Walkup, J., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S., Sherrill, J., Ginsburg, G. S., Rynn, M. A., McCracken, J., Waslick, B., Iyengar, S., March, J. S., & Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. New England Journal of Medicine, 359, 2753–2766. https://doi.org/10.1056/NEJMoa0804633

Type of Study: Randomized controlled trial
Number of Participants: 488

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 12% Hispanic, 9% Black, 8% Other 3% Asian, and 1% American Indian
• Gender — 50% Male and 50% Female
• Status — Participants were children and adolescents with anxiety disorders.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The purpose of the study was to evaluate the relative efficacy of Coping Cat [now called C.A.T. Project] for youth aged 12–18. Participants were randomly assigned to one of four conditions: Coping CAT, sertraline, a combination of the two therapies, or a placebo drug. Measures utilized include the Anxiety Disorders Interview Schedule for DSM-IV-TR, Child Version, 20, the Clinical Global Impression–Improvement Scale, and the Pediatric Anxiety Rating Scale. Results indicate that both Coping Cat and sertraline reduced the severity of anxiety in children with anxiety disorders, and a combination of the two therapies had a superior response rate. Limitations include the exclusion of children and teens with major depression and pervasive developmental disorders may have limited the generalizability of the results to these populations, and the sample did not include the most socio-economically disadvantaged children.

Length of controlled postintervention follow-up: None.

Ginsburg, G. S., Kendall, P. C., Sakolsky, D., Compton, S. N., Piacentini, J., Albano, A. M., Walkup, J. T., Sherrill, J., Coffey, K. A., Rynn, M. A., Keeton, C. P., McCracken, J. T., Bergman, L., Iyengar, S., Birmaher, B., & March, J. (2011). Remission after acute treatment in children and adolescents with anxiety disorders: Findings from the CAMS. Journal of Consulting and Clinical Psychology, 79(6), 806–813. https://doi.org/10.1037/a0025933

Type of Study: Randomized controlled trial
Number of Participants: 488

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 12% Hispanic, 9% Black, 8% Other, 3% Asian, and 1% American Indian
• Gender — 50% Male and 50% Female
• Status — Participants were children and adolescents with anxiety disorders.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to report on remission rates in anxious youth who participated in the Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were randomly assigned to one of four conditions: Coping CAT, [now called C.A.T. Project] for youth aged 12–18, sertraline (SRT), a combination of the two therapies (COMB), or a placebo drug (PBO). Measures utilized include the Anxiety Disorders Interview Schedule (ADIS-C/P), the Clinical Global Impression Severity Scale (CGI-S), the Clinical Global Impression Improvement Scale (CGI-I), the Brief Symptom Inventory (BSI) and the State-Trait Anxiety Inventory ([STAI] Trait Version. Results indicate that remission rates after 12 weeks of treatment ranged from 46% to 68% for COMB, 34% to 46% for SRT, 20% to 46% for Coping Cat, and 15% to 27% for PBO. Youth who received COMB had significantly higher rates of remission compared to all other treatment groups. Both monotherapies had higher remission rates compared to PBO, but rates were not different from each other. Predictors of remission were younger age, nonminority status, lower baseline anxiety severity, absence of other internalizing disorders (e.g., anxiety, depression), and absence of social phobia. Limitations include the sample was comprised of volunteers and excluded youth meeting criteria for major depressive disorder; RCTs such as the CAMS are powered to detect response, not remission, which may explain the absence of consistent statistical differences using the CGI-S and CGI-I remission criteria; and the current study addressed the end of acute treatment (i.e., 12 weeks of treatment) and not the long-term impact of residual anxiety symptoms.

Length of controlled postintervention follow-up: None.

Cummings, C. M., Caporino, N. E., Settipani, C. A., Read, K. L., Compton, S. N., March, J., Sherrill, J., Piacentini, J., McCracken, J., Walkup, J. T., Ginsburg, G., Albano, A. M., Rynn, M., Birmaher, B., Sakolsky, D., Gosch, E., Keeton, C., & Kendall, P.  (2013). The therapeutic relationship in cognitive-behavioral therapy and pharmacotherapy for anxious youth. Journal of Consulting and Clinical Psychology, 81(5), 859–864. https://doi.org/10.1037/a0033294

Type of Study: Randomized controlled trial
Number of Participants: 488

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 9% African American, 8% Hispanic, 8% Other, 3% Asian, and 1% American Indian
• Gender — 50% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to examine the therapeutic relationship with cognitive-behavioral therapists and with pharmacotherapists for youth from the Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were randomly assigned to one of four conditions: Coping CAT [now called C.A.T. Project] for youth aged 12–18, sertraline, a combination of the two therapies, or a placebo drug. Measures utilized include the Child’s Perception of Therapeutic Relationship (CPTR), the Anxiety Disorders Interview Schedule for DSM–IV–Child and Parent Versions (ADIS-IV-C/P), the Clinical Global Impressions Scales (CGI), and the Pediatric Anxiety Rating Scale (PARS). Results indicate that for youth who received Coping CAT only, a stronger therapeutic relationship predicted positive treatment outcome. In contrast, the therapeutic relationship did not predict outcome for youth receiving sertraline, combined treatment, or placebo. Limitations include the therapeutic relationship was measured at Session 6 and was rated by youth; therapist or observer ratings merit further study; and the CAMS consisted of mostly white therapists and youth from middle-class families, findings cannot be generalized to other groups.

Length of controlled postintervention follow-up: None.

Ginsburg, G. S., Becker, E. M., Keeton, C. P., Sakolsky, D., Piacentini, J., Albano, A. M., Compton, S. N., Iyengar, S., Sullivan, K., Caporino, N., Peris, T., Birmaher, B., Rynn, M., March, J., & Kendall, P. C. (2014). Naturalistic follow-up of youths treated for pediatric anxiety disorders. JAMA Psychiatry, 71(3), 310–318. https://doi.org/10.1001/jamapsychiatry.2013.4186

Type of Study: Randomized controlled trial
Number of Participants: 288

Population:

• Age — 11–26 years (Mean=17 years)
• Race/Ethnicity — 82% White, 9% African American, 8% Hispanic, 7% Other, and 3% Asian
• Gender — 160 Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to determine whether acute clinical improvement and treatment type (i.e., cognitive behavioral therapy, medication, or their combination) predicted remission of anxiety and improvement in global functioning at a mean of 6 years after randomization, and to examine predictors of outcomes at follow-up to the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). Participants were randomly assigned to one of four conditions: Coping CAT, [now called C.A.T. Project] for youth aged 12–18, sertraline, a combination of the two therapies, or a placebo drug in the Child/Adolescent Anxiety Multimodal Study (CAMS). Measures utilized include the Clinical Global Impression–Severity Scale, the Children’s Global Assessment Scale, the Brief Family Assessment Measure, the Brief Symptom Inventory, the State-Trait Anxiety Inventory–Trait, the Anxiety Disorders Interview Schedule Supplemental Services Form, and the Life Events Scale. Results indicate that almost half of the sample (46.5%) was in remission at the 6-year follow-up. Responders to the initial treatment in the 2008 study were significantly more likely to be in remission at the 6-year follow-up and had less severe anxiety symptoms and were higher functioning. There were no differences in outcomes at the 6-year follow-up across the 4 interventions. Limitations include the naturalistic nature of the follow-up study; the current assessment was cross-sectional, providing only a snapshot of current functioning, and does not provide data on remission or recurrences of illness during the follow-up period; and CAMELS sample varied from the CAMS sample on several variables, limiting the generalizability of the findings, particularly to male youths and youths from nonwhite and lower-SES backgrounds.

Length of controlled postintervention follow-up: Mean=6 years, Range=4–9 years.

Compton, S. N., Peris, T. S., Almirall, D., Birmaher, B., Sherrill, J., Kendall, P. C., March, J. S., Gosch, E. A., Ginsburg, G. S., Rynn, M. A., Piacentini, J. C., McCracken, J. T., Keeton, C. P., Suveg, C. M., Aschenbrand, S. G., Sakolsky, D., Iyengar, S., Walkup, J. T., & Albano, A. M. (2014). Predictors and moderators of treatment response in childhood anxiety disorders: Results from the CAMS trial. Journal of Consulting and Clinical Psychology, 82(2), 212–224. https://doi.org/10.1037/a0035458

Type of Study: Randomized controlled trial
Number of Participants: 488

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 9% African American, 8% Hispanic, 8% Other, 3% Asian, and 1% American Indian
• Gender — 50% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to examine predictors and moderators of treatment outcomes among 488 youths ages 7–17 years meeting criteria for diagnoses of separation anxiety disorder, social phobia, or generalized anxiety disorder in the Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were randomly assigned to one of four conditions: Coping CAT, [now called C.A.T. Project] for youth aged 12–18, sertraline, a combination of the two therapies, or a placebo drug. Measures utilized include the Multidimensional Anxiety Scale for Children (MASC), Screen for Child Anxiety-Related Emotional Disorders (SCARED), Mood and Feelings Questionnaire (MFQ), Child Anxiety Impact Scale (CAIS), the Physical Symptom Checklist (PSC), Anxiety Disorder Interview Schedule–Clinician Severity Rating (ADIS–CSR), Clinical Global Impression Scale–Severity (CGI–S), Children’s Global Assessment Scale (CGAS), State–Trait Anxiety Inventory, A-Trait Scale (STAI–A–Trait), Brief Symptom Inventory (BSI), Brief Family Assessment Measure–III (BFAM–III), and the Caregiver Strain Questionnaire (CSQ). Results indicate that youth with lower levels of baseline symptom severity and less caregiver strain had better outcomes independent of the type of treatment received. Having more severe and impairing anxiety, greater caregiver strain, and a principal diagnosis of social phobia were associated with less favorable outcomes. Limitations include variability on some potential predictors/moderators was constrained (e.g., youth with comorbid depression were excluded as were children with severe cognitive limitations).

Length of controlled postintervention follow-up: None.

Gonzalez, A., Peris, T. S., Vreeland, A., Kiff, C. J., Kendall, P. C., Compton, S. N., Albano, A. M., Birmaher, B., Ginsburg, G. S., Keeton, C. P., March, J., McCracken, J., Rynn, M., Sherrill, J., Walkup, J. T., & Piacentini, J. (2015). Parental anxiety as a predictor of medication and CBT response for anxious youth. Child Psychiatry & Human Development, 46(1), 84–93. https://doi.org/10.1007/s10578-014-0454-6

Type of Study: Randomized controlled trial
Number of Participants: 488

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 9% African American, 8% Hispanic, 8% Other, 3% Asian, and 1% American Indian
• Gender — 50% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used a subset of the same sample as Walkup et al. (2008). The purpose of the study was to evaluate how parental anxiety predicted change in pediatric anxiety symptoms across four different interventions. Participants were randomly assigned to one of four conditions: Coping CAT, [now called C.A.T. Project] for youth aged 12–18, sertraline (SRT), a combination of the two therapies (COMB), or a placebo drug. Measures utilized include Anxiety Disorders Interview Schedule for DSM-IVTR, Child Version (ADIS-IV), the Pediatric Anxiety Rating Scale (PARS), the Mood and Feelings Questionnaire, Child- and Parent-reports (MFQ-C/MFQ-P), and the State-Trait Anxiety Inventory-Trait Scale (STAI -Trait). Results indicate that parental anxiety was not associated with youth’s pretreatment anxiety symptom severity. Controlling for parental trait anxiety, youth depressive symptoms, and youth age, there was a main effect of COMB treatment indicating that youth who received both medication and the Coping Cat benefitted most. In addition, there was an interaction between parental anxiety and SRT treatment. Counter to expectations, higher levels of parental anxiety predicted a more favorable symptom trajectory within the SRT condition leading to faster and greater reduction in youth anxiety compared to youths whose parents had lower levels of anxiety. Parental anxiety did not significantly influence youth anxiety trajectories in the other treatment conditions. Limitations include lack of generalizability to other ethnic populations and lack of follow-up.

Length of controlled postintervention follow-up: None.

Peris, T. S., Compton, S. N., Kendall, P. C., Birmaher, B., Sherrill, J., March, J., Gosch, E., Ginsburg, G., Rynn, M., McCracken, J. T., Keeton, C. P., Sakolsky, D., Suveg, C., Aschenbrand, S., Almirall, D., Iyengar, S., Walkup, J. T., Albano, A. M., & Piacentini, J. (2015). Trajectories of change in youth anxiety during cognitive-behavior therapy. Journal of Consulting and Clinical Psychology, 83(2), 239–252. https://doi.org/10.1037/a0038402

Type of Study: Randomized controlled trial
Number of Participants: 488 children

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 12% Hispanic, 9% Black, 8% Other, 3% Asian, and 1% American Indian
• Gender — 50% Male and 50% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive– behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). Measures utilized include the Clinical Global Impression Scale-Severity (CGI-S), the Children’s Global Assessment Scale (CGAS), the Anxiety Disorders Interview Schedule-Child/Parent Versions (ADIS C/P), the Negative Affect Self-Statement Questionnaire (NASSQ), the Physical Symptom Checklist (PSC), and the Pediatric Anxiety Rating Scale (PARS). Results indicate that introduction in the C.A.T. Project of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment, while the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior). Limitations include the attrition rate of the original study sample at the follow-up time point, lack of follow-up, and reliance on self-reported measures.

Length of controlled postintervention follow-up: None.

Kendall, P. C., Cummings, C. M., Villabø, M. A., Narayanan, M. K., Treadwell, K., Birmaher, B., Compton, S., Piacentini, J., Sherrill, J., Walkup, J., Gosch, E., Keeton, C., Ginsburg, G., Suveg, C., & Albano, A. M. (2016). Mediators of change in the Child/Adolescent Anxiety Multimodal Treatment Study. Journal of Consulting and Clinical Psychology, 84(1), 1–14. https://doi.org/10.1037/a0039773

Type of Study: Randomized controlled trial
Number of Participants: 488 children

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 12% Hispanic, 9% Black, 8% Other, 3% Asian, and 1% American Indian
• Gender — 50% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia. Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to 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). Participants were randomly assigned to one of four conditions: Coping CAT, [now called C.A.T. Project] for youth aged 12–18, sertraline, a combination of the two therapies, or a placebo drug. Measures utilized include the Coping Questionnaire, Parent and Child/Youth Versions (CQ-C/P), the Negative Affectivity Self-Statement Questionnaire (NASSQ), the Anxiety Disorders Interview Schedule-Child/Parent Versions (ADIS-IV-C/P), and the Pediatric Anxiety Rating Scale (PARS). Results indicate that residualized gains in coping efficacy mediated gains in the Coping CAT, 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. Limitations include the attrition rate of the original study sample at the follow-up time point, additional services or medication during the follow-up period was not controlled, and the lack of generalizability of the findings (particularly to male youths and youths from nonwhite and lower-SES backgrounds).

Length of controlled postintervention follow-up: 3 months.

Makover, H. B., Kendall, P. C., Olino, T., Carper, M. M., Albano, A. M., Piacentini, J., Peris, T., Langley, A. K., Gonzalez, A., Ginsburg, G. S., Compton, S., Birmaher, B., Sakolsky, D., Keeton, C., & Walkup, J. (2020). Mediators of youth anxiety outcomes 3 to 12 years after treatment. Journal of Anxiety Disorders, 70, Article 102188. https://doi.org/10.1016/j.janxdis.2020.102188

Type of Study: Randomized controlled trial
Number of Participants: 319 youth

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 12% Hispanic, 9% Black, 8% other, 3% Asian, and 1% American Indian
• Gender — 55% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to 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. Participants were randomly assigned to one of four conditions: Coping CAT, [now called C.A.T. Project] for youth aged 12–18, sertraline, a combination of the two therapies, or a placebo drug. Measures utilized include the Anxiety Disorders Interview Schedule-Child/Parent Versions (ADIS C/P), the Coping Questionnaire, Parent and Child/Youth versions (CQ-C/P), the Negative affectivity self-statement questionnaire (NASSQ), the Self-report of Ambiguous Social Situations for Youth (SASSY), the ADIS Supplemental Services Form, and the Pediatric Anxiety Rating Scale (PARS). Results indicate that 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 (Coping CAT) 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. Limitations include anxious self-statements did not converge, and therefore could not be tested as a mediator of outcomes; the reliance on self- and parent-report measures of putative mediators; and there were structural differences between the administration of a combined treatment and the administration of two monotherapy conditions.

Length of controlled postintervention follow-up: 3–12 years (Mean=6.5 years).

Wu, M. S., Caporino, N. E., Peris, T. S., Pérez, J., Thamrin, H., Albano, A. M., Kendall, P. C., Walkup, J. T., Birmaher, B., Compton, S. N., & Piacentini, J. (2020). The impact of treatment expectations on exposure process and treatment outcome in childhood anxiety disorders. Journal of Abnormal Child Psychology, 48(1), 79–89. https://doi.org/10.1007/s10802-019-00574-x

Type of Study: Randomized controlled trial
Number of Participants: 279 youth

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 12% Hispanic, 9% Black, 8% Other, 3% Asian, and 1% American Indian
• Gender — 50% Female, 50% Male
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to examine the relationship between caregivers’ and youths’ treatment expectations and characteristics of exposure tasks (quantity, mastery, compliance) in cognitive-behavioral therapy (CBT) for childhood anxiety. Additionally, compliance with exposure tasks was tested as a mediator of the relationship between treatment expectations and symptom improvement. Participants were randomly assigned to one of four conditions: Coping CAT, [now called C.A.T. Project] for youth aged 12–18, sertraline, a combination of the two therapies, or a placebo drug. Measures utilized include the Anxiety Disorders Interview Schedule-Child/Parent Versions (ADIS C/P) and the Pediatric Anxiety Rating Scale (PARS). Results indicate that for both caregivers and youths, more positive expectations that anxiety would improve with treatment were associated with greater compliance with exposure tasks, and compliance mediated the relationship between treatment expectations and change in anxiety symptoms following treatment. Additionally, more positive parent treatment expectations were related to a greater number and percentage of sessions with exposure. More positive youth treatment expectations were associated with greater mastery during sessions focused on exposure. Limitations include exposure variables were rated by the therapist on a measure developed specifically for the Child/Adolescent Anxiety Multimodal Study (CAMS) trial, which may have limited the ability to examine other potential variables of interest from other informants (e.g., parent’s perception of child mastery of exposures); although the sample was recruited from various sites across the U.S., the predominance of non-Hispanic White participants may limit generalizability in the community; the study evaluated the relationship between treatment expectations and the exposure component of CBT only; and the correlational analyses are cross-sectional in nature, precluding inferences in causality.

Length of controlled postintervention follow-up: None.

Peris, T. S., Sugar, C. A., Rozenman, M. S., Walkup, J. T., Albano, A. M., Compton, S., Sakolsky, D., Ginsburg, G., Keeton, C., Kendall, P. C., McCracken, J. T., & Piacentini, J. (2021). Long-term service use among youth previously treated for anxiety disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 60(4), 501–512. https://doi.org/10.1016/j.jaac.2020.07.911

Type of Study: Randomized controlled trial
Number of Participants: 319 youth

Population:

• Age — 7–17 years
• Race/Ethnicity — 79% White, 12% Hispanic, 9% Black, 8% Other, 3% Asian, and 1% American Indian
• Gender — 55% Female
• Status — Participants were children with a primary diagnosis of separation or generalized anxiety disorder or social phobia.

Location/Institution: New York State Psychiatric Institute–Columbia University Medical Center–New York University; Duke University Medical Center; Johns Hopkins Medical Institutions; Temple University–University of Pennsylvania; University of California, Los Angeles; and Western Psychiatric Institute and Clinic–University of Pittsburgh Medical Center

Summary: (To include basic study design, measures, results, and notable limitations)
The study used the same sample as Walkup et al. (2008). The purpose of the study was to (1) describe rates of long-term service use among subjects previously enrolled in a landmark study of youth anxiety disorder treatment and followed into early adulthood; (2) examine predictors of long-term service use; and (3) examine the relationship between anxiety diagnosis and service use over time. Participants were a large demographically diverse sample of anxious youths who received early state-of-the-art intervention via the Child/Adolescent Anxiety Multimodal Study (CAMS) and were subsequently assessed in the Child/Adolescent Anxiety Multimodal Extended Long-Term Study (CAMELS) as they moved into early adulthood. Participants were randomly assigned to one of four conditions: Coping CAT, [now called C.A.T. Project] for youth aged 12–18, sertraline, a combination of the two therapies, or a placebo drug. Measures utilized include the Anxiety Disorders Interview Schedule— Fourth Edition (ADIS), the Mood and Feelings Questionnaire (MFQ), the Life Events Scale, the Brief Family Assessment Measure, and the Beck Depression Inventory (BDI). Results indicate that overall, 65.1% of participants endorsed receiving some form of anxiety treatment over the course of the follow-up period, with more subjects reporting medication use than psychotherapy; 35.2% reported consistent use of services over the course of the study. Overall, service use declined over time in subjects with less severe anxiety but remained steady in those with recurrent/chronic symptoms. Levels of life stress and depressive symptoms were associated with amount of service use over time whereas treatment-related variables (type of initial intervention, acute response, remission) were not. A subset of youths remained chronically anxious despite consistent service use. Limitations include that there were a greater proportion of White, higher-income, and 2-parent families than in the original study, and data relied on self-report of service use and did not capture the quality of services received.

Length of controlled postintervention follow-up: Mean=6.52 years