Date of Award


Degree Type


Degree Name

Doctor of Philosophy in Psychology


Clinical Psychology



First Advisor

Ellen C. Flannery-Schroeder


Cognitive-behavioral therapy (CBT) with exposure is an effective treatment for anxiety disorders but involves acute discomfort, rendering treatment engagement a challenge. Willingness to engage in exposure is of interest, because a child has to willingly approach a feared stimulus. This preliminary study investigated child engagement during exposures in CBT for anxiety disorders, with the development, validation, and field testing of a measure of self-efficacy over three time points. The measure, Self-Efficacy During Exposure-Child (SEE-C), is a 9-item, self-report measure of self-efficacy during exposure for youth 8-17 years old. A sample of eight reviewers at least 2-years post licensure (M = 14.06; SD = 4.71) with expertise in CBT for childhood anxiety provided feedback on the SEE-C’s face and content validity. Field testing included a sample of 24 child-parent dyads recruited from an anxiety clinic in the Northeast U.S. Child-parent dyads were asked to complete measures of child self-efficacy; child anxiety symptoms; and child school, social, and family functioning. Children were also asked to complete a measure of motivation. Analyses revealed the SEE-C to demonstrate significant increases in child self-efficacy, reductions in child anxiety symptoms, and increases in social and family functioning over treatment. Internal consistency of the SEE-C was acceptable to excellent, and exploratory principle component analysis suggested a three-factor solution, with loadings ranging from 0.5 to 0.9. The SEE-C adds to the literature as the first measure of child self-efficacy designed for use during exposure in CBT for anxiety. Findings provide insight into those factors that contribute to a child’s engagement during exposure. Reported effect sizes are promising and warrant greater investigation of the SEE-C’s utility.



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