| 1. |
- Wergeland, Gro Janne H., et al.
(författare)
-
An effectiveness study of individual vs. group cognitive behavioral therapy for anxiety disorders in youth
- 2014
-
Ingår i: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 57, s. 1-12
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Conducted a randomized controlled trial to investigate the effectiveness of cognitive behavioral therapy (CBT), and compared the relative effectiveness of individual (ICBT) and group (GCBT) treatment approaches for anxiety disorders in children and adolescents.Methods: Referred youth (N = 182, M age = 11.5 years, range 8-15 years, 53% girls) with separation anxiety, social phobia, or generalized anxiety disorder were randomly assigned to ICBT, GCBT or a waitlist control (WLC) in community clinics. Pre-, post-, and one year follow-up assessments included youth and parent completed diagnostic interview and symptom measures. After comparing CBT (ICBT and GCBT combined) to WLC, ICBT and GCBT were compared along diagnostic recovery rates, clinically significant improvement, and symptom measures scores using traditional hypothesis tests, as well as statistical equivalence tests.Results: Significantly more youth lost all anxiety disorders after CBT compared to WLC. Full diagnostic recovery rate was 25.3% for ICBT and 20.5% in GCBT, which was not significantly different. There was continued lack of significant differences between ICBT and GCBT at one year follow-up. However, equivalence between GCBT and ICBT could only be demonstrated for clinical severity rating of the principal anxiety disorder and child reported anxiety symptoms post-treatment.Conclusion: Findings support the effectiveness of CBT compared to no intervention for youth with anxiety disorders, with no significant differences between ICBT and GCBT. However, the relatively low recovery rates highlight the need for further improvement of CBT programs and their transportability from university to community settings.
|
|
| 2. |
- Wergeland, Gro Janne H., et al.
(författare)
-
Predictors of dropout from community clinic child CBT for anxiety disorders
- 2015
-
Ingår i: Journal of Anxiety Disorders. - : Elsevier BV. - 0887-6185 .- 1873-7897. ; 31, s. 1-10
-
Tidskriftsartikel (refereegranskat)abstract
- The aim was to investigate predictors of treatment dropout among 182 children (aged 8-15 years) participating in an effectiveness trial of manual-based 10-session individual and group cognitive behavior therapy (CBT) for anxiety disorders in community clinics. The dropout rate was 14.4%, with no significant difference between the two treatment conditions. We examined predictors for overall dropout (n=26), early (<= session 4, n = 15), and late dropout (>= session 5, n = 11). Overall dropout was predicted bylaw child and parent rated treatment credibility, and high parent self-rated internalizing symptoms. Low child rated treatment credibility predicted both early and late dropout. High parent self-rated internalizing symptoms predicted early dropout, whereas low parent rated treatment credibility predicted late dropout. These results highlight the importance of addressing treatment credibility, and to offer support for parents with internalizing symptoms, to help children and families remain in treatment.
|
|
| 3. |
- Wergeland, Gro Janne H., et al.
(författare)
-
Predictors of treatment outcome in an effectiveness trial of cognitive behavioral therapy for children with anxiety disorders
- 2016
-
Ingår i: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 76, s. 1-12
-
Tidskriftsartikel (refereegranskat)abstract
- A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8–15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.
|
|
| 4. |
- Bjaastad, Jon Fauskanger, et al.
(författare)
-
Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT) for Anxiety Disorders in Youth : Psychometric Properties
- 2016
-
Ingår i: Psychological Assessment. - : American Psychological Association (APA). - 1040-3590 .- 1939-134X. ; 28:8, s. 908-916
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of the present study was to evaluate the psychometric properties of the Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT). The CAS-CBT is an 11-item scale developed to measure adherence and competence in cognitive-behavioral therapy (CBT) for anxiety disorders in youth. A total of 181 videotapes from the treatment sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014) comprising youth (N = 182, M age = 11.5 years, SD = 2.1, range 8-15 years, 53% girls, 90.7% Caucasian) with mixed anxiety disorders were assessed with the CAS-CBT to investigate interitem correlations, internal consistency, and factor structure. Internal consistency was good (Cronbach's alpha = .87). Factor analysis suggested a 2-factor solution with Factor 1 representing CBT structure and session goals (explaining 46.9% of the variance) and Factor 2 representing process and relational skills (explaining 19.7% of the variance). The sum-score for adherence and competence was strongly intercorrelated, r = .79, p < .001. Novice raters (graduate psychology students) obtained satisfactory accuracy (ICC > .40, n = 10 videotapes) and also good to excellent interrater reliability when compared to expert raters (ICC = .83 for adherence and .64 for competence, n = 26 videotapes). High rater stability was also found (n = 15 videotapes). The findings suggest that the CAS-CBT is a reliable measure of adherence and competence in manualized CBT for anxiety disorders in youth. Further research is needed to investigate the validity of the scale and psychometric properties when used with other treatment programs, disorders and treatment formats.
|
|
| 5. |
- Fauskanger Bjaastad, Jon, et al.
(författare)
-
Do clinical experience, formal cognitive behavioural therapy training, adherence, and competence predict outcome in cognitive behavioural therapy for anxiety disorders in youth?
- 2018
-
Ingår i: Clinical Psychology and Psychotherapy. - : Wiley. - 1063-3995 .- 1099-0879. ; 25:6, s. 865-877
-
Tidskriftsartikel (refereegranskat)abstract
- Objective The aim was to investigate whether clinical experience, formal cognitive behavioural therapy (CBT) training, adherence, and competence predict outcome in CBT for anxiety disorders in youth. Method Videotapes (N = 181) from the sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014, Behaviour Research and Therapy, 57, 1-12) comprising youth (N = 182, M age = 11.5 years) with mixed anxiety disorders were assessed for treatment adherence and competence using the Competence and Adherence Scale for CBT for anxiety disorders in youth (Bjaastad et al., 2016, Psychological Assessment, 28, 908-916). Therapists' (N = 17) clinical experience and educational background were assessed. Participants completed a diagnostic interview (Anxiety Disorders Interview Schedule, child and parent versions) and an anxiety symptom measure (Spence Children's Anxiety Scale, child and parent versions) at pretreatment, posttreatment, and 1-year follow-up. Results Higher therapist adherence was related to better treatment outcomes, whereas number of years of clinical experience and competence was related to worse outcomes. However, these findings were not consistent across informants and the time points for the assessments. Interaction effects suggested that competence among therapists with formal CBT training was related to better patient outcomes. Conclusions Therapist adherence, competence, and clinical experience are associated with outcomes of manualized CBT for youth anxiety disorders, but mixed findings indicate the need for more research in this area.
|
|
| 6. |
- Fjermestad, Krister W., et al.
(författare)
-
Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders - Predictors and Associations with Outcomes
- 2022
-
Ingår i: Journal of Child and Family Studies. - : Springer Science and Business Media LLC. - 1062-1024 .- 1573-2843. ; 31, s. 308-320
-
Tidskriftsartikel (refereegranskat)abstract
- To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work. Exposure to feared situations is an effective CBT component. However, there is little observation-based empirical research on how exposure relates to outcomes and other clinical variables. In a randomized controlled community clinic trial for youth with anxiety disorders, observers reliably rated exposure quality for 68 youths aged 8 to 15 years based on 118 videotaped sessions. The treatment program was the manual-based FRIENDS program. Three exposure quality elements (preparation, post-processing, and parent contribution to exposure) were examined in relation to pre-treatment demographic and clinical variables, outcomes, and youth- and therapist-rated alliance using multilevel hierarchical regression models. The outcomes were diagnostic recovery, clinical severity and anxiety symptoms change from pre- to post-treatment and one-year follow-up, and treatment dropout. The results showed that parent contribution to exposure was higher for boys and younger children. Parent contribution to exposure, but no other exposure element, was associated with a larger likelihood of diagnostic recovery and larger clinical severity reduction at one-year follow-up. Exposure quality was unrelated to outcomes at post-treatment, dropout, or alliance. We conclude that enhancing parent contribution to exposure during treatment could improve long-term outcomes after CBT for youth anxiety disorders. Exposure elements should be observed in larger samples to further examine their potential role for CBT outcomes.
|
|
| 7. |
- Fjermestad, Krister W., et al.
(författare)
-
Factor Structure and Validity of the Therapy Process Observational Coding System for Child Psychotherapy-Alliance Scale
- 2012
-
Ingår i: Journal of clinical child and adolescent psychology (Print). - : Informa UK Limited. - 1537-4416 .- 1537-4424. ; 41:2, s. 246-254
-
Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to examine the factor structure and psychometric properties of an observer-rated youth alliance measure, the Therapy Process Observational Coding System for Child Psychotherapy-Alliance scale (TPOCS-A). The sample was 52 youth diagnosed with anxiety disorders (M age = 12.43, SD = 2.23, range = 8-15; 56% boys; 98% Caucasian) drawn from a randomized controlled trial. Participants received a manualized individual cognitive behavioral treatment, the FRIENDS for life program, in public community clinics in Norway. Diagnostic status, treatment motivation, and perceived treatment credibility were assessed at pretreatment. Using the TPOCS-A, independent observers rated child-therapist alliance from the third therapy session. Child-and therapist-reported alliance measures were collected from the same session. An exploratory factor analysis supported a one-factor solution, which is consistent with previous studies of self-and observer-rated youth alliance scales. Psychometric analyses supported the interrater reliability, internal consistency, and convergent/divergent validity of the TPOCS-A. Accumulating psychometric evidence indicate that the TPOCS-A has the potential to fill a measurement gap in the youth psychotherapy field. In youth psychotherapy, alliance may be unidimensional, so establishing a strong bond and engaging the child in therapeutic activities may both be instrumental to establishing good alliance early in treatment. However, it is important to be cautious when interpreting the factor analytic findings, because the sample size may have been too small to identify additional factors. Future research can build upon these findings by examining the factor structure of youth alliance measures with larger, more diverse samples.
|
|
| 8. |
- Fjermestad, Krister W., et al.
(författare)
-
Therapist-youth agreement on alliance change predicts long-term outcome in CBT for anxiety disorders
- 2016
-
Ingår i: Journal of Child Psychology and Psychiatry. - : Wiley. - 0021-9630 .- 1469-7610. ; 57:5, s. 625-632
-
Tidskriftsartikel (refereegranskat)abstract
- Background: In individual cognitive behavioral therapy (ICBT) for youth anxiety disorders, it is unclear whether, and from whose perspective, the alliance predicts outcome. We examined whether youth- and therapist-rated alliance, including level of youth-therapist alliance agreement, predicted outcome in a randomized controlled trial.Methods: Youth (N = 91, M age = 11.4 years (SD = 2.1), 49.5% boys, 86.8% Caucasian) diagnosed with separation anxiety disorder, social phobia, or generalized anxiety disorder drawn from the ICBT condition of an effectiveness trial were treated with an ICBT program. Youth- and therapist-rated alliance ratings, assessed with the Therapeutic Alliance Scale for Children (TASC-C/T), were collected following session 3 (early) and 7 (late). Early alliance, change in alliance from early to late, and level of youth-therapist agreement on early alliance and alliance change were examined, in relation to outcomes collected at posttreatment and 1-year follow-up. Outcome was defined as primary diagnosis loss and reduction in clinicians' severity ratings (CSR; Anxiety Disorders Interview Schedule; ADIS-C/P) based on youth- and parent-report at posttreatment and follow-up, and youth treatment satisfaction collected at posttreatment (Client Satisfaction Scale; CSS).Results: Early TASC-C scores positively predicted treatment satisfaction at posttreatment. Higher levels of agreement on change in TASC-C and TASC-T scores early to late in treatment predicted diagnosis loss and CSR reduction at follow-up.Conclusions: Only the level of agreement in alliance change predicted follow-up outcomes in ICBT for youth anxiety disorders. The findings support further examination of the role that youth-therapist alliance discrepancies may play in promoting positive outcomes in ICBT for youth anxiety disorders. Clinical trial number NCT00586586, clinicaltrials.gov.
|
|
| 9. |
- Haug, Thomas, et al.
(författare)
-
Self-help treatment of anxiety disorders : A meta-analysis and meta-regression of effects and potential moderators
- 2012
-
Ingår i: Clinical Psychology Review. - : Elsevier BV. - 0272-7358 .- 1873-7811. ; 32:5, s. 425-445
-
Forskningsöversikt (refereegranskat)abstract
- Self-help treatments have the potential to increase the availability and affordability of evidence-based treatments for anxiety disorders. Although promising, previous research results are heterogeneous, indicating a need to identify factors that moderate treatment outcome. The present article reviews the literature on self-help treatment for anxiety disorders among adults, with a total sample of 56 articles with 82 comparisons. When self-help treatment was compared to wait-list or placebo, a meta-analysis indicated a moderate to large effect size (g = 0.78). When self-help treatment was compared to face-to-face treatment, results indicated a small effect that favored the latter (g = -0.20). When self-help was compared to wait-list or placebo, subgroup analyses indicated that self-help treatment format, primary anxiety diagnosis and procedures for recruitment of subjects were related to treatment outcome in bivariate analyses, but only recruitment procedures remained significant in a multiple meta-regression analysis. When self-help was compared to face-to-face treatment, a multiple meta-regression indicated that the type of comparison group, treatment format and gender were significantly related to outcome. We conclude that self-help is effective in the treatment of anxiety disorders, and should be offered as part of stepped care treatment models in community services. Implications of the results and future directions are discussed.
|
|
| 10. |
- Haug, Thomas, et al.
(författare)
-
Stepped care versus face-to–face cognitive behavior therapy for panic disorder and social anxiety disorder : Predictors and moderators of outcome
- 2015
-
Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 71, s. 76-89
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD).Method: Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses.Results: Lower social functioning, higher impairment from the anxiety disorder, and a comorbidcluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help.Conclusions: In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive treatment.ClinicalTrials.govIdentifier: NCT00619138.
|
|
