Cognitive Mediation of Cognitive-Behavioural Therapy Outcomes for Anxiety-Based School Refusal

Background: Cognitive-behavioural therapy (CBT) has proven to be effective for anxiety-based school refusal, but it is still unknown how CBT for school refusal works, or through which mechanisms. Aims: Innovative statistical approaches for analyzing small uncontrolled samples were used to investigate the role of self-efficacy in mediating CBT outcomes for anxiety-based school refusal. Method: Participants were 19 adolescents (12 to 17 years) who completed a manual-based cognitive-behavioural treatment. Primary outcomes (school attendance; school-related fear; anxiety) and secondary outcomes (depression; internalizing problems) were assessed at post-treatment and 2-month follow-up. Results: Post-treatment increases in school attendance and decreases in fear about attending school the next day were found to be mediated by self-efficacy. Mediating effects were not observed at 2-month follow-up. Conclusions: These findings provide partial support for the role of self-efficacy in mediating the outcome of CBT for school refusal. They contribute to a small body of literature suggesting that cognitive change enhances CBT outcomes for young people with internalizing problems. Regarding methodology, the product of coefficient test appears to be a valuable way to study mediation in outcome studies involving small samples.

[1]  C. Essau,et al.  The Wiley-Blackwell handbook of the treatment of childhood and adolescent anxiety , 2013 .

[2]  P. Westenberg,et al.  School refusal and anxiety in adolescence: non-randomized trial of a developmentally sensitive cognitive behavioral therapy. , 2011, Journal of anxiety disorders.

[3]  P. Westenberg,et al.  The Role of Cognition in School Refusal: An Investigation of Automatic Thoughts and Cognitive Errors , 2011, Behavioural and Cognitive Psychotherapy.

[4]  D. Beidel,et al.  Mediators and moderators of outcome in the behavioral treatment of childhood social phobia. , 2009, Journal of the American Academy of Child and Adolescent Psychiatry.

[5]  P. Westenberg,et al.  Cognitive Behavior Therapy for Anxious Adolescents: Developmental Influences on Treatment Design and Delivery , 2009, Clinical child and family psychology review.

[6]  R. Rapee,et al.  Cognitive-behavioral treatment versus an active control for children and adolescents with anxiety disorders: a randomized trial. , 2009, Journal of the American Academy of Child and Adolescent Psychiatry.

[7]  N. Gonzales,et al.  Psychosocial Interventions for School Refusal Behavior in Children and Adolescents. , 2009, Child development perspectives.

[8]  C. Viswesvaran,et al.  Evidence-Based Psychosocial Treatments for Phobic and Anxiety Disorders in Children and Adolescents , 2008, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[9]  D. Mackinnon.  Introduction to Statistical Mediation Analysis , 2008 .

[10]  J. Abela,et al.  Cognitive vulnerability to depression in children and adolescents: A developmental psychopathology perspective. , 2008 .

[11]  J. Abela,et al.  Handbook of depression in children and adolescents , 2008 .

[12]  N. King,et al.  Treatment of School Refusal , 2007 .

[13]  B. Chu,et al.  Disorder-specific Effects of CBT for Anxious and Depressed Youth: A Meta-analysis of Candidate Mediators of Change , 2007, Clinical child and family psychology review.

[14]  Stéphane Bouchard,et al.  Temporal relationship between dysfunctional beliefs, self-efficacy and panic apprehension in the treatment of panic disorder with agoraphobia. , 2007, Journal of behavior therapy and experimental psychiatry.

[15]  Thomas H. Ollendick,et al.  Concurrent Validity and Informant Agreement of the ADHD Module of the Anxiety Disorders Interview Schedule for DSM-IV , 2007 .

[16]  P. Kendall,et al.  The role of self-statements as a mediator in treatment for youth with anxiety disorders. , 2007, Journal of consulting and clinical psychology.

[17]  A. Albano,et al.  When Children Refuse School: Therapist Guide: A cognitive-behavioral therapy approach , 2007 .

[18]  C. Kearney.  Forms and functions of school refusal behavior in youth: an empirical analysis of absenteeism severity. , 2007, Journal of child psychology and psychiatry, and allied disciplines.

[19]  R. Gallop,et al.  The psychometric properties of the MASC in a pediatric psychiatric sample. , 2006, Journal of anxiety disorders.

[20]  W. O'donohue,et al.  Practitioner's guide to evidence based psychotherapy , 2006 .

[21]  T. Exner,et al.  Revisiting “Success”: Posttrial Analysis of a Gender-Specific HIV/STD Prevention Intervention , 2006, AIDS and Behavior.

[22]  S. Hofmann,et al.  Mediation of changes in anxiety and depression during treatment of social phobia. , 2005, Journal of consulting and clinical psychology.

[23]  J. Hudson.  Efficacy of Cognitive—Behavioural Therapy for Children and Adolescents With Anxiety Disorders , 2005, Behaviour Change.

[24]  J. Seeley,et al.  Potential mediators of cognitive-behavioral therapy for adolescents with comorbid major depression and conduct disorder. , 2005, Journal of consulting and clinical psychology.

[25]  R. DeRubeis,et al.  Determinants of change in cognitive therapy for depression , 1990, Cognitive Therapy and Research.

[26]  David P Mackinnon,et al.  Confidence Limits for the Indirect Effect: Distribution of the Product and Resampling Methods , 2004, Multivariate behavioral research.

[27]  Paula M. Barrett and Thomas H. Ollendick.  Handbook of interventions that work with children and adolescents , 2004 .

[28]  S. Maxwell,et al.  Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. , 2003, Journal of abnormal psychology.

[29]  M. Nock,et al.  Delineating mechanisms of change in child and adolescent therapy: methodological issues and research recommendations. , 2003, Journal of child psychology and psychiatry, and allied disciplines.

[30]  Adrian Angold,et al.  School refusal and psychiatric disorders: a community study. , 2003, Journal of the American Academy of Child and Adolescent Psychiatry.

[31]  T. Ollendick,et al.  Cognitive Change and Enhanced Coping: Missing Mediational Links in Cognitive Behavior Therapy with Anxiety-Disordered Children , 2003, Clinical child and family psychology review.

[32]  R. Gonzalez.  Applied Multivariate Statistics for the Social Sciences , 2003 .

[33]  H. Kraemer,et al.  Mediators and moderators of treatment effects in randomized clinical trials. , 2002, Archives of general psychiatry.

[34]  J. McCracken,et al.  Concurrent Validity of the Anxiety Disorders Section of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions , 2002, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.

[35]  B. Tonge,et al.  Evaluation of child therapy and caregiver training in the treatment of school refusal. , 2002, Journal of the American Academy of Child and Adolescent Psychiatry.

[36]  M. Place,et al.  The coping mechanisms of children with school refusal , 2002 .

[37]  Melvin Lewis.  Child and Adolescent Psychiatry: A Comprehensive Textbook , 2002 .

[38]  S. West,et al.  A comparison of methods to test mediation and other intervening variable effects. , 2002, Psychological methods.

[39]  J. Stevens,et al.  Applied multivariate statistics for the social sciences, 4th ed. , 2002 .

[40]  J. Weisz,et al.  Mechanisms of action in youth psychotherapy. , 2002, Journal of child psychology and psychiatry, and allied disciplines.

[41]  H. Merckelbach,et al.  The connection between cognitive development and specific fears and worries in normal children and children with below-average intellectual abilities: a preliminary study. , 2002, Behaviour research and therapy.

[42]  N. King,et al.  School refusal in children and adolescents: a review of the past 10 years. , 2001, Journal of the American Academy of Child and Adolescent Psychiatry.

[43]  M. Place,et al.  School Refusal: A Changing Problem Which Requires a Change of Approach? , 2000 .

[44]  M. Kushner,et al.  Imipramine plus cognitive-behavioral therapy in the treatment of school refusal. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[45]  D. Schunk,et al.  Self-Efficacy and Academic Motivation , 2002 .

[46]  Golda S. Ginsburg,et al.  Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial. , 1999, Journal of consulting and clinical psychology.

[47]  M. Okada,et al.  Factors responsible for the prolongation of school refusal , 1999, Psychiatry and clinical neurosciences.

[48]  H. Merckelbach,et al.  Correlations between Two Multidimensional Anxiety Scales for Children , 1998, Perceptual and motor skills.

[49]  B. Tonge,et al.  Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[50]  C. G. Last,et al.  Cognitive-behavioral treatment of school phobia. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.

[51]  B. Tonge,et al.  The Self-efficacy Questionnaire for School Situations: Development and Psychometric Evaluation , 1998, Behaviour Change.

[52]  P. Thuras,et al.  Somatic symptoms in anxious-depressed school refusers. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[53]  J. Parker,et al.  The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[54]  G. Holmbeck.  Toward terminological, conceptual, and statistical clarity in the study of mediators and moderators: examples from the child-clinical and pediatric psychology literatures. , 1997, Journal of consulting and clinical psychology.

[55]  Self-talk in youth with anxiety disorders: states of mind, content specificity, and treatment outcome. , 1996, Journal of consulting and clinical psychology.

[56]  J. A. Sergeant,et al.  Vragenlijst voor angst bij Kinderen (VAK) , 1995 .

[57]  W. Silverman,et al.  The Legend and Myth of School Phobia. , 1995 .

[58]  Terri Gullickson,et al.  Encyclopedia of human behavior , 1995 .

[59]  T. Achenbach.  Manual for the child behavior checklist/4-18 and 1991 profile , 1991 .

[60]  W M Grove,et al.  How does cognitive therapy work? Cognitive change and symptom change in cognitive therapy and pharmacotherapy for depression. , 1990, Journal of consulting and clinical psychology.

[61]  E. McNamara.  The Self-Management of School Phobia: A Case Study , 1988, Behavioural and Cognitive Psychotherapy.

[62]  I. J. Mansdorf,et al.  Cognitive-behavioral psychotherapy for separation anxious children exhibiting school phobia. , 1987, Journal of the American Academy of Child and Adolescent Psychiatry.

[63]  D. A. Kenny,et al.  The moderator-mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. , 1986, Journal of personality and social psychology.

[64]  Michael J. Kovacs.  Children’s Depression Inventory , 2014 .

[65]  T. Ollendick.  Reliability and validity of the Revised Fear Surgery Schedule for Children (FSSC-R). , 1983, Behaviour research and therapy.

[66]  A Bandura,et al.  Cognitive processes mediating behavioral change. , 1977, Journal of personality and social psychology.

[67]  C. Pritchard,et al.  School Phobia: Its Classification and Relationship to Dependency , 1970, British Journal of Psychiatry.

[68]  R. Methven.  School refusal. , 1968, The New Zealand medical journal.