Between- and within-person relations between treatment modules and symptom improvements across six randomized controlled trials

J Consult Clin Psychol. 2025 Nov;93(11):735-748. doi: 10.1037/ccp0000972.

ABSTRACT

OBJECTIVE: Most youth psychotherapies contain multiple treatment elements; little is known about their relative effectiveness. We assessed symptom improvements associated with treatment elements, represented by modules within modular psychotherapy.

METHOD: Data from six clinical trials of the modular approach to therapy for children with anxiety, depression, trauma, or conduct problems modular psychotherapy were combined (N = 490; 5,403 sessions; 6-15 years) to test effects of modules grouped into seven common treatment principles: feeling calm (e.g., relaxation strategies), increasing motivation (e.g., contingency management), repairing thoughts (e.g., cognitive restructuring), solving problems (e.g., problem solving), trying the opposite (e.g., exposure), engagement/psychoeducation (e.g., building rapport), and future planning (e.g., planning skill use). Multilevel models with autoregressive covariance controlled for previous symptoms, session number, and baseline symptoms; accounted for temporality with each session occurring prior to associated outcomes; importantly, we modeled associations between outcomes and between- and within-person use of treatment principles. Measures included weekly youth- and caregiver-reported internalizing, externalizing, and total symptoms, plus idiographic top problems.

RESULTS: A between-person effect linked future planning (Bs = -.369 to -.368; ps < .05) to better outcomes. Better within-person effects were observed for increasing motivation (Bs = -0.087 to -0.057; ps < .05), trying the opposite (Bs = -.087 to -.056; ps < .05), and future planning (B = -0.146; p < .001). Six outcomes showed worse within-person effects for engagement/psychoeducation (Bs = .036-.099; ps < .05); efforts to build engagement drove this finding; those efforts were associated with less use of skills-focused principles.

CONCLUSIONS: Increasing motivation, trying the opposite, and future planning were associated with especially good outcomes; therapists’ engagement attempts were associated with less focus on skill building and poorer immediate outcomes. Results may inform youth psychotherapy decision-making research and practice. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

PMID:41182706 | DOI:10.1037/ccp0000972