Satisfying Update to Evolving Research & Practice in Treating Anxiety
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?
I was bothered by the case studies that were presented in this talk.
Nearly every single one was embedded with a cultural stereotype. Here are just 3 examples:
Gender Stereotype/ Sexism:
The case about the teenage boy, a patient at the clinic, who had done well throughout his weeks of treatment, though at the end, Kendall says, “Honestly, I think the kid got better because the therapist was a really good-looking woman.”
The case about how Kendall went for a walk with a patient, a young girl, and that they had passed by an elderly couple. Kendall says he was able to ease the girl’s anxiety that the couple had somehow thought badly of her by explaining, “What old people do is read the obituaries, and eat dinner at 4:30, though they get there by 4.”
The case about the boy from North Philadelphia, a patient, who was afraid to ride in a car. He had 7 or 8 siblings. In an attempt to teach the boy about road traffic, Kendall explained to him that the yellow and white lines painted on the road are there for directing cars, though, he wondered to us, “Who knows in *that* neighborhood.”
Perpetuating cultural stereotypes is exactly what psychologists are not supposed to do.
The APA requires professional psychologists to be “aware of and respect cultural, individual, and role differences, including those based on age, gender, gender identity, race, ethnicity, culture, national origin, religion, sexual orientation, disability, language, and socioeconomic status.”
Not only did this speaker directly violate this guideline repeatedly; he seemed to make a comedy routine out of it.
What bothered me almost as much was that nobody in the audience seemed to notice this. There was applause and howls of laughter throughout the presentation.
A day later, one of the program organizers told me that the audience review sheets had all been read, and that Kendall got 100% rave reviews (excluding mine).
This is exactly how cultural stereotypes are perpetuated. This speaker was rewarded handsomely for what he said. Someone even asked him for his autograph at the break. No one, besides me, said anything in objection to it.