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Exploring the Mechanisms in Cognitive Behavioural Therapy for Anxious Children: Does Change in Emotion Regulation Explain Treatment Effect?

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Abstract

Cognitive behavioural therapy (CBT) for childhood anxiety has shown moderate effects. However, inconsistency in findings during the last decades of treatment research and lack of measurable treatment gains over time has led to a call for optimizing interventions by identifying the active mechanisms involved and for whom such interventions are effective. It has been suggested that the moderate effects may be explained by the fact that emotion regulation rarely is directly targeted in CBT-interventions and that interventions may be more effective for children with a certain level of problems with emotion regulation. Using data from a randomized controlled trial with 160 children and their mothers at baseline (t1) and posttreatment (t2), we examined whether being randomized to CBT predicted change in anxiety symptoms from t1 to t2 and whether this change was mediated by change in emotion regulation from t1 to t2. We also investigated whether the strength of this indirect pathway depended on the level of emotion regulation problems at baseline. Latent baseline target moderated mediation analyses within a structural equation modelling framework were conducted. Results showed a significant indirect pathway between receiving CBT to improved emotion regulation, which again was significantly associated with reductions in anxiety symptoms. The findings suggest that the effect of CBT is similar for children irrespective of initial levels of emotion regulation measured broadly, whereas there was some evidence of a baseline moderation effect of the subdomain emotional control. Emotion regulation, and especially emotional control, seems to be an underlying mechanism for positive effects of CBT for anxiety disorders in children, possibly indicating that a greater emphasis on emotion regulation may optimize the intervention.

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Funding

186036/V50 Grant Funding Number Norwegian Research Council to conduct the main study. Primary sponsor: The Centre for Child and Adolescent Mental Health – Eastern and Southern Norway (RBUP East and South), Gullhaugveien 1–3, 0484 Oslo, mail@r-bup.no.

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Authors and Affiliations

  1. Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway

    S. S. Helland, S. Baardstu, J. Kjøbli & S. P. Neumer

  2. Norwegian Institute of Public Health, Oslo, Norway

    S. Baardstu

  3. Akershus University Hospital, Lorenskog, Norway

    M. Aalberg

  4. Institute of Education, University of Oslo, Oslo, Norway

    J. Kjøbli

  5. The Regional Centre for Child and Youth Mental Health and Child Welfare – Northern Norway, RKBU Nord, The Arctic University of Norway, Tromso, Norway

    S. P. Neumer

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  1. S. S. Helland
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Correspondence to S. S. Helland.

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Ethics Approval

Ethics approval for the study was given by the Regional Committees for Medical and Health Research Ethics (REK; https://helseforskning.etikkom.no), reference number 2010/3187/REK sør-øst C. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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The study was conducted in accordance with prevailing ethical standards in the field and approval from the Norwegian Data Inspectorate. Informed consent was obtained from all participants.

Conflict of Interest

S.-P. Neumer receives royalties from the sale of the Coping Cat manual.

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Helland, S.S., Baardstu, S., Kjøbli, J. et al. Exploring the Mechanisms in Cognitive Behavioural Therapy for Anxious Children: Does Change in Emotion Regulation Explain Treatment Effect?. Prev Sci 24, 214–225 (2023). https://doi.org/10.1007/s11121-022-01341-z

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