Citations

AbstractObjectiveThe goal of the current study is to advance efforts to increase the quality of care for childhood anxiety disorder (CADs) through (1) detailing the content of community‐based treatment sessions, (2) exploring the validity of therapist surveys, (3) examining the influence of setting differences, and (4) testing the effects of a technology‐based training on use of nonexposure strategies.MethodsThirteen therapists were randomly assigned to technology‐based training in the use of exposure therapy or treatment as usual (TAU) for CADs. Therapeutic techniques were coded from 125 community‐based treatment sessions.ResultsConsistent with survey responses community therapists spent the majority of session time reviewing symptoms (34% of session time), implementing nonexposure cognitive behavioral therapy (CBT; 36%), and rarely engaged in exposure (3%). An integrated behavioral health setting was associated with greater endorsement of exposure on survey, p < 0.05, although this difference was not significant in session recordings, p = 0.14. Multilevel models indicated that technology‐based training that has been shown to increase exposure, also decreased use of nonexposure CBT techniques (2% vs. 29%, p < 0.001).ConclusionThe study supports the validity of survey‐based findings that community‐based care for CADs consists of non‐exposure CBT techniques. Efforts should be invested in dissemination of within‐session exposure.

ABSTRACT: Background: When adolescents present with symptoms of unexplained weight loss, underweight, or poor appetite, eating disorders (EDs) are commonly on the list of differential diagnoses. However, the relationship of these symptoms to other psychiatric disorders is often less clear. Methods: Using the Rochester Epidemiology Project database, a retrospective cohort study of adolescents (13–18 years) with billing diagnoses of weight loss, underweight, or loss of appetite was conducted between January 2005 and December 2017. Patients who presented with conditions commonly associated with weight loss, underweight, or poor appetite (e.g., cancer) were excluded. This study sought to examine the proportion of patients who received ED and psychiatric diagnoses within 5 years of the index visit and patient characteristics associated with these diagnoses. Results: Of 884 patients diagnosed with symptoms of unexplained weight loss, underweight, or poor appetite, 662 patients (M age = 15.8; SD = 1.6; 66.0% female) met study criteria. Within 5 years of the index visit, the lifetime prevalence of all psychiatric disorders was 70% (n = 461) and of EDs was 21% (n = 141). For both psychiatric disorders and EDs, sex and race were significantly associated with receiving a diagnosis within 5 years. Decrease in body mass index (BMI) percentile was associated with receiving an ED diagnosis, whereas the highest historical BMI percentile was associated with receiving a psychiatric diagnosis. Conclusion: Patients presenting with symptoms of unexplained weight loss, underweight, or poor appetite are at risk not only for EDs but also for other psychiatric disorders that may require further assessment and follow-up.

Abstract Although community therapists rarely use exposure when treating youth with anxiety disorders, they are more likely to endorse the use of imaginal exposure, relative to in vivo or interoceptive exposure. Such use of imaginal exposure could reflect a sub-optimal replacement for in vivo exposure or a targeted intervention to address anxiety-provoking thoughts, such as in generalized anxiety disorder. The current study used the survey responses of 178 community-based clinicians to examine these competing hypotheses. The results indicated that therapist endorsement of more clearly defined imaginal exposure was significantly lower than other techniques such as cognitive restructuring or that imaginal exposure was other used instead of more intensive forms of exposures. In addition, most of the endorsed interventions were targeted at helping youth cope with anxiety rather than corrective learning. Alternatively, there was no observed association between imaginal exposure and treatment of general anxiety. These finding suggest that community therapist use of imaginal exposure is suboptimal and unlikely to improve treatment outcomes.

Abstract Exposure is the most important component of therapy for anxiety disorders and obsessive–compulsive disorder (OCD) in children and adolescents. Unfortunately, few clinicians offer this treatment, making it very difficult for youth and their families to seek effective care. In this installment of the Association for Behavioral and Cognitive Therapy’s Series on Implementation of Clinical Approaches, Whiteside, Ollendick, and Biggs deliver a succinct yet comprehensive guide to the use of exposure therapy with youth suffering from anxiety and OCD. Within the heart of this book, clinicians will discover a clear step-by-step model, illustrated with sample dialogue, for engaging their young patients in this most effective treatment. Detailed case examples bring to life the application of all forms of exposure (in vivo, imaginal, and interoceptive) to a wide range of anxiety and OCD presentations. Beyond teaching the mechanics for implementing exposure, the authors present a clinical model for understanding how exposure works, synthesizing the key issues from current competing theories. This model can enhance the ability of clinicians to apply exposure to new and more challenging presentations. In addition, the authors review common challenges to implementing exposure in real-world settings to assist clinicians in overcoming frequently encountered barriers. Clinicians can feel confident in the validity of the approach as the authors concisely review the foundation of history and research supporting exposure. Within this compact book, clinicians will find a comprehensive guide to build their expertise in the delivery of exposure therapy for children and adolescents suffering from anxiety disorders or OCD.

The current study extends the psychometric support for the Child Sheehan Disability Scale (CSDS) as a measure of impairment associated with childhood anxiety disorders, including obsessive compulsive disorder. The CSDS was completed by 1,481 predominately Caucasian youth (55.4% female) ages 8 to 17 ( M = 12.68, SD = 2.78) from primarily two-parent households and a parent across community, outpatient, intensive outpatient treatment, and residential settings. The results replicated and extended the previously found strong convergent validity, discriminant validity, and treatment sensitivity with a revised parent-report item in the larger sample. Moreover, the CSDS successfully differentiated between patients receiving treatment of different levels of intensity. These data were used to develop preliminary qualitative descriptors associating individual scores with a likely level of indicated treatment to enhance the clinical applicability of the CSDS. This study establishes the CSDS as one of the briefest and most rigorously evaluated measures of impairment associated with child anxiety. However, the performance of the CSDS must be examined in more representative samples before being applied to diverse populations.