Mediators of change in the Child/Adolescent Anxiety Multimodal Treatment Study.


Journal Article

OBJECTIVE: Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). METHOD: Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met Diagnostic and Statistical Manual for Mental Disorders-Fourth Edition (DSM-IV) criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. RESULTS: Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. CONCLUSIONS: The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator.

Full Text

Duke Authors

Cited Authors

  • Kendall, PC; Cummings, CM; Villabø, MA; Narayanan, MK; Treadwell, K; Birmaher, B; Compton, S; Piacentini, J; Sherrill, J; Walkup, J; Gosch, E; Keeton, C; Ginsburg, G; Suveg, C; Albano, AM

Published Date

  • January 2016

Published In

Volume / Issue

  • 84 / 1

Start / End Page

  • 1 - 14

PubMed ID

  • 26460572

Pubmed Central ID

  • 26460572

Electronic International Standard Serial Number (EISSN)

  • 1939-2117

Digital Object Identifier (DOI)

  • 10.1037/a0039773


  • eng

Conference Location

  • United States