Session Content in Parent-Coached Exposure Therapy Versus Cognitive Behavioral Therapy for Childhood Anxiety Disorders

Background Parent-Coached Exposure Therapy (PCET) is an intervention for childhood anxiety disorders that focuses predominantly on exposure and includes parents as exposure coaches. PCET was recently demonstrated to be more effective and efficient than traditional cognitive-behavioral therapy (CBT) in reducing anxiety symptom severity.Objective The aim of the current manuscript was to code the presence and duration of therapeutic techniques in session recordings to (1) demonstrate PCET and CBT were administered with high fidelity, (2) establish that PCET and CBT differ in purposeful ways, and (3) provide benchmarks for the delivery of PCET.Method Participants were 64 youth between 7–17yo (Age: M = 11.92, SD = 3.07, 68.8% Female, and 79.7% White) randomized to receive PCET (n = 37) or CBT (n = 24). One-third of the available session recordings (n = 119 recordings) were selected, and therapeutic elements were identified by trained and reliable coders (average Cohen’s kappa = 0.9) using a coding scheme geared toward exposure therapy and CBT techniques.Results PCET sessions contained significantly greater session time spent on exposure and significantly less time spent on anxiety management strategies (e.g. cognitive restructuring and relaxation) compared to CBT (ps < 0.05). In line with expectations, parents were present significantly more in PCET, with parents present for the majority of PCET sessions.Conclusions The results of the current analysis provide strong support that PCET differs in predicted and purposeful ways from traditional CBT. Findings also suggest that both interventions were delivered with fidelity. Benchmarks for implementing PCET to fidelity are also provided. ClinicalTrials.gov Identifier NCT05777161.