What I'm about to explain could be it's own entire post (and maybe will be soon!) but when you've got a PhD in clinical psychology you can go down a research road, a clinical practice road, or a road that combines the two. In the career I'm pursuing I'm a little bit of a combo but I'm primarily interested in clinical practice. When you're primarily pursuing clinical practice it's really easy to lose track of the current research. So each month as a way of keeping myself accountable for staying up to date on what's being published, I'll write a short summary of an article that I like that was published within the last year. Happy reading!
May Article: Reward Sensitivity Predicts the Response to Cognitive Behavioral Therapy for Children with Autism and Anxiety
The authors: Matthew J. Hollocks,Jeffrey J. Wood,Eric A. Storche ,An-Chuen Cho,Connor M. Kerns &Philip C. Kendall
The journal: Journal of Clinical Child & Adolescent Psychology
Summary: This study compared two Cognitive-Behavioral Therapy (CBT) program for the treatment of anxiety in Autistic youth. This study compared Coping Cat (a general CBT for anxiety program) and Behavioral Interventions for Anxiety in Children with Autism (BIACA) (a CBT for anxiety program designed specifically for Autistic youth). There were 148 Autistic youth enrolled in this study and they were between the ages of 7-13 years old. They were randomized in 3 groups- 1) treatment as usual, 2) Coping Cat, 3) BIACA. I would estimate this means there were ~49 kids in each group. This study compared how well Coping Cat worked for these kids compared to BIACA.
They also wanted to see if other things- like the way these kids make decisions- had an impact on how helpful each of these different therapies were, so they also had kids complete a risk-taking/decision making measurement task called the Adapted Iowa Gambling Task (AIGT). From what I'm able to gather, this task measures rewards based decision making and higher scores indicate better decision making in terms of ability to access rewards.
This study found that for the kids who received Coping Cat, kids who scored higher on the AIGT (who made decisions more likely to lead to rewards/were more reward sensitive) showed less improvement during treatment. This was not true for BIACA where AIGT score/reward sensitivity did not have a relationship with how well kids did in treatment. The results from the Coping Cat kids make sense- decision making geared to avoid loss and access rewarding feelings (like relief) can really maintain anxiety. These kids probably have a harder time with treatment. The article reasons that since BIACA is more reward heavy in the treatment phase than Coping Cat, the rewards offered as a part of treatment were able to outweigh the natural reward of avoiding an anxiety provoking situation.
Why did you choose this article, Ashley? I chose this article for a couple reasons. Most of my research and clinical work is in the domain of Autism and/or Anxiety so these are areas I really try to stay up to date in. I'll probably venture out and blog about something totally out of my comfort zone at some point, but wanted to start off in my area of expertise. It's not the most important thing, but there's also a lot of big names on this paper- Kendall is a big anxiety guy at Temple University, Kerns is a well known lady in the research world of the overlap of Autism and anxiety. But my personal fave on this article is Jeff Wood as he does a lot of research on anxiety in kids who are non-speaking/partially verbal and that is my favorite population of kids to work with.
What did you think? Overall, I like this article. I'm a big believer in gradual, controlled, informed, exposures therapy for anxiety and often take this approach with my own patients. I think the idea that higher cognitive skills and being better at reward based decision making could be a risk factor for continued anxiety is interesting. I'd never thought about it that way before but now that I have it makes sense. I also think it's a nice strengths based way to present treatment (i.e., "you have a strength in rewards based decision making that is probably great for you most of the time, but is tripping you up in this specific area. We need to make the rewards of treatment greater than the rewards of avoidance.") For those of you who don't vibe with external rewards and prizes (yet another post for another day) this might be a nice opportunity to incorporate some motivational interviewing into your CBT. For example, make sure your patient really understands and is noticing what there is to be gained from reducing their anxiety.
Comments