Mediators of youth anxiety outcomes 3 to 12 years after treatment

Heather B. Makover, Philip C. Kendall, Thomas Olino, Matthew M. Carper, Anne Marie Albano, John Piacentini, Tara Peris, Audra K. Langley, Araceli Gonzalez, Golda S. Ginsburg, Scott Compton, Boris Birmaher, Dara Sakolsky, Courtney Keeton, John Walkup

Research output: Contribution to journalArticlepeer-review


Objective: Test changes in perceived coping efficacy, negative self-statements, and interpretive biases to threat during treatment as potential mediators of the relationship between randomly assigned treatment conditions and long-term anxiety follow-ups. Age at randomization was also tested as a moderator of mediational relationships. Method: Participants included 319 youth (ages 7–17) from the Child/Adolescent Multimodal Study (CAMS) who participated in a naturalistic follow-up beginning an average of 6.5 years after the end of the CAMS intervention. The intervention conditions included cognitive behavioral therapy (CBT; Coping Cat), pharmacotherapy (sertraline), combined CBT and sertraline, and pill placebo. Putative mediators were measured four times during the intervention phase. Follow-up consisted of four annual assessments of current anxiety. Results: Reductions on a measure of interpretive bias to threat over the course of the combined condition intervention, as compared to the placebo condition, mediated anxiety outcomes at the first follow-up visit. This mediated effect was not significant for the CBT-only or sertraline-only conditions when compared to the placebo condition. No other significant mediated effects were found for putative mediators. Age did not significantly moderate any mediated effects. Conclusion: Changes in youth-reported interpretive biases to threat over the course of combined youth anxiety interventions, as compared to a placebo intervention, may be associated with lower anxiety an average of 6.5 years following treatment.

Original languageEnglish (US)
Article number102188
JournalJournal of Anxiety Disorders
StatePublished - Mar 2020


  • Childhood anxiety disorders
  • Cognitive behavior therapy
  • Interpretive biases
  • Mediators
  • Treatment outcomes

ASJC Scopus subject areas

  • Clinical Psychology
  • Psychiatry and Mental health


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