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

Meghan M. Smith, Bryce D. McLeod, Michael A. Southam-Gerow, Amanda Doss, Philip C. Kendall, John R. Weisz

Research output: Contribution to journalArticle

16 Scopus citations


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.

Original languageEnglish (US)
JournalBehavior Therapy
StateAccepted/In press - Mar 2 2016


  • Cognitive-Behavioral Treatment
  • Evidence-Based
  • Implementation
  • Youth

ASJC Scopus subject areas

  • Clinical Psychology

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    Smith, M. M., McLeod, B. D., Southam-Gerow, M. A., Doss, A., Kendall, P. C., & Weisz, J. R. (Accepted/In press). Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings? Behavior Therapy.