Wednesday, October 11, 2017

Spending More Time on Exposure Tasks During CBT May Improve Outcomes in Anxious Youth

Encouraging youth with anxiety disorders to gradually confront anxiety-provoking situations is recognized as a key component of cognitive-behavioral therapy (CBT), but few studies have examined specific exposure characteristics that predict treatment outcomes. A study published Monday in the Journal of the American Academy of Child and Adolescent Psychiatry suggests the number of CBT sessions in which exposure tasks are practiced may predict treatment outcomes.

[T]he findings support the importance of prioritizing exposure tasks within CBT sessions, revealing a positive link between the number of sessions in which exposure is practiced and favorable outcome,” Tara S. Peris, Ph.D., of the UCLA Semel Institute for Neuroscience and Human Behavior and colleagues wrote. “This link appears to be especially important for younger children, whose developmental level may limit the benefit of cognitive restructuring, another critical element of treatment.”

Peris and colleagues analyzed a subset of data from youth aged 7 to 17 who participated in the Child/adolescent Anxiety Multimodal treatment Study (CAMS). The study participants, all whom had been diagnosed with separation anxiety disorder, generalized anxiety disorder, or social phobia, were randomly assigned to CBT (n = 139) or a combination of CBT and sertraline (n = 140) for 12 weeks. Youth in both groups received 14, 60-minute sessions; during CBT sessions 1-6, youth learned about skills for managing anxiety, and during CBT sessions 7-14, youth were exposed to anxiety-provoking situations. Youth in the combination therapy group also received sertraline (starting with 25 mg/day and adjusting up to 200 mg/day by week 8).

The researchers used regression analyses to examine the impact of five therapist-reported exposure characteristics on acute treatment outcomes: the percentage of treatment sessions that included exposure exercises; percentage of exposure sessions that included challenging (versus easy or medium) exposure tasks as rated by therapists based on each youth’s Subjective Units of Distress Scale ratings/symptom hierarchy; cumulative dose of exposure; average clinician rating of the youth’s skill mastery during sessions focused on exposure; and average clinician rating of the youth’s treatment compliance during sessions that focused on exposure.

These analyses revealed “a dose-response relationship between therapist-reported quantity of exposure and independent evaluations of treatment outcome, with more time devoted to exposure linked to better outcomes. Similarly, greater time spent on more difficult (rather than mild or moderate) exposure tasks predicted better outcomes, as did therapist ratings of child compliance and mastery,” the authors reported. The findings highlight the importance of collaborating with youth to understand the reasoning behind exposure practice and repeating/revisiting specific tasks to ensure a sense of mastery. 

For related information, see the Psychiatric News article “Child Psychiatrists Look at Specialty From Both Macro, Micro Perspectives.”

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