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Beyond 16 Sessions: Extending Manualized Treatment of Anxious Youth

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Abstract

Cognitive behavioral therapy (CBT) is well established as an efficacious treatment for anxious youth, yet a number of youth remain symptomatic after the 10–16 sessions of treatment stipulated by most CBT treatment manuals. While a significant minority do not respond, no study has examined the frequency and impact of additional therapy sessions. This study examined youth receiving outpatient therapy at an anxiety clinic who were offered the option to continue treatment after completing 16 sessions of manual-based CBT. Fifty-nine percent of participants chose to continue treatment, with an average of approximately 20 total sessions across participants. Therapist ratings demonstrated a significant overall improvement between session 16 and the final session. No pre-treatment measure of symptom severity differed between those who extended treatment and those who ended at session 16. Parent-rated anxiety differed between groups at session 16, as did the length of time to complete 16 sessions. Findings indicate that extending treatment is not uncommon, is typically limited to several additional sessions, and is associated with an increase in treatment gains. Current results suggest that two factors at session 16, parental perceptions of anxiety and time to complete 16 sessions, are influential and may be central to the decision to continue treatment past this point. Clinical implications and future directions are discussed.

Highlights

  • Fifty-nine percent of anxious youth chose to extend treatment beyond 16 sessions, with an average of 20 total sessions across participants.

  • Therapist ratings demonstrated a significant overall improvement between session 16 and the final session.

  • No pre-treatment measure of symptom severity differed between those who extended treatment and those who ended at session 16.

  • Parent-rated anxiety differed between groups at session 16, as did the length of time to complete 16 sessions.

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Funding

H.E.F. was supported by the National Institute of Health [grant number F31MH112211]. Other authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Temple University, Philadelphia, PA, 19122, USA

    Elana R. Kagan, Hannah E. Frank, Mark J. Knepley & Philip C. Kendall

  2. Johns Hopkins School of Medicine, Baltimore, MD, 21205, USA

    Elana R. Kagan

  3. Warren Alpert Medical School of Brown University, Providence, RI, 02906, USA

    Hannah E. Frank

  4. NYU Langone Child Study Center, NY, NY, 10016, USA

    Mark J. Knepley

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  1. Elana R. Kagan
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Correspondence to Elana R. Kagan.

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Conflict of Interest

P.C.K. receives royalties from the sale of materials related to the treatment of anxious youth. The authors do not have any conflict of interest to report.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Temple University IRB; reference number 13430) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

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Kagan, E.R., Frank, H.E., Knepley, M.J. et al. Beyond 16 Sessions: Extending Manualized Treatment of Anxious Youth. J Child Fam Stud 30, 493–501 (2021). https://doi.org/10.1007/s10826-020-01872-5

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