4 - (SYM 30) Process-outcome Relationships in Transdiagnostic Brief Behavioral Therapy for Anxiety and Depression in Youth

Background: Anxiety and depression in youth are common, co-occurring, and associated with significant functional impairment both separately and in combination. Efficacious psychosocial interventions have been developed for each disorder; however, a significant portion of youth (~40%) do not respond to treatment. Further, much about therapeutic processes associated with favorable outcomes remains unclear, limiting attempts to refine treatments and improve intervention effects. The current investigation tests process-outcome relationships in an effectiveness trial of a transdiagnostic intervention for anxiety and depression based in an active clinical practice setting with a large and diverse sample of youths.

Method: Therapy process data were examined from 95 youth (ages 8-15; 56.8% female; 74.7% non-Hispanic White) with anxiety and/or depressive disorders who completed a transdiagnostic Brief Behavioral Therapy. Both between-session and in-session processes were evaluated. Post-treatment outcomes included global functioning (Clinician Global Assessment Scale) and disorder-specific clinician-rated measures (Pediatric Anxiety Rating Scale; Children’s Depression Rating Scale). Single process predictor models were individually associated with outcomes, including clinical and demographic covariates. Process variables significant in single predictor models were tested in combined models.

Results: Observed in-session minutes practice of active behavioral components was uniquely and significantly predictive of youth functioning post-treatment, while both between-session parent engagement and therapeutic alliance were uniquely and significantly predictive of youth anxiety outcome. After controlling for correlated youth and family characteristics, significant predictors of depression outcome did not emerge in this sample.

Conclusions: This study indicates that different therapy processes might be important for different outcomes in a transdiagnostic intervention, with higher use of behavioral strategies, greater parental engagement between sessions, and positive therapeutic alliance most strongly associated with global functioning and anxiety outcomes. Findings reinforce the importance of engagement of parents and youth in care as well as stakeholder perspective in delivering evidence-based treatments.