Thompson E. Davis

One-Session Treatment of Specific Phobias in Youth: A Randomized Clinical Trial in the United States and Sweden.

One hundred and ninety-six youth, ages 7-16, who fulfilled Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for various specific phobias were randomized to a one-session exposure treatment, education support treatment, or a wait list control group. After the waiting period, the wait list participants were offered treatment and, if interested, rerandomized to 1 of the 2 active treatments. The phobias were assessed with semistructured diagnostic interviews, clinician severity ratings, and behavioral avoidance tests, whereas fears, general anxiety, depression, and behavior problems were assessed with self- and parent report measures. Assessments were completed pretreatment, posttreatment, and at 6 months following treatment. Results showed that both treatment conditions were superior to the wait list control condition and that 1-session exposure treatment was superior to education support treatment on clinician ratings of phobic severity, percentage of participants who were diagnosis free, child ratings of anxiety during the behavioral avoidance test, and treatment satisfaction as reported by the youth and their parents. There were no differences on self-report measures. Treatment effects were maintained at follow-up. Implications of these findings are discussed.

One-session treatment of specific phobias: a detailed description and review of treatment efficacy.

One-Session Treatment (OST) is a form of massed exposure therapy for the treatment of specific phobias. OST combines exposure, participant modeling, cognitive challenges, and reinforcement in a single session, maximized to three hours. Clients are gradually exposed to steps of their fear hierarchy using therapist-directed behavioral experiments. Although there are several studies in the literature examining the efficacy of OST, little has been done to summarize this research. In the following review, research on and empirical support for OST are reviewed with an emphasis on the types of stimuli, samples, and methodologies utilized. Research generally supports OSTs efficacy, although replication by independent examiners using adult and child samples is needed using more rigorous comparisons (e.g., psychological placebo or other treatments). Overall, OST continues to be a promising treatment for specific phobias; however, a great deal more investigation is needed to identify mechanisms of change, mediators, and moderators.

Evidence-based treatment of anxiety and phobia in children and adolescents: current status and effects on the emotional response.

Research on treatments for childhood anxiety disorders has increased greatly in recent decades. As a result, it has become increasingly necessary to synthesize the findings of these treatment studies into reviews in order to draw wider conclusions on the efficacy of treatments for childhood anxiety. Previous reviews of this literature have used varying criteria to determine the evidence base. For the current review, stricter criteria consistent with the original Task Force (1995) guidelines were used to select and evaluate studies. Studies were divided by anxiety disorder; however, many studies combine various anxiety disorders in their samples. As a result, these were included in a combined anxiety disorder group. Using more traditional guidelines, studies were assigned a status of well-established, probably efficacious, or experimental based on the available literature and the quality of the studies. While some treatments do meet the criteria for well-established status, it is clear from this examination that gaps remain and replication is necessary to establish many of these treatments as efficacious. In addition, there still appears to be a lack of research on the effects of treatment on the physiological and cognitive aspects of fear and anxiety.

Quality of life across the schizotypy spectrum: findings from a large nonclinical adult sample

OBJECTIVE It is well documented that patients with schizophrenia have impoverished quality of life (QOL). Efforts to determine the underpinnings of this impoverishment have implicated negative symptoms more than positive or disorganized symptoms. However, only a minority of individuals with the liability to schizophrenia will ever show manifest illness, and it is presently unclear the degree to which QOL is affected in individuals with subclinical symptoms of the disorder (ie, schizotypy). The present study examined the relative contributions of negative, positive, and disorganized schizotypy symptoms to QOL. METHODS Measures of schizotypal symptoms and subjective and objective QOL were obtained from a sample of 1395 adults. RESULTS Measures of schizotypal symptoms significantly corresponded to all measures of QOL, although the magnitude of correlations were significantly larger for subjective than objective measures. The negative symptom dimension explained a substantial portion of unique variance in the social domains of QOL above and beyond that accounted for by the other schizotypy dimensions. CONCLUSIONS These findings highlight the deleterious impact of schizotypal symptoms, particularly negative symptoms. Further research clarifying the mechanism underlying this relationship is called for.

Specific phobia in youth: phenomenology and psychological characteristics.

Sociodemographic and psychological characteristics of 62 youth with animal and natural environment types of specific phobia were examined in a treatment-seeking sample. Differences due to age, sex, ethnicity, family structure, and family socioeconomic status were not found between youth with the two types of specific phobia. Moreover, differences were not obtained between the two groups in the clinical severity of their phobias, the perceived dangerousness of the feared outcomes associated with their phobias, the perceived levels of coping with their phobias, or overall fearfulness. However, differences between youth with the two types of specific phobias were found on somatic/anxious symptoms, depressive symptoms, and life satisfaction. In addition, differences were noted on withdrawn, somatic complaints, anxious/depressed symptoms, and social problems as reported by the mothers of these youngsters. Finally, differences in the percent of co-occurring anxiety disorders between youth with the two types of specific phobia were found. On all of the domains in which differences were found, youth with the natural environment type fared more poorly than those with the animal type. These findings converge with those obtained in treatment studies which indicate that youth with the natural environment type are more difficult to treat than youth with the animal type.

Treating Selective Mutism Using Modular CBT for Child Anxiety: A Case Study

Selective mutism is a rare, debilitating condition usually seen in children. Unfortunately, there is little research examining effective treatments for this disorder, and designing an evidence-based treatment plan can be difficult. This case study presents the evidence-based treatment of an 8-year-old Caucasian boy with selective mutism using an established treatment for anxiety—Modular Cognitive-Behavioral Therapy for Childhood Anxiety Disorders (Chorpita, 2007). The treatment consisted of 21 sessions and included modules on psychoeducation, exposure, cognitive restructuring, social skills, and maintenance and relapse prevention. The clients symptoms were greatly improved by the end of treatment based on fear hierarchy ratings, self-report and parent-report questionnaires, and child and parent clinical interviews. In addition, at discharge the client no longer met criteria for selective mutism. Improvements were maintained when the client was reassessed at 1-month and 6-month follow-up appointments.

The Relationship Among Self-Efficacy, Negative Self-Referent Cognitions, and Social Anxiety in Children: A Multiple Mediator Model

Evidence suggests that general self-efficacy, an individuals beliefs about his global abilities, and social self-efficacy, an individuals beliefs in his ability to navigate social situations, are strongly connected to levels of social anxiety. Negative self-statements, also known as negative self-referent cognitions, have also been linked with levels of social anxiety. Although self-efficacy and negative self-statements have been shown to be important variables in the phenomenology and maintenance of social anxiety in children, they have yet to be examined in conjunction with one another. The purpose of this study was to examine the relationship between negative self-referent cognitions and self-efficacy and to examine both general self-efficacy and social self-efficacy as mediator variables in the relationship between negative self-statements and social anxiety. Results were based on a sample of 126 children ages 11 to 14 years. A significant association between negative self-statements and both general self-efficacy and social self-efficacy was established. Results also indicated that general self-efficacy fully mediated the relationship between negative self-statements and social anxiety; however, contrary to hypotheses, social self-efficacy did not mediate the relationship between negative self-statements and social anxiety. Implications and future recommendations are discussed.

The Effect of Communication Deficits on Anxiety Symptoms in Infants and Toddlers With Autism Spectrum Disorders

Autism spectrum disorders (ASDs) are life-long developmental disorders characterized by impairments in the development of reciprocal social and communication skills, abnormal language development, and a restricted repertoire of behaviors and interests. While it has been known for some time that children with ASD can evince elevated rates of anxiety symptoms, little research has been conducted on whether deficits in communication skills affect the range of anxiety symptoms in infants and toddlers with ASD. This study represents a first attempt to determine whether deficits in communication skills have an effect on the expression of anxiety in infants and toddlers with autistic disorder and pervasive developmental disorder-not otherwise specified. Seven hundred thirty-five infants were evaluated with respect to the nature and extent of anxiety symptoms and developmental functioning. Both receptive and expressive communication skills appeared to play a significant role in the manifestation of anxiety symptoms.

Characteristics of Children With ADHD and Comorbid Anxiety

Objective: The following comorbid subgroups of ADHD have been proposed: ADHD Only, ADHD + anxiety disorders (ANX), ADHD + oppositional defiant disorder/conduct disorder (ODD/CD), and ADHD + ODD/CD + ANX. The current study examined a subset of these groups. Method: A total of 134 children and adolescents (M age = 9.92; range = 6-17) from a clinic-referred sample (n = 407) were grouped based on a semistructured diagnostic interview: ADHD only (n = 41), ADHD + ANX (n = 31), and ANX Only (n = 62). Results: Findings supported greater parent-reported anxiety symptoms in anxiety groups, and greater parent- and teacher-reported attention problems in ADHD groups. ADHD groups performed worse on a continuous performance test, whereas ADHD + ANX performed worse on working memory than ADHD Only. ADHD + ANX reported more physical anxiety symptoms than ADHD Only. Conclusion: Comorbid anxiety should be considered in ADHD assessment and treatment.

Intensive one-session treatment of specific phobias

Whether it’s dogs, spiders, blood, heights or some other fear, specific phobias are one of the most prevalent mental health problems, affecting as many as one in eight people. In recent years, cogn ...