Process Factors Associated with Improved Outcomes in CBT for Anxious Youth: Therapeutic Content, Alliance, and Therapist Actions

Cognitive behavioral therapy (CBT) has been established as an empirically supported treatment for anxiety in youth. Recent efforts have been underway to elucidate the evidence- based process factors that are associated with successful outcomes. These factors have included both therapy content (homework; exposure tasks) and therapy process (therapeutic alliance; therapist actions). Although exposure tasks have been identified as a key component of CBT, they are not always implemented with the greatest efficacy, in session or at home. Successful implementation of exposure tasks may rely, in part, on a strong therapeutic alliance. Furthermore, therapist actions influence the alliance and client motivation and participation in homework and exposure tasks. A review of the relevant literature indicates that additional research is needed to elucidate the interaction between therapeutic process factors, such as alliance and therapist actions, and therapeutic content, including exposure tasks.