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Title: Mechanisms of change in successful treatment of childhood anxiety disorders
Author: Maiden, Zoë
ISNI:       0000 0004 8499 6449
Awarding Body: Royal Holloway, University of London
Current Institution: Royal Holloway, University of London
Date of Award: 2017
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Randomised control trials (RCT) have shown that Cognitive Behaviour Therapy (CBT) is an effective treatment for Childhood Anxiety Disorders (CADs), yet not superior to active controls. Understanding the mechanisms of change for successful CAD treatment could improve outcomes, yet few studies have examined this. A recent RCT found no significant differences in treatment outcomes for guided parent-delivered CBT (GPD-CBT) and brief Solution Focused Therapy (SFBT). The present study aimed to provide an exploratory investigation of mechanisms of change in these two different, successful CAD treatments. The author developed a novel Mechanism of Change Coding Scheme (MoCCS), which included 15 variables based on cognitivebehavioural theory, examining exposure characteristics, coping skills, coping efficacy and anxiety management strategies. Audio-recordings from two treatment sessions for 91 children (45 GPD-CBT, 46 SFBT) were coded. MoCCS variables relationship to various measures of treatment outcome were examined using hierarchal regressions. Reinforcement of Exposure predicted greater improvement post-treatment for both groups. Conversely, Promotion of Exposure, Promotion of Exposure in Multiple Contexts and Promotion of Distraction predicted less improvement post-treatment. For GPD-CBT, moderate levels of Reinforcement of Coping predicted greater improvement, whereas Promotion of and Use of Cognitive Restructuring predicted less improvement. For SFBT, Promotion and Use of Cognitive Restructuring predicted more improvement. However, findings were not consistent across MoCCS measurement points or outcome measures. Engagement with Exposure, Promotion and Engagement with Exposure with a Variety of Stimuli, Engagement with Exposure in Multiple Contexts, Safety-Seeking Behaviours and Coping Efficacy did not significantly predict treatment outcomes for either intervention. Implications for CAD treatment, particularly regarding the use of reinforcement are discussed, yet the limitations of this study make conclusions tentative. It is suggested that future research should focus on directly manipulating potential mechanisms of change and evaluating their relationship to treatment outcome.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available
Keywords: Anxiety Disorders ; Child Psychology ; Mechanism ; Treatment