Shorter communicationChild involvement, alliance, and therapist flexibility: Process variables in cognitive-behavioural therapy for anxiety disorders in childhood
Section snippets
Participants
Children (N = 151 ages 6–14; 71 boys) and their parents completed independent structured diagnostic interviews conducted by separate diagnosticians. Child diagnoses were obtained from the Anxiety Disorders Interview Schedule (ADIS-IV-C/P or ADIS-III-R-C/P; Silverman, 1987, Silverman et al., 1996) conducted at the Child and Adolescent Anxiety Disorders Clinic (CAADC), Temple University. Children participated in an RCT (n = 44 from Kendall, Hudson, Gosch, Flannery-Schroeder, & Suveg, 2008; n = 58
Coder training
Coders (n = 12) were provided readings on childhood anxiety, its treatment, coding manuals for the process measures, then tested to evaluate their knowledge. Coders used manuals to code each of the process variables, watching and coding training sessions. Coders were required to reach a reliability of .80 on each of the factor scores (intra-class correlation for interval data; Kappa for agreement data). Coders not reaching the criteria continued watching training tapes and coding separate tapes
Reliability assessments
Inter-rater reliability was conducted at post training; midway and at the end of coding. Tapes were given to coders at intervals throughout. Coders discussed their ratings, and discrepancies were discussed and resolved. At the end of coding, overall ICC for all scale and subscale scores was assessed. Child variables: Therapeutic Alliance = .81; Child Work = .83; Child Readiness = .83; CIRS = .90. Therapist Variables: Therapeutic Alliance = .80; Technical Work = .75; Technical Lapse = .69;
Discussion
The current study used taped sessions from multiple RCT's of CBT for children with anxiety disorders. Results found that measures of child and therapist process variables demonstrated several between-process relations and associations with treatment outcome. The current study was the first to utilize observer-ratings of weekly sessions for multiple client and therapist factors and provides the most comprehensive description available in the literature of the shape of change for child and
Acknowledgements
This research was supported by NIMH grant MH60653 awarded to Philip C. Kendall, Jennifer L Hudson, Elizabeth Gosch and Brian Chu. Thank you to the many committed coders involved in this study.
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2018, Journal of Anxiety DisordersCitation Excerpt :The association between SOP and poorer outcome is in line with our hypothesis and with a previous meta-analysis, demonstrating poorer outcome for youth with SOP following treatment with a generic CBT program, compared to youth with GAD or SAD (Reynolds, Wilson, Austin, & Hooper, 2012). The use of generic CBT programs, such as in the present study, could help explain why results are poorer for youths with SOP, compared to youth with SAD or GAD (Hudson et al., 2014). That is, youth with SOP may need CBT programs which are tailored differently than programs for youth with SAD and GAD.