Exposure Therapy for Children with Anxiety and OCD
Abstract Psychoeducation is an integral component of evidence-based treatments for anxiety disord... more Abstract Psychoeducation is an integral component of evidence-based treatments for anxiety disorders and obsessive-compulsive disorder (O–CD) in children and adolescents. In cognitive-behavioral therapy (CBT) for anxiety and OCD, psychoeducation is used to provide a rationale for exposure therapy for the young person and their family, to build rapport with the child, and to enhance the child’s motivation and engagement in exposure therapy. In this chapter, we provide a practical guide to effectively delivering psychoeducation to anxious youth and their families, including how to provide a rationale for exposure therapy and explain how it is conducted, strategies for building rapport during psychoeducation, ways to maximize success in exposure therapy via psychoeducation, as well as strategies to manage challenges that commonly arise during psychoeducation.
Supplemental Material, JBD866906_supplementary_table_2 for Mindfulness interventions in schools: ... more Supplemental Material, JBD866906_supplementary_table_2 for Mindfulness interventions in schools: Integrity and feasibility of implementation by Lisa-Marie Emerson, Natalja Nabinger de Diaz, Ashra Sherwood, Allison Waters and Lara Farrell in International Journal of Behavioral Development
Blood-Injection-Injury (BII) phobia is a complex and debilitating condition that is associated wi... more Blood-Injection-Injury (BII) phobia is a complex and debilitating condition that is associated with excessive fear and avoidance of seeing blood or injuries, receiving injections or invasive medical procedures (American Psychiatric Association (APA), 2013). It effects 3 to 4% of adults and 0.8 to 1% of children and adolescents, and can lead to serious health consequences as sufferers may avoid seeking assistance from health professionals or receiving medical treatments for diagnosed illnesses (Depla, ten Have, van Balkom, & Graaf, 2008; Essau, Conradt, & Petermann, 2000; Öst & Hellström, 1997). BII phobia has largely been neglected in the child and adolescent literature. To date the majority of the research relating to this disorder has been conducted with adults. From the adult literature it is evident that BII phobia has a complex clinical presentation that is characterised by a unique physiological (e.g., fainting) and emotional (e.g., disgust) response. Behavioural and cognitive...
Childhood obsessive–compulsive disorder (OCD) is among the most prevalent and disabling mental he... more Childhood obsessive–compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable “treatment gap” and “quality gap” in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, du...
Section I: Overview of Complexities in Anxiety Disorders.- Chapter 1: Nature and Etiological Mode... more Section I: Overview of Complexities in Anxiety Disorders.- Chapter 1: Nature and Etiological Models of Anxiety Disorders.- Chapter 2: Prognostic Indicators of Treatment Response for Adults with Anxiety.- Chapter 3: Prognostic Indicators of Treatment Response for Children with Anxiety Disorders.- Chapter 4: Continuing to Advance Empirically-Supported Treatments: Factors in Empirically-Supported Practice for Anxiety Disorders.- Section II: Complexities in Childhood and Adolescent Anxiety Disorders.- Chapter 5: Treatment of Childhood Anxiety in Autism Spectrum Disorders.- Chapter 6: Treatment of Comorbid Anxiety and Disruptive Behavior in Youth.- Chapter 7: Diagnosis and Cognitive Behavioral Treatment of Anxiety Disorders in Young Children.- Chapter 8: Treating Obsessive-Compulsive Disorder in the Very Young Child.- Chapter 9: Treatment of Childhood Tic Disorders with Comorbid OCD.- Chapter 10: Treatment of Childhood Anxiety in the Context of Limited Cognitive Functioning.- Chapter 11: Special Considerations in Treating Anxiety Disorders in Adolescents.- Chapter 12: Social Anxiety and Socialization Among Adolescents.- Chapter 13: PANDAS: Immune Related OCD.- Section III: Complexities in Adult Anxiety Disorders.- Chapter 14: Treatment of Posttraumatic Stress Disorder with Comorbid Borderline Personality Disorder: Integrating Dialectical Behavior Therapy and Prolonged Exposure.- Chapter 15: Treatment of Anxiety and Comorbid Cluster A Personality Disorders.- Chapter 16: Treatment of Comorbid Depression.- Chapter 17: Limited Motivation, Patient-Therapist Mismatch, and the Therapeutic Alliance.- Chapter 18: Substance Abuse and Anxiety Disorders: The Case of Social Anxiety Disorder and PTSD.- Section IV: Cross Developmental Complexities.- Chapter 19: Treatment of Comorbid Anxiety Disorders across the Lifespan.- Chapter 20: Family Conflict and Childhood Anxiety.- Chapter 21: Assessment and Treatment of Comorbid Anorexia Nervosa and Obsessive Compulsive Disorder.- Chapter 22: Cluster C Personality Disorders and Anxiety Disorders.- Chapter 23: Therapist Barriers to the Dissemination of Exposure Therapy.- Chapter 24: Harnessing the Web: Internet and Self-Help Therapy for People with Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder.- Chapter 25: Where Do We Go From Here? How Addressing Clinical Complexities Will Result in Improved Therapeutic Outcomes.
This study explored the expression, occurrence, and treatment outcomes of comorbid body dysmorphi... more This study explored the expression, occurrence, and treatment outcomes of comorbid body dysmorphic disorder (BDD) in 107 youth (7–17 years) seeking treatment for primary obsessive–compulsive disorder (OCD). In the overall sample, appearance anxiety (AA) was positively associated with OCD-related impairment, severity, symptom frequency, comorbid symptoms, and maladaptive emotion regulation. Comorbid BDD occurred in 9.35% of youth, equally affected males and females, and was associated with older age. AA negligibly reduced following treatment. Compared to those without (a) comorbid BDD and (b) without any comorbidity, youth with comorbid BDD reported greater social impairment and reduced global functioning but did not differ on the occurrence of comorbid anxiety and mood disorders. OCD response or remission rates did not differ. In youth with comorbid BDD, AA did not significantly reduce following treatment. Results suggest a more severe expression accompanies comorbid BDD in youth wi...
Research on mindfulness-based interventions (MBIs) has proliferated in recent years and the integ... more Research on mindfulness-based interventions (MBIs) has proliferated in recent years and the integration of mindfulness-based programs in school settings has been at the forefront of implementation research. Recent reviews of studies evaluating the efficacy of school-based mindfulness programs have produced mixed findings, which may in part be due to methodological differences across studies to date, as well as adaptations of MBIs in order to implement them within school settings. For example, there are vast differences across studies in the content, delivery, and training requirements of school-based MBIs, which may influence both fidelity and efficacy. This systematic review aimed to synthesize the literature on the implementation of school-based MBIs and determine the degree to which the interventions align to standards for MBIs. A systematic search identified studies evaluating the effects of a school-based MBI on mental health outcomes in schools, utilizing quantitative and qual...
Journal of the American Academy of Child and Adolescent Psychiatry, 2018
Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obs... more Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obsessions and compulsions are symptoms rather than necessary or natural thoughts and behaviors. It has been estimated that 20% to 45% of youth with OCD exhibit poor or absent insight. Identified correlates of poor insight include younger age, increased OCD severity, impairment, and family accommodation; lower intellectual and adaptive functioning; and greater depressive symptoms. Poorer insight has also been associated with reduced response across treatment groups (ie, selective serotonin reuptake inhibitor [SSRI], cognitive behavioral therapy [CBT], combined SSRI plus CBT, or pill placebo)..
Child psychiatry and human development, Dec 24, 2017
Research has shown high rates of comorbid psychiatric disorders among samples of youth with obses... more Research has shown high rates of comorbid psychiatric disorders among samples of youth with obsessive-compulsive disorder (OCD) (Farrell et al., Psychiatry Res 199(2):115-123, 2012; Lewin et al., Psychiatry Res 178(2):317-322, 2010; POTS Team, J Am Med Assoc 292(16):1969-1976, 2004). Autism and autistic traits co-occur at high rates within clinical samples of youth with OCD (Ivarsson and Melin in J Anxiety Disord 22(6):969-978, 2008; Stewart et al. in Child Psychiatry Hum Dev 1-9, 2016). This study extends the literature by examining the relationship between ASD traits, family accommodation, and functional impairment in a sample of youth with OCD across a wide age range (n = 80; aged 7-17 years). Results indicated that autistic traits, as measured by the social responsiveness scale (SRS), were elevated in 32.5% of youth (based on a T-score of 66T and above) relative to typically developing youth, as well as youth with non-autism-related psychiatric disorders (Constantino and Gruber ...
Exposure Therapy for Children with Anxiety and OCD
Abstract Psychoeducation is an integral component of evidence-based treatments for anxiety disord... more Abstract Psychoeducation is an integral component of evidence-based treatments for anxiety disorders and obsessive-compulsive disorder (O–CD) in children and adolescents. In cognitive-behavioral therapy (CBT) for anxiety and OCD, psychoeducation is used to provide a rationale for exposure therapy for the young person and their family, to build rapport with the child, and to enhance the child’s motivation and engagement in exposure therapy. In this chapter, we provide a practical guide to effectively delivering psychoeducation to anxious youth and their families, including how to provide a rationale for exposure therapy and explain how it is conducted, strategies for building rapport during psychoeducation, ways to maximize success in exposure therapy via psychoeducation, as well as strategies to manage challenges that commonly arise during psychoeducation.
Supplemental Material, JBD866906_supplementary_table_2 for Mindfulness interventions in schools: ... more Supplemental Material, JBD866906_supplementary_table_2 for Mindfulness interventions in schools: Integrity and feasibility of implementation by Lisa-Marie Emerson, Natalja Nabinger de Diaz, Ashra Sherwood, Allison Waters and Lara Farrell in International Journal of Behavioral Development
Blood-Injection-Injury (BII) phobia is a complex and debilitating condition that is associated wi... more Blood-Injection-Injury (BII) phobia is a complex and debilitating condition that is associated with excessive fear and avoidance of seeing blood or injuries, receiving injections or invasive medical procedures (American Psychiatric Association (APA), 2013). It effects 3 to 4% of adults and 0.8 to 1% of children and adolescents, and can lead to serious health consequences as sufferers may avoid seeking assistance from health professionals or receiving medical treatments for diagnosed illnesses (Depla, ten Have, van Balkom, & Graaf, 2008; Essau, Conradt, & Petermann, 2000; Öst & Hellström, 1997). BII phobia has largely been neglected in the child and adolescent literature. To date the majority of the research relating to this disorder has been conducted with adults. From the adult literature it is evident that BII phobia has a complex clinical presentation that is characterised by a unique physiological (e.g., fainting) and emotional (e.g., disgust) response. Behavioural and cognitive...
Childhood obsessive–compulsive disorder (OCD) is among the most prevalent and disabling mental he... more Childhood obsessive–compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable “treatment gap” and “quality gap” in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, du...
Section I: Overview of Complexities in Anxiety Disorders.- Chapter 1: Nature and Etiological Mode... more Section I: Overview of Complexities in Anxiety Disorders.- Chapter 1: Nature and Etiological Models of Anxiety Disorders.- Chapter 2: Prognostic Indicators of Treatment Response for Adults with Anxiety.- Chapter 3: Prognostic Indicators of Treatment Response for Children with Anxiety Disorders.- Chapter 4: Continuing to Advance Empirically-Supported Treatments: Factors in Empirically-Supported Practice for Anxiety Disorders.- Section II: Complexities in Childhood and Adolescent Anxiety Disorders.- Chapter 5: Treatment of Childhood Anxiety in Autism Spectrum Disorders.- Chapter 6: Treatment of Comorbid Anxiety and Disruptive Behavior in Youth.- Chapter 7: Diagnosis and Cognitive Behavioral Treatment of Anxiety Disorders in Young Children.- Chapter 8: Treating Obsessive-Compulsive Disorder in the Very Young Child.- Chapter 9: Treatment of Childhood Tic Disorders with Comorbid OCD.- Chapter 10: Treatment of Childhood Anxiety in the Context of Limited Cognitive Functioning.- Chapter 11: Special Considerations in Treating Anxiety Disorders in Adolescents.- Chapter 12: Social Anxiety and Socialization Among Adolescents.- Chapter 13: PANDAS: Immune Related OCD.- Section III: Complexities in Adult Anxiety Disorders.- Chapter 14: Treatment of Posttraumatic Stress Disorder with Comorbid Borderline Personality Disorder: Integrating Dialectical Behavior Therapy and Prolonged Exposure.- Chapter 15: Treatment of Anxiety and Comorbid Cluster A Personality Disorders.- Chapter 16: Treatment of Comorbid Depression.- Chapter 17: Limited Motivation, Patient-Therapist Mismatch, and the Therapeutic Alliance.- Chapter 18: Substance Abuse and Anxiety Disorders: The Case of Social Anxiety Disorder and PTSD.- Section IV: Cross Developmental Complexities.- Chapter 19: Treatment of Comorbid Anxiety Disorders across the Lifespan.- Chapter 20: Family Conflict and Childhood Anxiety.- Chapter 21: Assessment and Treatment of Comorbid Anorexia Nervosa and Obsessive Compulsive Disorder.- Chapter 22: Cluster C Personality Disorders and Anxiety Disorders.- Chapter 23: Therapist Barriers to the Dissemination of Exposure Therapy.- Chapter 24: Harnessing the Web: Internet and Self-Help Therapy for People with Obsessive-Compulsive Disorder and Post-Traumatic Stress Disorder.- Chapter 25: Where Do We Go From Here? How Addressing Clinical Complexities Will Result in Improved Therapeutic Outcomes.
This study explored the expression, occurrence, and treatment outcomes of comorbid body dysmorphi... more This study explored the expression, occurrence, and treatment outcomes of comorbid body dysmorphic disorder (BDD) in 107 youth (7–17 years) seeking treatment for primary obsessive–compulsive disorder (OCD). In the overall sample, appearance anxiety (AA) was positively associated with OCD-related impairment, severity, symptom frequency, comorbid symptoms, and maladaptive emotion regulation. Comorbid BDD occurred in 9.35% of youth, equally affected males and females, and was associated with older age. AA negligibly reduced following treatment. Compared to those without (a) comorbid BDD and (b) without any comorbidity, youth with comorbid BDD reported greater social impairment and reduced global functioning but did not differ on the occurrence of comorbid anxiety and mood disorders. OCD response or remission rates did not differ. In youth with comorbid BDD, AA did not significantly reduce following treatment. Results suggest a more severe expression accompanies comorbid BDD in youth wi...
Research on mindfulness-based interventions (MBIs) has proliferated in recent years and the integ... more Research on mindfulness-based interventions (MBIs) has proliferated in recent years and the integration of mindfulness-based programs in school settings has been at the forefront of implementation research. Recent reviews of studies evaluating the efficacy of school-based mindfulness programs have produced mixed findings, which may in part be due to methodological differences across studies to date, as well as adaptations of MBIs in order to implement them within school settings. For example, there are vast differences across studies in the content, delivery, and training requirements of school-based MBIs, which may influence both fidelity and efficacy. This systematic review aimed to synthesize the literature on the implementation of school-based MBIs and determine the degree to which the interventions align to standards for MBIs. A systematic search identified studies evaluating the effects of a school-based MBI on mental health outcomes in schools, utilizing quantitative and qual...
Journal of the American Academy of Child and Adolescent Psychiatry, 2018
Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obs... more Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obsessions and compulsions are symptoms rather than necessary or natural thoughts and behaviors. It has been estimated that 20% to 45% of youth with OCD exhibit poor or absent insight. Identified correlates of poor insight include younger age, increased OCD severity, impairment, and family accommodation; lower intellectual and adaptive functioning; and greater depressive symptoms. Poorer insight has also been associated with reduced response across treatment groups (ie, selective serotonin reuptake inhibitor [SSRI], cognitive behavioral therapy [CBT], combined SSRI plus CBT, or pill placebo)..
Child psychiatry and human development, Dec 24, 2017
Research has shown high rates of comorbid psychiatric disorders among samples of youth with obses... more Research has shown high rates of comorbid psychiatric disorders among samples of youth with obsessive-compulsive disorder (OCD) (Farrell et al., Psychiatry Res 199(2):115-123, 2012; Lewin et al., Psychiatry Res 178(2):317-322, 2010; POTS Team, J Am Med Assoc 292(16):1969-1976, 2004). Autism and autistic traits co-occur at high rates within clinical samples of youth with OCD (Ivarsson and Melin in J Anxiety Disord 22(6):969-978, 2008; Stewart et al. in Child Psychiatry Hum Dev 1-9, 2016). This study extends the literature by examining the relationship between ASD traits, family accommodation, and functional impairment in a sample of youth with OCD across a wide age range (n = 80; aged 7-17 years). Results indicated that autistic traits, as measured by the social responsiveness scale (SRS), were elevated in 32.5% of youth (based on a T-score of 66T and above) relative to typically developing youth, as well as youth with non-autism-related psychiatric disorders (Constantino and Gruber ...
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