Behavioral Practice and Homework Completion as Predictors of Outcome in a Transdiagnostic Brief Behavioral Therapy for Anxiety and Depression in Youth.

Exposure and behavioral activation have been identified as key therapeutic components in evidence-based treatment for youths with anxiety and depression, respectively. The current study expanded this work to transdiagnostic treatment for youths with anxiety and depression and examined links between (a) amount of in-session exposure/behavioral activation, (b) out-of-session homework completion, and (c) anxiety, depression, and functioning outcomes of youths following a brief behavioral therapy. Therapy data were examined from 95 youths (ages 8-16; 56.8% female; 74.7% non-Hispanic White) with anxiety and/or depressive disorders who completed a transdiagnostic Brief Behavioral Therapy (BBT) as part of a randomized effectiveness trial. Observers recorded the occurrence of in-session youth participation in active behavioral practice (Minutes Practice) throughout session, and therapists rated Homework Completion after each session. Posttreatment outcomes (Week 16) included global functioning (Clinician Global Assessment Scale; CGAS) and disorder-specific clinician-rated measures of anxiety (Pediatric Anxiety Rating Scale; PARS) and depression (Children's Depression Rating Scale-Revised; CDRS-R). Controlling for baseline functioning, higher levels of in-session Minutes Practice were associated with higher youth functioning posttreatment (CGAS). Similarly, greater homework completion was associated with improved anxiety outcome (PARS), controlling for baseline PARS. Neither process was significantly associated with youth depression posttreatment. In sum, behavioral practice both in- and between-sessions appears beneficial for improving global functioning and anxiety outcomes in a transdiagnostic treatment for pediatric anxiety and depression. We discuss findings in the context of this intervention (primarily behavioral), sample (e.g., primarily anxious), and complex youth and family characteristics that may influence both in- and between session processes and outcomes.