If you were lucky enough to participate in the FCP Workshop today, then you enjoyed a good one. “Clinical Strategies Within Empirically Supported Treatment for Anxiety in Youth” was presented by Dr. Philip C. Kendall. Dr. Kendall is a Professor of Psychology, and Director of the Child and Adolescent Anxiety Disorders Clinic at Temple University. As expected, he described the guiding theory and the nature, symptoms, and experience of anxiety in youth. He addressed cognitive, behavioral, family (parenting) and emotional factors as well as intervention strategies within Cognitive Behavioral Therapy for anxiety in youth. Dr. Kendall used case examples, with an adequate smattering of research to support his presentation.
Many in the audience have heard Dr. Kendall speak in the past. In fact he was brought back to the FCP Professional Lecture Series by popular request. This workshop served as a both an initial introduction, and a satisfying update of his previous lectures and evolution of the work at his clinic at Temple University.
Dr. Kendall briefly described the symptoms of anxiety in young people, differentiating this disorder from depression and other behavioral health problems. He also pointed out that most children with serious anxiety problems have co-morbid disorders such as depression, or physical illness. He said that a common misperception that anxiety will resolve with age is not true. He described untreated anxiety in youth as a “Gateway” disorder leading to substance abuse and other serious mental health problems as adults.
Another common misperception is that anxiety is bad. He made it clear that anxiety, like all emotions is neither good, nor bad. It serves as a warning that some action may be required.
For example, feeling anxious before an important speech or exam is normal. The problems start when the anxiety becomes debilitating, interfering with development and preventing the child from action, such as going to school. He stressed that the key to treatment, is helping the child learn to tolerate and cope with the anxious feelings, not to immediately try to eliminate them through overprotection or excessive reassurance. Dr. Kendall suggested that parent participation is important in therapy, but the alliance with the child is most important. His research has shown that overprotective parenting, or explosive and unpredictable parenting, are predictors of the anxious child.
Some elements of treatment strategies suggested by Dr. Kendall were described. He said that the therapist should not act as an agent of society, or the parent. The child should learn to problem solve by asking a series of questions, not being told what to do. A hierarchy of behavioral exposures to anxious situations should be developed with the child, and the child should choose where to start (e.g. afraid of elevators, start with getting on and off a locked elevator, then spending increasing amounts of time on a moving elevator, after a trusting relationship has been established.)
To be successful, the therapist should experience concerns with the child (go on the elevator with them at first). Also, help the child become more comfortable talking about their thoughts, by thinking out-loud (modeling). Dr. Kendall said that despite another common misperception, exposure of the child to an anxiety producing stimulus does not interfere with the therapeutic alliance, once trust is established. The clinic uses a 16 session model, with exposure introduced about half-way through. Research suggests that there may be some resistance at first, but the relationship is typically maintained throughout the program.
In short, this was another excellent presentation by Dr. Kendall. He is the quintessential experienced speaker with this topic. He was relaxed, knowledgeable and self-confident. The audience resonated with his good humored style, and appeared relaxed as well. Questions were handled with the expertise of a good speaker. Even the few questions that were slightly off topic were addressed. He quickly brought the flow back on topic. Although time did not allow completion of all slides in his handout, the workshop appeared to be a success. Like a good meal, very satisfying but leaving us hungry for more.
What did you think?