Does Training Parents in Reinforcement Skills or Relationship Skills Enhance Individual Youths’ Cognitive Behavioral Therapy for Anxiety? Outcome,Specificity,and Mediation

Abstract

We conducted a dismantling design treatment study comparing individual cognitive behavioral therapy (CBT), CBT targeting parents’ reinforcement skills (CBT + Reinf), and CBT targeting parents’ relationship skills (CBT+ Relat) in 341 youths with primary anxiety diagnoses. At posttreatment, youths in CBT with parent involvement had lower anxiety than youths in CBT. At 12-month follow-up, youths in CBT + Relat maintained lower anxiety relative to CBT. At posttreatment, negative reinforcement was significantly lower in CBT + Reinf than CBT + Relat and CBT; negative reinforcement partially mediated anxiety reduction in youths. Reducing parental negative reinforcement in CBT + Reinf was associated with lower parental psychological control, which also partially mediated anxiety reduction in youths. Some of these mediational dynamics continued through follow-up. Targeting concrete behavioral parenting skills, especially negative reinforcement, produced treatment specificity and partial mediation relative to less concrete targeting and enhanced CBT. Findings highlight complexities in identifying mechanisms through which targeting of parenting skills produces anxiety reduction in youths and suggest avenues for future research.