Impact of youth and caregiver worries about treatment on therapeutic process factors and posttreatment outcomes |
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| Affiliation: | 1. Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA;2. Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA;3. Department of Psychiatry, New York Presbyterian-Weill Cornell Medicine, New York, NY, USA;4. Department of Sociology, Temple University, Philadelphia, PA, USA;1. School of Applied Psychology, Griffith University, Australia;2. School of Psychology, Curtin University, Australia;3. Department of Psychology & Department of Psychiatry & Biobehavioral Sciences, UCLA, United States;4. School of Psychology and Counselling, Queensland University of Technology, Australia;1. University of North Carolina at Chapel Hill, United States;2. Rogers Memorial Hospital, United States;1. Department of Psychology and Neuroscience, Faculty of Science, Dalhousie University, 1355 Oxford St., Halifax, Nova Scotia B3H 4R2, Canada;2. Department of Psychology, Faculty of Arts, University of New Brunswick, 38 Dineen Drive, Fredericton, New Brunswick E3B 5A3, Canada;3. Department of Psychology, Faculty of Science, St. Francis Xavier University, 2323 Notre Dame Ave., Antigonish, Nova Scotia B2G 2W5, Canada;4. Department of Psychiatry, Faculty of Medicine, Dalhousie University, 5909 Veteran’s Memorial Lane, 8th Floor, Abbie J. Lane Memorial Building, QEII Health Sciences Centre, Halifax, Nova Scotia B3H 2E2, Canada;1. Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Public Health Research Institute and Amsterdam Neuroscience Research Institute, Amsterdam, the Netherlands;2. Program for Research and Care on Violence and PTSD (PROVE), Department of Psychiatry, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil;3. Department of Clinical Psychology, Utrecht University, Utrecht, the Netherlands;4. Department of Psychology, University of Montana, Missoula, MT, United States;5. ARQ National Psychotrauma Centre, Diemen, the Netherlands;1. San Francisco VA Health Care System, San Francisco, CA, USA;2. University of California – San Francisco, San Francisco, CA, USA;3. White River Junction Veterans Affairs Medical Center, White River Junction, VT, USA;4. Geisel School of Medicine at Dartmouth, Hanover, NH, USA |
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| Abstract: | ObjectiveTo 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).MethodsParticipants 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.ResultsResults 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.ConclusionsFindings 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. |
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| Keywords: | Treatment worries Cognitive behavioral therapy Youth anxiety Predictors |
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