Institute 2 - The Practice and Ethics of Exposure Based CBT for Youth with Anxiety Disorders And/or OCD: What They Didn’t Prepare You for in Graduate School!

Since the onset of the pandemic, referrals for treatment of anxiety disorders (ADs) and obsessive-compulsive disorder (OCD) in children, adolescents, and emerging adults (hereafter, “youth”) have increased at an alarming rate. Affected youth evidence significant distress, global impairments in functioning, and high risk for the development of secondary conditions. Exposure-based cognitive behavioral therapy (EXCBT) is the most well studied psychosocial treatment yet backed by nearly 50 years of randomized controlled trials and dissemination studies establishing its empirical support, EXCBT is not widely available due to a failure of adequately training clinicians to competency as well as treatment “deserts” in the USA. Moreover, misinformation and myth about exposure therapy for anxiety and OCD fuels resistance to clinicians learning to administer this modality as well as fear among youth who may benefit from its effectiveness. The presenters will bring to bear in this institute their collective experience in treating youth with ADs and OCD using EXCBT, from their clinical trials as well as practices and training programs. After a review of the theoretical and empirical bases of exposure, the brunt of the institute will be spent in walking through the practice and ethics involved in assessment, treatment planning, and implementation of exposure therapy. Setting up exposures for youth at different ages and developmental stages, which bring their own unique challenges in terms of ecological validity and involvement of parents or partners, will be examined. Ethical issues in conducting exposures both within and outside of the therapy office will be addressed, with particular attention to quandaries that occur, such as when an exposure may conflict with religious or cultural beliefs. While conveying some basic information on exposure work, the presenters will focus on challenging clinical presentations, such as treating the comorbidity of social phobia and selective mutism in adolescents, addressing pure cognitive compulsions, dealing with religiosity, and interoceptive exposure. The presenters will use case examples, give demonstrations, and will encourage questions and interaction with attendees throughout the institute.

Outline:
Exposure-based cognitive behavioral therapy (EXCBT) is backed by nearly 50 years of research establishing its empirical support, yet EXCBT is not widely available due clinician skill and availability. Misinformation and myth about EXCBT for anxiety and OCD fuels resistance to clinicians learning this modality, as well as fear of EXCBT among potential patients. The presenters will share their collective experience in treating youth with ADs and OCD using EXCBT through a review of the theoretical and empirical bases of exposure, with the brunt of the institute focused on the practice and ethics involved in assessment, treatment planning, and implementation of EXCBT. The challenges of conducting exposures for youth at different ages and developmental stages and involvement of significant others will be examined. Ethical issues in conducting exposures both within and outside of the therapy office will be addressed, with particular attention to quandaries involving conflict with religious or cultural beliefs. Beyond some basic information on exposure work, the presenters will focus on challenging clinical presentations, such as treating comorbidity, addressing pure cognitive compulsions, dealing with taboo and culture, and interoceptive exposures. The presenters will use case examples, give demonstrations, and will encourage questions and interaction with attendees throughout the institute.