Date of Submission


Degree Type


Degree Name

Doctor of Psychology (PsyD)



Department Chair

Robert A DiTomasso, PhD, ABPP, Chair, Department of Psychology

First Advisor

Elizabeth Gosch, PhD, ABPP, Chairperson

Second Advisor

Susan Panichelli Mindel, PhD

Third Advisor

Catherine M Barber, PhD


This study examined a mediation model of the relationship between play, process variables (child involvement and collaboration), and treatment outcome in a randomized clinical trial (RCT) of CBT for childhood anxiety disorders. Additionally, it explored the use of play in CBT for children. Participants (N=43; M age = 10.09) took part in a RCT which evaluated the effectiveness of an individual cognitive-behavioral treatment (ICBT) versus a family cognitive-behavioral treatment (FCBT), for childhood anxiety disorders. Archival data (videotaped treatment sessions) at a university based clinic for childhood anxiety disorders was coded for treatment interventions (play and cognitive-behavioral) and process variables (child involvement and collaboration). The Baron and Kenny (1986) model was used to examine the relationship between play, process variables, and treatment outcome and to increase understanding of the mediating effect of process variables. Results did not support the primary hypotheses that process variables (i.e., child involvement and collaboration) would mediate the relationship between play and treatment outcome because play was not a predictor of treatment outcome. However, exploratory analysis indicated that more play interventions were observed at the start of treatment, compared with mid-treatment, and also with younger children (seven to 11), compared with older children (12 and 13). More play interventions were observed during individual CBT sessions, compared with family CBT session, although the difference did not reach significance. Exploratory analysis provided support for the use of play in CBT for childhood anxiety disorders. These findings contribute to endeavors to identify and understand factors for change in CBT for children.