(PS3-D84) The Underestimated Anticipatory Anxiety – Anxiety Progression During Exposure for Children and Adolescents with Anxiety Disorders

Theoretical

Background: Even though exposure-based CBT is a highly successful treatment for anxiety disorders, individual treatment responses vary substantially, and not all treated children and adolescents improve or fully benefit in the long-term. In order to extend treatment efficacy, it is crucial to determine key treatment components and understand underlying processes of individual treatment response more precisely. Our study was designed to examine exposure mechanisms by systematically focusing on anxiety trajectories during exposure exercises in a large multicenter randomized controlled trial (RCT) in Germany (KibA - Kids Beating Anxiety, FKZ 01EE1402C).

Methods: 1599 standardized records of exposure exercises were analyzed from 352 children and adolescents (age: M = 11.28, SD = 2.25, range 7-16 years) with anxiety disorders (separation anxiety disorder, social anxiety disorder, specific phobia). They rated their anxiety levels prior, during, and after exposure in five consecutive therapy sessions. Within-session reduction of anxiety levels was analyzed using a hierarchical linear mixed model (LMM).
Distinct trajectories were derived and individuals were categorized according to type and pattern of trajectory distributions using agglomerative hierarchical cluster analysis.

Results: Based on the anxiety ratings over the course of a session, we identified six different anxiety trajectories. Surprisingly, two thirds (66%) of the exposures followed a decrease pattern. Thus, the anxiety level was highest prior to the exposure and decreased during the exposure to post. The pattern of a reverse u-shape, which is typically described by the majority of clinicians in the psychoeducation phase, was only present in 23% of all exposure exercises. Six clusters with distinct compositions of response patterns could be identified.

Discussion and

Conclusion: The present study is the first to examine anxiety trajectories in exposure exercises in more detail through the evaluation of standardized exposure records using a large youth patient sample. The current data extend previous knowledge and offer novel insights into anxiety trajectories: for the first time, trajectories of anxiety during exposure were evaluated on the process-level. Furthermore, the findings highlight that future studies should pay more attention to anticipatory anxiety, as it seems to play a more relevant role for a significant number of children and adolescents than previously assumed.