A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management

Whiteside, Stephen P.; Sim, Leslie; Morrow, Allison S.; Farah, Wigdan; Hilliker, Daniel R.; Murad, M. Hassan; Wang, Zhen

doi:10.1007/s10567-019-00303-2

Cited by 124 publications

(83 citation statements)

References 115 publications

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“…Given that exposure appears to be the key ingredient in the treatment of anxiety disorders in children and young people (Ale et al 2015;Kendall et al 2005;Whiteside et al 2015Whiteside et al , 2019, it is critical that we understand how best to deliver it to improve treatment outcomes. This review identified a lack of consistent support for any potential optimisation strategies, wide ranging methodological inconsistencies among studies, and highlighted that most of the potential optimisation strategies identified within the adult literature have not been explored.…”

Section: Resultsmentioning

confidence: 99%

Optimising Exposure for Children and Adolescents with Anxiety, OCD and PTSD: A Systematic Review

Plaisted

Waite

Gordon

et al. 2021

Clin Child Fam Psychol Rev

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Cognitive behavioural therapy is an effective treatment for anxiety disorders in children and young people; however, many do not benefit. Behavioural exposure appears to be the critical ingredient in the treatment of anxiety disorders. Research with adults has identified innovative strategies to optimise exposure-based treatments, yet it is not clear how to optimise the effects of exposure for children and young people. This review was a preliminary exploration of the association between potential optimisation strategies and treatment procedures and outcomes for the treatment of child anxiety symptoms/disorders. We searched Psych-Info and Medline databases using a systematic search strategy and identified 29 articles. We found preliminary evidence that some specific strategies may enhance the effects of exposure, such as dropping safety behaviours, parents and therapists discouraging avoidance, and the use of homework. However, not one significant finding was replicated by another study for the same timepoint using the same methodology. To a large degree, this lack of replication reflects a limited number of studies combined with a lack of consistency across studies around conceptualisations, methodological approaches, and outcome measures making it difficult to make meaningful comparisons between studies and draw firm conclusions. Examination is needed of a wide range of theoretically-driven potential optimisation strategies using methodologically robust, preclinical studies with children and young people. Furthermore, the methods used in future research must enable comparisons across studies and explore developmental differences in the effects of particular optimisation strategies.

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Section: Resultsmentioning

confidence: 99%

Optimising Exposure for Children and Adolescents with Anxiety, OCD and PTSD: A Systematic Review

Plaisted

Waite

Gordon

et al. 2021

Clin Child Fam Psychol Rev

View full text Add to dashboard Cite

show abstract

“…Such an approach may also address the specific components (e.g., exposure therapy or cognitive restructuring) that drive the greatest change in mechanisms. A recent study examining treatment components noted that CBT programs that included a relaxation component was significantly linked with smaller treatment effect sizes when compared with treatment that did not include relaxation (Whiteside et al, 2020). The specific mechanisms that underlie this occurrence, however, remains unclear.…”

Section: Discussionmentioning

confidence: 99%

Potential mechanisms of change in cognitive behavioral therapy for childhood anxiety: A meta‐analysis

Luo

McAloon

2020

Depression and Anxiety

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Cognitive‐behavioral therapy (CBT) is regarded as an effective treatment for anxiety disorders in childhood. Researchers have begun to investigate potential mechanisms of change that drive these positive outcomes, including shifts in cognitions, behavior, and affect. However, few studies have established the mediational effects of these factors as a proxy for establishing mechanistic change. This meta‐analysis attempts to synthesize the literature on potential mechanisms of change in CBT for childhood anxiety and investigates the mediational effects of these factors on treatment outcomes. Seventeen studies met the inclusion criteria. Across studies, five potential mediators were identified: externalizing difficulties, negative self‐talk, coping, fear, and depression. Results indicated that CBT was effective in improving outcomes on all potential mediators, except for fear. Mediational analyses showed that externalizing difficulties, negative self‐talk, coping, and depression mediated anxiety following treatment. Fear did not mediate the relationship. Implications for future mechanisms of change research are proposed.

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“…4 CBT for child anxiety disorders has not consistently outperformed active control conditions, and an emerging line of research suggests that this may be due to the underuse-particularly with children-of the most active component of anxiety treatment protocols, namely, exposure. 5 Exposure is the process by which individuals directly challenge catastrophic, anxiety-driven beliefs via safe behavioral experiments. During such treatment, individuals gradually expose themselves to situations that arouse fearful expectations and learn that the feared outcome does not happen and the anxiety they feel is manageable.…”

Section: What Is the Evidence-based Psychotherapy For Pediatric Anxiementioning

confidence: 99%

New issue of food allergy: Phobia of anaphylaxis in pediatric patients

Dahlsgaard

Lewis

Spergel

2020

Journal of Allergy and Clinical Immunology

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Your 10-year-old patient with peanut allergy has come for her annual appointment. Her allergy was identified after an anaphylactic event as a toddler that she does not remember. The main concern described by parents is not the food allergy, but anxiety. Over the last year-after experiencing minor allergic symptoms that did not require epinephrine-the child has become increasingly fearful of accidental crosscontamination, even under the most remote of circumstances. She no longer sits near someone eating peanut butter and runs from a room if she smells it. She has stopped eating with friends at school or going on playdates without her mother. There is overwashing of hands and ''constant'' seeking of reassurance that minor stomach aches or ''feeling hot'' aren't signs of an impending allergic reaction. The patient's mother has grown preoccupied with news reports of anaphylactic deaths that are shared on social media. She complains that her husband is ''too cavalier'' about food safety while he snaps back that his wife has become ''too coddling.'' He then begrudgingly admits that he recently removed all peanut products from the family home, such that their daughter can have ''one safe place'' where she ''doesn't have to feel anxious about her allergy.'' This has led to conflicts with her siblings, who want to eat peanut butter sandwiches and enjoy their Halloween candy in relative peace. You wonder if this level of anxiety warrants referral to a mental health provider, and which type? So many of your patients present with comorbid anxiety these days, and you want to make sure they receive evidence-based, effective care.

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A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management

Cited by 124 publications

References 115 publications

Optimising Exposure for Children and Adolescents with Anxiety, OCD and PTSD: A Systematic Review

Optimising Exposure for Children and Adolescents with Anxiety, OCD and PTSD: A Systematic Review

Potential mechanisms of change in cognitive behavioral therapy for childhood anxiety: A meta‐analysis

New issue of food allergy: Phobia of anaphylaxis in pediatric patients

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