Characteristics of Exposure Sessions as Predictors of Differential Treatment Response in a Sample of Anxious Youth

Abstract

Guidelines for conducting effective exposure treatment with anxious youth emphasize content (e.g., preparation for and processing of the exposure) and process (e.g., collaboration and youth involvement) variables as important elements of exposure task sessions, but there is a paucity of research examining these guidelines. Using multiple regression, this study evaluated the extent to which independent observers' ratings of process (i.e., collaboration and youth involvement) and content variables (i.e., preparation for and processing after the exposure task) were predictive of treatment outcome in a sample of 61 anxiety-disordered youth. Results indicated that collaboration between the youth and therapist significantly predicted improvement in treatment outcome as measured by youth-, parent-, and teacher-reports. Youth involvement in exposure task sessions predicted improved outcome as measured by teacher-report. Contrary to expectation, preparation for exposure did not predict outcome, but post-event processing of the exposure task was significantly predictive of clinician-rated diagnostic outcome. Exploratory analyses suggest that treatment responders were more likely to be assigned between-session exposure tasks as "homework" and were more likely to be rewarded for their efforts in session. Treatment implications and future directions are discussed.