Profiles of Temperament among Youth with Specific Phobias: Implications for CBT Outcomes

Mediation Effects of Group Cohesion in Group-Based Cognitive Behavioral Therapy for Youth Anxiety Disorders

There is limited research on group cohesion as a potential outcome facilitator in group-based cognitive-behavioral treatment (GCBT) for youth. We examined if group cohesion mediated the relation between the temperamental trait behavioral inhibition and posttreatment outcomes following GCBT for youth with anxiety disorders. The sample comprised 88 youth (M age = 11.2 years) from a randomized controlled effectiveness trial. The outcomes were posttreatment clinical severity and treatment satisfaction. Group cohesion fully mediated the relation between behavioral inhibition and posttreatment severity. Higher group cohesion was associated with lower posttreatment clinical severity. There was no significant association between behavioral inhibition and treatment satisfaction, hence no mediation. We conclude that group cohesion is a factor that can be targeted by clinicians to potentially enhance GCBT outcomes.

Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders

The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.

Predictors and Moderators Two Treatments of Oppositional Defiant Disorder in Children

OBJECTIVE

The aim of this study was to examine predictors and moderators of behavioral improvement in children with Oppositional Defiant Disorder (ODD) following treatment with Parent Management Training (PMT) and Collaborative and Proactive Solutions (CPS). Initial problem severity, inconsistent discipline, parental attributions of child misbehavior, and child lagging cognitive skills were examined.

METHOD

One hundred and forty-five children aged between 7 and 14 (103 males, M = 8.88 years, ethnicity representative of the wider Australian population) were randomly assigned to PMT and CPS. Assessment was conducted at baseline, post-intervention, and at 6-month follow-up, using independently rated semi-structured diagnostic interviews and parent-ratings of ODD symptoms. Using an intent-to-treat sample in this secondary analysis (Murrihy et al., 2022), linear regressions and PROCESS (Hayes, 2017) were used to examine these predictors and possible moderators of treatment.

RESULTS

Higher pre-treatment levels of conduct problems, lagging skills, and inconsistent discipline predicted poorer behavioral outcomes following both treatments. The only characteristic that moderated treatment outcome was child-responsible attributions - mothers who were more likely to attribute their child's problematic behaviors to factors in the child had significantly poorer outcomes in PMT than CPS at 6-month follow-up.

CONCLUSIONS

CPS may be a more beneficial treatment than PMT for families who have been identified as having higher levels of child-responsible attributions before commencing treatment for ODD. While tentative, this provides promising insights as to how treatment outcomes for children with ODD may be improved.

Parent- and Child-Factors in Specific Phobias: The Interplay of Overprotection and Negative Affectivity

Specific phobias are among the most prevalent anxiety disorders in children and adolescents. Although brief and intensive treatments are evidence-based interventions (Davis III et al. Annual Review of Clinical Psychology, 15, 233-256, 2019), up to one-third of youth do not show significant change in their symptoms following these interventions. Hence, consideration of additional factors influencing treatment response is necessary. Child-factors such as temperament and parent-factors such as parenting behaviors both contribute to the development of specific phobias and their maintenance over time. Specifically, we addressed child temperament (negative affectivity) and parenting behaviors (overprotection) that could uniquely predict clinical outcomes for specific phobias and that might interact to inform goodness-of-fit in the context of these interventions. We also considered whether child- and/or parent-gender shaped the effects of temperament or parenting on clinical outcomes. Participants were 125 treatment-seeking youth (M age = 8.80 years; age range = 6-15 years; 51.5% girls) who met criteria for specific phobia and their mothers and fathers. Mothers' reports of children's negative affectivity uniquely predicted poorer specific phobia symptom severity and global clinical adjustment at post-treatment. Interaction effects were supported between parental overprotection and child negative affectivity for post-treatment fearfulness. The direction of these effects differed between fathers and mothers, suggesting that goodness-of-fit is important to consider, and that parent gender may provide additional nuance to considerations of parent-child fit indices.