Attachment as a predictor of non response to CBT treatment in children with anxiety disorders

Attachment security as an outcome and predictor of response to trauma-focused cognitive-behavioral therapy among maltreated children with posttraumatic stress: A pilot study

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a frontline intervention for posttraumatic stress disorder (PTSD) symptoms among maltreated children. Research suggests that active caregiver participation predicts positive treatment outcomes, but these studies are often based on the perception of the caregiver. Youth perceptions of the caregiver as a source of support who might help confront distressing memories (i.e., attachment security) and how they relate to TF-CBT treatment are unexplored. This paper uses data from a small randomized controlled feasibility trial of TF-CBT to conduct a pilot examination of whether (a) attachment security may improve through the course of TF-CBT, and (b) pre-treatment attachment security predicts response to TF-CBT for the amelioration of posttraumatic stress. Results favored the conclusion that those beginning treatment with attachment insecurity may demonstrate improvement for this outcome by the end of treatment (n = 8; t = 3.3, p = .013, Cohen's d = 1.17). However, although significant improvements were found over the course of treatment for PTSD, there was no evidence that pre-treatment attachment security predicted PTSD outcome (n = 29; ∆R² < .01, ∆F(1,26) = .001, p = .969). The limitations of the current pilot study are discussed, as well as directions for future research.

Attachment and the Development of Psychopathology: Introduction to the Special Issue

When Bowlby [...]

Increasing access to low-intensity interventions for childhood anxiety: A pilot study of a guided self-help program for Scandinavian parents

Cognitive Behavior Therapy (CBT) is an effective treatment for child anxiety. However, access to treatment is limited. It has been suggested that low-intensity formats of parent-delivered CBT may improve access to treatment. Our aim was to develop and pilot-test the acceptability and effect of a low-intensity therapist-guided parent-delivered group program for anxious children (age 7-12 years) adjusted to the Scandinavian culture. The program required 1.5 hours of therapist-time per family. Mothers, fathers and children reported on revised child anxiety and depression scale (RCADS) at referral, pre- and post-treatment. Mothers and fathers also gave a qualitative account of their experiences. Thirty-one families were enrolled and only one family dropped out. Mean age of the children was 9 years. Intent-to-treat analyses revealed significant reductions in anxiety and depressive symptoms from pre- to post-treatment for all informants. Large effect sizes were found for child anxiety symptoms as reported by mothers and fathers, and for child depressive symptoms as reported by mothers. Medium to large effect sizes was found for the self-reported anxiety symptoms by the children, and for depressive symptoms reported by both children and fathers. More than 93% of the parents would recommend the program. Results suggest that our program may provide a new approach to improve access to treatment for anxious children in Scandinavia; however, further research must be conducted before firm conclusions can be drawn.