Treating Speech Anxiety in Youth: A Randomized Controlled Microtrial Testing the Efficacy of Exposure Only Versus Exposure Combined With Anxiety Management Strategies

Rachel De Jong,Miriam J.J Lommen,Marieke E Timmerman,Wiljo J.P.J Van Hout

doi:10.1016/j.beth.2021.03.010

Abstract

CBT for anxious youth usually combines anxiety management strategies (AMS) with exposure, with exposure assumed to be critical for treatment success. To limit therapy time while retaining effectiveness, one might optimize CBT by restricting treatment to necessary components. This study tested whether devoting all sessions to exposure is more effective in reducing speech anxiety in youth than devoting half to AMS including cognitive or relaxation strategies and half to exposure. After a 6-week waitlist period, adolescents with speech anxiety (N = 65; age 12–15; 42 girls) were randomized to a 5-session in-school group-based CBT training consisting of either (1) exposure-only (EXP+EXP) or (2) cognitive strategies followed by exposure (COG+EXP) or (3) relaxation strategies followed by exposure (REL+EXP). Clinical interviews, speech tests, and self-report measures were assessed at pretest, posttest, and follow-up. For all conditions (a) the intervention period resulted in a stronger decline of speech anxiety than waitlist period; (b) there was a large sized reduction of speech anxiety that was maintained at six-week follow-up; (c) there was no meaningful difference in the efficacy of EXP+EXP versus COG+EXP or REL+EXP. These findings suggest that devoting all sessions to exposure is not more effective than combining exposure with AMS. AMS appeared neither necessary for CBT to be effective, nor necessary for youth to tolerate exposure. This indicates that CBT can be optimized by restricting treatment to exposure.

Highlights

After a 6-week waitlist period, adolescents with speech anxiety (N = 65; age 12–15; 42 girls) were randomized to a 5-session in-school groupbased cognitive behavioral therapy (CBT) training consisting of either (1) exposure-only (EXP+EXP) or (2) cognitive strategies followed by exposure (COG+EXP) or (3) relaxation strategies followed by exposure (REL+EXP)
Youths were randomized to a CBT training of five sessions consisting of either exposure-only training (EXP+EXP), cognitive strategies followed by exposure (COG +EXP), or relaxation strategies followed by exposure (REL+EXP)
The current study tested whether exposure only (EXP+EXP) is more effective in reducing speech anxiety in youth than a combination of exposure preceded by anxiety management strategies (AMS) like cognitive (COG+EXP) or relaxation strategies (REL+EXP)

Summary

Methods design

This study was a single-blind, randomized controlled microtrial comparing three parallel groups in a 6-week waitlist-intervention period design. Sample Size A priori power analyses using G*Power 3.1 (Faul et al, 2007) suggested that for a repeated measures MANOVA with three groups (EXP+EXP vs COG +EXP vs REL+EXP), four time points (screening, pretest, posttest, follow-up), alpha = .05 and power = .80, a total sample of 12 was required to be able to (1) detect a large within-subject time effect of 0.77 (passive control: Reynolds et al, 2012). We built the random intercept model including a dummy variable for session (pretest and mid-test), followed by the dummy variables for time (posttest and follow-up), to explore which dimensions of anxiety (thoughts vs feelings vs actions) were affected by which specific component (COG vs REL vs EXP). All analyses were conducted following the intent-to-treat principle, including all 65 participants

Results preliminary analysis

Discussion

Evaluation of

Conclusion

Participants Interventions Outcomes