A Retrospective Examination of the Similarity Between Clinical Practice and Manualized Treatment for Childhood Anxiety Disorders

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Abstract

The objective of this study was to facilitate the bidirectional communication between researchers and clinicians about the treatment of childhood anxiety disorders, including obsessive-compulsive disorder. Forty-four children were assessed before and after cognitive behavioral treatment with the parent versions of the Spence Child Anxiety Scale and Child Sheehan Disability Scale. In this retrospective study, treatment sessions were coded for the presence of exposures, relaxation, anxiety management, and behavior management. Results showed improved functioning within the clinical sample and suggested that treatment could be shorter, with exposure exercises implemented earlier in the course of treatment than described in manuals. Moreover, improvements in functioning were positively related to the use of exposures, and negatively related to the use of other anxiety management strategies. These results are discussed in the context of efforts to increase the availability of evidence-based treatments and are interpreted as supporting the development of more flexible treatment manuals.

Section snippets

Participants

Data regarding 43 child patients (21 male, 48.8%) ranging in age from 6 to 18 (M = 11.59, SD = 3.2) seen in an outpatient clinic between January 2005 and March 2008 were extracted from an IRB-approved clinical database. Patients were selected on the basis of having questionnaires regarding anxiety symptoms completed before and after treatment. A wide age range was preserved to reflect the variability in patients likely to be treated for anxiety. The majority of children were Caucasian (34, 79.1%;

Treatment Descriptions

The first round of data analysis was conducted to describe the nature of the treatment provided and examine how this compared to the treatment manuals. Since there are different commonly accepted manuals for the treatment of OCD versus the other anxiety disorders, these groups were examined separately for these analyses. Single sample t-tests were used to compare the current treatment to the protocol described in the published manuals. The percentage of sessions that included the various

Discussion

The first goal of this study was to compare the structure of treatment administered in a clinical practice to that described in prominent treatment manuals. These analyses indicated that the intervention provided in this clinical setting was shorter and introduced exposures earlier than what is prescribed in the published manuals. In addition, relaxation strategies were rarely used clinically despite their prevalence in the anxiety but not the OCD treatment manual. Although, anxiety management

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