Characteristics of Exposure Sessions as Predictors of Treatment Response in Anxious Youth

Abstract

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.

Acknowledgments

This research was supported in part by grants from the National Institute of Mental Health to Philip C. Kendall (MH59087; MH60653).

Notes

Note. ESRF = Exposure Session Rating Form; ICC = intraclass correlation coefficient; STIC = “Show that I Can” task; SUDS = Subjective Units of Distress rating.

Note. ESRF = Exposure Session Rating Form; STIC = “Show that I Can” task; SUDS = Subjective Units of Distress rating.

Note. ADIS CSR = Anxiety Disorders Interview Schedule for Children Clinician Severity Rating; CGAS = Children's Global Assessment Scale; MASC = Multidimensional Anxiety Scale for Children; CBCL = Child Behavior Checklist; TRF = Teacher Report Form.

^a n = 61.

^b n = 58.

^c n = 56.

^d n = 51.

^e n = 55.

^f n = 54.

*p < .05.