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 Jensen-Doss, Philip C. Kendall, John R. Weisz

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

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)
Pages (from-to)501-516
Number of pages16
JournalBehavior Therapy
Volume48
Issue number4
DOIs
StatePublished - Jul 2017

Keywords

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

ASJC Scopus subject areas

  • Clinical Psychology

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