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. 2025 Feb;56(1):153-165.
doi: 10.1007/s10578-023-01540-x. Epub 2023 May 26.

Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety

Emily L Bilek  1 , Allison E Meyer  2 , Rachel Tomlinson  3 , Carol Chen  4
Affiliations

Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety

Emily L Bilek et al. Child Psychiatry Hum Dev. 2025 Feb.

Abstract

This pilot examines a self-distancing augmentation to exposure. Nine youth with anxiety (ages 11-17; 67% female) completed treatment. The study employed a brief (eight session) crossover ABA/BAB design. Exposure difficulty, engagement with exposure, and treatment acceptability were examined as primary outcome variables. Visual inspection of plots indicated that youth completed more difficult exposures during augmented exposure sessions [EXSD] than classic exposure sessions [EX] by therapist- and youth-report and that therapists reported higher youth engagement during EXSD than EX sessions. There were no significant differences between EXSD and EX on exposure difficulty or engagement by therapist- or youth-report. Treatment acceptability was high, although some youth reported that self-distancing was "awkward". Self-distancing may be associated with increased exposure engagement and willingness to complete more difficult exposures, which has been linked to treatment outcomes. Future research is needed to further demonstrate this link, and link self-distancing to outcomes directly.

Keywords: Anxiety disorders; Cognitive behavioral therapy; Exposure therapy; Self-distancing; Youth.

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Conflict of interest statement

Declarations. Competing interest: The authors report no relevant financial or non-financial competing interests. Ethical Approval: Participants provided informed consent/assent prior to participation and received incentives of up to $130 for full participation. Procedures were approved by the Institutional Review Board at Michigan Medicine (Protocol: 00141761).

Figures

Fig. 1
Fig. 1
Study design
Fig. 2
Fig. 2
Estimated marginal means of exposure difficulty by therapist and youth report
Fig. 3
Fig. 3
Estimated marginal means of exposure engagement by therapist and youth report
See this image and copyright information in PMC

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