Family Factors in Child Anxiety Treatment Trajectory and Outcome: An Examination Using Hierarchical Linear Modeling and Profile Analysis via Principal Component Analysis

Katherine Bassell Crowe, Fordham University


Well-supported interventions for child anxiety include cognitive behavior therapy (CBT) and pharmacotherapy, yet even these approaches leave many symptomatic. Family variables have been previously investigated for their role in child anxiety treatment to explain differential treatment response. Past research has demonstrated that existing family dysfunction and caregiver strain predict poorer response to CBT but also that these family variables improve over the course of treatment, even when not directly targeted. This research investigated how these family variables differentially predict treatment trajectory and response—as measured by both anxiety symptoms and functional impairment—across CBT-based and pharmacotherapy-only interventions (Aim 1). It additionally investigated how constellations of child and family variables differ across treatment responders to these approaches (Aim 2). A total of 488 youth with a primary anxiety disorder completed a 12-week trial of either sertraline (SRT), CBT (CBT), a combination of both (COMB), or a pill placebo (PBO). Hierarchical linear modeling was used to examine Aim 1, and profile analysis via principal component analysis was used to examine Aim 2. Regarding Aim 1, family functioning was not predictive of treatment trajectory or response. However, treatment group significantly moderated the relationship between caregiver strain and functional impairment: lower baseline strain predicted better functioning at treatment's end for participants receiving CBT compared to PBO, and higher strain predicted better functioning for participants receiving COMB compared to CBT. Greater reductions in caregiver strain also predicted greater reductions in anxiety symptoms and impairment over time and at treatment's end across groups. Regarding Aim 2, total severity of profiles of baseline child and family variables did not differ between treatment responders and non-responders. Significant differences did exist between coordinates of profiles of treatment responders across the active treatment conditions, particularly SRT compared to CBT and COMB. COMB and CBT profiles had higher scores on child anxiety and global impairment and subjective caregiver strain. The SRT profile had higher child anxiety-related impairment and depressive symptoms and parental distress than the other groups. In sum, caregiver strain may be particularly important for understanding response to anxiety interventions generally as well as to particular interventions. Further, these findings demonstrate how constellations of baseline child and family variables can be used to facilitate treatment matching.

Subject Area

Clinical psychology

Recommended Citation

Crowe, Katherine Bassell, "Family Factors in Child Anxiety Treatment Trajectory and Outcome: An Examination Using Hierarchical Linear Modeling and Profile Analysis via Principal Component Analysis" (2018). ETD Collection for Fordham University. AAI10746295.