Early intervention and treatment prediction in childhood specific phobias: Combining One-Session-Treatment with app-based technology

Background: With estimated prevalence greater than 10%, specific phobia is the most common and also one of the earliest onset mental disorders in children. Specific phobia is characterized by an excessive and persistent fear of a specific object or situation (APA, 2013) and is a strong predictor for the onset of a range of other disorders. For example, children with a specific phobia have over four-times greater chance of developing other anxiety disorders, including panic disorder and generalized anxiety disorder and over two-times more chance of developing affective disorders including bipolar disorder, and depression. Early recogntion and intervention is thus very important in this at-risk group of children, but unfortunately, very few children with phobias receive adequate treatment. Furthermore, there is limited research on predictors of treatment or on underlying active ingredients of anxiety that can help personalize treatment, and the few existing studies examined these factors in relative isolation (Klein et al., 2011, 2012, 2014, 2017; in press). What we need is an easily accessible, evidence-based early intervention for children that does not stigmatize and contributes to the strengthening of self-control of children and parents. Goals: To improve early recognition and intervention for specific phobias and to personalize their treatment among children. More specifically, I will test: 1) the efficacy of a low-cost evidence-based early intervention that consists of a new updated parent-augmented One-Session Treatment (OST) for specific phobias in children 2) whether a newly developed, theory-driven personalized app, supporting the intervention, adds to the short- and long-term effectiveness of the intervention in term of anxiety symptoms reduction and functioning, 3) what active underlying mechanisms of OST can by identified, by including state-of-the-art methodology examining moderators and mediators of treatment outcome, based on the developmental bio-psychosocial framework put forth by Waters and Craske (2016), including extinction learning and biased cognitive processes. Methods and Study Type: This study employs a multicenter pragmatic randomized controlled trial with 2 active treatments, and a 4-week waiting baseline control period. See Figures 1 and 2 for the trial flow and time line. In total, 168 children will be included who have a (sub)clinical specific phobia with a request for help between the ages of 6 and 13 years. The two active treatments will either be 1) a combination of the face-to-face OST supported by an app that helps children to complete exposure exercises for 4 weeks following OST, or 2) face-to-face OST only without the personalized app. The interactive app will be therapist-supported, personalized to, for example, age, gender, subtype of fear of the child and contain movie fragments of the child’s own OST session. Additionally, the study includes physiological, cognitive and behavioral measures and follows a multi-informant approach including reports from children, parents, therapists and blinded clinicians. Innovation and Significance: This project will be the first study worldwide to test an early intervention parent-augmented One-Session Treatment for children, supplemented by a therapist-supported personalized app. It is the next step to develop short, low-cost, efficient and effective early interventions for high-risk children. By combining clinical studies with fundamental research on childhood specific phobias, I can further develop the efficacy of treatments. Earlier and more successful treatment of childhood specific phobias will reduce the suffering of children and their families, and may also prevent the development of mental health problems and improve functioning later in life. Expertise and Feasibility: I am a scientist-practitioner specialized in childhood anxiety. The project follows-up on my dissertation (Cum Laude) about specific phobia and my recently developed cognitive model of childhood anxiety. I have experience as a team leader on 6 large multicenter projects on childhood anxiety with total funding of over 2.5M euro. I will collaborate with a team of experienced childhood anxiety researchers from throughout the world, an experienced IT-team, and a client panel. The study will run in 5 different clinics with approximately 65 included children per year. Implementation: With the help of this grant, I can further develop the efficacy of the One-Session Treatment, develop individualization options, study underlying active treatment mechanisms, and help implement this early intervention and opening ‘Durfpoli’s’ on different locations in The Netherlands, building upon earlier work of myself and my collaborators. I will also provide workshops and lectures for therapists, schools and help develop policy to increase awareness of the importance for early detection and intervention in children with specific phobias.