(PS5-54) The Role of Expressive Reluctance in Cognitive Behavioral Therapy for Youth with Anxiety Disorders

Research has identified that youth with anxiety disorders have deficits in emotional competence, including expressing their emotions (i.e., expressive reluctance). However, little is known about how expressive reluctance changes during cognitive-behavioral therapy (CBT) for anxiety among youth. The current study examined changes in expressive reluctance among youth ages 7-17 with a primary anxiety disorder who completed CBT (N = 126). Diagnoses were determined by independent evaluators who completed semi-structured interviews (ADIS-5-C/P) with youth and their caregivers. Self-report questionnaires, including the Multidimensional Anxiety Scale for Children (MASC) and the Emotion Expressivity Scale for Children (EESC), were completed at pretreatment, week 8 of treatment, and posttreatment. The level of expressive reluctance differed significantly between pretreatment and week 8, as well as between pretreatment and posttreatment. Changes in expressive reluctance from pretreatment to posttreatment significantly predicted anxiety symptoms at posttreatment (F(1.915, 239.35) = 14.348, P < 0.001). Adolescents (13-17) demonstrated significantly more expressive reluctance than children (7-12) at pretreatment (t(124)=-2.59, p = .005) and week 8  (t(124)=-2.48, p = .007), but not posttreatment (t(124)= -1.28, p = .102). Findings suggest that expressive reluctance decreases throughout CBT for anxiety, and a greater ability to share emotions predicted lower levels of anxiety following treatment. Overall, findings highlight the idea that expressive reluctance is a valuable target for a therapist working with youth-- and particularly adolescents-- with anxiety.