Showing posts with label Therapy/Interventions. Show all posts
Showing posts with label Therapy/Interventions. Show all posts

High Cost of Positive Psychology Services is a Barrier.

"Integrating Autism and the Positive Psychology fields faces significant barriers, starting with the high cost of therapy, which automatically makes it inaccessible to a large portion of autistics and their families. Being autistic already comes with a big financial cost." - Hari Srinivasan 

https://www.liebertpub.com/doi/10.1089/aut.2024.38246.pw



 

How Your Posture Can Influence Your Emotions - Tips for Autistics

 

How Your Posture Can Influence Your Emotions -  Tips for Autistics

Did you know that the way you sit or stand can impact how you feel? Research by Peper and Lin (2012) has shown that adopting certain body positions can significantly influence your emotional state. For example, sitting upright can boost your mood and energy levels, while slouching can make you feel more down or even depressed.

Why This Matters for Autistics

For many autistics, understanding and managing emotions can be a unique challenge. However, becoming aware of how body posture affects feelings can be a simple yet effective tool for emotional regulation.

Here’s how posture can help:

  • Boost Mood: Standing or sitting up straight can naturally elevate your mood and increase your energy levels.
  • Manage Emotions: When feeling anxious or low, adjusting your posture to a more upright position can help improve your emotional state.
  • Easy to Implement: This strategy doesn’t require any special equipment or training. Just being mindful of your posture can make a difference!

Quick Tips to Try:

  • Check Your Posture: Throughout the day, notice if you’re slouching. Straighten up to see if it changes how you feel.
  • Practice Mindfulness: Engage in activities like stretching or gentle yoga to improve body awareness and posture.
  • Encourage Awareness: Have people around you check in on you and perhaps gently remind you about posture as a tool for emotional management. 
By paying attention to your body position, you can take control of your emotional well-being in a simple and effective way. Give it a try and see how a small change in posture can make a big difference!




Peper, E., & Lin, I. (2012). Increase or decrease depression: How body postures influence your energy level. Biofeedback, 40(3), 125-130.- They found that an upright posture can promote a more positive mood and energy levels, while a slumped posture can lead to increased feelings of depression.

Disability is both a cause and consequence of poverty

 

"Disability is both a cause and consequence of poverty. 
We're more that 2x likely to live in poverty than non-disabled people"

Disability and poverty are intrinsically linked, creating a vicious cycle that exacerbates the challenges faced by the disabled. This disparity stems from systemic barriers in education, employment, and healthcare. Disabled individuals often encounter limited job opportunities, workplace discrimination, and inadequate support services, significantly hindering their ability to secure stable and well-paying employment. According to the National Council on Disability, these employment challenges contribute heavily to the higher poverty rates among disabled individuals (National Council on Disability, 2017). The lack of accessible education further compounds this issue, as it restricts the skill development necessary for competitive employment.

Moreover, poverty can lead to or worsen disability, creating a continuous loop of disadvantage. Individuals living in poverty often have limited access to healthcare, resulting in untreated medical conditions that can lead to further disability. The financial strain associated with poverty can prevent people from obtaining necessary assistive devices or modifications, further diminishing their quality of life and ability to participate fully in society. The World Health Organization (WHO) emphasizes that this cyclical relationship underscores the need for comprehensive policies and programs that address both poverty alleviation and disability inclusion simultaneously (WHO, 2011). Breaking this cycle requires concerted efforts to create inclusive educational and employment opportunities, enhance social support systems, and ensure equitable access to healthcare and other essential services for disabled people. Investing in these areas not only improves the lives of disabled individuals but also fosters a more inclusive and equitable society, reducing overall poverty and promoting economic stability.

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A plain language version

Disability and Poverty: A Tough Cycle

Disability and poverty are closely connected. This makes life harder for disabled people. Here’s why:

  1. Education: Many disabled people don’t get a good education. This makes it hard for them to learn skills needed for good jobs.

  2. Jobs: Disabled people often face problems finding jobs. There aren’t enough job opportunities, and some employers discriminate against them. Without good jobs, it’s hard to earn enough money.

  3. Healthcare: Poor people often can’t afford good healthcare. This can lead to untreated health problems that cause or worsen disabilities.

  4. Support Services: Disabled people need special support, like assistive devices or home modifications, but these can be expensive. Without money, they can’t get the help they need.

The National Council on Disability says that these problems make more disabled people live in poverty. The World Health Organization also says that we need to solve both poverty and disability issues together.

To break this cycle, we need to:

  • Provide better education for disabled people.
  • Create more job opportunities and stop workplace discrimination.
  • Offer better social support services.
  • Make healthcare and housing affordable and accessible for everyone.

When we invest in these areas, we help disabled people live better lives. This also helps reduce poverty and builds a stronger, fairer society for everyone.

2 versions of this post

In PlainSpeak Plain Language for Lay Reader

For Scientific/Academic Audience

A kinder ABA is a therapist driving you to the point of frustration, then offering to hold your hand

https://link.springer.com/article/10.1007/s40617-023-00833-w 

Good grief is all I can say. 

Adding the prefix of "Kind" to something does not automatically make anything automatically Kinder. As is peppering a paper with the word "Kind" to sublimely influence you that it must be kind. 

And a sample size of 4 autistics in the study makes this a valid method, how?

And what did this  "kind" translate to exactly. when a therapist drives you to the point of a tantrum in the first place, then offers to hold your hand, and saying "I can see you are frustrated."

Is this a new marketing strategy by the (massive-profits with no accountability) ABA industry to make even more profits of desperate families. 

Please don't joke around with studies trying to whitewash stuff. This is not helping.  




Autism Space seen as profit making space by Private Equity

 Autism Space seen as profit making space by Private Equity

This is a continuing and troubling trend in autism. 

'...private equity investments per year tripled or quadrupled from 2018 to 2021 compared to 2015.

 ...expected investment to continue at breakneck speed

“...They needed to start showing profits and revenue that match their valuation. … So at some point, [investors] need to start seeing a return on their investment,”

 ...autism therapy space could be at the point of the investment life cycle where investors are pressuring operators to shift from scale to efficiency and profitability.

...opening clinics that reach targeted patients while being “financially healthy,” Marsh said. 

https://bhbusiness.com/2022/07/22/why-the-massive-investment-in-autism-companies-created-a-ticking-timebomb/

Power dynamics of ABA

https://autisticselfadvocatesagainstaba.wordpress.com/2020/04/13/problematic-and-traumatic-why-nobody-needs-aba/?fbclid=IwAR3aeHROwIEr2uaRmsw7i1oBuOy90Cln8cMgi_nJ4bZGT87VckcUhTUoOqA

Some points that resonated in this article. 

The problem with reinforcements. 

  • "tablet time” is used as reinforcement. This is a problem because many autistics rely on their tablets for communication. Many autistics are non-speaking, and to take away their means of communication is one reason increasingly aggressive or “challenging” behaviors persist — they are not being heard or understood and the only way left to communicate their discomfort, pain, or any other needs has been taken away."
The loss of childhood.
  • "A child is typically expected to participate in 25-40 hours of ABA therapy each week; that is 5-8 hours a day of repetitive, uncomfortable, or potentially painful demands and broken down tasks, of few or no breaks, of being presumed incompetent, and of not having adequate accommodations.
  • A full-time job is expected of kids under the age of 4, and there is no strong evidence to suggest that it is effective or beneficial. Children should be allowed to have a childhood, and that is not possible when they must sit through 25-40 hours of therapy each week. This level of intervention leaves little time for rest, play, and learning outside of therapy, which can wreak havoc on a child’s mental health."
Lack of training and quality control. 
  • "Many ABA practitioners are Registered Behavior Technicians (RBT)s, which any 18-year old with a high school diploma could be by taking a 40-hour training and passing an exam."
Long term trauma and PTSD
  • "A survey of 460 autistic adults and caregivers of autistic children evidenced that 46% of those who participated in ABA therapy met the diagnostic criteria for PTSD, and 47% of those meeting this diagnostic threshold experienced severe symptoms (Kupferstein, 2018)."
Yet, still touted as the gold-standard EBT
  • "Yet ABA is still widespread throughout the United States and it is recommended under the premise of being an effective evidence-based practice. However, there is weak evidence that ABA is an effective behavioral treatment. Rated on the GRADE system the quality of evidence is low to very low (Reichow, Hume, Barton, & Boyd, 2018). In fact, “of the 58 studies done on Lovaas’ ABA therapy, only one was found to meet the U.S. Department of Education’s standards for scientific evidence."
Related Posts

An utter lack of accountability

Today there was a news article about a 7 year old autistic boy who went missing from his school during the school day. This was during a snowstorm, and he was found shivering and soaked in the middle of a busy traffic intersection by good neighborhood samaritans - and wearing just a thin t-shirt. 

The school of course insisted that the child had been missing a mere 2-3 minutes, though investigations show him having walked through a patch of woods and being outside for over 35 minutes. 

There had already been a plan in place as this autistic kid frequently eloped (a term used for kids who wander away). The police and parents were to be informed but neither happened. The good samaritans saw a kid darting about in traffic, stopped the traffic, rescued him, took him home and wrapped him in blankets. 

Unfortunately the school district missing an autistic child during the school day is more common that you would think. As is the practice of gaslighting parents on the details (fear of being sued!!). The fear of being sued apparently more critically important than any safety concerns of disabled children. 

When I was younger (~grade 3-4) I was in a classroom simply known as Room 20 in Dilworth Elementary. An autistic kid in my class did go missing for several hours. The school went into a lockdown as they searched for him. We were all asked to come indoors and stay inside. 

Later that afternoon, an old man who lived a few streets away returned the kid as he had found him wandering around. 

Of course, there was a lot of discussion in the class that day between the teacher and the classroom aides about how to downplay or not report this incident to the parents at all.  I don't know the end result of how much the parents were told,  but those overheard conversations about how to avoid revealing the truth about a missing child to its parents by educators are deeply disturbing. 

How can we autistics fully put our trust and faith in an education system if we don't believe educators (the ones supposed to nurture and help us) will only will watch their own back and not your back. 

https://www.youtube.com/watch?v=sJBoKDEUJy4

https://www.cambridgetoday.ca/local-news/autism-advocates-call-for-more-school-supports-after-7-year-old-with-autism-found-at-busy-intersection-8197389



Who has the dx, and who is the professional

This week I heard of an instance where an ABA therapist got offended at a something his autistic client did and quit over the autistic teen not following directions. 

The autistic teen had been asked to wait at a library, looks like that teen hung around for a while, and then decided to just walk back to his home alone after a while. 

I want to ask, who has the diagnosis here, who is the professional "behavior-therapist" here who is supposed to help shape behaviors instead of walking off in a huff. 

Why have the word "behavior" in applied-behavior-therapy if you don't want to even help with or deal with behavior in the first place. 

Private equity and ABA

Another example of private equity (valuation) driving ABA therapy. This does not bode well for the marginalized groups within autism and furthers the exploitative and profit hungry nature of autism therapy. 

When the focus is on $$$$, companies will turn away the "non-easy" cases (aka, autistic kids with behaviors) and take up cases they perceive are easy, so that they can show quick results to the investors. Given the heterogeneity of autism with the dx ratio now at 1:36, there are enough non-behavior kids to fill any amount of supply.   There is irony in behavior agencies turning away kids with behaviors who need help.

There is focus on valuation but not on quality control in ABA, because in autism if a kid does not improve, the fault is all on the kid, never the therapy. The one industry where there can be profits with no accountability. 


https://bhbusiness.com/2023/05/12/autism-therapy-providers-tie-upskilling-to-beating-turnover-serving-more-families/


Autism Space seen as profit making space by Private Equity

This is a continuing and troubling trend in autism. 


'...private equity investments per year tripled or quadrupled from 2018 to 2021 compared to 2015.

 ...expected investment to continue at breakneck speed

“...They needed to start showing profits and revenue that match their valuation. … So at some point, [investors] need to start seeing a return on their investment,”

 ...autism therapy space could be at the point of the investment life cycle where investors are pressuring operators to shift from scale to efficiency and profitability.

...opening clinics that reach targeted patients while being “financially healthy,” Marsh said. 

https://bhbusiness.com/2022/07/22/why-the-massive-investment-in-autism-companies-created-a-ticking-timebomb/


McGlade et al 2023: Effectiveness of Early Intervention Therapies

My take: If early childhood therapy was so "effective", then the thousands of kids who have had massive amounts of therapy all through childhood (starting with early intervention) would have "RECOVERED" may times over. Why are my challenges still significant - ie: all that therapy did not make a dent. Currently there is no such thing as gold-standard childhood therapy. Most autism therapy is hit-or-miss, at any age. Its just $$$$ spent on trial and error. Lots of careers and promotions. 

Recently there was a twitter post pointing out that since were were no readily available "statistics" (referring to it as a "cool autism fact")  showing numbers of the more significantly impacted adult autistics meant that numbers of this group must be overstated. Others in the thread  questioned if adult autistics who did not not speak, even existed, since that autistic posting had learned to speak at age 3. This an irresponsible statement and an erasure of the huge number of non-speaking or minimal verbal adults who need to be part of the autism solutions. 

Onto the paper. 

=======



Key Takeaways from paper. 
  • Limited evidence  to recommend very early interventions for infants and toddlers with autism.
    • Limited impact of early intervention for at-risk infants/toddlers (by age 3. 
    • No significant treatment effects for autism symptoms, cognitive outcomes, receptive/expressive language. Even neurocognitive outcomes (EEG and eye tracking) were inconsistent. 
  • Gold-standard early intervention is yet to be developed.  Future treatment will need to include novel and individualized intervention targets alongside the targeting of parental responsiveness.

Questions that arise. 
  • What are the implications of these findings for clinical practice and policy related to early intervention for autism?
  • What are the long-term outcomes of very early interventions for infants and toddlers with autism beyond age 3 years?
  • What are the ethical considerations related to intervening in infants and toddlers at increased likelihood of autism dx, and how can these be addressed in future research and practice?

McGlade, A., Whittingham, K., Barfoot, J., Taylor, L., & Boyd, R. N. (2023). Efficacy of very early interventions on neurodevelopmental outcomes for infants and toddlers at increased likelihood of or diagnosed with autism: A systematic review and meta-analysis. Autism Research, 16(4), 698-710. https://doi.org/10.1002/aur.2924

This is 2023. Why are shocks still part of Autistic Behavior Therapy?


This is 2023: Shocks are being used on autistics as part of ABA Therapy. The UN calls it "torture". Read this article by Eric Garcia in the Boston Globe. 


1965: The images show a Photo Essay that appeared in the 1965 issue of Life Magazine about ABA therapy being done on Autistic Kids with Dr Loovas. Shocks were used as aversives -  the floor is laced with metal strips and the autistic girl in the picture is barefooted.  



Moser, D., & Grant, A. (1965). Screams, slaps & love: A surprising, shocking treatment helps far-gone mental cripples. Life Magazine, 90-102

Vestibular, Proprioception in Autism

Lay summary:  Go to any Occupational Therapist and you are bound to hear the words vestibular and proprioception, sensory diet at least a few times.  

Why is this important: Understanding the role of sensory processing difficulties and the sensory systems involved (such as vestibular, proprioception, and somatosensory body mapping) can be helpful in developing effective interventions and support strategies for autistics.

Insights from CBT

This is not my fault

I didn't do this on purpose.

It's not fair to judge myself, because its not accurate to judge yourself. 

Remind myself, Don't judge myself for judging myself. 

Autism DeCal Fall2020

Class 5: 10/5/2020

Today we covered common therapies used in Autism. 

Our Guest speaker was Dr Lawrence Fung who heads the Stanford Neurodiversity Project



Class 4: 9/28/2020

Today we covered common therapies used in Autism. 

Our Guest speaker was Noor Pervez from ASAN to speak on intersectionality. 



Class 3: 9/21/2020

Today we wrapped up our "Law Enforcement" Topic and covered "Autism in the Context of the Disability Rights Movement."

Our guest speaker was Prof Steve Hinshaw with another powerful talk on Stigma.


Class 2: 9/14/2020


In today's Mini Lecture portion, we focused on Autism interaction with Law Enforcement

To prep students, we asked the question

We will be wrapping up this topic in the next class as we got ready for the Student Presentations and the Guest Speaker. 

We had our first Guest Speaker on - Dr Clarissa Kripke on Sensorimotor Issues in Autism. Some tech difficulties as our speaker was not able to access our Zoom. So switched to Google Hangouts!! 


Survey Q: What interests you about this class

  • A friend of mine works with kids with autism and I would like to educate myself more on this topic so that I can be more well versed in this subject area when i talk to them. I would like to learn about pretty much anything y'all find most important, I'm just a dude trying to learn as much as possible.
  • It is interesting to learn about the spectrum of autism and how individuals cope with certain levels of the spectrum.
  • I am interested in learning more about adults with autism and the kind of support needed and barriers experienced later on in life. I also know a little about who women and girls are less likely to be diagnosed with autism until later on in life due to the way ASD is gendered, but I am curious to learn more about that.
  • I hope to build my awareness and knowledge of autism so that I can better understand and be an ally to those around me. I feel that autism is often stigmatized as a disability, and I want to learn more about how we can combat this thinking. I want to learn what symptoms and behaviors are associated with autism.
  • - I am interested on how I can be more cognizant of those on the spectrum. Additionally, as an intended disability studies minor, I want to learn more about personal stories by listening to guest speakers etc.
  • I am very interested in taking this course because of my interest in better understanding disabilities on many levels. I am aiming to pursue a career in disability research but believe heavily in the importance of understanding disabilities on a personal / social level before having the right to study them on a molecular / neurological level.
  • As being on the spectrum, I want to learn more about the condition and maybe provide some insight into the daily life of an autistic person.
  • I want to learn more about the autism spectrum, and what it looks like to proactively involved.
  • more information about life with autism and advantages or disadvantages
  • As a Psychology major, I find that I haven't actually learned much about autism in my classes, although I've learned about mood disorders, intellectual disabilities, and learning disorders. So, I'd like to learn more about the realities of autism and treatment options available.
  • I would like to get a more holistic view about autism from different disciplines as well as hear from the guest speakers!
  • why they have tendency too hyperfixate. how to navigate social situations with them.
  • I've seen autism depicted in media, and am curious to see if their depictions are accurate, and i just want to understand and be able to empathize more with people who do have autism.
  • I've always wanted to take a class focused on Autism, and I came to know of this class through Obama's Instagram ;) I would like to learn more about Autism through the perspective of someone with Autism. I also would like to learn more about the biological basis behind autism. Overall, I am most excited to meet more people and hear everyone's various experiences.
  • Just want to gain some general understanding about Autism to be able to broaden my sensitivity to and understanding of the needs of neurodiverse people :)
  • I'd like to hear about what it's like to be autistic from someone who has autism and how to be a helpful ally.
  • I am pursuing the disability studies minor and would like to educate myself more around the topic of disability. I think this will be a great way to know more about autism as we are taught very little about it in school.
  • I would like to meet other people on the spectrum, hear there stories / experience and have a safe place to share my own.
  • I'm interested in this course because I've learned a couple of things about the autism spectrum from my child development and psychology classes, but not a significant amount, and I guess I've just realized recently that I'm relatively ignorant on the subject. I'd like to change that. I don't have anything specific in mind to learn more about but I'm very excited to learn more!
  • I would love to learn more about autism alongside disability justice. I took a city planning for disability course a while back and it was very valuable and I learned a lot!
  • I would like to educate myself about people with autism. I took a course with professor Hinshaw and it was really interesting and I would like to learn more about Autism.
  • I joined this class because I have a family member who was recently diagnosed and I wanted to learn as much as I could about Autism Spectrum Disorder so that I could support that family member. I'm interested in learning about family dynamics and learn more about the current research on ASD.
  • I would like to better understand autism and learn how I can positively impact the community.
  • I have a twin brother who was diagnosed with ASD in the 5th grade. From this course I want to learn more about ASD in hopes to better understand my brother. My brother is considered "high functioning", so I'm really curious how doctors diagnose someone with Autism and how they decide if they're low/high functioning. My brother has also struggled with IEP accommodations growing up, so I would like to know how disability programs work at public schools and how schools decide if a student qualifies for IEP/DSP accommodations.
  • I study neurodevelopment with relevance to ASD. I would like to learn more about ASD from perspectives beyond my research area, particularly disability rights/advocacy and intersectionality. I am hoping to have a better understanding of how I as a researcher can interact with the autism community in a positive way that doesn’t cause harm. I’m hoping this class will give me the space to think about ways to center the interests and needs of folks with autism in my research and beyond.
  • Really excited for this class
  • It’s felt like talking about autism was taboo, but I really want to understand what the experience is and how to support folks who may have autism.
  • Excited about the reading list you put together. 

Class 1: 9/31/2020

A little weird doing this all remote but we adapt for the times. Also have a grad student auditing the class which is kind of cool. 


Registration for the DeCal

 Registration for the 1-unit, seminar-style, 1:54 Autism Spectrum Disorders Decal is now open. Class has filled up very fast in past semesters.

https://classes.berkeley.edu/content/2020-fall-psych-198-006-grp-006

Course #23457 Enroll through CalCentral
Timings: Monday 5-7pm.
Class Starts: Aug 31, 2020
Class limit: 40
Contact: SpectrumDeCal@gmail.com

The Autism DeCal got featured on President Barack Obama's Instagram in July on 30th anniversary of the Americans with Disabilities Act


About the Decal: In this DeCal, not only will you learn about possible neurobiological roots of ASD, you will also discover its research beginnings, possible intervention therapies, family dynamics, law, the role of technology, media portrayals, child and adult life, stigma, public outreach, and public awareness.

The primary goal of this course is to stimulate and encourage a deeper understanding about individuals who meet the DSM-5 criteria for ASD and their families.

Instructors: Hari Srinivasan, Eli Oh, Helen Lee, Kate Bierly




CBT for adolescence

Hari Srinivasan
Psych 135 Treatment of Mental Illness
Prof Alison Harvey


CBT vs CBT+ABFT for Adolescents with Anxiety

The intervention chosen for this paper was Cognitive Behavior Therapy (CBT) for generalized anxiety disorder (GAD). I am no stranger to CBT having gone to bi-monthly sessions to deal with my anxiety and mood disorder for most of my teen years while living in South Bay. Anxiety and depression come with the territory of the frustrations of living a life with a disability, autism in my case. 

What was interesting about this study by Siqueland, Rynn and Diamond is not only in its use in the adolescent population but also in trying to see if the combination of CBT and ABFT (Attachment Based Family Therapy) would have better efficacy than just CBT alone. ABFT attempts to also address the interpersonal relationship component that teens have with their parents. 

The efficacy of CBT is well supported by independent and well designed studies. The basic presumption of CBT is that thoughts and feelings influence our behaviors and vice versa. Ergo, changing our negative thinking will result in lesser anxiety.

The fundamental underlying symptom that characterizes GAD is excessive and uncontrollable worrying.  This worry is perpetuated by a cycle of “maladaptive thinking” about the idea of worrying itself. This catastrophic spiral of negative automatic thoughts means, an inability to relax and further maladaptive behaviors that include avoiding any situations, images or thoughts that may provoke worry. 

The need of the hour is cognitive restructuring which aims to modify the cataclysmic thought patterns and belief systems and the change the mistaken impression that worrying serves an useful function. Essentially, cognitive therapy techniques according to the study focuses specifically on negative predictions about the future, and unhelpful attitudes about one’s ability to cope with difficult situations.”

For instance, one of my CBT exercises for several months was to  keep a journal of my thoughts every 20 minutes for 2 hours every day 3x a week. An example follows:
Thought: “Orientation schedule is making me dizzy. I’m gonna fall apart there.”
Feeling association with thought: anxious, scared
Cognitive Distortion: All or nothing - thinking in absolutes
Reframe: Go with do what you can then come right back home. 

Therapy techniques incorporate a scheduled “worry time” in order to control and limit exposure to the activities and situations that bring about worry. Pleasurable activities are also incorporated into the day’s schedule as well and the person is taught relaxation techniques. 

CBT techniques offer a controlled systematic exposure so that the person learns that their fears of negative outcomes do not necessarily come true. This means that over time, they experience a reduction in their anxiety. 

The study being discussed by Siqueland, Rynn and Diamond was done over two phases. The goal of Phase 1 was therapist training and checking the feasibility and acceptability of the combined condition (CBT-FAM). Phase 2 focused on implementing both the individual CBT and CBT-FAM.

Participants enrolled in the study were between the ages of 12-18 and had to meet the DSM-IV criteria for either GAD, Separation Anxiety Disorder or Social Phobia. A parent or caregiver also had to participate in the family treatment component. Participants were recruited through CARes (Child and Adolescent Research Service) at the University of Pennsylvania. Measurements were taken post-treatment and at the 6 and 9 month follow ups. 

The 16 session CBT for adolescents was modified from a standard manual designed for children (ages 8-13). There were 2 parent sessions as well. 

Skill building in the sessions focused on four areas ‘“(a) recognizing anxious feelings and somatic reactions to anxiety,  (b) clarifying cognition in anxiety provoking situations (unrealistic or negative attributions), (c) developing a plan to cope with the situation (modifying anxious self-talk into coping self talk as well as determining what coping actions might be effective), and (d) evaluating performance and administering self-reinforcement as appropriate.’’ Other behavioral techniques included contingent reinforcement and  relaxation techniques. A “FEAR” acronym was used - “F: feeling frightened/anxious, E: expecting bad things to happen, A: actions and attitudes that help, and R: results and rewards.”

The results of Phase 1 were not definitive but encouraging enough to proceed to phase 2.  The post treatment outcome for phase 2 showed that for CBT alone, 67% (4 out of 6) of the adolescents no longer met their primary anxiety diagnosis, while it was 40% (2 of of 5) for the CBT-FAM. When parenting variables are taken into account, the CBT group reported an increase in psychological control while the combined group reported the opposite. Follow up measures also favored CBT where 100% no longer met the diagnostic criteria compared to 80% in the combined group. Essentially the results for adolescents lined up with those for children in other studies, that is, two thirds no longer met their initial diagnosis

The study admits they were “not sufficiently powered to detect treatment differences.” The sample size was small and there was no control group. The study also failed include comorbidity such as suicide risk, OCD, Bipolar Disorder etc. However it did allow for the medication as long as it had been started 8 weeks before and would not be changed during the study.

It appears from the results of the study that CBT wins hands down as the treatment for anxiety disorders. However this has to tempered with the disappointment of the exclusion of comorbidity which is often the norm and not the exception in the real world when it comes to mental health. From personal experience I also have to wonder if 16 weeks is really enough.  Mental health is not like a infection that can quickly be killed by a course of antibiotics.The circumstances and challenges in one’s life keep changing over the decades and there may be some maintenance CBT required, in only to keep the person from slipping back. 

Citation: 

Siqueland, L., Rynn, M., & Diamond, G. S. (2005). Cognitive behavioral and attachment based family therapy for anxious adolescents: Phase I and II studies. Journal of Anxiety Disorders, 19(4), 361-381. Doi: http://dx.doi.org.libproxy.berkeley.edu/10.1016/j.janxdis.2004.04.006