Predictors of Cognitive Behavioral Treatment Outcomes in Anxious Youth and Implications for Individual Treatment Modifications

Anxiety and its related disorders are among the most common mental health challenges in young people, from children to emerging adults. Multiple well-researched psychosocial interventions targeting anxiety in young people exist, with cognitive-behavioral therapy (“CBT”) considered a “gold standard” treatment. Nevertheless, not all CBT recipients see successful treatment outcomes (e.g., anxiety disorder remission, significant symptom or impairment reduction). Further, contextual factors can make it difficult for families and individuals to access this treatment. There are critical needs to enhance CBT outcomes and develop and test alternative avenues of support for anxious youth, particularly when CBT may not be readily accessible. This dissertation addresses these needs in three projects by (1) evaluating the relationships between digital media and anxiety coping strategies and understanding in emerging adults, (2) identifying cognitive predictors of CBT outcomes in children and adolescents, and (3) examining a technology-based enhancement to CBT for anxious adolescents. In three chapters, I present findings on the relationships between social media usage, anxiety knowledge, and coping strategies in emerging adults (Chapter II), an analysis of metacognitive worries predicting CBT outcomes in anxious youth (Chapter III), and the use of text-message based prompts for CBT skill practice in adolescents (Chapter IV). Findings across studies revealed that using social media as an anxiety information source is associated with lower knowledge about anxiety and indiscriminate use of maladaptive and adaptive coping strategies (Chapter II); that dysfunctional metacognitive beliefs portend a poorer CBT outcome in children with anxiety disorders (Chapter III); and that providing text message-based prompts to practice CBT skills increases skill use outside of session in adolescents receiving CBT for anxiety disorders (Chapter IV). Findings from the three projects advance understanding of how young people cope with anxiety, variables that predict response to gold standard treatment for anxiety, and novel ways to enhance use of skills taught in gold standard treatment for anxiety.

Major Professor: Dr. Jeremy Pettit