Reduction in avoidance mediates effects of brief behavioral therapy for pediatric anxiety and depression

Selena A Baca; Pauline Goger; Dale Glaser; Michelle Rozenman; Araceli Gonzalez; John F Dickerson; Frances L Lynch; Giovanna Porta; David A Brent; V Robin Weersing

doi:10.1016/j.brat.2023.104290

Reduction in avoidance mediates effects of brief behavioral therapy for pediatric anxiety and depression

Behav Res Ther. 2023 May:164:104290. doi: 10.1016/j.brat.2023.104290. Epub 2023 Mar 8.

Authors

Affiliations

¹ Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA.
² Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California - San Diego, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA.
³ Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO, 80210, USA.
⁴ Psychology Department, California State University Long Beach, 1250 Bellflower Blvd, PSY-100, Long Beach, CA, 90840-0901, USA.
⁵ Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR, 97227, USA.
⁶ University of Pittsburgh Medical Center, Western Psychiatric Hospital, 100 N. Bellefield Ave, Pittsburgh, PA, 15213, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, 311 Bellefield Towers, Pittsburgh, PA, 15213, USA.
⁷ Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA; Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California - San Diego, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA. Electronic address: robin.weersing@sdsu.edu.

PMID: 36965232
DOI: 10.1016/j.brat.2023.104290

Abstract

Brief behavioral therapy (BBT) is an efficacious transdiagnostic intervention for pediatric anxiety and depression that targets behavioral avoidance as a key mechanism. It is unknown if change in avoidance mediates treatment effects, as theorized. Data on avoidance at baseline and Week 16 were available on 52 youth (ages 8-16 years) from a randomized controlled trial (Weersing, Jeffreys, et al., 2017) comparing BBT and assisted referral to community care (ARC). BBT had significant effects on youth-reported behavioral avoidance, and significant indirect effects on functioning and anxiety, statistically mediated through changes in youth-reported behavioral avoidance. Change in youth-reported avoidance was not a significant mediator of depression. Parent-report of avoidance was not impacted by treatment and was not a significant mediator. Overall, BBT appears to be an effective treatment for targeting behavioral avoidance, which in turn, may improve functioning and lessen anxiety. CLINICAL TRIAL REGISTRATION INFORMATION: https://clinicaltrials.gov; NCT01147614.

Keywords: Anxiety; Behavioral avoidance; Behavioral therapy; Depression; Functioning; Mechanism; Transdiagnostic; Youth.

Publication types

Randomized Controlled Trial

MeSH terms

Adolescent
Anxiety / therapy
Anxiety Disorders / diagnosis
Anxiety Disorders / therapy
Behavior Therapy
Child
Cognitive Behavioral Therapy*
Depression* / therapy
Humans

Associated data

ClinicalTrials.gov/NCT01147614