ABSTRACT
Objectives
Cognitive behavioral therapy (CBT) is the most researched treatment for childhood anxiety disorders (CADs). Improving outcomes and efficiency of CBT will require identifying and optimizing the most efficacious therapeutic components. Towards this end, a recent randomized controlled trial (RCT) found that Parent Coached Exposure Therapy (PCET) led to greater symptom improvement in less time than traditional CBT. To better understand and maximize these advantages, the current study explores the timing and course of symptom improvement in these two treatments for CADs, CBT, and PCET.
Methods
In this secondary analysis of data from the RCT, 56 youth aged 7−17 years (73.2% female) and a parent provided weekly ratings of anxiety symptom severity.
Results
The mean anxiety severity ratings decreased significantly in both conditions, but a significant condition by time interaction suggested that the pace of change differed between treatment for parent report, F (6.2, 335) = 2.96, p = 0.007. A series of post-hoc comparisons indicated that the ratings became significantly lower in the PCET group beginning in session 3 (effect size = 0.77) through post-treatment assessment. In addition, within each treatment condition the largest change in severity ratings occurred after the introduction of exposure, effect sizes of 0.68 for PCET and 0.56 for CBT. The child severity ratings followed a similar pattern but did not reach statistical significance.
Discussion
The implications of these exploratory and hypothesis-generating findings for designing treatment protocols to deliver exposure in a manner to maximize the amount, and pace, of improvement are discussed.