When Attempts to Help Backfire: Psychosocial Interventions that May Inadvertently Prolong Anxiety Among Youth

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Abstract
Anxiety disorders are among the most common and impairing mental health conditions in children and adolescents. Although exposure-focused cognitive behavioral therapy (CBT) is a well-established treatment for this population based on decades of psychological science, many available psychosocial interventions are not based on this strong empirical foundation. In some cases, interventions for youth with anxiety disorders have the potential to maintain anxiety in the long run. Grounded in a well-developed cognitive-behavioral theoretical frame, this commentary aimed to discuss popular and emerging psychosocial interventions for anxious youth that may inadvertently prolong anxiety. We argue that (1) although the availability of gold-standard CBT (with an adequate focus on exposure therapy) appears to be increasing, it continues to be difficult to access for many youth, (2) several available interventions prescribe avoidance-based strategies that do not enable a child to experience self-efficacy building and corrective learning experiences related to their fears or anxieties, thereby potentially maintaining anxiety in the long-run, and (3) several available interventions are not based in any clear, empirically-supported theoretical frame or evidence base, and thus have unclear benefits for anxiety. In a time when there is increasing alarm about anxiety disorders among youth, building systems that can support tried-and-true interventions based on strong science is of utmost importance. Future research, intervention deployment, and policy efforts should pay more attention to the harms that could arise from psychosocial interventions.

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