PARENTAL RESISTANCE IN COGNITIVE BHAVIORAL THERAPY FOR ANXIOUS YOUTH

Abstract

Objective: Resistance is a therapeutic process variable that can play an important role in treatment. The present study examined whether observer-rated parental resistance during parent-only sessions of cognitive-behavioral therapy (CBT) for anxious youth predicted the number of parent-reported between-session exposures completed, posttreatment outcome, and 36-week follow-up. Method: Participants (N = 272) were parents or adult caregivers of youth (age 7 to 17 years old) who received CBT for an anxiety disorder as participants in the Child/Adolescent Anxiety Multimodal study (CAMS). Parent-only therapy sessions were rated for resistance by observers. Measures of anxiety and overall symptom severity were completed at posttreatment and 36-week follow-up. Mediation analyses examined the indirect effect of the number of parent-reported exposures completed on the relationship between parent in-session resistance and therapy outcomes at posttreatment and 36-week follow-up. Additionally, resistance levels in participants in the CBT-only condition of CAMS were compared with resistance levels for participants in the CBT plus sertraline condition. Results: Analyses demonstrated that there was no significant difference in mean resistance scores between the CBT-only group and the CBT plus sertraline group. None of the 12 mediation tests found statistically significant indirect effects of the number of parent-reported exposures completed on the relationship between parent in-session resistance and therapy outcomes at posttreatment and 36-week follow-up. A significant relationship was found, however, between number of exposures completed and posttreatment Pediatric Anxiety Rating Scale (PARS) total scores, indicating a significant relationship between number of parent-reported exposures and posttreatment therapy outcomes. Conclusions: Parental resistance is not associated with outcomes for youth receiving CBT for anxiety. Number of exposures was significantly associated with one measure of posttreatment therapy outcomes.