Description
Anxiety and depression in youth are associated with substantial distress and impairment and are frequently co-occurring. A common core process in both disorders is avoidance in the face of negative affect. Brief behavioral therapy (BBT) is a transdiagnostic intervention that targets behavioral avoidance as a key mechanism. While BBT is effective in treating youth with anxiety and depression, we have yet to test whether behavioral avoidance statistically mediates treatment effects, as theorized. We hypothesized that youth self-reports of behavioral avoidance will mediate the relationship between treatment condition and anxiety, depression, and global functioning. Exploratory analyses were conducted testing parent-report of youth behavioral avoidance as a mediator of treatment outcomes as well. Data on avoidance were available on a subset of 52 youth (ages 8-16 years, M = 11.46, SD = 2.74; 59.6% female; 72.5% non-Hispanic White) with anxiety and/or depressive disorders who participated in a randomized controlled trial. Enrolled youth were randomly assigned to BBT (n = 30) or assisted referral to outpatient care (ARC; n = 22) in the community. At baseline and Week 16, measures were collected of youth-report (CAMS) and parent-report of youth behavioral avoidance (CAMP), global functioning (Children’s Global Assessment Scale; CGAS), anxiety (Pediatric Anxiety Rating Scale; PARS), and depression (Children’s Depression Rating Scale-Revised; CDRS-R). As hypothesized, BBT had significant indirect effects on functioning (b = 1.91, 95% CI [.16, 4.52]) and anxiety symptoms (b = -1.18, 95% CI [-2.78, -.11]), statistically mediated through changes in youth-reported behavioral avoidance. Change in youth-reported behavioral avoidance was not a significant mediator of depression symptoms (b = -.18, 95% CI [-1.73, 1.36]). BBT did not have significant effects on parent-report of youth behavioral avoidance and parent-reports did not mediate the relationship between treatment and any of the three clinical outcomes. BBT has shown to be an effective treatment for youths with anxiety and depression. As hypothesized, reductions in youth-report of behavioral avoidance were associated with increased functioning and lessened anxiety. Such findings point to the importance of targeting avoidance behaviors among youth struggling with anxiety and/or depression in order to improve the functioning of children with these disorders.
