(PS3-13) Identifying Early Predictors of Key Therapeutic Processes in a Transdiagnostic Brief Behavioral Therapy (BBT) for Youth Anxiety and Depression

Homework completion between session and behavioral practice in session have been identified as predictors of treatment outcomes in a transdiagnostic Brief Behavioral Therapy (BBT) for youth with anxiety and/or depressive disorders. Specifically, higher homework completion and more behavioral practice were associated with lower anxiety and higher functioning post-treatment. Previous work has focused on homework completion and behavioral practice during the active phase of BBT, which includes exposure and behavioral activation. This study sought to identify early predictors of these key therapeutic components, focusing on role of homework completion and child engagement early in treatment.

The sample included 95 youth (ages 8-15; 56.8% female; 74.7% non-Hispanic White) who participated in the treatment arm of a randomized effectiveness trial of BBT. Early homework completion (sessions 2-4), early child engagement (sessions 1-4), and late homework completion (sessions 6-11) were rated each session by therapists. Therapist ratings were averaged across corresponding sessions for each construct. Behavioral practice (Minutes Practice) was rated by observers as part of treatment adherence, who reported whether behavioral practice occurred during each 5-minute increment of a sampled session. Anxiety was rated on the Pediatric Anxiety Rating Scale (PARS; The Research Units on Pediatric Psychopharmacology Anxiety Study Group [RUPP], 2002), integrating both youth and parent reports. Global functioning was assessed with the Children’s Global Assessment Scale (CGAS; Shaffer et al., 1983).

Multiple regression analyses were conducted to test whether early homework completion and early engagement predict level of homework completion and behavioral practice in later treatment. The model predicting late homework completion was significant (R² = .33, p < .001); however, only early homework completion emerged as a significant positive unique contributor (β = .59, p < .001). The model predicting Minutes Practice was not significant (p = .168). A mediation analysis was conducted to examine whether late homework completion mediated the link between early homework completion and anxiety post-treatment. Results revealed a significant indirect effect (95% CI: [-1.7341], [-.1357]) and a non-significant direct effect (p = .245), suggesting that late homework completion fully mediated the link between early homework completion and anxiety outcomes.

Overall, higher early homework completion predicted higher late homework completion, which in turn predicted lower levels of anxiety post-treatment. Results suggest that early homework completion is an important indicator of late homework completion as it relates to anxiety outcomes and may allow therapists to notice youth that may need more encouragement during the active phase of treatment. No significant predictors of Minutes Practice emerged, likely as it is more built into the intervention compared to homework completion, which depends on youths’ own efforts. The poster will discuss demographic and clinical predictors, and limitations. Future studies should explore early predictors of key treatment processes to promote positive outcomes and identify areas for improvement.