Self-efficacy effects in combined CBT-attention training for pediatric anxiety

Augmenting cognitive behavioral therapy (CBT) with attention bias modification training (ABMT) has shown promising yet inconsistent results. Thus, research is needed to identify potential moderators of treatment outcomes. Self-efficacy beliefs have been linked to CBT treatment response and potentially to the cognitive mechanisms which influence engagement with ABMT. This study examined the relation between self-efficacy and treatment response among pediatric patients (N = 111) undergoing CBT for pediatric anxiety supplemented with either an active or sham ABMT. Moderated-mediation analyses revealed a significant interaction between child-reported self-efficacy and ABMT condition in predicting early treatment changes in parent-reported depressive symptoms (a₃ = -0.18, SE = 0.05, p < .01), indicating that the association between active ABMT and early depressive symptom change was conditional on self-efficacy. This greater early treatment change related to better overall treatment outcomes (b = 0.09, SE = 0.02, t = 4.33, p < .001). No associations emerged for clinician, parent, or child-reported anxiety (ps > 0.4). Findings that self-efficacy prior to CBT exposures influences ABMT responsiveness highlights high self-efficacy as a potential correlate of change in mood symptoms. Current findings elucidate the complex, yet significant role of self-efficacy in mood-related treatment response and the need for further investigation into the relations between self-efficacy, attentional biases, and treatment outcomes among multiple reporters.