Cognitive-Behavioral Therapy for Anxious Youth With a Physical Disability

Abstract

Cognitive-behavioral therapy (CBT) is the first-line psychological intervention for youth with an anxiety disorder. Despite the prevalence of anxiety in youth with physical disabilities, the application and evaluation of CBT for such youth is sparse. The current report illustrates ways to adapt, implement, and evaluate CBT for youth with anxiety and a physical disability describing "Olivia," a 12-year-old Caucasian female with generalized anxiety disorder, separation anxiety disorder, panic attacks, and cerebral palsy. Olivia received 24 one-hour sessions of outpatient CBT over the course of 9 months. At post-treatment, Olivia no longer met criteria for any anxiety diagnosis by parent-and child-report, with gains maintained at 2-month follow-up. Important therapeutic issues for working with comorbid anxious and physically challenged youth are addressed, such as therapeutic engagement, working within a multidisciplinary team, conflation of psychological and physical symptoms, parental accommodation, family interaction patterns, and modification of exposures and related treatment strategies.

Psychological Interventions for Individuals With Acquired Brain Injury, Cerebral Palsy, and Spina Bifida: A Scoping Review

“…Study sample sizes ranged from one to 49, with mean ages ranging from 6.87 to 15.9 years. Conditions studied included CP ( 36 , 39 , 41 ) and childhood onset ABI ( 33 – 35 , 37 , 40 , 42 , 43 ), consisting of TBI, with only one study having a variety of ABI conditions ( 40 ). No studies reported on interventions for SB.…”

“…Commonly identified psychological interventions used with individuals with childhood onset ABI and CP were acceptance and commitment therapy (ACT) ( 34 , 37 , 38 , 40 ), psychotherapy ( 39 , 41 ), and CBT ( 33 , 35 , 36 , 42 , 43 ), in combination with components of family therapy ( 34 ), psychoeducation ( 33 , 36 , 43 ), and Stepping Stones Triple P (SSTP) ( 40 ). Studies reporting on ACT were limited to individuals with childhood onset ABI, while studies investigating the use of psychotherapy only included individuals with CP.…”

Feasibility and Acceptability of a Toolkit to Facilitate Clinician Use of Exposure Therapy for Youth

“…Ideas generated for challenge cards were drawn from an extensive literature review, including previously published treatment manuals for youth anxiety (e.g., Albano & DiBartolo, 2007; Kendall & Hedtke, 2006), published articles on the application of exposure for youth (e.g., Kendall et al, 2006; Peterman, Read, Wei, & Kendall, 2015), published case studies (e.g., Heyne, Sauter, Ollendick, Van Widenfelt, & Westenberg, 2014; Peterman, Hoff, Gosch, & Kendall, 2015), in conjunction with clinical expertise. Recognizing that some exposures conducted within anxiety specialty clinics (e.g., going to the zoo to see or hold a snake, having a phlebotomist attend a therapy session to address blood-injection-injury fears) may not be feasible within the confines of an under-resourced clinic setting, READY distinguishes exposures that can be done without any additional materials or confederates from those that require additional materials.…”

“…Cards can be used to facilitate hierarchy building by asking clients to arrange challenges in order from easiest to hardest. Given emerging research suggesting that it may not be necessary to engage in exposures in a linear fashion from the bottom of the hierarchy to the top (Craske et al, 2014; Peterman et al, 2015), challenge cards do not need to be used in a particular order. For example, clinicians can select a handful of appropriate level exposure exercises that could potentially be completed in a single session and have the patient select one at random to complete.…”

Helping a Man With Cerebral Palsy Access Preferred Internet Content Using Assistive Technology and a Participant-Directed Support Model

“…For individuals with CP who have such issues, clinicians will need to provide an appropriate, evidence-based psychological treatment. Along these lines, Peterman, Hoff, Gosch, and Kendall (2015) described the effective treatment of anxiety in a 12-year-old girl with CP. The treatment, which involved 24, 1-hr sessions using an age-adapted version of cognitive-behavioral therapy, resulted in marked reductions in anxiety symptoms.…”