Temporal precedence in the identification of mediators of change: A brief comment on "Mediators of change in the child/adolescent multimodal treatment study" (Kendall et al., 2016).

OBJECTIVE: Comment on the issue of temporal precedence and the implications for interpreting the results of the mediation analyses in the Child/Adolescent Multimodal Treatment Study.

METHOD: Review of Kendall et al. (2016).

RESULTS: Kendall et al. reported that residualized (baseline to posttreatment) change in coping efficacy, but not anxious self-talk, mediated residualized (baseline to follow-up) change in anxiety symptoms in cognitive-behavior therapy (CBT), sertraline (SRT), and CBT + SRT compared to placebo. Because the measure of anxiety symptoms included data from follow-up, it was concluded that "the gains being referred to can be viewed as 'change following treatment'" (p. 8) and, therefore, the analyses captured "true temporal precedence" (p. 3). However, the anxiety scores represented an amalgam of change occurring within and after treatment, and available data suggest much of the anxiety change occurred during the treatment, the time when the change in coping occurred.

CONCLUSIONS: Given the measurement timeline, a clear and unambiguous claim of demonstrating temporal precedence is not justified. Nonetheless, these results remain important for other reasons when interpreted in the context of the broad cognitive-behavioral conceptual model of anxiety that led to the selection of these mediators for examination. (PsycINFO Database Record