{"doi":"10.1016/j.jaacop.2025.04.003","title":"Exposure-Focused Cognitive-Behavioral Therapy for Youth Anxiety Disorders: Superiority Over Relaxation-Based Comparator and Predictors of Response","abstract":"Objective Evidence supports exposure-focused cognitive-behavioral therapy (EF-CBT) for child and adolescent anxiety disorders, but protocols comparing EF-CBT with other therapy modalities (eg, relaxation) are understudied, and little is known about predictors of EF-CBT response. Extending an interim report, this study compared EF-CBT with an active comparator, relaxation and mentorship training (RMT), and examined predictors of EF-CBT response. Method Participants were 139 youths with transdiagnostic anxiety disorders (age range 7-18 years, mean age 12.3). Sample demographics were male, 24.5%; female, 75.5%; Asian, 0.7%; Black, 5.8%; multiracial, 0.7%; other, 0.7%; other Pacific Islander, 11.5%; unknown, 2.9%; White, 77.7%; 5.8% Hispanic/Latino. Participants were randomized (2:1 ratio) to 12 sessions of EF-CBT (n = 94) or RMT (n = 45). Treatment response was determined by independent evaluator ratings on the Pediatric Anxiety Rating Scale and the Clinical Global Impressions–Improvement scale. Results EF-CBT was associated with 3.53 higher odds of treatment response based on Clinical Global Impressions–Improvement scale (EF-CBT 47.1%, RMT 20.1% response rate) whether delivered in person or via teletherapy. Notably, age moderated EF-CBT response, such that younger age predicted better outcomes ( F 1,89 = 4.38, p = .04). By contrast, number of anxiety diagnoses, comorbid externalizing symptoms, and subclinical depressive symptoms did not predict EF-CBT outcomes. Conclusion As expected, EF-CBT was more effective than the RMT comparator. Greater improvement in younger patients receiving EF-CBT suggests that response to exposure may be developmentally sensitive. Plain language summary 139 youths with clinical anxiety disorders received either exposure-focused cognitive-behavioral therapy (EF-CBT) or a relaxation-focused treatment (RMT). Youth who received EF-CBT were 3.5 times more likely to respond better to treatment than those who received RMT. Younger age was associated with better outcomes in EF-CBT, which may inform clinician use of exposure therapy. Clinical Trial Registration Information Dimensional Brain Behavior Predictors of CBT Outcomes in Pediatric Anxiety (Anxiety-CBT); https://clinicaltrials.gov/study/NCT02810171","journal":"JAACAP Open","year":2025,"id":519446,"datarank":0.3102982443419206,"base_score":1.9459101490553132,"endowment":1.9459101490553132,"self_citation_contribution":0.29188652235829704,"citation_network_contribution":0.018411721983623546,"self_endowment_contribution":0.29188652235829704,"citer_contribution":0.018411721983623546,"corpus_percentile":null,"corpus_rank":null,"citation_count":6,"citer_count":3,"citers_with_citation_signal":1,"citers_with_endowment":1,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9586,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT02810171"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1102409,"name":"Ann M. Iturra‐Mena","orcid":"0000-0001-9485-7539","position":1,"is_corresponding":false},{"id":238332,"name":"Hannah Becker","orcid":"0000-0001-6944-1208","position":2,"is_corresponding":false},{"id":284530,"name":"K. Luan Phan","orcid":"0009-0004-8693-6690","position":3,"is_corresponding":false},{"id":282959,"name":"Christopher S. Monk","orcid":"0000-0001-9391-4669","position":4,"is_corresponding":false},{"id":237643,"name":"Kate D. Fitzgerald","orcid":"0000-0002-6502-7031","position":5,"is_corresponding":false},{"id":672783,"name":"Emily L. Bilek","orcid":"0000-0003-3122-3840","position":0,"is_corresponding":true}],"reference_count":57,"raw_metadata":null,"created_at":"2026-07-19T02:49:18.751199Z","pmid":"41367992","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}