Symposia
Child / Adolescent - Anxiety
Emily Bilek, ABPP, Ph.D.
Clinical Assistant Professor
University of Michigan
Ann Arbor, Michigan
Background: Increasing youth perseverance through difficult tasks might boost participation in difficult exposures, which could in turn improve treatment response (e.g., Peris et al., 2017). Self-distancing [SD], or taking an outsider’s perspective, is a simple cognitive strategy which has been shown to increase task-based perseverance in youth (White et al., 2016). It has also been linked to emotion regulation, executive function, and engagement with anxiety provoking stimuli (e.g., Moser et al., 2017; White & Carlson 2016; Streamer et al., 2017). This presentation will present proof of concept and acceptability data from a pilot trial examining SD as an augmentation for exposure therapy.
Method: Nine youth with clinically significant anxiety, ages 11-17 (M: 14) completed 8-sessions of treatment (6 exposures). Each participant received exposures both with (EXSD) and without (EX) SD (counter-balanced ABA/BAB design). One group (n=5) received a “large” dose (4 sessions) of EXSD and one group (n=4) received a “small” dose (2 sessions) of EXSD.
MEASURES: Youth and therapists reported on Exposure Difficulty and Engagement. Caregivers and youth reported on anxiety severity (SCARED) and completed a Treatment Acceptability Questionnaire (TAQ).
Results: Due to sample size, analyses should be interpreted with caution. Therapists and youth reported higher levels of Exposure Difficulty in the large EXSD dose group than the small dose group (M differences >.5, ns). Therapists reported slightly higher Exposure Engagement on EXSD exposures than EX exposures (M differences >.5, ns); youth did not corroborate this report. Caregivers reported trend reductions in anxiety from pre- to post- (M:38.4-32.7; change: -5.7; t(8)=2.1, p=0.07); youth did not report this to the same extent (M:41.6-38.2; change: -3.4; t(8)=1.5, ns). However, youth in the large dose group reported more improvement (M change: -6.2) than the small dose group (M change: +.3; t(7)=-1.4, ns), though this was still not significant and caregivers did not corroborate. TAQ revealed high levels of acceptability with treatment and exposure by both caregiver and youth report. Varying levels of acceptability of SD were reported by youth.
Conclusion: This small pilot provides the first support for SD as a deployable strategy to increase youth engagement in difficult exposures. A well powered RCT is planned to confirm whether EXSD can increase Exposure Difficulty/Engagement and examine impact on treatment outcomes. Limitations and additional implications will be discussed.