Abstract
BackgroundD‐Cycloserine has potential to enhance exposure therapy outcomes. The current study presents a preliminary randomized, placebo‐controlled double‐blind pilot trial of DCS‐augmented one‐session treatment (OST) for youth (7–14 years) with specific phobia. A secondary aim of this pilot study was to explore the effects of youth age and within‐session fear reduction as potential moderators of DCS outcomes in order to generate hypotheses for a larger trial. It was hypothesized that DCS would be associated with greater improvements than placebo, that children (7–10 years) would have greater benefits than adolescents (11–14 years), and that DCS effects would be stronger for participants with the greater within‐session fear reduction during the OST.MethodsThirty‐five children and adolescents were randomized to either OST combined with DCS (n = 17), or OST combined with placebo (PBO; n = 18) and assessed at 1 week, 1 month, and 3 month following treatment.ResultsThere were no significant pre‐ to post‐treatment or follow‐up benefits of DCS relative to placebo. Secondary analyses of age indicated that relative to PBO, DCS was associated with greater improvements for children (but not adolescents) on measures of severity at 1‐month follow‐up. Children in the DCS condition also showed significantly greater improvement to 1 month on global functioning relative to other groups. Conversely, adolescents had significant post‐treatment benefits in the PBO condition on symptom severity measures relative to DCS, and adolescents in the DCS condition had significantly poorer functioning at 3 months relative to all other groups. Finally, there was a trend for within‐session fear reduction to be associated with moderating effects of DCS, whereby greater reduction in fear was associated with greater functioning at one‐month follow‐up for children who received DCS, relative to PBO.LimitationsThe study sample was small and therefore conclusions are tentative and require replication.ConclusionsAge and within‐session fear reduction may be important moderators of DCS‐augmented one‐session exposure therapy, which requires testing in a fully powered randomized controlled trial.
Highlights
There is strong empirical support (Silverman et al, 1999; Vigerland et al, 2013) for cognitive- behavioral treatments (CBT) involving exposure therapy, and one variant of CBT, the one-session treatment (OST) approach developed by Öst (1989), has been deemed well established for treating specific phobias (Davis & Ollendick, 2005)
To be eligible to participate, youth were required to meet diagnostic criteria for a specific phobia, be aged between 7 and 17 years, have at least one parent willing to engage in the treatment, and if taking psychotropic medication be stabilized on their current dose for at least 12 weeks
A secondary hypothesis generating aim was to explore both patient-level and therapy-level variables which may be associated with moderating the effects of DCS augmentation, the effects of age and within-session fear reduction
Summary
Specific phobias are highly prevalent (Bener, Ghuloum, & Dafeeah, 2011; Kessler et al, 2005; Ollendick, Hagopian, & King, 1997), onset early in life, and in childhood, they are associated with academic disruption (Dweck & Wortman, 1982; Ialongo, Edelsohn, Werthamer‐ Larsson, Crockett, & Kellam, 1995; Klein & Last, 1989), social and personal distress (Ollendick & King, 1994; Ollendick, King, & Muris, 2002; Strauss, Lease, Kazdin, Dulcan, & Last, 1989) and interference in daily life (Essau, Conradt, & Petermann, 2000; Ollendick, King, & Muris, 2004; Ollendick et al, 1997). In the only study to date, Byrne et al (2015) examined DCS-augmented single-session exposure therapy in 35 children (6–14 years) with either a dog or spider phobia. They examined generalization of fear extinction by examining postsession fear and avoidance across stimuli and contexts. Clinical studies of factors enhancing fear reduction during exposure therapy and neuroscience research on developmental differences in the neural basis of extinction learning suggest that age and within-session fear reduction may be two important moderators of outcomes of DCS-augmented exposure therapy for specific phobias in youth. Based on prior adult studies (Smits et al, 2013), we hypothesized that the therapeutic effects of DCS-augmented OST would be stronger for those with the greatest reduction of fear during the OST, relative to others with lower reduction of fear
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