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Answer those questions from Multi-informant Expectancies and Treatment Outcomes for Anxiety in Youth, APA format 1 page? a. Describe Research design and method. 1. Was the Population clearly identified and described; 2. How were study participants chosen 3. Was sample size adequate and biases minimized? b. Data collection and measurement: 1. Were key variables operationalized? 2. Were instruments used to measure valid and reliable? c. Procedures: 1. Did researcher take reasonable steps to assure accurate and complete data. 3. Results: a. What Statistical method was used? b. What were the results? Include level of significance and if the results appear likely and could be reproduced. c. Were study limitations clearly defined? What were they? 4. Summary: a. Despite limitations, do study findings appear valid? b. Do the results provide an answer to your PICOT question? c. Do the results apply to your identified patient population? 5. Review this appraisal along with the other selected studies and synthesize an answer to the following question posed by the IOWA Model: a. Is there sufficient evidence to recommend a practice change? YES or NO b. Identify next step? 

 

-the article : Multi-informant Expectancies and Treatment Outcomes for Anxiety in Youth..

Abstract Expectancies for a favorable treatment outcome have been associated with actual favorable outcomes but have been understudied in youth with anxiety. The current study applied structural equation modeling in a sample of anxious youth (N=488; 7-17 years, M=10.69, SD=2.80) to examine whether a multi-informant latent expectancies factor, indicated by youth, parent, and therapist reports, predicted a latent posttreatment anxiety factor, controlling for a latent pretreatment anxiety factor. Both anxiety latent factors were indicated by youth, parent, and independent evaluator (IE) reports. Analyses also examined whether treatment condition (cognitive behavioral therapy, sertraline, combination, pill placebo) moderated the association between expectancies and outcome, and whether this association difered across development. Findings indicated that informant reports loaded similarly onto the latent factors. Results also demonstrated that treatment expectancies were positively associated with outcomes, and that this relationship held across treatment type and age group. Treatment implications and future research directions are discussed. Keywords Anxiety disorders · Behavior therapy · Cognitive therapy Expectancies about psychological and pharmacological therapies are defned as “anticipatory beliefs that clients bring to treatment and can encompass beliefs about the procedures, outcomes, therapists, or any other facet of the intervention and its delivery” [1]. Although the construct of “expectancy” has been operationalized somewhat diferently across studies, its core is the belief that the treatment will lead to improvements in functioning and symptom reduction at posttreatment [2]. These expectancies have been examined as non-specifc factors associated with outcome across a variety of treatments and a range of disorders in adult samples [2-4], with results from most studies supporting the hypothesis that adult clients who expect to beneft more from treatment do, in fact, show increased beneft [5]. However, it is unlikely that fndings pointing to a positive association between expectancies and outcomes for adults automatically generalize to youth [1, 6]. Primary caregivers are typically in control of treatment decisions for youth and they play a role in implementation of homework assignments and/or medication administration [7]. In addition, relational processes between therapist and client may be diferent with younger clients compared to adult clients [6]. Thus, multiple expectancies (e.g., parent, therapist, and youth) are likely involved when considering treatment outcomes for youth compared to adults, and the relative contribution of multiple individuals must be considered when examining whether * Lesley A. Norris t..1@temple.edu 1 Department of Psychology, Temple University, Philadelphia, PA, USA 2 Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA 3 New York State Psychiatric Institute—Columbia University Medical Center, New York, NY, USA 4 Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA 5 Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA 6 Department of Psychiatry, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA 7 Duke University Medical Center, Durham, NC, USA 8 Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA Child Psychiatry & Human Development (2019) 50:1002-1010 1003 1 3 the relationship between expectancies and outcomes holds in samples of youth. The majority of studies that have examined expectancies in youth have focused on the role that parent expectancies play in treatment attendance (and/or withdrawal). Early work reported that increased discrepancy between caregiver expectancies was associated with treatment termination, highlighting the importance of examining the expectancies of multiple individuals when predicting outcomes [8-11]. A more recent study found that mothers with lower selfreported expectancies for parent training reported increased barriers to treatment participation [1]. In this study, a curvilinear relationship was documented between maternal expectancies and termination, with mothers reporting either high or low expectancies attending the most sessions. Conversely, another study reported a positive linear relationship between parent expectancies of their child’s academic performance and attendance in a treatment protocol designed for adolescent substance abuse [12]. Finally, additional results demonstrated that an experimental manipulation of parent pretreatment expectancies led to increased treatment utilization, but not improved attendance rates [13]. Thus, although fndings are somewhat mixed, results highlight a potential association between parent expectations and adherence to youth treatments. Comparatively fewer studies have examined the role that expectancies play in youth treatment outcomes. These studies provide preliminary evidence that youth and therapist expectancies together may be important in predicting outcomes for youth with internalizing disorders. In one study examining an exposure-based treatment of childhood obsessive compulsive disorder (OCD), youth, parent, and therapist expectancies were examined separately as predictors of both symptom improvement and post-treatment OCD symptom severity [14]. Youth and therapist expectancies predicted unique variance in symptom improvement, although only therapist expectancy predicted unique variance in post-treatment OCD symptom severity. Thus, therapist expectancies showed similar but non-overlapping associations to child expectancies with post-treatment outcome, suggesting that the relative contribution of multiple informants’ treatment expectancies should be examined. The Treatment for Adolescents with Depression Study (TADS) similarly found that adolescents (ages 12-17) with higher treatment expectancies showed more positive outcomes across treatment conditions, although therapist expectancies were not examined [15]. Surprisingly, given the well-documented association between parent expectancies and treatment adherence, parent expectancies were not associated with outcomes in either study. However, it is possible that parent expectancies are associated with outcomes diferentially across development, given that children are more dependent on caregivers for medication administration and treatment attendance than adolescents. In addition, parent expectancies may be more important in predicting outcome for diferent diagnostic profles, particularly anxiety disorders. Successful treatment of youth anxiety disorders has been linked in part to reduction in parental accommodation of youth anxiety symptoms [16] and parents are often asked to facilitate at-home exposures in CBT protocols (e.g., setting up and coaching youth through exposures; not responding to reassurance seeking behaviors). It is possible that given the importance of parents in youth anxiety treatment, parental expectancies may play a more meaningful role in outcomes for anxious youth than in other populations. Expectancies remain an understudied concept for treatment-seeking youth with anxiety disorders. However, studies using the Child and Adolescent Multimodal Study (CAMS) sample, the largest youth anxiety intervention study to date, have highlighted the role of expectancies as predictors of general treatment adherence (e.g., session attendance, medication adherence, and exposure compliance). For example, one study using CAMS data found that youth and their caregiver’s positive pretreatment expectancies for how Cognitive Behavioral Therapy (CBT) and combination of CBT and Sertraline (COMB) would afect youth anxiety were signifcantly associated with greater exposure compliance, and that compliance mediated the relationship between pretreatment expectancies and outcome at posttreatment, although the sertraline (SRT) and pill placebo (PBO) conditions were not examined [17]. Using the same measure of expected improvement, two other studies found that increased parent and child expectancies predicted increased medication adherence [18], and that increased parent expectancies predicted increased session attendance [19]. Although these studies demonstrated an association between expectancies and treatment adherence and suggested a potential indirect role between expectancies and treatment outcome, expectancies were not directly associated with outcome in the one study to examine this association directly [20]. Analyses to date in the CAMS sample have examined youth and parent expectancies separately within treatment conditions, rather than assessing the relative combination of multiinformant expectancies across treatment types to determine whether diferent informants’ expectancies predict outcome diferentially across treatment conditions. The expectancy construct has also been operationalized primarily as expected improvement unique to each active treatment condition. Specifcally, youth and their caregivers (but not therapists) were asked “how much do you think (CBT, medication, or combination) will afect your anxiety?” with responses ranging from very much improved to very much worse. This assessment of expectancies of symptom improvement has not been paired with an assessment of more general expectancies for increased real-world, functional outcomes and is not in line with studies pointing to expectancy as a non-specifc predictor for a range 1004 Child Psychiatry & Human Development (2019) 50:1002-1010 1 3 of treatments. In addition, this assessment of expectancies rests on the assumption that youth and their caregivers presented to the study with some understanding of the four treatments under study in CAMS. Although this may have been the case for individuals who opted to enroll in a randomized controlled trial (RCT) for youth anxiety treatment, it is likely that clients who present to real-world clinics may have less specifc expectancies about treatment outcome that would be better assessed using more general measures. In addition, past CAMS studies have not examined therapist expectancies, which might be important to consider given that therapist expectancies have been associated with outcome in other samples. Thus, studies are needed to examine how youth, parent and therapist expectancies for changes in anxiety symptoms and quality of life are associated with posttreatment outcomes across all treatment conditions so that results will be more generalizable to realworld clinical settings. The current study examined the degree to which a latent expectancies factor, indicated by youth-, parent-, and therapist-reported expectancies for posttreatment (1) control over anxiety, (2) change in anxiety overall, and (3) improvement in life overall predicted a latent posttreatment anxiety factor, indicated by youth, parent, and Independent Evaluator (IE) reports of youth anxiety. Creation of a latent expectancies factor indicated by three informant reports allowed for the comparison of relative contributions of youth, parent, and therapist expectancies to outcomes, rather than examining each informant in isolation, and better accounted for measurement error. The relationship between expectancies and posttreatment anxiety was then examined controlling for a latent pretreatment anxiety factor, indicated by youth, parent, and IE reports. The four treatment conditions (CBT, SRT, COMB, and PBO) were examined as a potential moderator, and model ft was compared for children and adolescents. PBO was included given the positive association between expectancies and pill placebo response in the CAMS sample [21]. It was hypothesized that: (1) higher expectancies, controlling for pretreatment anxiety, would predict decreased posttreatment anxiety, (2) the positive relationship between expectancies and posttreatment anxiety would not difer across treatment conditions, and (3) the models would difer across developmental stage, with child and therapist expectancies loading more substantially onto the expectancy factor for adolescents, and parent expectancies loading more substantially onto the expectancy factor for children. Methods Participants Youth ages 7-17 (N = 488; M = 10.69, SD = 2.80) meeting Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) [22] criteria for a principal diagnosis of Separation Anxiety Disorder (SAD), Social Anxiety Disorder (SoP), Generalized Anxiety Disorder (GAD), or a combination participated, after completing informed assent/consent as approved by Internal Review Boards at each site. Study method and sample demographics are reported elsewhere [23, 24]. Measures Pediatric Anxiety Rating Scale (PARS) [25] The PARS is a general measure of youth and adolescent anxiety severity that includes the 50-item symptom checklist and a 7-item severity scale. The symptom checklist asks youth, parents and IEs to indicate presence or absence of anxiety symptoms during the past week. Anxiety symptoms are categorized into social interactions or performance situations, separation, generalized, specifc phobia, acute physical signs and symptoms, and other. The severity scale asks the youth, parents and IEs to rate number, frequency, severity, avoidance, and interference concurrent with anxiety symptoms in the past week along a scale of 0 (none) to 7 (extreme). The combined severity scale items yield a total score, which was used as the primary measure of pre (baseline) and posttreatment anxiety. The PARS has demonstrated inter-rater reliability (r=0.97), internal consistency (α=0.64) and retest reliability (r=0.55) [25]. Treatment Expectancies Treatment expectancies were assessed using a 3-item multi-informant measure administered after youth and their primary caregivers completed their frst session of active treatment or placebo. Youth, caregivers, and the care provider (therapist or psychiatrist) indicated expected improvement for youth following treatment. Informants were asked to indicate along a scale of 1 (strongly disagree) to 5 (strongly agree) whether they expected the youth would (1) have better control over his or her anxiety, (2) be less anxious overall, and (3) have life improve overall after treatment. The 3-item treatment expectancies measure demonstrated internal consistency for youth—(α=0.85), parent—(α = 0.93), and therapist—(α = 0.89) reports in the current sample. Responses for these three items were averaged to yield a treatment expectation score for each informant. Averaging was selected rather than summing the three items together to reduce the impact of missing data. Informant expectancies within each of the four treatment conditions are presented in Table 1. Child Psychiatry & Human Development (2019) 50:1002-1010 1005 1 3 Procedure Eligible youth and their primary caregivers were randomized into (1) CBT (Coping Cat; N=139), (2) medication (Sertraline SRT; N=133), (3) Combination of CBT and SRT (COMB; N=140), or (4) pill placebo (PBO; N=76). Participants in the CBT and COMB conditions completed fourteen sessions of the Coping Cat treatment protocol [26] over 12 weeks. Youth and their primary caregivers (both biological parents when possible) were assessed at baseline (week 0), week 4, week 8, posttreatment (week 12) and throughout a 36-week naturalistic follow-up period using the same battery of youth, parent and IE measures. Analytic Plan Using Mplus Version 7.31 [27], three latent constructs (expectancy, pretreatment anxiety, and posttreatment anxiety) were created. Expectancy was indicated by average youth-, parent-, and IE-reported expectancy scores. Average expectancy scores were calculated by averaging all complete items of the treatment expectancy measure, which better accounted for missingness than summing the three items together. Pretreatment anxiety was indicated by youth-, parent-, and IE-reported PARS total score at pretreatment. Posttreatment anxiety was indicated by youth-, parent-, and IEreported PARS total scores at posttreatment. Latent anxiety factors were selected as measures of pre- and post-treatment anxiety severity rather than using scores from reliable IEs alone so that measurement-level diferences in how much each informant contributed to the latent construct could be examined, and to better account for measurement error. The variance of the three latent constructs were constrained at 1 so that the factor loadings could be freely estimated. A free and a constrained model were then ft to the data to examine whether the four treatment conditions moderated the relationship between expectancy and posttreatment anxiety, allowing for covariance between the pretreatment anxiety and expectancy latent constructs. In the free model, differences in the relationship between the three latent factors were permitted across treatment conditions (CBT, COMB, SRT, and PBO). In the constrained model, diferences were not permitted across treatment conditions. A non-signifcant Chi square diference test between the two models was considered an indication that the more parsimonious constrained model should be retained, whereas a signifcant Chi square diference was considered an indication that the free model should be retained. Model ft for the selected model, either constrained or free, and the relationships among the latent factors were then examined. If the free model was the optimal ftting model, pairwise diferences across treatment conditions were examined to determine whether relationships among factors varied for each of the four treatments. However, if the constrained model was retained, results were interpreted similarly to an omnibus ANOVA test and followup comparisons within treatment conditions (e.g., diferences between CBT versus medication) were not examined. To examine if model ft difered by development, a child (7-12 years) and adolescent (13-17 years) grouping variable was created. Regression paths from the expectancies latent factor to the posttreatment latent anxiety factor were compared across the two groups to determine whether there were signifcant diferences. Results Bivariate correlations between multi-informant expectancy and youth anxiety measures were examined (Table 2). Patterns of intercorrelations showed signifcant positive associations across youth (M = 3.90, SD = 0.91, range 1-5), parent (M = 4.02, SD = 0.85, range 1-5), and therapist (M =4.35, SD =0.67, range 2-5) expectancies. However, all correlation coefcients fell in the small range, suggesting a weak positive linear relationship among youth, parent, and therapist expectancies. Youth, parent and therapist average expectancies were not signifcantly associated with youth—(M = 15.77, SD = 5.86, range 0-30), parent—(M =18.46, SD =4.79, range 5-30), or IE-reported (M =19.16, SD =4.20, range 7-30) PARS total scores at baseline. Across all informants, PARS total scores at baseline were negatively correlated with PARS total scores at posttreatme

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