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theses

Research on the relationship between therapist adherence and treatment outcome in cognitive behavioral therapy (CBT) has yielded mixed findings (e.g., Webb et al., 2012). A new avenue for clarifying this relationship is to examine the relationship between adherence and symptom change at “critical sessions” in therapy. Sudden gains (SGs) and sudden regressions (SRs), which refer to large, stable symptom change occurring between two consecutive treatment sessions, may represent critical sessions in therapy, as they have been associated with treatment outcome among adults and children with various psychological disorders (e.g., Aderka et al., 2012; Conklin, Wyszynski & Chu, submitted for publication). The current study uses observational coding to assess the relationship between therapist extensiveness (a dimensional adherence construct), child involvement in session, and SGs/SRs during CBT for youth anxiety. Participants include 68 youth (ages 8 – 17 years) with a principal anxiety disorder diagnosis who were treated in an open efficacy trial of the Coping Cat, a manual-based CBT protocol (Kendall & Hedtke, 2006). Therapist extensiveness of four key Coping Cat interventions (i.e., relaxation, exposure, cognitive restructuring, and problem-solving) was assessed via observational coding, and child involvement in therapy sessions was assessed via therapist report (CIRS). Client symptom change across treatment sessions was measured by symptom report (STAIC) at each therapy session. It was hypothesized that greater therapist extensiveness would predict and be predicted by SGs, while lower therapist extensiveness would predict and be predicted by SRs. It was also hypothesized that SGs would predict greater child involvement while SRs would predict reduced child involvement. Logistic regression analyses demonstrated that total therapist extensiveness predicted SGs at the trend level, while extensiveness did not predict SRs. Multiple regression analyses demonstrated that SGs predicted significantly greater therapist exposure extensiveness and overall extensiveness in the next session. SRs predicted greater therapist cognitive restructuring extensiveness at the trend level. Methodological limitations, such as insufficient power to detect significant effects, recommendations for future research, and clinical implications are discussed.

ETD_8207

Psy.D.

Includes bibliographical references

by Phoebe Durland

doi:10.7282/T3B27ZBM

ETD doctoral

The author owns the copyright to this work.