Mediators of Youth Anxiety Outcomes 3 to 12 Years After Treatment

Abstract

Objective: Test changes in (a) perceived coping efficacy, (b) negative self-statements, and (c) interpretive biases to threat as potential mediators of the relationship between treatment condition and long-term follow-up (average of 6.5 years after intervention). Test moderating effect of age at time of randomization on mediational effect for the 3 putative mediators. Method: Participants included 301 youth who had participated in the Child/Adolescent Multimodal Study (CAMS) and agreed to participate in a naturalistic follow-up study beginning an average of 6.5 years after the end of the acute treatment phase. In the intervention phase, participants (ages 7 to 17) were randomized to cognitive behavioral therapy (CBT), pharmacotherapy (sertraline), combined CBT and sertraline, or pill placebo. Putative mediators were measured at 4 time-points over the course of the intervention phase. The follow-up study consisted of five annual assessment visits that included ratings of current anxiety based on an interview by an independent evaluator who was blind to the randomization of participants. Results: Reductions on a measure of interpretive biases to threat over the course of the combined intervention condition mediated anxiety outcomes at the first follow-up visit. No other significant mediated effects were found for any of the putative mediators. Age did not significantly moderate any mediated effects. Conclusions: The findings suggest that interpretive biases to threat, an often elevated characteristic of anxious youth, may be important to address as part of the treatment of anxiety in order to maintain reductions in anxiety in the years following treatment. The specificity of this finding to the combined CBT and sertraline condition offers support for the synergistic effect of CBT and sertraline when implemented in tandem to reduce anxiety-related cognitive factors with long-term implications.