I need someone to write 5-6 pages essay

3/21/2019

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TREATMENTS FOR ANXIETY PART 3

BEHAVIOR THERAPY: EXPOSURE

 Exposure: have children face what frightens them, while providing ways of coping other than escape and avoidance

 Usually graded exposure – gradually exposed to fears, starting with least-anxiety provoking and working up

 Have child rate distress before, during, after exposure using Subjective Units of Distress Scale (SUDS) or “fear thermometer”

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CBT FOR ANXIETY

 Almost always used with exposure-based treatments

 Teaches children to understand how thinking contributes to anxiety and how to modify their maladaptive thoughts to decrease their symptoms

 Response rate ~60% for CBT in child anxiety disorders

 Improvement shown to last 8-13 years after treatment

 Gains from treatment seem to increase over time  67% response to CBT at post-treatment

 82% response to CBT 1 year later

COPING CAT

 Empirically tested CBT approach to treating anxiety disorders in children

 16 weeks of individual CBT  Includes 2 parent sessions

 Adapted into group, family, and computer-assisted formats  Family-based CBT didn’t improve outcomes overall, but

seems indicated when children are younger and/or parents are anxious

 Computer-assisted requires a “Coach”

 Components: Skills (Cognitive Restructuring, Relaxation Training, Problem Solving) and Exposure

FEAR Acronym

Feeling Frightened?

Expecting Bad Things to Happen

Attitudes and Actions that Help

Results and Rewards

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SESSIONS 1-8 (LEARN AND PRACTICE SKILLS)

F: What is anxiety? Bodily reactions to anxiety? Progressive muscle relaxation & deep breathing

E: Identifying anxious self-talk; How cognitions can increase/maintain anxiety; Thinking traps (i.e. catastrophizing, all or nothing thinking, perfectionistic thinking)

A: Attitudes - Come up with “Coping Thoughts”; Use probabilities, alternative ways of thinking, evaluating feared outcomes, etc.

Actions – Problem Solving (Brainstorm, Evaluate, Choose)

R: Monitor results; Rewards from self and others

 Session 4 & 9 include parents

 For homework, kids write about two times they used relevant step(s)

My heart was racing

They won’t like me. They will be mean.

That didn’t happen last time I started a new dance class, so it probably won’t happen this time either.

I was friendly and smiled at them. I did relaxation before I left.

Great! I made a new friend. being happy about a new friend.

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SESSIONS 10-16

 Create a fear hierarchy

 Gradually work up hierarchy

 Using imaginal and in vivo exposures

 Come up with a Coping Plan using FEAR steps

 Spend time completing exposure

 Process afterward and reward

 BE CREATIVE and SILLY

 Identify out-of-session practice to do at home

EXAMPLE EXPOSURES  Meet a new adult or kid (play game, ask questions)

 Complete a scavenger hunt (list of items they have to go around and ask other people for)

 Give a speech in front of an audience (audience members whisper, look bored, text, ask questions, throw things at them, walk out)

 Mess up hair/put toilet paper on shoe and walk around the office building and outside

 Sit in a dark room alone for a certain number of minutes

 Going to a restaurant and ordering something

 Parent comes late to pick them up from a session

 Parent is “missing” from waiting room

 Child ‘forgets’ to complete school HW, or answers question wrong on purpose

 Draw a picture and have someone evaluate it

 Handling bees (dead ones and alive ones in box)

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TREATING SPECIFIC PHOBIA

CBT + MEDICATION

 SSRI’s also effective for child anxiety

 Work better for child anxiety than depression (Note: work best for OCD)

 CAMS (Child-Adolescent Anxiety Multimodal Study)

 RCT comparing placebo, sertraline (Zoloft), CBT, CBT + sertraline

 488 youth 7-17 with diagnoses of separation anxiety, social anxiety, and GAD

 Treatment response rates:

 60% for CBT

 55% for sertraline (Zoloft)

 81% for combination therapy

 Rates comparable to CBT, but CBT considered first line

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ROLE OF PARENTS IN TREATMENT

Treatment in a family context may result in more dramatic and lasting effects. Why?

 Positive parental modeling

 Reducing avoidance

 Reinforcing when child uses coping skills

 Helping to practice exposures outside of therapy