Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

Benito, Kristen; Herren, Jennifer; Freeman, Jennifer B.; Garcia, Abbe; Block, Paul; Cantor, Elizabeth; Chorpita, Bruce F.; Wellen, Brianna; Stewart, Elyse; Georgiadis, Christopher; Frank, Hannah E.; Machan, Jason T.

doi:10.1016/j.beth.2020.10.003

Cited by 12 publications

(6 citation statements)

References 32 publications

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“…Rates of optimal and suboptimal delivery behaviors will be calculated for each therapist with recorded session data, and in-session behavior will be examined as a function of post-training TBES scores using GLM (Gaussian distribution); these will be conducted as two separate tests examining optimal and suboptimal behaviors. Finally, the relationship between negative beliefs and rates of exposure utilization, calculated as a percentage of sessions with and without exposure delivery, will be assessed using correlational analyses consistent with past training trials incorporating the EPCS coding system [( 54 , 55 ); Hypothesis 4].…”

Section: Anticipated Resultsmentioning

confidence: 99%

“…Exposure Guide (EG). The EG is a quality monitoring tool that has been validated in previous and ongoing exposure therapist training studies ( 54 , 55 ). The tool is completed by therapists following a treatment session, and rates the extent to which specific behaviors occurred during the session, along with quality indicators such as: using a hierarchy to choose the exposure, patient participation in exposure selection, clear presentation of exposure task, taking anxiety ratings, post-processing the exposure, discussing avoidance after the session, gathering new information about anxiety, tapping the core fear, and whether the exposure was too hard or too easy.…”

Section: Methodsmentioning

confidence: 99%

“…Anxiety treatment was informed by a flexible treatment manual used by our research team in previous exposure training studies ( 54 , 55 ), as well as treatment strategies employed as usual practice. The study explicitly did not require use of a specific treatment protocol, but instead encouraged “flexibility within fidelity” to the provided manual by applying a workshop knowledge about exposure principles and their intended function on patients’ presenting concerns ( 60 ).…”

Section: Methodsmentioning

confidence: 99%

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Exposure to exposure: A protocol for leveraging exposure principles during training to address therapist-level barriers to exposure implementation

Kemp

Benito²,

Herren³

et al. 2023

Front. Psychiatry

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BackgroundExposure therapy is a highly effective but underutilized treatment for anxiety disorders. A primary contributor to its underutilization is therapist-level negative beliefs about its safety and tolerability for patients. Given functional similarities between anxious beliefs among patients and negative beliefs among therapists, the present protocol describes how exposure principles can be leveraged during training to target and reduce therapist negative beliefs.MethodsThe study will take place in two phases. First, is a case-series analysis to fine-tune training procedures that is already complete, and the second is an ongoing randomized trial that tests the novel exposure to exposure (E2E) training condition against a passive didactic approach. A precision implementation framework will be applied to evaluate the mechanism(s) by which training influences aspects of therapist delivery following training.Anticipated resultsIt is hypothesized that the E2E training condition will produce greater reductions in therapists’ negative beliefs about exposure during training relative to the didactic condition, and that greater reduction in negative beliefs will be associated with higher quality exposure delivery as measured by coding of videotaped delivery with actual patients.ConclusionImplementation challenges encountered to date are discussed along with recommendations for future training interventions. Considerations for expansion of the E2E training approach are also discussed within the context of parallel treatment and training processes that may be tested in future training trials.

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Section: Anticipated Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Exposure to exposure: A protocol for leveraging exposure principles during training to address therapist-level barriers to exposure implementation

Kemp

Benito²,

Herren³

et al. 2023

Front. Psychiatry

Self Cite

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“…Here, quality ERP sessions require habituation, defined as sessions in which distress levels decrease from the first measurement until the last measurement, and the decrease in distress occurs in the absence of avoidance, reduced task difficulty, and accommodation as defined previously [ 12 ]. This theory also assumes that there is an optimal level of distress that is neither too low nor too high for conducting effective exposures [ 59 ]. As subjective distress may not correspond to physiological levels of arousal, we will use both measures.…”

Section: Methodsmentioning

confidence: 99%

A Wearable Artificial Intelligence Feedback Tool (Wrist Angel) for Treatment and Research of Obsessive Compulsive Disorder: Protocol for a Nonrandomized Pilot Study

Lønfeldt¹,

Clemmensen²,

Pagsberg³

2023

JMIR Res Protoc

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Background Obsessive compulsive disorder (OCD) in youth is characterized by behaviors, emotions, physiological reactions, and family interaction patterns. An essential component of therapy involves increasing awareness of the links among thoughts, emotions, behaviors, bodily sensations, and family interactions. An automatic assessment tool using physiological signals from a wearable biosensor may enable continuous symptom monitoring inside and outside of the clinic and support cognitive behavioral therapy for OCD. Objective The primary aim of this study is to evaluate the feasibility and acceptability of using a wearable biosensor to monitor OCD symptoms. The secondary aim is to explore the feasibility of developing clinical and research tools that can detect and predict OCD-relevant internal states and interpersonal processes with the use of speech and behavioral signals. Methods Eligibility criteria for the study include children and adolescents between 8 and 17 years of age diagnosed with OCD, controls with no psychiatric diagnoses, and one parent of the participating youths. Youths and parents wear biosensors on their wrists that measure pulse, electrodermal activity, skin temperature, and acceleration. Patients and their parents mark OCD episodes, while control youths and their parents mark youth fear episodes. Continuous, in-the-wild data collection will last for 8 weeks. Controlled experiments designed to link physiological, speech, behavioral, and biochemical signals to mental states are performed at baseline and after 8 weeks. Interpersonal interactions in the experiments are filmed and coded for behavior. The films are also processed with computer vision and for speech signals. Participants complete clinical interviews and questionnaires at baseline, and at weeks 4, 7, and 8. Feasibility criteria were set for recruitment, retention, biosensor functionality and acceptability, adherence to wearing the biosensor, and safety related to the biosensor. As a first step in learning the associations between signals and OCD-related parameters, we will use paired t tests and mixed effects models with repeated measures to assess associations between oxytocin, individual biosignal features, and outcomes such as stress-rest and case-control comparisons. Results The first participant was enrolled on December 3, 2021, and recruitment closed on December 31, 2022. Nine patient dyads and nine control dyads were recruited. Sixteen participating dyads completed follow-up assessments. Conclusions The results of this study will provide preliminary evidence for the extent to which a wearable biosensor that collects physiological signals can be used to monitor OCD severity and events in youths. If we find the study to be feasible, further studies will be conducted to integrate biosensor signals output into machine learning algorithms that can provide patients, parents, and therapists with actionable insights into OCD symptoms and treatment progress. Future definitive studies will be tasked with testing the accuracy of machine learning models to detect and predict OCD episodes and classify clinical severity. Trial Registration ClinicalTrials.gov NCT05064527; https://clinicaltrials.gov/ct2/show/NCT05064527 International Registered Report Identifier (IRRID) DERR1-10.2196/45123

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“…It is a highly efficient method to draw inferences about the effects of an intervention while controlling for multiple threats to internal validity, such as history, repeated assessment, and regression to the mean Kazdin, 2011). Although the sample size is generally small in this design, it has been successfully used to test treatment of co-occurring ADHD and anxiety in children ages 8-12 (N = 8; Jarrett & Ollendick, 2012) as well as novel implementation approaches for pediatric OCD (N = 8; Benito et al, 2020) and childhood specific phobia (N = 8; Farrell et al, 2021) interventions.…”

Section: Methods Study Designmentioning

confidence: 99%

Enhancing daily affect in youth experiencing high‐conflict parental divorce: A multiple baseline trial of an online prevention program

O’Hara

Boring

Sandler

et al. 2022

Family Court Review

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This study investigated the effects of a highly interactive, online cognitive-behavioral youth coping program: Children of Divorce-Coping with Divorce (CoD-CoD; Boring et al., 2015) on children exposed to high levels of interparental conflict (IPC). A multiple-baseline experimental design (N = 9) evaluated within-subject intervention effects on change in daily positive and negative affect before, during, and after the intervention (nobservations = 462). Participants were youth ages 11-16 who reported high exposure to IPC and whose parents had filed for divorce or parenting plan determinations in the prior year. A significant interaction effect indicated change in positive affect, but not negative affect, between the intervention and baseline phases. Positive affect linearly decreased during the baseline phase and flattened during the intervention phase. Results indicate that CoD-CoD was effective in interrupting a decline in youth-reported positive affect in a high-IPC sample, which may indicate a buffering effect against depression. Critical future directions include conducting large-scale randomized trials with children from high-IPC families to assess for whom the program is effective and assess long-term effects across a broad range of important outcomes.

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Improving Delivery Behaviors During Exposure for Pediatric OCD: A Multiple Baseline Training Trial With Community Therapists

Cited by 12 publications

References 32 publications

Exposure to exposure: A protocol for leveraging exposure principles during training to address therapist-level barriers to exposure implementation

Exposure to exposure: A protocol for leveraging exposure principles during training to address therapist-level barriers to exposure implementation

A Wearable Artificial Intelligence Feedback Tool (Wrist Angel) for Treatment and Research of Obsessive Compulsive Disorder: Protocol for a Nonrandomized Pilot Study

Enhancing daily affect in youth experiencing high‐conflict parental divorce: A multiple baseline trial of an online prevention program

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