Self-disclosure as a predictor of outcomes in cognitive-behavioral therapy for anxious youth

Abstract

Cognitive-Behavioral Therapy (CBT) is an empirically supported treatment for anxious youth; however, approximately 30% of youths continue to meet diagnostic criteria for their primary anxiety disorder at posttreatment. Efforts to identify predictors and moderators of outcome in CBT are encouraged in order to enhance treatment efficacy. One potential predictor is youth pretreatment self-disclosure (e.g. Panichelli-Mindel, Flannery-Schroeder, Kendall, & Angelosante, 2005). Using a sample of 101 Anxiety Disordered (AD) youths meeting criteria for a primary diagnosis of Generalized Anxiety Disorder (GAD), Separation Anxiety Disorder (SAD), or Social Phobia (SOP) who were treated with 16-weeks of CBT (individual or family), this study examined (a) youth self-disclosure as a predictor of CBT outcomes, (b) pre- to post-treatment change in disclosure and distress during disclosure task, for responders relative to nonresponders, (c) disclosure and distress while disclosing in anxious youth relative to community volunteers (N=74); and (d) disclosure and distress while disclosing in treatment responders and nonresponders (posttreatment), and community volunteers. Videotaped recordings of a four-minute Youth Speech Sample (YSS) in which the youth was instructed to talk about him/herself were coded by reliable coders who were blind to diagnostic status, using the Youth Self-Disclosure Rating Scale (YSDRS) for each of the variables of interest (Feared Situations, Personal Content, Global Rating of Disclosure, and Distress while Disclosing). Text analysis software was used to measure Disclosure Language. Treatment outcome was measured using posttreatment diagnostic status and severity, youth self-report, and mother- and father-reports. Findings of the present study indicate that pretreatment disclosure does not predict CBT outcomes for anxious youth. Additionally, there were no differences in the pre- to post-treatment change in disclosure and distress for responders and nonresponders; however, a main effect of treatment on disclosure of personal content was observed, such that youths disclosed more at posttreatment relative to pretreatment. Anxious youths appear more distressed in the disclosure task relative to community volunteers, but groups do not differ in their level of disclosure. Similarly, treatment responders and nonresponder at posttreatment were rated as more distressed while disclosing relative to community volunteers, but do not differ in their level of disclosure. Clinical implications and future directions are discussed.