Augmented Treatment of Specific Phobias in Children

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DESCRIPTION (provided by applicant): The overall aim of the proposed investigation is to compare the efficacy of One-Session Treatment (OST: a variant of Cognitive-Behavior Therapy) to family-enhanced OST (Augmented OST) in the treatment of Specific Phobia in children. In our presently funded NIMH project, we have shown that OST is more effective in treating specific phobias in youth than Education/Support Treatment (EST) or Wait List Control conditions at post-treatment (60%, 26%, and 0% diagnosis free, respectively) and at 6-month follow-up (60% for OST and 42% for EST, with Waitlist participants randomly assigned to either OST or EST conditions following a 1 month wait). Although OST was shown to be superior to these conditions, it is evident that 40% of the youth who received this treatment were not diagnosis free at post-treatment or 6 month follow-up and that they continued to experience distressing symptoms. Herein, based on feedback from our parent stakeholders, we propose to augment standard OST procedures with a parent-management supplement that provides education to the parents about the nature, course, and causes of specific phobias and equips them with effective strategies to address lingering distress and avoidance in their children following OST. In brief, we propose to compare the standard OST procedure to a parent-enhanced one in a randomized clinical control trial with 154 children between 7 and 12 years of age. Specific aims are twofold: 1) to evaluate the efficacy of OST and a parent-augmented OST (Augmented OST) with children in a randomized trial; and 2) to explore moderators of treatment outcome, including the effects of parental psychopathology and overprotective parenting practices. One hundred and fifty-four children (77 boys, 77 girls) between 7 and 12 years of age who meet DSM-IV criteria for a specific phobia will be randomly assigned to individual OST or to Augmented OST treatments. (The age range is restricted to 7 to 12 years of age because family-based enhancement strategies have been found to be most effective with this age group). Post-Treatment and 1,6, and 12 month follow-up evaluations will be conducted. As such, this project will recruit the largest sample of phobic youth ever undertaken in the Unified States. It will provide valuable information about the disorder, its treatment, and the moderators of treatment outcome. This efficacy trial will lay the foundation for an effectiveness trial.