Considerations in the use of exposure with children

Exposure interventions, both imaginal and in vivo, are an integral part of cognitive behavioral treatments for anxiety disorders and have been found to be efficacious when used to treat various fears and phobias. Although most of the literature has focused on the use of exposure with adults, there is increasing interest in the use of these techniques with anxious children and adolescents. The premise underlying exposure's efficacy is that although it is initially uncomfortable, anxiety will eventually diminish and erroneous cognitions will be disconfirmed when one is exposed repeatedly to a feared stimulus in the absence of the feared negative consequence. In this article the use of exposure techniques with children and adolescents will be discussed, focusing particularly on increasing the developmental sensitivity of these techniques to maximize their effects for younger patients. Various exposure techniques in younger patients will be described, core principles of exposure treatment for anxious children will be delineated, and application for specific pediatric anxiety disorders will be discussed.