Targeting Approach Behaviors in Exposures With Self-distancing to Improve Outcomes in Youth Specific Phobia

Anxiety disorders impact 1 in 3 youths by the time of adolescence, and can lead to depression, substance use, school issues, and suicide risk. Specific phobia is the earliest occurring and most common anxiety disorder and increases risk for later onset of other anxiety disorders (e.g., separation, social, generalized anxiety disorders), OCD, depression, and substance abuse problems. Exposure therapy is the standard treatment for specific phobia, but many still struggle with symptoms even after treatment. For exposure therapy to be effective, youth with specific phobia must actively approach feared situations to learn that feared outcomes do not occur. Therefore, strategies to facilitate approach behaviors during exposure therapy may improve treatment outcomes.

Self-distancing (SD) is a technique that may help youths approach their fears in exposure therapy. SD utilizes second or third-person language to enhance a person's psychological distance from self, helping them to "take a step back" from emotional situations and adopt a more objective perspective. In community samples, SD has been found to boost determination and persistence during difficult tasks, including those that induce anxiety (e.g., giving a speech). However, SD has yet to be tested as a strategy for helping clinically anxious youth engage with exposures. Additionally, objective measures of approach are needed for measuring and modifying novel exposure therapy augmentation strategies, such as SD, to improve treatment outcomes.

This study will examine if SD increases the ability to approach feared stimuli during a behavioral approach test (BAT). 20 youth (7-12.99 years) with specific phobia of spiders will be randomized to either a SD or a control condition. In the SD condition, participants will engage with the exposure task (BAT) from a self-distanced view (e.g., "Emily will touch a spider"), while in the control condition the subject will use first-person perspective (e.g., "I will touch a spider") Before and after the exposure therapy session, a BAT will be applied. This study will assess: 1) Approach -indexed using both behavioral (ability to get physically closer to spider, and video-derived motion analysis) and neuro-physiological (i.e., electroencephalogram [EEG], heart rate [HR], heart rate variability [HRV] and electrodermal activity [EDA]) metrics, collected during a BAT and 2) severity of specific phobia using validated self-report scales. During SD or control intervention, continuous audio and video data will be collected to derive behavioral metrics of engagement with the intervention (i.e., video-derived motion analysis and audio-derived linguistic metrics) and participants will be asked to subjectively rate their distress and engagement with the activity. Data will be analyzed to determine whether SD improves behavioral, neural, and physiological markers of approach to feared stimuli in youth with specific phobia and reduces symptom severity, and to explore the degree to which changes in video and audio-derived objective metrics of behavioral engagement with the intervention associate with changes in subjective ratings of fear/distress, subjective self-report of engagement and symptom severity.