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Mediators of Change in the Child/Adolescent Anxiety Multimodal Treatment Study
Journal of consulting and clinical psychology
  • Phillip C. Kendall
  • Colleen M. Cummings
  • Marianne A Villa
  • Martina K. Narayanan
  • Kimberli Treadwell
  • Boris Birmaher
  • Scott Compton
  • John Piacentini
  • Elizabeth Gosch, Philadelphia College of Osteopathic Medicine
  • et al.
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Objective: Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). Method: Participants were 488 youth (ages 7–17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM–IV) criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. Results: Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. Conclusions: The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator.

This article was published in Journal of consulting and clinical psychology, October 2015.

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Citation Information
Phillip C. Kendall, Colleen M. Cummings, Marianne A Villa, Martina K. Narayanan, et al.. "Mediators of Change in the Child/Adolescent Anxiety Multimodal Treatment Study" Journal of consulting and clinical psychology (2015)
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