Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety

Emily L Bilek; Allison E Meyer; Rachel Tomlinson; Carol Chen

doi:10.1007/s10578-023-01540-x

Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety

Child Psychiatry Hum Dev. 2023 May 26:1-13. doi: 10.1007/s10578-023-01540-x. Online ahead of print.

Authors

Emily L Bilek¹, Allison E Meyer², Rachel Tomlinson³, Carol Chen⁴

Affiliations

¹ Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Rd., SPC 5765, Ann Arbor, MI, 48109, USA. ealaird@med.umich.edu.
² Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA.
³ Department of Psychology, University of Michigan, Ann Arbor, MI, USA.
⁴ Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Rd., SPC 5765, Ann Arbor, MI, 48109, USA.

Abstract

This pilot examines a self-distancing augmentation to exposure. Nine youth with anxiety (ages 11-17; 67% female) completed treatment. The study employed a brief (eight session) crossover ABA/BAB design. Exposure difficulty, engagement with exposure, and treatment acceptability were examined as primary outcome variables. Visual inspection of plots indicated that youth completed more difficult exposures during augmented exposure sessions [EXSD] than classic exposure sessions [EX] by therapist- and youth-report and that therapists reported higher youth engagement during EXSD than EX sessions. There were no significant differences between EXSD and EX on exposure difficulty or engagement by therapist- or youth-report. Treatment acceptability was high, although some youth reported that self-distancing was "awkward". Self-distancing may be associated with increased exposure engagement and willingness to complete more difficult exposures, which has been linked to treatment outcomes. Future research is needed to further demonstrate this link, and link self-distancing to outcomes directly.

Keywords: Anxiety disorders; Cognitive behavioral therapy; Exposure therapy; Self-distancing; Youth.