Childhood Fears, Phobias, and Related Anxieties

In this chapter, we have reviewed prevalence information, assessment considerations, and four general categories of empirically supported treatment methods for reducing children\u27s (and adolescent\u27s) fears, phobias and related anxieties. In addition, variations of each method were discussed as was research supporting the relative effectiveness and efficacy of these methods. Reinforced practice and participant modeling procedures have been found to have the most empirical support, followed by systematic desensitization, modeling and cognitive behavior therapy approaches. Of key importance is the recent emphasis on guidelines for treatment efficacy. Interest in this topic has increased considerably not only among researchers and practitioners, but also policymakers, the insurance industry, and the general public. The ubiquity of the evidence-based designation, however, has engendered considerable debate. For example, Kazdin and Weisz (2003) noted that \u27...treatments must use replicable procedures (e.g., treatments codified in manuals), must be evaluated in well-controlled experiments, and must show replication of effects so there are assurances that any seemingly wonderful outcome or effect in fact can be reproduced... (p. xiii). In addition, the APA Presidential Task Force on Evidence-Based Practice (APA, 2005) adopted the following definition of the term: Evidence-based practice in psychology is the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences (APA, 2005). Although there is little question about the relative effectiveness of the treatment procedures discussed in this chapter in comparison to no treatment control conditions, little comparison outcome research has been published on the relative efficacy of these methods in, for example, school settings--especially in relation to an attention placebo and wait-list control condition. In addition, many of the effectiveness studies which have been published have excluded participants who have various comorbid emotional, behavioral, and/or learning problems, when it could be argued that such participants may, in fact, be more representative of those individuals whom clinicians see on a regular basis within the clinic, school, private practice, or hospital setting. Assuming that this is the case, it would be important for future research to examine the relative contribution of various comorbid psychiatric or psychoeducational conditions to the outcome of each of these latter treatment methods. Research is also needed that examines the conditions under which these fear and anxiety reduction approaches, in particular, are effective. In addition, research is needed on the relative contribution of various relationship variables on the outcome of treatment using these therapy procedures. Furthermore, research efforts should be focused on the prevention of anxiety disorders in children and adolescents. Implementing intervention programs, for example in a school setting, within a three-tiered prevention framework has potential benefits for reaching a significant number of youth suffering from anxiety. Use of this model may help to reduce the overall incidence of anxiety as well as the long-term consequences associated with these disorders