Change in disgust reactions following cognitive-behavioral therapy for childhood anxiety disorders

Abstract

Disgust, in addition to fear, is a prominent emotional state associated with avoidance of distressing stimuli. While most of the research in disgust has been conducted in relation to Obsessive-Compulsive Disorder (OCD), recent data has also implicated disgust in the etiology of anxiety disorders in general. Studies have shown that decreases in disgust are key to symptom reduction in individuals with OCD. However, there has been little empirical work exploring whether these interventions are efficacious for childhood anxiety disorders that present with prominent disgust components. This study examined how disgust propensity in children with anxiety disorders responds to cognitive-behavioral therapy (CBT) with an emphasis on exposure. Forty-one children, ages 7 to 17, with anxiety disorders were evaluated for disgust propensity and were treated with intensive, weekly, CBT. It was found that disgust levels decreased following treatment across all anxiety disorder diagnoses, where children with primary OCD exhibited significantly greater reductions. Clinical implications and suggestions for further research of the treatment of disgust in relation to childhood anxiety disorders are discussed.

OCD: obsessive–compulsive … disgust? The role of

“…19 Correlated reductions in DP and contaminationbased symp toms have been replicated by other studies. 21,23 Although many studies have examined disgust vulnerabil ity in patients with contaminationbased OCD, it remains un clear how DS and DP relate to the other symptom dimen sions. Studies have reported that disgust scores significantly correlate with OCD symptoms of checking and symmetry/ ordering, but it is unknown why this is the case.…”

“…34 These results highlight the importance of incorporating various facets of disgust into exposurebased treatments because clin ically meaningful symptom reductions may depend on ade quately extinguishing feelings of disgust. Several studies have reported significant associations between reductions in DP scores and symptom improvement in adults 21,35 and chil dren 23 posttreatment. Therefore, identifying strategies that effectively target disgust may not only reduce symptoms, but may also reduce costs, dropout rates and duration of treat ments.…”

Factors Predicting Youth Anxiety Severity: Preliminary Support for a Standardized Behavioral Assessment of Parental and Youth Avoidance Behaviors

“…However, it may also be the case that parental behavior is modeled to youth, such that observation of parental anxietyrelated behavior results in increased youth anxiety regarding avoided situations (Fisak & GrillsTaquechel, 2010). Although it is unlikely that youth observe automatic biases as assessed via the AAT (i.e., differences in response latency in the order of milliseconds), AAT biases correspond with more overt anxiety-related behavior (Amir et al, 2013;Klein et al, 2011;Taylor & Amir, 2012) and thus may be a feasible proxy for such real-life behaviors. Future research employing larger samples with multiple time points may clarify the directionality and clinical significance of this association.…”

“…Moreover, disgust propensity decreases following cognitive behavior therapy (Taboas, Ojserkis, & McKay, 2014). We also included happy faces to remain consistent with previous AAT studies (Heuer et al, 2007;Roelofs et al, 2010;Taylor & Amir, 2012) and because biases for happy faces have been demonstrated in individuals with social anxiety disorder (Ernst et al, 2013;Heuer et al, 2007;Roloefs et al, 2010) as well as generalized anxiety disorder (Bradley, Mogg, White, Groom, & de Bono, 1999). Thus, standardization of disgust, happy, and neutral pictures for our AAT may have relevance across anxiety disorders in both youth and adults.…”

“…In this study, we administered an AAT to clinically anxious youths and their parents. We chose to include pictures of faces portraying disgust, happy, and neutral expressions, consistent with our previous research using the AAT (Taylor & Amir, 2012). Disgust propensity and/or disgust sensitivity have been implicated across several anxiety disorders, including social anxiety disorder (Amir, Najmi, & Bomyea, & Burns, 2010), specific phobias (Muris, Merckelbach, de Jong, & Ollendick, 2002), generalized anxiety disorder (Olatunji, Tart, Ciesielski, McGrath, & Smits, 2011), and obsessive-compulsive disorder (Olatunji et al, 2011).…”