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Study finds predictors of better CBT adherence in youth with anxiety

PHILADELPHIA — Female sex, higher family socioeconomic status, lower externalizing factors and other variables predicted better treatment adherence and improved anxiety among youth, according to data presented at the Anxiety and Depression Association of America annual conference.

“Cognitive behavioral therapy for anxiety disorders is effective, but about 20% to 40% of youth are not responsive to treatment. One reason for nonresponse may be related to youth adherence to treatment. Previous studies with adults have demonstrated that adherence to CBT is associated with outcomes,” Phyllis Lee, PhD, of University of Connecticut Health Center, Farmington, and colleagues wrote.

To determine predictors of treatment adherence and associations between adherence and treatment outcomes, researchers assessed 279 youth aged 7 to 17 years with DSM-IV-TR diagnoses of separation, generalized or social anxiety disorder who received CBT during the Child/Adolescent Anxiety Multimodal Study. Clinicians rated treatment adherence and reported number of CBT sessions attended during a 12-week period.

Regression analyses indicated female sex (P < .05), high socioeconomic status background (P < .05), lower externalizing behaviors (P < .01), higher family functioning (P < .01), greater child treatment expectancy of positive outcomes (P < .01) and a more positive therapeutic relationship at first CBT session (P < .01) were significant predictors of higher adherence.

When controlling for demographics and baseline anxiety, greater adherence to CBT significantly predicted decreased anxiety symptoms after 12 weeks of treatment.

Youth adherence predicted an additional 9% to 12% variance in treatment outcomes, beyond the 12% variance predicted by demographics and baseline anxiety, according to hierarchical regression analysis.

“These results highlight the importance of measuring and examining predictors of youth adherence to CBT for anxiety treatment as higher adherence was associated with better outcomes. Findings also provide clinicians information about risks for nonadherence which can inform treatment planning,” the researchers concluded. – by Amanda Oldt

Reference:

Lee P, et al. Youth adherence to CBT for anxiety disorders: Predictors and associations with outcomes. Presented at: Anxiety and Depression Association of America Conference; March 31-April 3, 2016; Philadelphia.

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