Trajectories of change in youth anxiety during cognitive-behavior therapy

Tara S. Peris, Scott N. Compton, Philip C. Kendall, Boris Birmaher, Joel Sherrill, John March, Elizabeth Gosch, Golda Ginsburg, Moira Rynn, James T. McCracken, Courtney P. Keeton, Dara Sakolsky, Cynthia Suveg, Sasha Aschenbrand, Daniel Almirall, Satish Iyengar, John T. Walkup, Anne Marie Albano, John Piacentini

Research output: Contribution to journalArticlepeer-review

72 Scopus citations


Objective: To evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks. Method: Four hundred eighty-eight youths ages 7-17 years (50% female; 74% ≤12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls. Results: Longitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior). Conclusions: Findings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed.

Original languageEnglish (US)
Pages (from-to)239-252
Number of pages14
JournalJournal of Consulting and Clinical Psychology
Issue number2
StatePublished - Apr 1 2015


  • child anxiety
  • cognitive-behavior therapy
  • treatment components

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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