responders to group CBT for anxiety in youth found that those with social anxiety and comorbid mood disorders were less likely to show improvement in their primary anxiety diagnosis after treatment.
“A study on non-responders to group CBT for anxiety in youth (aged 7–17) found that those with social anxiety and comorbid mood disorders were less likely to show improvement in their primary anxiety diagnosis after treatment [43].”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [43]
In qualitative interviews, youth with social phobia reported feeling nervous about what others thought of them in the group.
“youth with social phobia reported feeling nervous about what others thought of them in the group.”
From Developing a primary care-based cognitive behavioral intervention for anxiety in children through a participatory approach: a qualitative study. (2026) · cites this paper as [43]
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“However, many behavioral treatments do not fully address the needs of many adolescents because they only treat one disorder, so they will not achieve the desired results (17).”
BackgroundNagamitsu, S., Okada, A., Sakuta, R., Ishii, R., Koyanagi, K., Habukawa, C., Katayama, T., Ito, M., Kanie, A., Otani, R., et al. (2024) · doi:10.2196/preprints.60943
Nagamitsu, S., Okada, A., Sakuta, R., Ishii, R., Koyanagi, K., Habukawa, C., Katayama, T., Ito, M., Kanie, A., Otani, R., et al. (2025) · JMIR Formative Research · doi:10.2196/60943 · Cited by 2 · see citing works
Shuman, T. J., & Crandal, B. R. (2025) · CBT: science into practice · doi:10.1007/978-3-031-91439-3_16
- Authors
- Lundkvist‐Houndoumadi, I., & Thastum, M.
- Affiliations
- Aarhus University (DK)
- Corresponding author
- Lundkvist‐Houndoumadi, Irene
- ORCID
- Thastum, Mikael
- Venue
- Clinical Psychology & Psychotherapy
- Publisher
- Wiley
- Published
- 2015-10-30
- Volume
- 24
- Issue
- 1
- Pages
- 82-93
- ISSN
- 1063-3995 (ISSN-L)
- 1099-0879
- OpenAlex
- W1823065458
- Cited by
- 39
- References
- 51
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 6 · 2023: 7 · 2022: 6 · 2021: 5 · 2020: 1 · 2019: 5 · 2018: 4 · 2017: 1
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology & Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- Scopus (Elsevier) (submittedVersion)
- Funders
- TrygFonden (10691)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- treatment non-response, cognitive behavioral therapy, children and adolescents, anxiety disorders, social anxiety disorder, group therapy, parental involvement, clinical predictors, youth motivation
- MeSH terms
- Phobia, Social, Adolescent, Anxiety Disorders, Attitude, Child, Denmark, Female, Humans, Individuality, Male, Motivation, Professional-Patient Relations, Psychotherapy, Group, Comorbidity, Cognitive Behavioral Therapy, Caregivers, Treatment Failure, Mood Disorders
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