Relapse prevention. As the child meets with continued success, the therapist should begin discussing with the child issues relating to termination, including relapse prevention. Specifically, the importance of continued exposures is emphasized. However, children also should understand that like any accomplishment, if you don't use it, you lose it, and be warned of the possibility for slips. The analogy of a person on a diet who successfully loses 20 pounds but then eats a piece of cake at a party can be a helpful learning tool. Together, the child and the therapist should explore the different ways that the person could interpret their slip. This case is analyzed until it becomes evident that an adaptive interpretation is that the slip is a single event: "It does not mean that everything is blown or ruined. I need to pick myself back up and get back on the positive track I was on."
SummaryThe treatment summarized in this article has empirical evidence for producing positive treatment response in children with social phobia, separation anxiety and generalized anxiety disorder. It would seem important, therefore, when working with children who present with these anxiety disorders to ensure that the main therapeutic procedures, particularly exposure exercises, are included in any treatment plan. The other strategies, such as the contingency contracting and self-control procedures, may be used to help facilitate the likelihood that children will engage in successful exposures (see Silverman and Kurtines [1996] for further details).
Despite the evidence for the treatment, it is important that future research be conducted on examining the essential components of the exposure-based cognitive behavioral psychosocial interventions for use with anxiety disorders in children in terms of identifying and evaluating the main mediators of change. Also important is research on the moderators of changes in terms of identifying and evaluating for whom the treatment works. It also would be important that future research focus on comparing this treatment with other treatments, including other psychosocial interventions as well as psychopharmacological treatments.
