Skip to main content
SpringerLink
Log in

Modular Cognitive Behavioral Therapy for Youth with Anxiety Disorders: A Closer Look at the Use of Specific Modules and their Relation to Treatment Process and Response

  • Original Paper
  • Published:
School Mental Health Aims and scope Submit manuscript

Abstract

Recent data have emerged suggesting the benefits of a modular rather than manualized approach to treating anxiety disorders, particularly in school settings. However, little is known about the use of specific modules or their relation to treatment process or response. Using data from a modular cognitive behavioral treatment for anxiety disorders delivered by school clinicians, this study examined (a) the frequency of module use (e.g., exposure, cognitive restructuring), (b) whether therapy session process variables (e.g., therapeutic relationship) varied by module, and (c) the relation between specific module use and treatment response. Data from 124 therapy sessions were used to address these questions. Therapy sessions were delivered by 11 school-based clinicians to a sample of 16 volunteer youth (mean age 11.1 years; 68.8 % female, 87.5 % African-American) as part of a randomized controlled trial (Ginsburg et al. in Child Youth Care Forum 41:1–19, 2011). After each therapy session, clinicians identified the module used and rated various process variables. Treatment response was assessed by blind evaluators who conducted diagnostic interviews with children and parents post-intervention and at a 1-month follow-up. The most frequently used modules were exposure (47 % of sessions), psychoeducation (20 % of sessions), and cognitive restructuring (18 % of sessions). Session process variables (e.g., child involvement, therapeutic relationship) varied by module. No individual module predicted treatment response. Findings suggest that newly trained clinicians do not use CBT modules with equal frequency and type of module does not appear to affect key treatment variables. Future studies are needed to explore the reasons clinicians select specific modules as well as the quality of implementation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Addis, M. E., & Krasnow, A. D. (2000). A national survey of practicing psychologists’ attitudes toward psychotherapy treatment manuals. Journal of Consulting and Clinical Psychology, 68(2), 331–339. doi:10.1037/0022-006X.68.2.33.

    Article  PubMed  Google Scholar 

  • Angold, A., Erkanli, A., Farmer, E. Z., Fairbank, J. A., Burns, B. J., Keeler, G., et al. (2002). Psychiatric disorder, impairment, and service use in rural African American and White youth. Archives of General Psychiatry, 59(10), 893–904. doi:10.1001/archpsyc.59.10.893.

    Article  PubMed  Google Scholar 

  • Becker, K. D., & Domitrovich, C. E. (2011). The conceptualization, integration, and support of evidence-based interventions in the schools. School Psychology Review, 40(4), 582–589.

    Google Scholar 

  • Beidas, R. S., Benjamin, C. L., Puleo, C. M., Edmunds, J. M., & Kendall, P. C. (2010). Flexible applications of the coping cat program for anxious youth. Cognitive and Behavioral Practice, 17(2), 142–153. doi:10.1016/j.cbpra.2009.11.002.

  • Chiu, A. W., McLeod, B. D., Har, K., & Wood, J. J. (2009). Child–therapist alliance and clinical outcomes in cognitive behavioral therapy for child anxiety disorders. Journal of Child Psychology and Psychiatry, 50(6), 751–758. doi:10.1111/j.1469-7610.2008.01996.x.

    Article  PubMed  Google Scholar 

  • Chorpita, B. F. (2007). Modular cognitive-behavioral therapy for childhood anxiety disorders. New York, NY: Guilford Press.

    Google Scholar 

  • Chorpita, B. F., Taylor, A. A., Francis, S. E., Moffitt, C. E., & Austin, A. A. (2004). Efficacy of modular cognitive behavior therapy for childhood anxiety disorders. Behavior Therapy, 35, 263–287.

    Article  Google Scholar 

  • Chorpita, B. F., Bernstein, A., & Daleiden, E. L. (2008). Driving with roadmaps and dashboards: Using information resources to structure the decision models in service organizations. Administration and Policy in Mental Health and Mental Health Services Research, 35(1–2), 114–123. doi:10.1007/s10488-007-0151-x.

    Article  PubMed  Google Scholar 

  • Chu, B. C., & Kendall, P. C. (2004). Positive association of child involvement and treatment outcome within a manual-based cognitive-behavioral treatment for children with anxiety. Journal of Consulting and Clinical Psychology, 72(5), 821–829. doi:10.1037/0022-006X.72.5.821.

    Article  PubMed  Google Scholar 

  • Costello, E. J., Egger, H. L., & Angold, A. (2004). Developmental epidemiology of anxiety disorders. In T. H. Ollendick & J. S. March (Eds.), Phobic and anxiety disorders in children and adolescents: A clinician’s guide to effective psychosocial and pharmacological interventions (pp. 61–91). New York, NY: Oxford University Press.

    Google Scholar 

  • Elkins, R., McHugh, R., Santucci, L. C., & Barlow, D. H. (2011). Improving the transportability of CBT for internalizing disorders in children. Clinical Child and Family Psychology Review, 14(2), 161–173. doi:10.1007/s10567-011-0085-4.

    Article  PubMed  Google Scholar 

  • Farmer, E. Z., Burns, B. J., Phillips, S. D., Angold, A., & Costello, E. (2003). Pathways into and through mental health services for children and adolescents. Psychiatric Services, 54(1), 60–66. doi:10.1176/appi.ps.54.1.60.

    Article  PubMed  Google Scholar 

  • Forgatch, M. S., Patterson, G. R., & DeGarmo, D. S. (2005). Evaluating fidelity: Predictive validity for a measure of competent adherence to the Oregon model of parent management training. Behavior Therapy, 36(1), 3–13. doi:10.1016/S0005-7894(05)80049-8.

  • Galla, B. M., Wood, J. J., Chiu, A. W., Langer, D. A., Jacobs, J., Ifekwunigwe, M. et al. (2011) One year follow-up to modular cognitive behavioral therapy for the treatment of pediatric anxiety disorders in an elementary school setting. Child Psychiatry & Human Development. Advance online publication. doi:10.1007/s10578-011-0258-x.

  • Garb, H. N. (2005). Clinical judgment and decision making. Annual Review of Clinical Psychology, 1(1), 67–89. doi:10.1146/annurev.clinpsy.1.102803.143810.

    Article  PubMed  Google Scholar 

  • Ginsburg, G. S., Becker, K. D., Kingery, J., & Nichols, T. (2008). Transporting CBT for childhood anxiety disorders into inner-city school-based mental health clinics. Cognitive and Behavioral Practice, 15(2), 148–158. doi:10.1016/j.cbpra.2007.07.001.

    Article  Google Scholar 

  • Ginsburg, G. S., Becker, K. D., & Drazdowski, T. K. (2011). Treating anxiety disorders in inner city schools: Results from a pilot randomized controlled trial comparing CBT and usual care. Child and Youth Care Forum, 41(1), 1–19. doi:10.1007/s10566-011-9156-4.

    Article  Google Scholar 

  • Gudiño, O. G., Lau, A. S., Yeh, M., McCabe, K. M., & Hough, R. L. (2009). Understanding racial/ethnic disparities in youth mental health services: Do disparities vary by problem type? Journal of Emotional and Behavioral Disorders, 17(1), 3–16. doi:10.1177/1063426608317710.

    Article  Google Scholar 

  • Guy, W. (Ed.). (1976). ECDEU assessment manual for psychopharmacology, revised. Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol, Drug Abuse, and Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research Programs.

  • Herschell, A. D., Kolko, D. J., Baumann, B. L., & Davis, A. C. (2010). The role of therapist training in the implementation of psychosocial treatments: A review and critique with recommendations. Clinical Psychology Review, 30, 448–466. doi:10.1016/j.cpr.2010.02.005.

    Article  PubMed  Google Scholar 

  • Huey, S. R., Henggeler, S. W., Brondino, M. J., & Pickrel, S. G. (2000). Mechanisms of change in multisystemic therapy: Reducing delinquent behavior through therapist adherence and improved family and peer functioning. Journal of Consulting and Clinical Psychology, 68(3), 451–467. doi:10.1037/0022-006X.68.3.451.

    Google Scholar 

  • Kendall, P. C., Robin, J. A., Hedtke, K. A., Suveg, C., Flannery-Schroeder, E., & Gosch, E. (2005). Considering CBT with anxious youth? Think exposures. Cognitive and Behavioral Practice, 12(1), 136–150. doi:10.1016/S1077-7229(05)80048-3.

    Article  Google Scholar 

  • Kendall, P. C., Comer, J. S., Marker, C. D., Creed, T. A., Puliafico, A. C., Hughes, A. A., et al. (2009). In-session exposure tasks and therapeutic alliance across the treatment of childhood anxiety disorders. Journal of Consulting and Clinical Psychology, 77(3), 517–525. doi:10.1037/a0013686.

    Article  PubMed  Google Scholar 

  • Kendall, P. C., Gosch, E., Furr, J. M., & Sood, E. (2008). Flexibility within fidelity. Journal of the American Academy of Child & Adolescent Psychiatry, 47(9), 987–993. doi:10.1097/CHI.0b013e31817eed2f.

    Google Scholar 

  • Kodjo, C. M., & Auinger, P. (2004). Predictors for emotionally distressed adolescents to receive mental health Care. Journal of Adolescent Health, 35(5), 368–373. doi:10.1016/j.jadohealth.2003.12.005.

    PubMed  Google Scholar 

  • Liber, J. M., McLeod, B. D., Van Widenfelt, B. M., Goedhart, A. W., van der Leeden, A. M., Utens, E. J. et al. (2010). Examining the relation between the therapeutic alliance, treatment adherence, and outcome of cognitive behavioral therapy for children with anxiety disorders. Behavior Therapy, 41(2), 172–186. doi:10.1016/j.beth.2009.02.003.

    Google Scholar 

  • Lyon, A. R., Charlesworth-Attie, S., Vander Stoep, A., & McCauley, E. (2011). Modular psychotherapy for youth with internalizing problems: Implementation with therapists in school-based health centers. School Psychology Review, 40(4), 569–581.

    Google Scholar 

  • Merikangas, K., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L. et al. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989.

    Google Scholar 

  • Merikangas, K., He, J., Burstein, M., Swendsen, J., Avenevoli, S., Case, B. et al. (2011). Service utilization for lifetime mental disorders in U.S. Adolescents: Results of the National Comorbidity Survey-Adolescent Supplement (NCSA). Journal of the American Academy of Child & Adolescent Psychiatry, 50(1), 32–45. doi:10.1016/j.jaac.2010.10.006.

  • Mufson, L. (2010). Interpersonal psychotherapy for depressed adolescents (IPT-A): Extending the reach from academic to community settings. Child and Adolescent Mental Health, 15(2), 66–72. doi:10.1111/j.1475-3588.2009.00556.x.

    Article  Google Scholar 

  • Mufson, L. H., Dorta, K., Olfson, M., Weissman, M. M., & Hoagwood, K. (2004). Effectiveness research: Transporting interpersonal psychotherapy for depressed adolescents (IPT-A) from the lab to school-based health clinics. Clinical Child and Family Psychology Review, 7(4), 251–261. doi:10.1007/s10567-004-6089-6.

    Article  PubMed  Google Scholar 

  • Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). The cruelest cure? Ethical issues in the implementation of exposure-based treatments. Cognitive and Behavioral Practice, 16(2), 172–180. doi:10.1016/j.cbpra.2008.07.003.

    Article  Google Scholar 

  • Schoenwald, S. K., Chapman, J. E., Sheidow, A. J., & Carter, R. E. (2009). Long-term youth criminal outcomes in MST transport: The impact of therapist adherence and organizational climate and structure. Journal of Clinical Child and Adolescent Psychology, 38(1), 91–105. doi:10.1080/15374410802575388.

    Google Scholar 

  • Shimokawa, K., Lambert, M., & Smart, D. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78, 298–311. doi:10.1037/a0019247.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., Pina, A. A., & Viswesvaran, C. (2008). Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. Journal of Clinical Child and Adolescent Psychology, 37(1), 105–130.

    Article  PubMed  Google Scholar 

  • Simpson, D., Suarez, L., & Connolly, S. (2012). Treatment and outcomes for anxiety disorders among children and adolescents: A review of coping strategies and parental behaviors. Current Psychiatry Reports. Advance online publication. doi:10.1007/s11920-012-0254-2.

  • Southam-Gerow, M. A., Weisz, J. R., Chu, B. C., McLeod, B. D., Gordis, E. B., & Connor-Smith, J. K. (2010). Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics? An initial effectiveness test. Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 1043–1052.

    Article  PubMed  Google Scholar 

  • Tobon, J. I., Eichstedt, J. A., Wolfe, V., Phoenix, E., Brisebois, S., Zayed, R. S., et al. (2011). Group cognitive-behavioral therapy for anxiety in a clinic setting: Does child involvement predict outcome? Behavior Therapy, 42(2), 306–322. doi:10.1016/j.beth.2010.08.008.

    Article  PubMed  Google Scholar 

  • Vande Voort, J., Svecova, J., Jacobsen, A., & Whiteside, S. P. (2010). A retrospective examination of the similarity between clinical practice and manualized treatment for childhood anxiety disorders. Cognitive and Behavioral Practice, 17(3), 322–328. doi:10.1016/j.cbpra.2009.12.002.

    Article  Google Scholar 

  • Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., et al. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359(26), 2753–2766.

    Article  PubMed  Google Scholar 

  • Waller, G., Stringer, H., & Meyer, C. (2012). What cognitive behavioral techniques do therapists report using when delivering cognitive behavioral therapy for the eating disorders? Journal of Consulting and Clinical Psychology, 80(1), 171–175. doi:10.1037/a0026559.

    Google Scholar 

  • Weisz, J. R., Chorpita, B. F., Palinkas, L. A., Schoenwald, S. K., Miranda, J., Bearman, S. K., et al. (2011) Testing standard and modular designs for psychotherapy with youth depression, anxiety, and conduct problems: A randomized effectiveness trial. Archives of General Psychiatry. Advance online publication. doi:10.1001/archgenpsychiatry.2011.147.

Download references

Acknowledgments

This study was supported by a grant from the National Institute of Mental Health (MH90027497) awarded to Golda S. Ginsburg, Ph.D. During the preparation of this manuscript, Dr. Becker was supported by the National Institute of Mental Health (T32 MH 18834).

Author information

Authors and Affiliations

  1. Department of Psychology, University of Miami, Coral Gables, FL, USA

    Emily M. Becker

  2. The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Kimberly D. Becker

  3. Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, 550 North Broadway/Suite 202, Baltimore, MD, 21205, USA

    Golda S. Ginsburg

Authors
  1. Emily M. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kimberly D. Becker
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Golda S. Ginsburg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Golda S. Ginsburg.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Becker, E.M., Becker, K.D. & Ginsburg, G.S. Modular Cognitive Behavioral Therapy for Youth with Anxiety Disorders: A Closer Look at the Use of Specific Modules and their Relation to Treatment Process and Response. School Mental Health 4, 243–253 (2012). https://doi.org/10.1007/s12310-012-9080-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12310-012-9080-2

Keywords

Search

Navigation