abstract: Parental over-control (excessively restrictive and regulatory parenting behaviors) has been consistently identified as a robust risk factor in the development and maintenance of child anxiety problems. However, current understanding of the parental over-control to child anxiety relation is limited by a lack of specificity. The broad ‘parental over-control’ construct represents a heterogeneous category of related but distinct parenting behaviors each of which may exert a unique effect on child anxious emotion. Still, research to date has generally failed to consider this possibility. Moreover, culturally cognizant theory and emerging empirical evidence suggest cross-ethnic (Caucasian vs. Hispanic/Latino) differences in the utilization of various parenting strategies as well as the effects of parenting behaviors on child outcomes. But, only a handful of studies have considered the potential differences in the functioning of parental over-control behaviors within a Hispanic/Latino cultural framework. Using a sample of 98 pre-adolescent children at-risk for anxiety problems, the present study sought to further explicate the association between parental over-control and child anxiety symptoms in the context of ethnic and cultural diversity. Results suggest that parents’ use of overprotection and (lack of) autonomy granting might be particularly relevant to child anxiety, compared to parental intrusiveness and behavioral control. Findings also indicate that some youth may be more vulnerable to parental over-control and suggest that cultural values may play a role in the relation between over-controlling parenting and child anxiety symptoms. Knowledge about cross-cultural variations in the relation among parental over-control behaviors and the development of anxiety symptoms is important because it can improve the cultural robustness of child anxiety theory and has potential to inform culturally sensitive child anxiety prevention and intervention efforts. / Dissertation/Thesis / Doctoral Dissertation Psychology 2016

Phobic and anxiety disorders are one of the most common, if not the most common and debilitating psychopathological conditions found among children and adolescents. As a result, a treatment research literature has accumulated showing the efficacy of cognitive behavioral treatment (CBT) for reducing anxiety disorders in youth. This dissertation study compared a CBT with parent and child (i.e., PCBT) and child group CBT (i.e., GCBT). These two treatment approaches were compared due to the recognition that a child’s context has an effect on the development, course, and outcome of childhood psychopathology and functional status. The specific aims of this dissertation were to examine treatment specificity and mediation effects of parent and peer contextual variables. The sample consisted of 183 youth and their mothers. Research questions were analyzed using analysis of variance for treatment outcome, and structural equation modeling, accounting for clustering effects, for treatment specificity and mediation effects. Results indicated that both PCBT and GCBT produced positive treatment outcomes across all indices of change (i.e., clinically significant improvement, anxiety symptom reduction) and across all informants (i.e., youths and parents) with no significant differences between treatment conditions. Results also showed partial treatment specific effects of positive peer relationships in GCBT. PCBT also showed partial treatment specific effects of parental psychological control. Mediation effects were only observed in GCBT; positive peer interactions mediated treatment response. The results support the use CBT with parents and peers for treating childhood anxiety. The findings’ implications are further discussed in terms of the need to conduct further meditational treatment outcome designs in order to continue to advance theory and research in child and anxiety treatment.

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.

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Establishing evidence-based training for therapists is of paramount importance for effective dissemination of evidence-based interventions. Using cognitive-behavioral therapy (CBT) for child anxiety, this study compared three therapist training conditions: (1) routine training: a workshop that covered a specific manual, (2) computer training: computer-based training via an interactive DVD, and (3) augmented training: a workshop that included a focus on core CBT competencies and active learning with behavioral rehearsal. Training success was operationalized as: (1) adherence to CBT for child anxiety, (2) therapeutic skillfulness, (3) a knowledge test, (4) and training satisfaction. The study also investigated the degree to which consultation following training impacted therapist outcomes. Participants (115 therapists) were randomly assigned to training condition and, following training, were invited to participate in weekly consultation. The results indicate that all three training conditions were effective in improving therapist adherence, skill, and knowledge. Participants were most satisfied with the in-person conditions. With regard to consultation, the number of consultation hours attended significantly predicted therapist training outcomes. This finding underscores the importance of consultation when training therapists. / Psychology

We assessed the relationship between several therapist variables and treatment outcome by examining the predictive power of therapist training/demographic characteristics, therapist competence and treatment integrity, and therapist style, to child outcome in a sample of 279 youth who participated in the Child and Adolescent Anxiety Multimodal Study (CAMS). All youth participated in 14 sessions of CBT (randomly assigned either with medication or without) delivered by trained therapists. Youth across both treatment conditions experienced significant treatment gains with youth in the CBT+MED and CBT only conditions showing greater gains than those in the placebo group. Therapist (a) prior clinical experience and (b) prior anxiety-specific clinical experience were significant predictors of treatment outcome across both parent- and diagnostician- rated measures. Higher levels of prior clinical experience predicted better outcome; higher levels of anxiety-specific experience were less favorable. Therapist treatment integrity, competence, and a collaborative style were also predictive of outcome. Therapists who were more collaborative and empathic, followed the treatment manual, and implemented it in a developmentally appropriate way, had youth with better treatment outcomes. Clinical implications and recommendations for future research are discussed. / Psychology

Objective: To examine the impact of treatment outcome and treatment condition (Cognitive-behavioral therapy, CBT; Sertraline, SRT; COMB, CBT and SRT; Placebo) for youth treated for anxiety disorders on global and domain-specific functioning across a 3 to 12 year, naturalistic follow-up. Method: A subset (319) of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated in an average of 3.38 assessments during the follow-up period. All youth met criteria for a principal anxiety disorder pretreatment. Growth curve modeling examined the impact of treatment outcomes (response/remission) and treatment condition on global functioning, global and domain- specific impairment, and life satisfaction across the follow-up period. Logistic regression explored the impact of treatment response and condition on low frequency events (arrests/convictions) and educational achievement (high school graduation/college enrollment). Results: Growth curve analyses revealed that treatment responders/remitters demonstrated better global functioning, increased life satisfaction, and decreased overall impairment at their first follow-up assessment (growth curve mean intercept). The positive effect of treatment response on life satisfaction, but not global functioning or overall impairment, attenuated across the follow-up period. Treatment response also predicted decreased academic impairment at first follow-up. Participants in the COMB condition demonstrated improved functional trajectories with regards to family life and academic grade-point average. CBT participants demonstrated a greater decline in overall impairment and problems with self-care/independence across the follow-up. Treatment response and condition did not predict legal outcomes, school attendance, high school graduation, college attendance, occupational outcomes, or social/peer relationships. Conclusion: Response to early intervention is associated with improved overall functioning, as well as functioning within specific domains (academics) 3 to 12 years posttreatment. Treatment type differentially predicted functional trajectories. Findings support the positive impact of pediatric anxiety treatment on functioning during adolescence and emerging adulthood. / Psychology

This document proposes a study to ascertain if a relationship exists between levels of child and parent anxiety symptoms during an intervention designed to decrease anxiety in youth. This document systemically describes family variables related to anxiety in youth at the individual, parent-child, marital, whole family, and extra familial subsystem levels, in addition to previous research analyzing parental anxiety and the direction of change between child and parent anxiety during youth-focused interventions. The study involves gathering anxiety symptom data from parent and child participants at 14 time points and analyzing it using dependent samples t-test, regression, and ANOVA repeated measure analyses. These analyses serve to answer the research questions of whether child and parent anxiety symptoms improve in a youth-focused CBT intervention for anxiety from pre- to post-treatment, whether there exists a significant relationship between the severity of anxiety symptoms in youth and parents surrounding a youth-focused anxiety intervention, and whether this relationship is consistent. / text

Alliance and client involvement are thought to be important therapy process factors in child psychotherapy; however, few studies have investigated them over the course of treatment. The present study examined change in alliance, client involvement, and the relationship between the two over time in an effectiveness study comparing cognitive behavioral therapy (CBT) and usual clinical care (UC) for child anxiety disorders. The sample included 40 clinically-referred children (57.50%, female, mean age = 10.81, SD = 2.11, 35.00% Caucasian, 32.50% Latino/Hispanic, 5.00% African-American, 7.50% mixed ethnicity, 20.00% not reported) and 39 therapists employed by community clinics. Two doctoral-level students comprised the coding teams for each measure and independently rated alliance and client involvement in all available recorded sessions. Unconditional multilevel growth models indicated alliance and client involvement did not significantly change over time. Findings suggest that when measured by observational coders, initial levels of alliance and client involvement remain relatively stable throughout different treatments for child anxiety in community settings. Existing therapy process models may require further specification based on treatment setting and method of measurement. In practice, these findings suggest strategies to bolster initial alliance and client involvement could help improve the impact and delivery of child anxiety treatment in community settings.