Transitioning From In-Person to Telehealth Cognitive-Behavioral Therapy for Social Anxiety Disorder During the COVID-19 Pandemic: A Case Study in Flexibility in an Adverse Context.

Social anxiety disorder (SAD) is a condition in which people consistently and persistently experience significant fear and/or anxiety about one or more social situations in which they may be scrutinized and negatively evaluated. SAD has historically been found to respond well to cognitive-behavioral therapy (CBT) delivered both in-person and via telehealth; however, comparatively little information is available regarding response to treatment in the context of Coronavirus Disease 2019 (COVID-19) pandemic social and physical distancing guidelines, which have affected the way in which behavioral health services are delivered, as well as opportunities for interpersonal interactions which are either spontaneous or assigned as exposures. The current case study describes "Jennifer" (a pseudonym), a college student with a primary diagnosis of SAD, who was treated with primarily CBT interventions for 18 individual sessions over the course of approximately 6 months, which included treatment with a psychologist and a graduate student, implemented both in-person and via telehealth, both before and during the COVID-19 pandemic. Jennifer responded well to treatment, as evidenced by her self-report and decreases in symptom measure scores, engaged in CBT adapted to pandemic restrictions, and was able to utilize strategies learned during SAD treatment to address generalized anxiety and pandemic-related concerns. This case study demonstrates the feasibility of transitioning SAD care between providers and formats, as well as the robustness and flexibility of CBT strategies in the face of significant change, stress, and limitations of the external environment.

A Case Study of a Woman with Obsessions Related to COVID-19.

This de-identified case study seeks to increase the understanding of the process and impact of modifying exposure and response prevention (ERP) to address obsessions associated with COVID-19. The case study presents the assessment, diagnosis, and treatment of obsessive-compulsive disorder via televideo utilizing ERP for a woman who presented with difficulty with contamination and harm obsessions related to COVID-19. Over the course of 7 months, including an initial evaluation, this client attended 24 treatment sessions via synchronous video telehealth. Psychoeducation, self-monitoring, in vivo and imaginal exposures, response prevention, and behavioral activation strategies were utilized. Following treatment, this client was successfully managing symptoms and her scores on the Yale Brown Obsessive-Compulsive Scale and Sheehan Disability Scale had decreased significantly.

Predictive Relationship Between Parental Beliefs and Accommodation of Pediatric Anxiety.

Behavior performed by parents to assist a youth in avoiding or alleviating anxiety, known as accommodation, is ubiquitous among pediatric anxiety disorders and strongly related to poor treatment outcome. According to cognitive-behavioral theory, the beliefs parents hold regarding accommodation should predict parental accommodating behavior. Unfortunately, little is known about the beliefs parents hold regarding accommodation, as there exists no validated measure of this construct. First, the psychometric properties were examined for the Parental Accommodation Scale (PAS), a novel measure of parental accommodating behavior frequency (PAS-Behavior scale) and parental beliefs about accommodation (PAS-Belief scale). Second, the relationship between parental beliefs about accommodation and accommodation frequency was examined. Results provide preliminary evidence of the internal consistency and convergent validity of the PAS. Stronger positive beliefs about accommodation significantly predicted accommodation frequency, even after controlling for youth anxiety severity. Specifically, beliefs that accommodation prevents youth from losing behavioral and emotional control significantly predicted accommodation frequency. Therefore, efforts to decrease accommodation in clinical settings should involve correcting maladaptive parental beliefs about accommodation, with a particular emphasis on beliefs regarding the necessity of accommodation in preventing a youth from losing behavioral and emotional control.