Treatment Mechanisms, Community Empowerment, & Technology Innovations (TCT) Lab

Background: Numerous randomized controlled trials (RCTs) have examined the e ﬃ cacy of cognitive behavioral therapy (CBT) in reducing anxiety symptoms. However, relatively fewer studies have examined the e ﬀ ectiveness of CBT in naturalistic treatment settings. There is even less known about the mechanisms underlying successful outcomes in naturalistic samples receiving CBT. This study aimed to examine the absolute and relative mediation of emotion regulation (ER) di ﬃ culties and anxiety sensitivity (AS) on anxiety symptom reduction. Methods: Participants were treatment-seeking patients ( N = 247) at an outpatient anxiety clinic. Measures of di ﬃ culties in ER, AS, and disorder speci ﬁ c symptoms were administered at baseline, mid, and post-treatment. A composite anxiety score was calculated to measure anxiety disorder symptom severity across anxiety-related diagnoses. Results: Individual mediation models revealed that both AS and ER signi ﬁ cantly mediated the reduction in anxiety-related symptoms over the course of treatment. A multiple mediation model found that ER was the strongest mediator (indirect e ﬀ ect = − 1.030, 95% CI = − 2.172 to − 0.153). Further analyses revealed that the ER subscale of impulse control di ﬃ culties (e.g., the tendency to avoid when confronted with a feared stimulus) was the strongest mediator (indirect e ﬀ ect = − 0.849, 95% CI = − 1.913 to − 0.081). Limitations: This study relied solely on self-report measures of ER, AS, and anxiety pathology, and did not have a control group. Conclusions: These results suggest that improvement in the ability to control impulses may act as a mechanism of anxiety symptom reduction and may be important to target in CBT with naturalistic samples. Abstract Childhood is a developmental period associated with high risk of posttraumatic stress disorder (PTSD). Available validated pencil-and-paper diagnostic tools can be difficult for younger children to engage with given format and length. This study investigated psychometric properties of a briefer, more interactive game version of the Child PTSD Symptom Scale for DSM-5 (CPSS-5). Participants ( n = 49) were children attending primary care appointments between 8 to 12 years of age who were exposed to a DSM-5 Criterion A trauma. Participants completed the 6-item screening version of the CPSS-5 delivered in mobile tablet game format (the CPSS-5 Screen Team Game) and a self-report version of the full CPSS-5 (CPSS-5-SR) before their medical appointments. The mobile game showed adequate internal consistency ( α = 0.79), was significantly positively correlated to the total CPSS-5-SR ( r = .74, p < .001, n = 49), and with the total of the six identical items of the CPSS-5-SR ( r = .79, p < .001, n = 49), demonstrating good convergent validity. Receiver operating characteristic (ROC) analyses revealed a cut-off score of 9 on the screening game as indicative of probable PTSD. Implementation of this screening game into primary care settings could be a low-burden method to greatly increase the detection of pediatric PTSD for referral to appropriate integrated care interventions. Screen items into a more interactive, game format was conceived by co-authors Dr. Judith Cohen and Dr.AnthonyMannarino. Thefinalproductofthe CPSS-5ScreenTeamGame was developed through a collaboration between the Center for Traumatic Stress in Children and Adolescents at Allegheny Hospital and the Entertainment Technology Center of Carnegie Mellon University, with sup- port from the Highmark VITAL Program. The CPSS-5 Screen Team Game will be available at no cost from the Apple Store and Google Play.