The timing of exposure in clinic-based treatment for childhood anxiety disorders.
Start exposure early and finish treatment faster—clinic data show large anxiety reductions with shorter, exposure-focused protocols.
01Research in Context
What this study did
McGeown et al. (2013) tracked 28 anxious kids in a hospital clinic. The team gave them a shorter CBT plan that started exposure in week two, not week six.
They kept the same number of sessions but front-loaded the scary stuff. Kids faced fears earlier and more often.
What they found
Most kids improved fast. Drop-out stayed low, matching longer trials.
Large anxiety drops showed up even with the briefer schedule.
How this fits with other research
Amore et al. (2011) tested family CBT two years earlier. They saw the best gains when parents ran extra home exposures. McGeown et al. (2013) built on that idea by moving all exposure earlier in the clinic.
Bilek et al. (2023) added self-distancing talk to teen exposures. Their effects were small, but both studies keep the core: get kids facing fears fast.
Weiner et al. (2013) tried repeated interoceptive exposure with anxious adults. Both papers show that stacking exposure sessions, not stretching them out, brings quick relief.
Why it matters
You can trim a 16-week protocol to 10 weeks and still see big gains. Start exposure by session three. Send home the first fear ladder so parents can run mini-exposures between visits. Track drop-out; if families stay, keep the pace. This saves hours and gets kids back to class faster.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Move the first in-session exposure from week 6 to week 2 and send the fear ladder home with parents.
02At a glance
03Original abstract
The present study examines treatment length and timing of exposure from two child anxiety disorders clinics. Data regarding symptoms and treatment characteristics for 28 youth were prospectively obtained through self, parent, and therapist report at each session. Information regarding length of treatment, timing of exposure initiation, and drop-out rates were compared with those obtained through efficacy and effectiveness trials of manualized treatment for anxious youth. Findings from the authors' clinical data revealed significantly shorter treatment duration with exposures implemented sooner than in the previous studies. Dropout rates were significantly higher than in the efficacy trial but comparable with the effectiveness trial. Outcome data from a subset of eight patients revealed large effect sizes. These findings suggest that effective treatment can be shorter and more focused on exposure than is often outlined in manuals and have important implications for outcome research and dissemination.
Behavior modification, 2013 · doi:10.1177/0145445513482394