Are changes in children's communication patterns predictive of treatment outcomes for children with anxiety?

Anxiety is the most prevalent childhood psychopathology. Cognitive behavioural therapy is considered the most effective treatment, but outcomes remain variable. This study investigated children's communication patterns in child-therapist conversations and whether changes in these patterns, from rigid to more flexible, were associated with better treatment outcomes. Fifty-three children (31% boys), with a mean age in years of M = 9.68 (SD = 1.85), completed a 12-week cognitive behavioural therapy program. Maternal as well as children's reports of children's anxiety were assessed pretreatment and posttreatment. Additionally, 15-min segments of two therapy sessions were audiotaped and children's conversational turns were coded for properties of response and initiative. The structure of children's communication patterns was further quantified using recurrence quantification analysis. As expected children entering treatment were characterised by rigid and inhibited conversational behaviour. Children who became less repetitive and deterministic over time had better maternal-rated treatment outcomes. These findings did not generalize to child reports. Last, the hypothesis that the positive relation between the breaking of rigid communication patterns and treatment outcome would be mediated by increases in proactive conversational behaviours of the child was only partly supported. These study findings contribute to the emergent literature on processes of change in childhood anxiety treatment by providing initial support for the hypothesis that breaking rigid (communication) patterns may be a prerequisite of clinical change.