Investigating non-response to CBT for childhood anxiety

Anxiety disorders are among the most commonly diagnosed psychological disorders in childhood. Although cognitive behavioural therapy (CBT) has demonstrated general efficacy in treating childhood anxiety, it remains unclear why nearly four out of ten young people do not respond to treatment. This study investigated a group of children and adolescents who retained one or more anxiety disorders after completing a course of CBT. Participants comprised 1509 anxious young people (5 – 18 years) whose data were collected from nine global clinical sites, with assessments at pre- and post-treatment, and at least once more at 3, 6, or 12-month follow-up. Cluster analyses were used to identify three response groups within the sample as delayed responders, relapsed responders, and non-responders. Significant predictors of these response groups included primary anxiety severity, a primary diagnosis of social anxiety disorder, comorbid anxiety disorders, and maternal psychopathology. Influential process factors included treatment delivery and intensity. Finally, growth curve models confirmed non-linear treatment response trajectories revealing distinctly different pathways of response for all groups following completion of treatment. Together, these findings enhance our ability to identify and profile a childhood anxiety treatment non-responder and may assist the future development of clinical tools which may enable clinicians to deliver the right care to the right child at the right time.