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Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043–1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303–311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138–144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616–629, 2013; Kendall et al. Cogn Behav Pract 12:136–148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34–43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: Despite considerable research efforts, consistent predictors of cognitive behavioral therapy (CBT) outcome for social anxiety disorder (SAD) are scarce. A dynamic focus on individual symptom reactivity and resilience patterns may show promise in predicting treatment response. This pilot study is the first to investigate whether rate of return to baseline after a one-session positive interpretation training indicates resilience and predicts CBT-response among individuals with SAD. Method: Participants (N = 39) completed an interpretation bias assessment before and after training, and once a day for three days after the training, followed by a six-week CBT-program. Participants completed SAD-assessments pre-treatment, during treatment, and post-treatment. Return to baseline was operationalized as the individualized slope of negative and positive interpretations across interpretation bias assessments. Results: Intention-to-treat analyses showed no significant relation between both negative and positive interpretation bias and CBT-response. Similarly, for completers-only, most analyses also showed no such relationship. Conclusion: These findings suggest that slower return to baseline as a resilience index does not have predictive value for CBT-outcome in individuals with SAD. Future studies should incorporate experience-sampling to capture subtle changes in interpretation bias. [ABSTRACT FROM AUTHOR]

This study examined whether distorted cognition changes during cognitive behavioural therapy (CBT) in children (N = 61; aged 7–12) with social anxiety disorder (SAD) and whether changes in distorted cognition from pre- to post-treatment predict SAD at 6-month follow-up. Baseline distorted cognition was also examined as a predictor of post-treatment outcome. Multiple informant SAD-measures were obtained pre-treatment, post-treatment and at 6-month follow-up. Children reported on interpretation bias and dysfunctional beliefs. A decrease in interpretation bias and dysfunctional beliefs was prospectively related to greater SAD change between post-treatment and 6-month follow-up. Child-reported SAD-change at post-treatment predicted greater change in dysfunctional beliefs at 6-month follow-up. Higher baseline interpretation bias predicted greater change in SAD-severity at post-treatment. Children with greater distorted cognition reductions during treatment, showed greater treatment gains at 6-month follow-up. Children who do not show this reduction may require additional efforts focused on distorted cognition to maximally benefit from treatment. [ABSTRACT FROM AUTHOR]

The current study examined whether children varying in their levels of social anxiety, separation anxiety and spider fear exhibit a negative interpretation bias specific for their fears. Furthermore, age and gender were assessed as moderators of this relation. Children (N = 603) of the age of 7-12 years were asked to solve ambiguous scenarios reflecting social threat, separation threat or spider threat. Children's levels of anxiety were assessed with self-report questionnaires. Results indicated that children scoring higher on self-reported social anxiety, separation anxiety or spider fear, displayed a negative interpretation bias for the threat-scenarios pertaining to their specific anxiety or fear, even after controlling for comorbidity with other anxiety subtypes. Contrary to our hypotheses, we did not find moderating effects of age or gender. These results indicate that even in a community sample, content-specificity of negative interpretation biases is present. [ABSTRACT FROM AUTHOR]