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Guidelines for conducting effective exposure treatment with anxious youth emphasize content (e.g., preparation for and processing of the exposure) and process (e.g., collaboration and youth involvement) variables as important elements of exposure task sessions, but there is a paucity of research examining these guidelines. Using multiple regression, this study evaluated the extent to which independent observers' ratings of process (i.e., collaboration and youth involvement) and content variables (i.e., preparation for and processing after the exposure task) were predictive of treatment outcome in a sample of 61 anxiety-disordered youth. Results indicated that collaboration between the youth and therapist significantly predicted improvement in treatment outcome as measured by youth-, parent-, and teacher-reports. Youth involvement in exposure task sessions predicted improved outcome as measured by teacher-report. Contrary to expectation, preparation for exposure did not predict outcome, but post-event processing of the exposure task was significantly predictive of clinician-rated diagnostic outcome. Exploratory analyses suggest that treatment responders were more likely to be assigned between-session exposure tasks as "homework" and were more likely to be rewarded for their efforts in session. Treatment implications and future directions are discussed. / Psychology

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The current study extended earlier findings about the RealVictory program by using a larger sample and by examining Victory Seeker phone use in more detail. Using a sample of 144 juveniles, it was found that as the number of calls answered increased, the likelihood of a rearrest and the number of rearrests decreased slightly but the differences were not statistically significant. However, as the number of calls increased, the likelihood of a felony rearrest decreased significantly and the total number of felony arrests decreased significantly. These findings suggest that Victory Seeker may be a useful tool to reinforce and provide follow-up after treatment.

Children with attention deficit hyperactivity disorder have less successful school experiences, as well as lives as adults, related to their challenges with self-regulation (Brook, Zhang, Brook, & Leukefeld, 2015). Children spend most of their school career in classrooms; however, teachers may not provide teaching or classroom environments that are conducive for learning for children with ADHD (Straker, Harris, Joosten, & Howie, 2018). These factors contribute to barriers to their success in school occupations, as well as their self-efficacy and participation (Major, Martinussen, & Wiener, 2013). However, evidence suggests that providing self-regulation strategies in classrooms improves success in school occupations. This doctoral project proposes a face-to-face continuing education course educating kindergarten through third grade teachers on strategies with a Classroom Self-regulation Toolbox facilitated by an occupational therapist. Self-regulation strategies of mindfulness, cognitive-behavioral, sensory, seating arrangements and ergonomics are included in the Toolbox. This continuing education course fosters collaboration between elementary teachers as well as elementary teachers and occupational therapists. This project will contribute to school-based occupational therapy by providing more evidence-based classroom interventions (The American Occupational Therapy Association, 2014) and improving collaboration between elementary school professionals.

Thesis (Ph.D.)--Boston University / Although meta-analytic studies support the efficacy of cognitive-behavioral therapy for social anxiety disorder, a proportion of patients drop out of treatment or fail to benefit. Research to date has explored patient- and treatment-specific predictors of poor treatment response, including comorbid depression, but has not evaluated variables related to the patient's social environment. Expressed emotion (EE), an index of critical, hostile, and overprotective attitudes expressed by a significant other toward an individual with a psychiatric or medical condition, has been found to predict psychiatric relapse and poor treatment outcome in a wide range of disorders. Because EE and a closely related construct, perceived criticism, have been shown to predict treatment outcome and course in anxiety and mood disorders, it was expected that EE and perceived criticism would also predict treatment outcome in social anxiety disorder. Forty patients undergoing 12-session group cognitive-behavioral therapy for social anxiety disorder completed questionnaires about their symptoms of social anxiety and depression, and levels of perceived criticism, before and after treatment. Each participant designated one significant other who was then assessed for EE using the Camberwell Family Interview, a semi-structured interview method. Results indicate that higher initial severity of social anxiety and lower levels of perceived criticism predicted treatment dropout. There was also a trend for participants with a significant other rated as high in emotional overinvolvement, one of the EE-subscales, to show less change on a composite measure of anxiety symptoms. Comorbid depression and critical EE were associated with pretreatment severity of social anxiety but not outcome. These findings add to an increasing body of literature showing that the manifestation of significant others' EE, and EE's effect on clinical outcome, can vary as a function of the identified patient's diagnosis. For socially anxious individuals, perceiving criticism in the social environment may provide an important impetus for seeking and adhering to treatment, whereas significant others' overprotective behavior may negatively impact their ability to benefit from treatment. Further research replicating these findings, clarifYing the mechanisms and developing supplemental interventions, are important future directions.

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