Characteristics of exposure sessions as predictors of treatment response in anxious youth.

Guidelines for conducting effective exposure treatment with anxious youth emphasize preparation for and processing of the exposure task as important elements, but limited research has examined these guidelines. Using multiple regression, this study evaluated the extent to which independent observers' ratings of preparation and processing of in-session exposure tasks were associated with treatment outcome in a sample of 61 anxiety-disordered youth. Results indicated that preparation for exposure was not related to outcome, but postevent processing of the exposure task was significantly associated with clinician-rated diagnostic improvements. Exploratory analyses suggest that treatment responders were more likely to be assigned between-session exposure tasks as "homework" and were more likely to be rewarded for their efforts in session. Although time is spent preparing youth for exposure tasks, the activities that occur after the task is conducted are influential in reducing youth anxiety over the course of treatment. Additional implications and future directions are discussed.

Safety-seeking and coping behavior during exposure tasks with anxious youth.

This study examined child behavior during exposure tasks and characteristics of the exposure tasks as related to outcomes when treating anxious youth. Participants (aged 7-13) were 87 anxiety-disordered children (37 girls; 50 boys) and their parents (84 mothers; 70 fathers) who completed a 16-session cognitive-behavioral therapy. Videotapes of exposure-based sessions were coded for (a) child use of safety-seeking behavior (SSB) and (b) coping behavior (CB) during exposure, (c) characteristics of the exposure tasks, and (d) child anxiety during exposure. Results indicated that child use of SSB, but not CB, during exposure was significantly predictive of poorer outcome. SSB was greater during exposure tasks for treatment nonresponders than for responders, whereas CB was greater for treatment responders. SSB increased over the course of exposure-based sessions, whereas CB remained stable. Child anxiety during exposure tasks and most exposure task characteristics were not significantly predictive of outcome.

"I'd rather not talk about it": emotion parenting in families of children with an anxiety disorder.

This study examined emotion socialization practices in families of children with an anxiety disorder (AD; n = 28) and of children who had no diagnoses (ND; n = 28) and considered gender differences. Youth (aged 8-13) and both parents discussed times when the child felt anxious, angry, and happy, for 5 min each. Fathers of AD children engaged in less explanatory discussion of emotion overall and exhibited less positive affect and more negative affect when interacting with sons than did fathers of ND children. Similar patterns emerged for mothers, although specific results varied by emotion type and child gender. Children with an AD demonstrated less positive affect overall and engaged in fewer problem-solving emotion regulation strategies when discussing anxious and angry situations than did children in the ND group. In both AD and ND groups, fathers appeared to have greater involvement in emotion-related discussions with sons versus daughters. The results highlight parents' contributions to the emotional development of their children, the ways in which socialization may go awry in families of AD children, and the implications for children's emotional functioning.

[Cognitive-behavioral therapy in social phobia]. / Terapia cognitivo-comportamental da fobia social.

OBJECTIVE: This article reviews relevant aspects of social phobia and the stages of treatment within cognitive-behavioral therapy in children and adolescents, as well as in adults. METHOD: A review of the literature published on the treatment of social phobia using cognitive-behavioral treatments was performed using the Medline database. RESULTS: A review of the literature suggests that social phobia is a chronic and prevalent condition, characterized by social inhibition and excessive shyness. Diagnosis and treatment of the disorder are usually determined by distress level and functional impairment. Population studies indicate that lifetime prevalence rates for social phobia range from 2.5 to 13.3%. The main techniques used in cognitive-behavioral therapy for social phobia are described and exemplified in a case report. CONCLUSIONS: There is a general consensus in the literature that cognitive-behavioral therapy is efficacious in the treatment of youth and adults with social phobia. Because of the early onset associated with social phobia, the identification of children at high risk for the development of social phobia should be prioritized in future investigations.

Terapia cognitivo-comportamental da fobia social / Cognitive-behavioral therapy in social phobia

OBJETIVO: Este artigo revisa aspectos relevantes da fobia social e os estágios de tratamento através da terapia cognitivo-comportamental em crianças, adolescentes e adultos. MÉTODO: A partir do banco de dados Medline, realizou-se revisão da literatura publicada a respeito do tratamento da fobia social por meio da terapia cognitivo-comportamental. RESULTADOS: Revisão da literatura sugere que a fobia social é uma condição prevalente e crônica, caracterizada por inibição social e timidez excessiva. Tanto o diagnóstico como o tratamento desse transtorno são comumente determinados pelo nível de incômodo e pelo prejuízo funcional. Estudos populacionais indicam taxas de prevalência ao longo da vida para a fobia social entre 2,5 e 13,3 por cento. As principais técnicas utilizadas na terapia cognitivo-comportamental para a fobia social são descritas e exemplificadas em um relato de caso. CONCLUSÕES: Há consenso geral na literatura de que a terapia cognitivo-comportamental é eficaz tanto para o tratamento de jovens como de adultos com fobia social. Uma vez que a fobia social com freqüência tem início precoce, a identificação de crianças com risco acentuado para o desenvolvimento de fobia social deve ser priorizada em investigações futuras.

OBJECTIVE: This article reviews relevant aspects of social phobia and the stages of treatment within cognitive-behavioral therapy in children and adolescents, as well as in adults. METHOD: A review of the literature published on the treatment of social phobia using cognitive-behavioral treatments was performed using the Medline database. RESULTS: A review of the literature suggests that social phobia is a chronic and prevalent condition, characterized by social inhibition and excessive shyness. Diagnosis and treatment of the disorder are usually determined by distress level and functional impairment. Population studies indicate that lifetime prevalence rates for social phobia range from 2.5 to 13.3 percent. The main techniques used in cognitive-behavioral therapy for social phobia are described and exemplified in a case report. CONCLUSIONS: There is a general consensus in the literature that cognitive-behavioral therapy is efficacious in the treatment of youth and adults with social phobia. Because of the early onset associated with social phobia, the identification of children at high risk for the development of social phobia should be prioritized in future investigations.