The use of exposure therapy for child anxiety disorders in a medical center

Anxiety disorders in childhood are common, debilitating, costly, and treatable. Cognitive-behavioral therapy (CBT) has been widely researched and exposure to feared stimuli is an effective treatment component. Previous research suggests that CBT and exposure are not provided consistently for adult anxiety disorders, but little is known about the treatment received by children in nonresearch settings. The current study examined the clinical documentation for 482 treatment sessions received by 86 youth ages 7-17 with an anxiety disorder. Treatment was delivered as part of nonresearch clinical practice within a large medical center including an anxiety specialty clinic, general mental health clinic, and primary care. Treatment sessions most frequently contained non-CBT interventions (45.4%), followed by exposure (35.1%), other CBT components (34.2%), and medication management (17.8%). The content of treatment was dependent on the setting in which it was delivered, with the majority of children seen outside the anxiety specialty clinic never introduced to exposure (76.1%). The results suggest that despite its demonstrated efficacy, exposure is underutilized for child anxiety disorders in nonresearch clinical settings.