THE RELATIONSHIP BETWEEN YOUTH INVOLVEMENT, THERAPIST BEHAVIORS, AND ANXIETY SYMPTOMS IN THE TREATMENT OF YOUTH ANXIETY

Abstract

Objective: Therapeutic processes that occur within session have been identified as a factor that may influence youth anxiety outcomes. The present study examined the relationships between positive and negative youth involvement, therapist therapeutic and nontherapeutic behaviors, and anxiety outcomes. Method: Sixty youth (aged 7-17) received cognitive-behavioral therapy for an anxiety disorder. Weekly session videos were rated by observers. Measures of anxiety severity were completed weekly and at posttreatment. Regression analyses examined the association between therapeutic processes and post-treatment outcomes. Univariate and bivariate latent difference score (LDS) models evaluated whether changes in one factor were prospectively associated with later changes in the same factor and in other factors. Results: Positive youth involvement significantly predicted reduced anxiety severity, greater improvement, and remission of principal anxiety disorder at posttreatment. Youth negative involvement during psychoeducation sessions predicted a reduced likelihood of remission. Therapist therapeutic behaviors during psychoeducation sessions predicted lower anxiety severity, greater improvement, and treatment response. Nontherapeutic behaviors in psychoeducation sessions were associated with increased anxiety severity, less improvement, and a reduced likelihood of treatment response and remission of principal anxiety disorder. When entered simultaneously, only nontherapeutic behaviors were significantly associated with increased anxiety severity. LDS models resulted in poor model fit, thus, the temporal sequence among involvement, therapist behaviors, and anxiety severity was not established. Conclusions: Youth involvement and therapist behaviors are associated with beneficial outcomes. Therapist nontherapeutic behaviors are strongly associated with poorer outcomes. Findings are discussed in relation to previous findings and future directions are proposed.