BackgroundChildren and adolescents demonstrate diverse patterns of symptom change and disorder remission following cognitive behavioural therapy (CBT) for anxiety disorders. To better understand children who respond sub‐optimally to CBT, this study investigated youths (N = 1,483) who continued to meet criteria for one or more clinical anxiety diagnosis immediately following treatment or at any point during the 12 months following treatment.MethodsData were collected from 10 clinical sites with assessments at pre‐and post‐treatment and at least once more at 3, 6 or 12‐month follow‐up. Participants were assigned to one of three groups based on diagnostic status for youths who: (a) retained an anxiety diagnosis from post to end point (minimal responders); (b) remitted anxiety diagnoses at post but relapsed by end point (relapsed responders); and (c) retained a diagnosis at post but remitted to be diagnosis free at end point (delayed responders). Growth curve models assessed patterns of change over time for the three groups and examined predictors associated with these patterns including demographic, clinical and parental factors, as well as treatment factors.ResultsHigher primary disorder severity, being older, having a greater number of anxiety disorders, having social anxiety disorder, as well as higher maternal psychopathology differentiated the minimal responders from the delayed and relapsed responders at the baseline. Results from the growth curve models showed that severity of the primary disorder and treatment modality differentiated patterns of linear change only. Higher severity was associated with significantly less improvement over time for the minimal and relapsed response groups, as was receiving group CBT, when compared to the delayed response group.ConclusionsSub‐optimal response patterns can be partially differentiated using variables assessed at pre‐treatment. Increased understanding of different patterns of change following treatment may provide direction for clinical decision‐making and for tailoring treatments to specific groups of clinically anxious youth. Future research may benefit from assessing progress during treatment to detect emerging response patterns earlier.

中文翻译：

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CBT 治疗儿童焦虑后的次优变化模式


背景在针对焦虑症的认知行为疗法（CBT）后，儿童和青少年表现出不同的症状变化和疾病缓解模式。为了更好地了解对 CBT 反应不佳的儿童，这项研究调查了青少年（氮= 1,483）在治疗后立即或治疗后 12 个月内的任何时间点继续符合一项或多项临床焦虑症诊断标准。方法从 10 个临床中心收集数据，并在治疗前和治疗后以及至少再次进行评估3、6 或 12 个月的随访。根据青少年的诊断状态，将参与者分配到三组之一：(a) 从术后到终点保留焦虑诊断（反应最小者）； (b) 焦虑诊断在术后缓解，但在终点时复发（复发反应者）； (c) 保留事后诊断，但在终点时免除诊断（延迟反应者）。生长曲线模型评估了三组随时间变化的模式，并检查了与这些模式相关的预测因素，包括人口统计学、临床和父母因素以及治疗因素。结果原发性疾病严重程度较高、年龄较大、患有焦虑症的数量较多、患有社交焦虑症以及较高的母亲精神病理学将基线时的最低反应者与延迟反应者和复发反应者区分开来。生长曲线模型的结果表明，原发疾病的严重程度和治疗方式仅区分线性变化的模式。 与延迟反应组相比，最低反应组和复发反应组（CBT 接受组）随着时间的推移，严重程度越高，改善程度显着降低。 结论 使用治疗前评估的变量可以部分地区分次优反应模式。增加对治疗后不同变化模式的了解可能会为临床决策和针对临床焦虑青年的特定群体制定治疗方案提供指导。未来的研究可能会受益于评估治疗过程中的进展，以便更早地发现新出现的反应模式。