Profiles of Temperament among Youth with Specific Phobias: Implications for CBT Outcomes

Abstract

Specific phobias (SPs) are characterized by excessive fear or anxiety regarding an object or situation. SPs often result in a host of negative outcomes in childhood and beyond. Children with SPs are broadly assumed to show dispositional over-regulation and fearfulness relative to children without SPs, but there are few attempts to distinguish dispositional patterns among children with SPs. In the present study, we examined trajectories of differing temperamental profiles for youth receiving a CBT-based treatment for their SP. Participants were 117 treatment seeking youth (M Age = 8.77 years, Age Range = 6 – 15 years; 54.7% girls) who met criteria for a SP and their mothers. Three temperament profiles emerged and were conceptually similar to previously supported profiles: well-adjusted; inhibited; and under-controlled. While all groups showed similarly robust reductions in SP severity following treatment, differences among the three groups emerged in terms of broader internalizing symptoms, externalizing symptoms, and global outlook. The well-adjusted group was higher in functioning initially than the other two groups. The inhibited group had initial disadvantages in initial internalizing symptoms. The under-controlled group showed greatest comorbidity risks and had initial disadvantages in both internalizing and externalizing symptoms. These distinct clusters represent considerable heterogeneity within a clinical sample of youth with SP who are often assumed to have homogenous behavior tendencies of inhibition and fearfulness. Findings suggest that considering patterns of temperament among children with phobias could assist treatment planning and inform ongoing refinements to improve treatment response.

Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders

“…According to the current findings on the relation from BI and social anxiety disorder to CBT outcomes, there seems to be a need to adjust CBT for youth with high BI and/or social anxiety disorder. Similar conclusions have previously been drawn separately for BI and social anxiety disorders (Capriola et al, 2017;Evans et al, 2021).…”

“…It is also possible that the impact of BI diminishes with age (Balle et al, 2022). These results indicate that youth with a history of higher BI benefit from treatment, which has been documented for youth with high BI and specific phobias and preschool children exposed to prevention interventions (Capriola et al, 2017;Ooi et al, 2022).…”

“…Capriola and colleagues (2017) investigated temperamental profiles and outcomes from one-session CBT among youth with specific phobias. They found that improvement was comparable across temperamental profiles when comorbidity was accounted for (Capriola et al, 2017). Other studies involving BI-related traits, such as negative affect and shyness, did not find a predictive relation to CBT outcomes (Carper, 2020;Festen et al, 2013).…”

Parent- and Child-Factors in Specific Phobias: The Interplay of Overprotection and Negative Affectivity

“…Theories of temperament suggest that early individual differences in negative affectivity may confer risks for both anxiety and depression in youth (Gulley et al, 2016;Vervoort et al, 2011). Further, previous findings suggest that temperamental characteristics predict children's response to anxiety interventions (e.g., Capriola et al, 2017;Festen et al, 2013;Hirshfeld-Becker, et al, 2010). Specifically, there is evidence that negative affectivity is associated with heightened threat appraisal which can hinder responsiveness to interventions like CBT (Lengua & Long, 2002).…”

Adaptation and psychometric properties of Severity Measure for Specific Phobia-Adult in an Indonesian sample

“…In contrast, a number of studies revealed that the onset of specific phobias is in childhood. The average age of specific phobia onset is 8.7 years and depends on the type of phobia, for example, school age children for entomophobia and middle adolescence for scelerophobia ( Capriola et al, 2017 ; Shahriari-Namadi et al, 2018 ; Settineri et al, 2019 ). Furthermore, another study found that around 10% of individuals with specific phobias are preschool children, 7% are boys and 13% are girls ( Paulus et al, 2014 ).…”