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Cognitive Mediation of Cognitive-Behavioural Therapy Outcomes for Anxiety-Based School Refusal

Published online by Cambridge University Press:  28 September 2012

Marija Maric ,
David A. Heyne ,
David P. MacKinnon ,
Brigit M. van Widenfelt  and
P. Michiel Westenberg
Marija Maric*
Affiliation:
Leiden University Institute of Psychology, the Netherlands
David A. Heyne
Affiliation:
Leiden University Institute of Psychology, the Netherlands
David P. MacKinnon
Affiliation:
Arizona State University, Tempe, USA
Brigit M. van Widenfelt
Affiliation:
Leiden University Medical Center, the Netherlands
P. Michiel Westenberg
Affiliation:
Leiden University Institute of Psychology, the Netherlands
*
Reprint requests to Marija Maric, Department of Developmental Psychology, University of Amsterdam, Weesperplein 4, 1018 XA, Amsterdam, the Netherlands. E-mail: m.maric@uva.nl
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Abstract

Background: Cognitive-behavioural therapy (CBT) has proven to be effective for anxiety-based school refusal, but it is still unknown how CBT for school refusal works, or through which mechanisms. Aims: Innovative statistical approaches for analyzing small uncontrolled samples were used to investigate the role of self-efficacy in mediating CBT outcomes for anxiety-based school refusal. Method: Participants were 19 adolescents (12 to 17 years) who completed a manual-based cognitive-behavioural treatment. Primary outcomes (school attendance; school-related fear; anxiety) and secondary outcomes (depression; internalizing problems) were assessed at post-treatment and 2-month follow-up. Results: Post-treatment increases in school attendance and decreases in fear about attending school the next day were found to be mediated by self-efficacy. Mediating effects were not observed at 2-month follow-up. Conclusions: These findings provide partial support for the role of self-efficacy in mediating the outcome of CBT for school refusal. They contribute to a small body of literature suggesting that cognitive change enhances CBT outcomes for young people with internalizing problems. Regarding methodology, the product of coefficient test appears to be a valuable way to study mediation in outcome studies involving small samples.

Keywords

CBTmediatorsschool refusalanxietyself-efficacy
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 41 , Issue 5 , October 2013 , pp. 549 - 564
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012 

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