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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儿童焦虑 CBT 后次优变化模式


背景儿童和青少年在焦虑症的认知行为疗法 （CBT） 后表现出不同的症状变化和障碍缓解模式。为了更好地了解对 CBT 反应不佳的儿童，本研究调查了在治疗后立即或治疗后 12 个月内的任何时候继续满足一种或多种临床焦虑诊断标准的青少年 （N = 1,483）。方法从 10 个临床站点收集数据，在治疗前和治疗后进行评估，并在 3、 6 或 12 个月的随访中至少再次进行评估。根据青少年的诊断状态，参与者被分配到三组中的一组，这些青少年：（a） 从帖子到终点保留了焦虑诊断（反应最少）;（b） 术后焦虑诊断缓解，但在终点复发（复发反应者）;（c） 在邮寄时保留诊断，但在终点时无诊断（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、焦虑障碍数量较多、患有社交焦虑障碍以及较高的母体精神病理学在基线时将最低反应者与延迟和复发反应者区分开来。生长曲线模型的结果表明，原发性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的严重程度与治疗组 CBT 的改善程度显著降低相关。结论使用治疗前评估的变量可以部分区分次优反应模式。增加对治疗后不同变化模式的理解可能为临床决策和为特定临床焦虑青年群体量身定制治疗提供方向。未来的研究可能受益于评估治疗期间的进展，以更早地发现新出现的反应模式。