Defense Date


Document Type


Degree Name

Doctor of Philosophy


Clinical Psychology

First Advisor

Michael A. Southam-Gerow, Ph.D.

Second Advisor

Bryce McLeod, Ph.D.

Third Advisor

Rosalie Corona, Ph.D.

Fourth Advisor

Terri Sullivan, Ph.D.

Fifth Advisor

Elizabeth Farmer, Ph.D.


The purpose of this exploratory study was to examine the extent to which pretreatment characteristics influence therapist treatment adherence by using data sampled from a randomized effectiveness trial and an efficacy study. Research suggests that youth-, family-, and therapist-level pretreatment characteristics influence therapist behavior; however, this area is underdeveloped as most studies have focused on externalizing problem areas, family-based approaches, and the use of parent or therapist report to assess for therapist adherence. To date, no research has examined this question with anxiety as the target problem, individual-focused CBT, and with observational therapist adherence data. An observational coding measure, Cognitive-Behavioral Therapy Adherence Scale for Youth Anxiety, was used to assess therapist adherence to CBT for youth anxiety. Hierarchical linear model analyses were conducted to estimate changes in therapist adherence over time, based on youth-, family-, and therapist-level pretreatment characteristic predictors. Results suggest that youth ethnicity/race, therapist openness to evidence-based practices, therapist theoretical orientation, and therapist age influence the process of therapy: in this case, therapist adherence. The current study provides essential evidence about potentially important predictors of therapist adherence for CBT youth anxiety and points to important clinical and treatment adoption implications.


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