Penn’s COTTAGe program expands services
Children as young as five years old can show signs of obsessive-compulsive disorder (OCD) and anxiety disorders, says Martin Franklin, PhD, director of Penn’s Child and Adolescent OCD, Tic, Trich and Anxiety Group (COTTAGe). And, says Franklin, a psychologist, kids that young can also benefit from some form of therapy.
Franklin and his team recently conducted research in conjunction with Duke and Brown Universities with its primary outcome showing that a mild form of cognitive behavior therapy (CBT), which exposes patients directly to their feared thoughts and situations, was more beneficial than relaxation therapy for five to eight year olds showing early signs of OCD. The outcomes of the randomized clinical trial were published last month in JAMA Psychiatry “Our results clearly indicated that CBT led to significantly better symptom reduction compared with relaxation,” says Franklin.
Franklin and his team at Penn and CHOP, including clinical director Diane Antinoro Burke, PsyD; post-doctoral fellows Hilary Dingfelder, PhD, and Courtney Weiner, PhD; clinician Joelle Beecher McGovern, PhD; clinical psychologist, Rinad Beidas, PhD, and practicum students at CHOP are experts and national leaders in the treatment of OCD, tic disorders such as Tourette Syndrome; Trichotillomania, chronic hair-pulling; phobias and anxiety disorders in kids from a very young age through adulthood using CBT.
CBT allows the team to assess a child’s need and directly address it, teaching corrective actions to help them meet their treatment goals. “If the patient fears elevators, we get them on elevators; they have a germ phobia, we slowly and safely introduce them to gross things,” says Franklin.
“We see kids with food-contamination fears and gradually introduce the idea that they have to learn to eat without the guarantees of safety, which most people don’t require. “We work slowly, often first encouraging them to eat food that they did not prepare themselves, then move on to food that was not prepared in the family kitchen, then food that was prepared by someone unknown to them,” says Franklin.
While 12-20 sessions is the typical need to have a lasting impact in children with common anxiety and phobias, the Center also treats children who may require medication in addition to therapy. Youth suffering from co-morbid/simultaneous depression may need medication to alleviate those symptoms first in order to help them engage more fully in the exposure-based treatments for anxiety. In these cases the COTTAGe team works with the treating psychiatrist to provide feedback on a child’s medication needs. With the parents, guardians or caretakers, they form a team to help every child.
The program has recently expanded its reach and is now providing services at Hall-Mercer Community Behavioral Health Center at Pennsylvania Hospital. Hall-Mercer provides a range of outpatient services for children and adults with developmental disabilities and mental illness, from adult day programs to treatment for childhood trauma.
Franklin’s staff, led by Dr. Dingfelder, is training clinicians at Hall-Mercer to identify anxiety disorders in children and adolescents and apply CBT treatment when necessary. “Anxiety does not necessarily have to be a patient’s primary psychiatric diagnosis,” says Franklin. “But, if we can help a patient with a social anxiety, no matter their other diagnoses, we may be able to change their lives for the better. A life without healthy social interaction can impair development and rob the patient of the resilience they will need later in life, and learning to confront situations that provoke anxiety rather than avoiding them can build confidence and help them get more out of life.”
Franklin and his team continue to further expand their influence and are now helping kids and families across the globe, through an international partnership with the country of Norway, training legions of therapists in the practice of CBT for youth suffering from OCD.