Exposure-Focused Cognitive-Behavioral Therapy for Youth Anxiety Disorders: Superiority Over Relaxation-Based...

Evidence supports exposure-focused cognitive-behavioral therapy (EF-CBT) for child and adolescent anxiety disorders, but protocols comparing EF-CBT with other therapy modalities (eg, relaxation) are understudied, and little is known about predictors of EF-CBT response. Extending an interim report, this study compared EF-CBT with an active comparator, relaxation and mentorship training (RMT), and examined predictors of EF-CBT response.

Participants were 139 youths with transdiagnostic anxiety disorders (age range 7-18 years, mean age 12.3). Sample demographics were male, 24.5%; female, 75.5%; Asian, 0.7%; Black, 5.8%; multiracial, 0.7%; other, 0.7%; other Pacific Islander, 11.5%; unknown, 2.9%; White, 77.7%; 5.8% Hispanic/Latino. Participants were randomized (2:1 ratio) to 12 sessions of EF-CBT (n = 94) or RMT (n = 45). Treatment response was determined by independent evaluator ratings on the Pediatric Anxiety Rating Scale and the Clinical Global Impressions-Improvement scale.

EF-CBT was associated with 3.53 higher odds of treatment response based on Clinical Global Impressions-Improvement scale (EF-CBT 47.1%, RMT 20.1% response rate) whether delivered in person or via teletherapy. Notably, age moderated EF-CBT response, such that younger age predicted better outcomes (F _1,89 = 4.38, p = .04). By contrast, number of anxiety diagnoses, comorbid externalizing symptoms, and subclinical depressive symptoms did not predict EF-CBT outcomes.

As expected, EF-CBT was more effective than the RMT comparator. Greater improvement in younger patients receiving EF-CBT suggests that response to exposure may be developmentally sensitive.

Dimensional Brain Behavior Predictors of CBT Outcomes in Pediatric Anxiety (Anxiety-CBT); https://clinicaltrials.gov/study/NCT02810171.