Impact of youth and caregiver worries about treatment on therapeutic process factors and posttreatment outcomes

Jonathan Rabner; Lesley A Norris; Margaret E Crane; Joshua Klugman; Philip C Kendall

doi:10.1016/j.janxdis.2023.102741

Impact of youth and caregiver worries about treatment on therapeutic process factors and posttreatment outcomes

J Anxiety Disord. 2023 Aug:98:102741. doi: 10.1016/j.janxdis.2023.102741. Epub 2023 Jun 16.

Authors

Jonathan Rabner¹, Lesley A Norris², Margaret E Crane³, Joshua Klugman⁴, Philip C Kendall⁵

Affiliations

¹ Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA. Electronic address: jrabner@temple.edu.
² Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA; Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA.
³ Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA; Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA.
⁴ Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA; Department of Sociology, Temple University, Philadelphia, PA, USA.
⁵ Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA.

PMID: 37348261
PMCID: PMC10527968 (available on 2024-08-01)
DOI: 10.1016/j.janxdis.2023.102741

Abstract

Objective: To examine the impact of youth- and caregiver-reported pretreatment worries about treatment (i.e., concerns about the effect of, perceptions of, or aspects involved in treatment) before cognitive behavioral therapy for anxiety on (1) clinician-rated therapeutic process factors (i.e., client engagement, client-therapist alliance, content mastery, and homework completion) and symptom change (i.e., improvement, anxiety severity) assessed throughout treatment and (2) independent evaluator-rated posttreatment outcomes (i.e., response, remission, and functional impairment).

Methods: Participants were 128 youth, aged 7-17 years, who sought treatment for a principal anxiety disorder, and their primary caregiver. Multilevel models were estimated to examine the relationship between worries about treatment and the set of therapeutic factors. Regression models examined the relationship between worries about treatment and posttreatment outcomes.

Results: Results indicated that greater youth-reported worries about treatment flattened/lessened improvement trajectories throughout treatment and had a positive association with higher anxiety severity and lower content mastery. Greater caregiver-reported worries about treatment were associated with greater homework completion, client engagement, and content mastery throughout treatment. Youth- and caregiver-reports of worries about treatment did not impact independent evaluator-rated posttreatment outcomes.

Conclusions: Findings support the notion that worries about treatment do not prevent youth from achieving favorable posttreatment outcomes, but do impact various therapeutic factors differentially across youth and caregiver report (e.g., content mastery, client engagement, and homework completion). The value of addressing worries about treatment at the start of therapy is discussed.

Keywords: Cognitive behavioral therapy; Predictors; Treatment worries; Youth anxiety.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Anxiety / therapy
Anxiety Disorders / psychology
Caregivers*
Cognitive Behavioral Therapy* / methods
Humans
Treatment Outcome

Abstract

Publication types

MeSH terms

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