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Cited by 33Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychotherapy Techniques and ApplicationsChild and Adolescent Psychosocial and Emotional Development

Shape of change in cognitive behavioral therapy for youth anxiety: Symptom trajectory and predictors of change.

Chu, Brian C., Skriner, Laura C., Zandberg, Laurie J.·2013·Journal of Consulting and Clinical Psychology
DOI 10.1037/a0033390
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Abstract

OBJECTIVE: Multilevel growth analysis was used to establish the mean growth trajectory (shape of change) for cognitive behavioral therapy (CBT) for youth with anxiety disorders. Two-level growth analysis was conducted to identify important between-youth predictors of session-by-session symptom change. METHOD: Fifty-five youth (ages 7-17; 50.9% male) and their parents participated in a 16- to 20-week CBT that emphasized affective, cognitive, and exposure-based exercises. Multilevel growth models (MLMs) were estimated to model session symptom data taking into account an "anxiety spike" hypothesized to occur at initiation of exposure sessions. Three models were compared: a cubic curve, a log-linear curve plus an exposure covariate, and a linear curve plus exposure covariate. Two-level MLM examined the effect of demographic traits (sex, age, race/ethnicity), pretreatment symptom severity, comorbid school refusal, early treatment factors (use of selective serotonin reuptake inhibitor medication, therapeutic alliance, treatment attrition), and pretreatment coping (engagement, disengagement, and involuntary coping). RESULTS: Fit indices provided support for the cubic growth model using either parent or youth anxiety data. Level 2 analysis identified youth age, symptom severity (anxiety, externalizing), early attrition, and engagement and disengagement coping as significant predictors of symptom trajectories. Predictors accounted for 34%-37% of between-youth variance in midtreatment anxiety scores. CONCLUSIONS: Findings suggest that the symptom course of CBT, and the effect of between-youth factors on treatment outcomes, is more complex than previously thought. Educating therapists and clients about findings can aid treatment expectations and dissemination efforts of empirically supported treatments.

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  • These findings are consistent with Chu et al who demonstrated a nonlinear symptom trajectory for youth engaging in face-to-face CBT, with participants tending to show a rapid response over the first six sessions and changes tending to taper off thereafter.

    “These findings are also consistent with those of Chu et al [26] who demonstrated a nonlinear symptom trajectory for youth engaging in face-to-face CBT; in fact, they reported that participants tended to show a rapid response over the first six sessions, with changes tending to taper off thereafter.”

    From Large-scale dissemination of internet-based cognitive behavioral therapy for youth anxiety: Feasibility and acceptability study (2018) · cites this paper as [26]

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Authors
Chu, B. C., Skriner, L. C., & Zandberg, L. J.
Affiliations
Rutgers, The State University of New Jersey (US)
ORCID
Venue
Journal of Consulting and Clinical Psychology
Publisher
American Psychological Association (APA)
Published
2013
Volume
81
Issue
4
Pages
573-587
ISSN
  • 0022-006X (ISSN-L)
  • 1939-2117
DOI
10.1037/a0033390
OpenAlex
W2332741612
Cited by
33
References
47
Citations by year
2026: 2 · 2025: 1 · 2024: 3 · 2023: 2 · 2021: 5 · 2020: 3 · 2019: 1 · 2018: 7 · 2017: 5 · 2015: 2 · 2014: 1 · 2013: 1
FWCI
1.80
Type
journal article
Language
en
Open access
closed
Locations
  • Journal of Consulting and Clinical Psychology (publishedVersion)
  • PubMed (publishedVersion)
  • Rutgers University Community Repository (Rutgers University) (submittedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
  • Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
Keywords
cognitive behavioral therapy, youth anxiety, anxiety disorders, symptom trajectories, exposure therapy, treatment discontinuation, coping, school refusal, selective serotonin reuptake inhibitors, therapeutic relationship, treatment engagement, externalizing problems
MeSH terms
Adolescent, Adult, Age Factors, Anxiety Disorders, Child, Female, Humans, Male, Severity of Illness Index, Models, Statistical, Cognitive Behavioral Therapy, Treatment Outcome

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