Parent-coached exposure therapy versus cognitive behavior therapy for childhood anxiety disorders.

Cognitive-behavioral therapy (CBT) is the strongest evidenced-based therapy for childhood anxiety disorders (CADs). However, CBT's impact is limited by its lack of clear superiority over treatment as usual, excessive length, and greater than 50% of patients remaining symptomatic. Parent-coached exposure therapy (PCET) is designed to treat CADs more effectively and efficiently through a focus on exposure and working with parents and youth together. In a randomized controlled trial, 78 patients (78% female) aged 7 to 17 with CADs were assigned to PCET or the gold-standard CBT. The primary outcome was independent evaluator ratings of anxiety severity at mid- and post-treatment. Secondary outcomes were parent- and child-reported symptoms. Patients receiving PCET had significantly lower mean scores than those receiving CBT on the primary outcome measure at mid-treatment (3.03 ± 0.14, 95% CI, 2.75-3.32 vs. 3.77 ± 0.16 95% CI, 3.45-4.08, p = 0.0010) and post-treatment (2.79 ± 0.14, 95% CI, 2.50-3.07 vs. 3.33 ± 0.16, 95% CI, 2.02-3.64, p = 0.0153). Similar significant results were found with the secondary parent- and child-reported outcomes. These superior results were achieved in PCET with fewer sessions (6.62, SD = 2.8) than those in CBT (8.00, SD = 3.1), p = 0.041. The superior effectiveness and efficiency of PCET likely results from the greater focus on implementing exposure exercises compared to traditional CBT.

The 5-Year Course of Medication Treatment in Childhood Anxiety Disorders.

OBJECTIVE: For pediatric psychiatric disorders, given the marked increase in use of medications without an understanding of the typical treatment course, the primary goal of the current study was to examine the course of pharmacotherapy over 5 years in children with newly diagnosed anxiety disorders. METHODS: We reviewed provider billing and prescription ordering records of a tertiary medical center from 2008 through 2015 to identify children (aged 7-17 years) newly diagnosed with an anxiety disorder and to determine the psychopharmacologic treatment that they received from 2010 through 2015. The frequency at which patients received prescriptions from 9 classes of psychotropic medications at any point during the study period was determined. We used χ² analyses and independent sample t tests to examine the relationship between receiving a psychotropic prescription and various patient characteristics. RESULTS: The study cohort included 108 patients (mean [SD] age = 12.8 [3.3] years). In this group, 73.1% received pharmacotherapy on at least 1 occasion over the 5-year period, and 41.7% received medications from more than 1 class. Of those who received a prescription, 50% (27/54) of patients remained on medication for 5 years. This estimate rose to 71% (5/7) within the subset of patients who were medication-naive at the beginning of the observation period and were still in high school during year 5. CONCLUSIONS: Guidelines implying discontinuation of medication after symptom remission and a limited period of stability do not accurately reflect clinical practice.

The Length of Child Anxiety Treatment in a Regional Health System.

Anxiety disorders are often undertreated due to unsuccessful dissemination of evidence-based treatments (EBTs). Lack of empirical data regarding the typical length of treatment in clinical settings may hamper the development of clinically relevant protocols. The current study examined billing records for 335 children ages 7-17 years to quantify the treatment received for newly diagnosed anxiety disorders within a regional health system. The vast majority of patients did not receive a sufficient number of appointments to complete the typical cognitive behavioral therapy protocol or reach the sessions introducing exposure. Although half of the sample received pharmacotherapy, the vast majority received fewer follow-up appointments than participants in pharmacotherapy research studies. Further, the type of treatment (i.e., number of sessions and medication) differed depending on utilization of specialty care. These results underscore the need to develop brief and flexible EBT protocols that can be standardized and implemented in community practice.

The Challenge of Empathy: A Pilot Study of the Use of Standardized Patients to Teach Introductory Psychopathology to Medical Students.

This pilot study compares standardized and actual psychiatric patients used to teach introductory psychopathology. In a blinded manner, students and psychiatric faculty interviewed both types of patients, using a small group format. Before and after the course, students and faculty completed a questionnaire about expectations and effectiveness. Students were divided in their opinions of standardized patients but generally preferred actual patients. Faculty were initially noncommittal, but after the course they strongly preferred actual patients. Although standardized patients offer some advantages over actual patients, limitations included difficulty developing empathy. Standardized patients could potentially be trained to convey emotions realistically, but further study of this is needed.