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Predicting Attrition in Guided Parent-Delivered Cognitive Behavioural Therapy for Anxious Children

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Predicting Attrition in Guided Parent-Delivered Cognitive Behavioural Therapy for Anxious Children Predicting attrition in guided parent-delivered cognitive behavioural therapy for anxious children Sarah Cook D. Clin.Psy. thesis (Volume 1), 2014 University College London UCL Doctorate in Clinical Psychology Thesis Declaration Form I confirm that the work presented in this thesis is my own. Where information has been derived from other sources, I confirm that this has been indicated in the thesis. Signature: Name: Sarah Cook Date: 14/07/2014 2 Overview Volume one of this thesis consists of three parts. Part one is a literature review that examines pre-treatment demographic, clinical, parent, child and therapist characteristics as predictors of outcome in the treatment of child anxiety disorders. Methodological weaknesses associated with existing prediction studies are considered and recommendations made for future research. Part two is an empirical paper which investigates predictors of treatment attrition in a guided manualised self-help CBT intervention for anxious children, delivered solely via parents. The results are discussed in relation to clinical implications and recommendations are made for increasing retention in low- intensity, parent-led treatments for childhood anxiety disorders. Part three is a critical appraisal which discusses the limitations of using observational measures to assess parent-child interactions and the challenges associated with outcome measurement in child anxiety research. The background context to the research is also outlined and the advantages and disadvantages of conducting research using pre-collected data are considered. 3 Acknowledgements I would like to thank my supervisors Cathy Creswell, Stephen Butler and Kerstin Thirlwall for their wisdom, patience enthusiasm and unwavering support throughout my thesis. I would also like to extend a huge thank you to Polly Waite for her help and advice with the systematic review. Special thanks go to my friend Mandy Lau for her invaluable help, support and encouragement throughout the final stages of the thesis. I would like to thank all of my friends and colleagues at the Winnicott Research Unit and Berkshire Child Anxiety Clinic and to all of the families who took part in this research. Most importantly, I would like to thank my wonderful husband Richard and amazing children David, Stephen and Hannah. I couldn’t have done this without your endless support and unfaltering belief in me. I am truly lucky to have such a wonderful family! Last but by no means least; I would like to thank my parents, friends and fellow trainees for their ongoing encouragement, compassion and incredibly useful hints and tips along the way. 4 Table of Contents Thesis Declaration Form .......................................................................................... 2 Overview .................................................................................................................. 3 Acknowledgements .................................................................................................. 4 Table of Contents ..................................................................................................... 5 List of Tables and Figures ........................................................................................ 8 Part One ................................................................................................................ 8 Part Two ................................................................................................................ 8 PART ONE: Literature Review ................................................................................... 9 Predictors of treatment outcome for child and adolescent anxiety disorders............... 9 Abstract .................................................................................................................. 10 Introduction ............................................................................................................ 11 Treatment of Anxiety Disorders in Children and Adolescents ........................... 11 Predictors of Treatment Outcome ....................................................................... 12 Rationale and Aims of the Present Review ........................................................ 13 Method .................................................................................................................... 14 Inclusion Criteria ................................................................................................ 14 Preliminary Search Strategy ............................................................................... 15 Study Selection ................................................................................................... 16 Data Extraction ................................................................................................... 19 Quality Evaluation .............................................................................................. 19 Characteristics of Included Studies..................................................................... 21 Participants. ..................................................................................................... 21 Interventions. ................................................................................................... 26 Assessment of treatment outcome. .................................................................. 27 Child anxiety diagnoses. ................................................................................. 28 Child anxiety symptoms. ................................................................................. 28 Assessment of predictors of treatment outcome. ............................................ 28 Results .................................................................................................................... 30 Associations Between Child Demographic Factors and Treatment Outcome .... 30 Age. ................................................................................................................. 30 Gender. ............................................................................................................ 31 Ethnicity. ......................................................................................................... 33 5 Socio-economic status (SES). ......................................................................... 34 Associations between Clinical Characteristics and Treatment Outcome ........... 37 Baseline anxiety symptom severity. ................................................................ 37 Anxiety diagnosis. ........................................................................................... 40 Comorbidity. ................................................................................................... 42 General comorbidity. ................................................................................... 42 Internalising comorbidity and treatment outcome. ...................................... 44 Externalising comorbidity and treatment outcome. ..................................... 45 Associations between Parental Factors and Treatment Outcome ....................... 46 Parental psychopathology. .............................................................................. 46 Self-report measures. ................................................................................... 47 Maternal psychopathology. ............................................................................. 47 Paternal psychopathology. .............................................................................. 47 General parental psychopathology. ................................................................. 48 Diagnostic interviews and parental psychopathology. ................................ 49 Parenting behaviours. ...................................................................................... 51 Other Child, Clinical and Therapist Characteristics Associated with Treatment Outcome .............................................................................................................. 57 Discussion .............................................................................................................. 59 Methodological Limitations ................................................................................ 63 Clinical Implications ........................................................................................... 64 References .............................................................................................................. 66 PART TWO: Empirical Paper ................................................................................... 84 Predicting attrition in guided parent-delivered cognitive behavioural therapy for anxious children ......................................................................................................... 84 Abstract .................................................................................................................. 85 Introduction ............................................................................................................ 86 Treatment Drop Outs .......................................................................................... 89 Parental Cognitions ............................................................................................. 91 Parental behaviour .............................................................................................. 92 Hypotheses .........................................................................................................
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