Vicarious extinction of phobic behavior in early childhood

Evidence Base Update: 50 Years of Research on Treatment for Child and Adolescent Anxiety

Anxiety disorders are the most common mental health disorder among children and adolescents. We examined 111 treatment outcome studies testing 204 treatment conditions for child and adolescent anxiety published between 1967 and mid-2013. Studies were selected for inclusion in this review using the PracticeWise Evidence-Based Services database. Using guidelines identified by this journal (Southam-Gerow & Prinstein, 2014), studies were included if they were conducted with children and/or adolescents (ages 1-19) with anxiety and/or avoidance problems. In addition to reviewing the strength of the evidence, the review also examined indicators of effectiveness, common practices across treatment families, and mediators and moderators of treatment outcome. Six treatments reached well-established status for child and adolescent anxiety, 8 were identified as probably efficacious, 2 were identified as possibly efficacious, 6 treatments were deemed experimental, and 8 treatments of questionable efficacy emerged. Findings from this review suggest substantial support for cognitive-behavioral therapy (CBT) as an effective and appropriate first-line treatment for youth with anxiety disorders. Several other treatment approaches emerged as probably efficacious that are not primarily CBT based, suggesting that there are alternative evidence-based treatments that practitioners can turn to for children and adolescents who do not respond well to CBT. The review concludes with a discussion of treatments that improve functioning in addition to reducing symptoms, common practices derived from evidence-based treatments, mediators and moderators of treatment outcomes, recommendations for best practice, and suggestions for future research.

Social modulation in extinction of aversive memories

Return of fear after extinction is a considerable challenge for the efficacy of exposure-based therapies. Fear recovery is most often modeled in the laboratory by changing the experimental context and studied in isolated animals. Since social context is an important factor affecting behavior, the question arises how it influences the recovery of extinguished fear. Here we present two novel behavioral models that allow studying social modulation of extinction memory retrieval. We show that the presence of a fearful cage mate results in a robust renewal of freezing as well as avoidance responses that were previously successfully extinguished.

Understanding basic behavioral support techniques as an alternative to sedation and anesthesia

Patients with special needs often present a challenge for the dental care team. The exacting and surgical nature of dental procedures requires significant patient cooperation to ensure the safe delivery of care. Some individuals who have special care needs have difficulty cooperating during treatment, thus creating a potentially harmful situation. Modern dentistry, particularly pediatric dentistry, provides the dental team with a variety of strategies designed to enable the team to safely provide comprehensive care in the least restrictive manner. These techniques range from tell-show-do, to medical stabilization, to general anesthesia. The effective use of noninvasive, nonpharmacologic behavioral guidance/support techniques cannot only avoid the need for sedation or general anesthesia, they can teach the patient to develop coping skills that may enable them to receive comprehensive care in a traditional dental setting over a lifetime. Unfortunately, many providers are inadequately trained in behavioral support strategies. This paper presents a review of noninvasive, nonpharmacologic behavioral support techniques with discussion regarding their application to persons with special care needs.

Behaviour Modification in Dentistry: a Review

The review evaluates the contribution which behaviour modification has made to the outstanding behavioural problems in dentistry: the treatment and management of the fear of routine conservation; the prevention of tooth and gum disease; the management of acute operative pain and chronic facial pain.

Investigations of dental fear and operative pain have been limited perhaps too much to patients, especially children, who attend for dental treatment. Behaviour modification has yet to help adequately those patients who avoid dentists and who may be the most acutely afraid and the most intolerant of dentistry. More adequate contributions here could be made if behavioural sciences were much more satisfactorily taught in dental undergraduate and postgraduate curricula than at present.

Useful contributions to preventive dentistry have already been made. The successful treatment of chronic facial pain will have to depend, at least in part, on a more adequate understanding of the psychophysiological mechanisms of the complaint. The nature of the placebo effect in treatment here also needs to be more thoroughly understood.

Empirically tested psychotherapies for youth internalizing and externalizing problems and disorders

This article is a review of specific psychotherapies that have been supported in clinical trials. Treatments that showed significant effects in studies published over a period of 4 decades were identified, with the goal of complementing the overall picture of treatment benefit provided in narrative reviews and meta-analyses with a detailing of the specific interventions that have shown significant effects. The article focuses on treatments for four broad clusters of problems and disorders that account for a very large proportion of youth mental health referrals: anxiety, depression, attention-deficit/hyperactivity, and conduct.