Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work. Exposure to feared situations is an effective CBT component. However, there is little observation-based empirical research on how exposure relates to outcomes and other clinical variables. In a randomized controlled community clinic trial for youth with anxiety disorders, observers reliably rated exposure quality for 68 youths aged 8 to 15 years based on 118 videotaped sessions. The treatment program was the manual-based FRIENDS program. Three exposure quality elements (preparation, post-processing, and parent contribution to exposure) were examined in relation to pre-treatment demographic and clinical variables, outcomes, and youth- and therapist-rated alliance using multilevel hierarchical regression models. The outcomes were diagnostic recovery, clinical severity and anxiety symptoms change from pre- to post-treatment and one-year follow-up, and treatment dropout. The results showed that parent contribution to exposure was higher for boys and younger children. Parent contribution to exposure, but no other exposure element, was associated with a larger likelihood of diagnostic recovery and larger clinical severity reduction at one-year follow-up. Exposure quality was unrelated to outcomes at post-treatment, dropout, or alliance. We conclude that enhancing parent contribution to exposure during treatment could improve long-term outcomes after CBT for youth anxiety disorders. Exposure elements should be observed in larger samples to further examine their potential role for CBT outcomes.publishedVersio

Does exposure quality predict treatment outcome? Evaluating the exposure component in the FRIENDS for Life program

Background: Cognitive behavioral therapy (CBT) is the recommended approach for anxiety disorders and successful exposure to feared stimuli is considered an essential part of treatment. Even though results from systematic reviews demonstrate recovery rates of approximately 60%, the number of non-responders is still high and we need to know more about what works. Recognition of the efficacious characteristics of the exposure component in CBT could be a step in the right direction. In this thesis, we investigated the quality of the exposure component in the FRIENDS program delivered in community clinics. The main objectives were to examine if the quality of the exposure component could be reliably assessed and to examine if the quality was related to diagnostic recovery in The Assessment and Treatment - Anxiety in Children and Adults Study (ATACA). Method: Eighty FRIENDS-sessions were rated with the Quality of the Exposure Component Form (QECF). The sample comprised Norwegian youth (N = 45) randomly selected from the ATACA-study. Age ranged from 8-15 years and all youth met diagnostic criteria for social phobia, separation anxiety disorder or generalized anxiety disorder prior to treatment. Reliability analyses were conducted to assess the psychometric properties of the QECF. Independent samples t-tests (two-tailed) were conducted to investigate whether there were significant differences in the quality of the exposure component between responders and non-responders at post-treatment and at one-year follow-up. Differences in quality at item and subscale level were examined by conducting additional independent samples t-tests (two-tailed). Logistic regression analyses were done to test whether the quality of the exposure component could predict treatment outcome, while controlling for age and gender. Results: Inter-rater and internal consistency reliability was good to excellent. There were no significant differences between responders and non-responders in the quality of the exposure component, neither in overall quality, nor at subscale or item level. Lastly, the quality of the exposure component could not predict diagnostic recovery. Conclusion: Findings from the current study revealed that the exposure quality could be reliably assessed. Yet, the exposure quality was not related to treatment outcome. Little variability in the data, limited quality, and low frequency of exposure may be the main reasons behind the null-findings

Adaptive detection and prediction of performance degradation in off-shore turbomachinery

Performance-based maintenance of machinery relies on detection and prediction of performance degradation. Degradation indicators calculated from process measurements need to be approximated with degradation models that smooth the variations in the measurements and give predictions of future values of the indicator. Existing models for performance degradation assume that the performance monotonically decreases with time. In consequence, the models yield suboptimal performance in performance-based maintenance as they do not take into account that performance degradation can reverse itself. For instance, deposits on the blades of a turbomachine can be self-cleaning in some conditions. In this study, a data-driven algorithm is proposed that detects if the performance degradation indicator is increasing or decreasing and adapts the model accordingly. A moving window approach is combined with adaptive regression analysis of operating data to predict the expected value of the performance degradation indicator and to quantify the uncertainty of predictions. The algorithm is tested on industrial performance degradation data from two independent offshore applications, and compared with four other approaches. The parameters of the algorithm are discussed and recommendations on the optimal choices are made. The algorithm proved to be portable and the results are promising for improving performance-based maintenance

Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work. Exposure to feared situations is an effective CBT component. However, there is little observation-based empirical research on how exposure relates to outcomes and other clinical variables. In a randomized controlled community clinic trial for youth with anxiety disorders, observers reliably rated exposure quality for 68 youths aged 8 to 15 years based on 118 videotaped sessions. The treatment program was the manual-based FRIENDS program. Three exposure quality elements (preparation, post-processing, and parent contribution to exposure) were examined in relation to pre-treatment demographic and clinical variables, outcomes, and youth- and therapist-rated alliance using multilevel hierarchical regression models. The outcomes were diagnostic recovery, clinical severity and anxiety symptoms change from pre- to post-treatment and one-year follow-up, and treatment dropout. The results showed that parent contribution to exposure was higher for boys and younger children. Parent contribution to exposure, but no other exposure element, was associated with a larger likelihood of diagnostic recovery and larger clinical severity reduction at one-year follow-up. Exposure quality was unrelated to outcomes at post-treatment, dropout, or alliance. We conclude that enhancing parent contribution to exposure during treatment could improve long-term outcomes after CBT for youth anxiety disorders. Exposure elements should be observed in larger samples to further examine their potential role for CBT outcomes