Elsevier

Behavior Therapy

Volume 48, Issue 4, July 2017, Pages 501-516
Behavior Therapy

Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?

https://doi.org/10.1016/j.beth.2016.07.004Get rights and content

Highlights

  • There were more similarities than differences in CBT delivery across settings

  • The strongest dose of CBT was delivered in the research setting

  • CBT delivered in both settings was mostly distinct from usual care in expected ways

Abstract

Does delivery of the same manual-based individual cognitive-behavioral treatment (ICBT) program for youth anxiety differ across research and practice settings? We examined this question in a sample of 89 youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with a primary anxiety disorder. The youths received (a) ICBT in a research setting, (b) ICBT in practice settings, or (c) non-manual-based usual care (UC) in practice settings. Treatment delivery was assessed using four theory-based subscales (Cognitive-behavioral, Psychodynamic, Client-Centered, Family) from the Therapy Process Observational Coding System for Child Psychotherapy–Revised Strategies scale (TPOCS-RS). Reliable independent coders, using the TPOCS-RS, rated 954 treatment sessions from two randomized controlled trials (1 efficacy and 1 effectiveness trial). In both settings, therapists trained and supervised in ICBT delivered comparable levels of cognitive-behavioral interventions at the beginning of treatment. However, therapists trained in ICBT in the research setting increased their use of cognitive-behavioral interventions as treatment progressed whereas their practice setting counterparts waned over time. Relative to the two ICBT groups, the UC therapists delivered a significantly higher dose of psychodynamic and family interventions and a significantly lower dose of cognitive-behavioral interventions. Overall, results indicate that there were more similarities than differences in manual-based ICBT delivery across research and practice settings. Future research should explore why the delivery of cognitive-behavioral interventions in the ICBT program changed over time and across settings, and whether the answers to these questions could inform implementation of ICBT programs.

Section snippets

Participants and Study Sites

Participants for the study included 89 youth participants from two randomized controlled trials conducted by separate research groups. Recorded treatment sessions (both audio and video) were analyzed for this study. Inclusion criteria for these recordings included: (a) a minimum of two audible sessions, and (b) received treatment from a single therapist (see Kendall et al., 2008, and Southam-Gerow et al., 2010, for more details on the participants and procedures). The youth were aged 7–15 years

Results

We first conducted sample bias analyses to examine whether our subsamples represented the full samples from the parent studies. One significant difference was found. Compared to the parent study, there was a lower percentage of African-American youth (0.00% vs. 16.70%) and a higher percentage of Caucasian youth (41.20% vs. 29.20%) in our YAS-ICBT group, χ2(3, n = 24) = 11.53, p = .009. As reported in Table 1, we also examined differences between groups (ICBT, YAS-ICBT, YAS-UC) on youth

Discussion

Does the delivery of the same treatment program, ICBT for youth anxiety, differ across research and practice settings? Therapists trained and supervised in the same ICBT program across both settings delivered similar patterns of intervention dosages (i.e., delivered strongest dosage of cognitive-behavioral interventions, followed by client-centered, family, and psychodynamic interventions), whereas therapists not trained in the ICBT program and providing UC delivered a distinct pattern of

Conflict of Interest Statement

The authors declare that there are no conflicts of interest.

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    Preparation of this article was supported by a grant from the National Institute of Mental Health (RO1 MH86529; McLeod & Southam-Gerow).

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