Modularised CBT for children with anxiety disorders: client feedback and therapeutic alliance as predictors of treatment outcome.

BACKGROUND: Modularised CBT is a promising intervention for childhood anxiety disorders (ADs). AIMS: The purpose of this study was to examine whether client feedback informed treatment (FIT) predicts treatment outcome of children with ADs. In addition, the predictive role of therapeutic alliance on treatment outcome was investigated. METHOD: Participants were children aged 7-17 years who all received individual modular CBT for their ADs and who were randomly allocated to either feedback informed treatment (FI-mCBT) (n=38) or modular treatment without feedback (mCBT) (n=58). Therapists in FI-mCBT received feedback regarding the child's anxiety symptoms and treatment satisfaction after each session. Anxiety symptoms were measured with the SCARED-71 at pre-treatment, after five sessions (mid-evaluation), post-treatment, and at 10 weeks follow-up. Alliance was measured with the Working Alliance Inventory and reported by child, therapist and observer. RESULTS: No differences were found in decreases of anxiety symptoms between FI-mCBT and mCBT over time. Overall, therapeutic alliance did not predict decreases of anxiety symptoms over time. However, child reported therapeutic alliance was positively associated with anxiety symptoms in general. No effects were found for therapist and observer reported alliance. CONCLUSIONS: Our results suggest that providing therapists with feedback does not seem to improve treatment outcome for modular CBT in children with ADs. Therapeutic alliance did not predict treatment outcome in the context of modular CBT.