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ViewAttendees 4

Symposia

Child / Adolescent - Anxiety

The Future of Child Anxiety Treatment: Parents, Exposure, and Technology

1 - (SYM 88) Formats for Exposure-based Treatment for Childhood Specific Phobia: A Randomized Microtrial Examining the Effects of (parent-guided) Homework versus In-session Exposure

Saturday, November 16, 2024
12:30 PM – 2:00 PM EST
Location: Regency Ballroom C2, Second Floor Mezzanine, Loews Hotel
Abstract Body

This presentation focuses on the differential effect of three formats of exposure-based treatment in childhood specific phobia. In routine clinical care, therapists often do not conduct in-session exposure exercises, even though the ‘golden standard’ includes therapist-guided in-session exposure. Rather, therapists provide homework assignments for the child or via the parents. We compared minimally-guided (MGE) and parent-guided (PGE) out-session homework formats to therapist guided in-session exposure (TGE). Children with specific phobia (N = 55, age 8–12, 56% girls) participated in a single-blind, randomized controlled micro-trial with a four-week baseline-treatment period design. Primary outcome was the clinician severity rating of the specific phobia, based on a semi-structured interview with children and parents conducted at pre-treatment, post-treatment, and at one-month follow-up. Secondary outcomes included a behavioral avoidance test and self-defined individualized goals at the different time points. TGE resulted in a larger decline of specific phobia severity from baseline to post-treatment compared to MGE but not compared to PGE. At follow-up, there were no meaningful differences in efficacy of TGE versus MGE or PGE from baseline to follow-up. More parental anxiety indicated less treatment efficacy of PGE from baseline to post-treatment. These findings suggest that, for short-term gains, exposure exercises may best be conducted in-session with therapist guidance. In the longer term, the homework-based formats reached comparable outcomes, potentially due to the gains reached by practicing with relevant stimuli in the home and school environment. An optimal format may combine in-session therapist-guided exposure for short-term gains, with homework assignments for overcoming fears in relevant contexts.