Therapist Behaviors During Exposure Tasks and Treatment Outcomes for Anxious Youth

Abstract Exposure tasks—where an individual confronts a feared stimulus/situation—are key in effective treatment for youth anxiety. However, optimal therapist behaviors during these exposures have not been determined. The current study examined the relationship between naturally occurring therapist behaviors that (a) increased, (b) decreased or (c) maintained the youth’s anxiety during exposures and treatment outcomes. Participants ( N = 107; ages 7–17) received cognitive behavioral therapy (CBT) for anxiety. Youth and their primary caregiver(s) completed a diagnostic interview and self- and parent-report measures pre- and post-treatment. Therapist behaviors in exposure session videos were rated by reliable coders. Youth showed significant improvement following CBT. The three broad categories of therapist behaviors (increase, decrease, maintain) occurred at a judicious rate and were not associated with differential outcomes. However, specific therapist behaviors during exposure significantly predicted outcome: greater therapist use of externalizing statements and encouragement of relaxation strategies predicted greater improvements. The use of more therapist behaviors to intensify the exposure predicted decreased odds of being a treatment responder. Findings indicate that although broad categories of therapist behaviors did not predict outcomes, specific therapist behaviors were significantly associated with differential outcomes.