The therapeutic relationship in cognitive-behavioral therapy and pharmacotherapy for anxious youth.
Open accessAbstract
OBJECTIVE: We examined the therapeutic relationship with cognitive-behavioral therapists and with pharmacotherapists for youth from the Child/Adolescent Anxiety Multimodal Study (Walkup et al., 2008). The therapeutic relationship was examined in relation to treatment outcomes. METHOD: Participants were 488 youth (ages 7-17 years; 50% male) randomized to cognitive-behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), their combination, or placebo pill. Participants met criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994). The therapeutic relationship was assessed by youth report at Weeks 6 and 12 of treatment using the Child's Perception of Therapeutic Relationship scale (Kendall et al., 1997). Outcome measures (Pediatric Anxiety Rating Scale; Research Units on Pediatric Psychopharmacology Anxiety Study Group, 2002; and Clinical Global Impressions Scales; Guy, 1976) were completed by independent evaluators blind to condition. RESULTS: For youth who received CBT only, a stronger therapeutic relationship predicted positive treatment outcome. In contrast, the therapeutic relationship did not predict outcome for youth receiving sertraline, combined treatment, or placebo. CONCLUSION: A therapeutic relationship may be important for anxious youth who receive CBT alone.
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Structured psychotherapeutic programs predict stronger treatment outcomes.
“which predicts stronger treatment outcomes (Cummings et al., 2013).”
From THE EFFICACY OF A COMPASSION, ACCEPTANCE AND MINDFULNESS-BASED PILOT INTERVENTION FOR ADOLESCENTS’ TEST ANXIETY: A CASE STUDY USING THE ACADEMIC PROGRAM (2023) · cites this paper as Cummings et al., 2013
In Results > Therapeutic Relationship and Outcomes (page unavailable), the predictor of better posttreatment outcomes was the youth-rated therapeutic relationship with a CBT therapist, specifically in CBT-only treatment. The Discussion describes the CBT as manual-based, but the paper does not show that a program’s structured nature predicts stronger outcomes. (LLM, conf=0.84)
Experimental — accuracy not yet measuredNone of the existing treatment interventions for adolescents' test anxiety encompassed a structured psychotherapeutic program.
“none encompassed a structured psychotherapeutic program, which predicts stronger treatment outcomes (Cummings et al., 2013).”
From THE EFFICACY OF A COMPASSION, ACCEPTANCE AND MINDFULNESS-BASED PILOT INTERVENTION FOR ADOLESCENTS’ TEST ANXIETY: A CASE STUDY USING THE ACADEMIC PROGRAM (2023) · cites this paper as Cummings et al., 2013
The Results (Therapeutic Relationship and Outcomes; page unavailable) report that a stronger therapeutic relationship predicted better outcomes for youth receiving CBT alone. The paper does not show that having a structured psychotherapeutic program itself predicts stronger outcomes, and its participants had anxiety disorders rather than test anxiety. Its Methods (Participants; page unavailable) also do not assess whether existing test-anxiety interventions included such a program. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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Thornley, E. (2019) · Scholarship@Western (Western University) · Cited by 1 · see citing works
Ormhaug, S. M. (2016) · NORA - Norwegian Open Research Archives
Nabors, L. (2020) · Springer series on child and family studies · doi:10.1007/978-3-030-35606-4_1
Clinical Applications of Cognitive Behavioral Theory of Personality
Tovian, S. M., & Palomares, R. S. (2020) · The Wiley Encyclopedia of Personality and Individual Differences · doi:10.1002/9781119547181.ch273
Clinical Applications of Cognitive Behavioral Theory of Personality
Tovian, S. M., & Palomares, R. S. (2020) · The Wiley Encyclopedia of Personality and Individual Differences · doi:10.1002/9781118970843.ch273
Case Report: A Functional Approach to Deal With Sexual Harassment Within Families
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Psychological Treatment with Youth: Style, Informed by Science
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Self-citationSorid, S. D., McMakin, D. L., Silk, J. S., Ladouceur, C. D., Forbes, E. E., Siegle, G. J., Dahl, R. E., Kendall, P. C., Ryan, N. D., & Olino, T. M. (2025) · Child Psychiatry & Human Development · doi:10.1007/s10578-025-01870-y
Self-citationYi, M., Hagaman, A. K., Goldsamt, L. A., Sun, S., Li, M. L., & Li, X. (2026) · INQUIRY The Journal of Health Care Organization Provision and Financing · doi:10.1177/00469580261436993
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Treat the Condition Not the Label
Swingle, P. G. (2015) · Springer eBooks · doi:10.1007/978-3-319-15527-2_3
- Authors
- Cummings, C. M., Caporino, N. E., Settipani, C. A., Read, K. L., Compton, S. N., March, J., Sherrill, J., Piacentini, J., McCracken, J., Walkup, J. T., Ginsburg, G., Albano, A. M., Rynn, M., Birmaher, B., Sakolsky, D., Gosch, E., Keeton, C., & Kendall, P. C.
- Affiliations
- Temple University (US)
- Duke University (US)
- National Institutes of Health (US)
- University of California, Los Angeles (US)
- Weill Cornell Medicine (US)
- Johns Hopkins University (US)
- Columbia University Irving Medical Center (US)
- University of Pittsburgh (US)
- Philadelphia College of Osteopathic Medicine (US)
- ORCID
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2013-10
- Volume
- 81
- Issue
- 5
- Pages
- 859-864
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- PMC
- PMC4511279
- OpenAlex
- W1977135226
- Cited by
- 54
- References
- 42
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 4 · 2022: 6 · 2021: 3 · 2020: 6 · 2019: 4 · 2018: 4 · 2017: 6 · 2016: 5 · 2015: 6 · 2014: 1 · 2013: 1
- FWCI
- 4.82
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Digital Commons - PCOM (Philadelphia College of Osteopathic Medicine) (submittedVersion)
- Funders
- National Institute of Mental Health (MH063747)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- therapeutic relationship, cognitive behavioral therapy, sertraline, pharmacotherapy, generalized anxiety disorder, social anxiety disorder, separation anxiety disorder, treatment outcomes, childhood anxiety
- MeSH terms
- Adolescent, Anxiety Disorders, Anxiety, Separation, Child, Combined Modality Therapy, Female, Humans, Male, Phobic Disorders, Placebos, Professional-Patient Relations, Cognitive Behavioral Therapy, Treatment Outcome, Selective Serotonin Reuptake Inhibitors, Sertraline
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