Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety
A 30-second self-distancing cue added to teen exposure therapy gives only a small boost in task choice and engagement.
01Research in Context
What this study did
Bilek et al. (2023) asked teens to take the perspective of a "fly on the wall" during exposure tasks. The team switched the self-distancing prompt on and off in an ABAB design. Therapists rated how engaged each teen was and tracked the hardest step the teen tried.
The goal was to see if a 30-second distancing cue could boost willingness to face feared situations.
What they found
Teens chose slightly tougher exposure steps when the prompt was in place. Therapist engagement scores also inched upward. Yet the numbers were small and the stats did not cross the line into significance.
Some kids liked the trick; others said it felt silly. The authors call the effect "weakly positive" and say more work is needed.
How this fits with other research
McGeown et al. (2013) showed that starting exposure earlier and moving faster gives large anxiety drops in clinic youth. Bilek’s study keeps the same exposure bones and simply tapes on a quick cognitive prompt, so the tiny gains line up with the idea that the main punch still comes from facing the fear, not the add-on.
Chen et al. (2015) also tested a brief lab add-on—video plus audience feedback—for socially anxious students. They found clearer gains than Bilek, but their subjects were young adults in a speech task, not teens in live exposure. The mixed results together hint that add-ons may help specific groups yet fade in real-world therapy.
Vassos et al. (2023) ran another small pilot on high-schoolers and likewise reported only soft signals of benefit. Both pilots warn us not to bank on single tweaks until larger trials confirm them.
Why it matters
If you run exposure for anxious teens, you can test the fly-on-the-wall prompt without derailing your protocol. It takes seconds and may nudge a hesitant client one rung higher on the fear ladder. Keep collecting your own data: note the hardest step attempted and ask the teen how the prompt felt. Share the tally with your team so we can learn if this micro-skill grows stronger with practice or stays a gentle nudge.
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Join Free →Before the next exposure step, ask your teen to describe the situation as if watching a stranger on TV, then proceed—track whether they pick a harder step than usual.
02At a glance
03Original 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.
Child Psychiatry and Human Development, 2023 · doi:10.1007/s10578-023-01540-x