Intensive Exposure and Response Prevention for Anxious Youth With a History of Self-Harm and Suicidality

A growing body of research points to the increase in suicidal thoughts and behaviors, nonsuicidal self-injury (NSSI), and anxiety within adolescents. Given the increase in these behaviors for adolescents and young adults within the United States, it has become increasingly likely for clinicians who specialize in anxiety and obsessive-compulsive (OC) disorders to encounter adolescents and young adults with suicidal or self-harming behaviors. However, a paucity of research has examined how to best treat this population with exposure and response prevention (ERP), one of the gold-standard treatments for anxiety and obsessive-compulsive disorder (OCD). The current naturalistic study investigated the efficacy of ERP therapy at an intensive outpatient program in reducing anxiety severity, functional impairment of anxiety, and depression symptoms among adolescents with anxiety disorders and OCD, with a focus on differences in outcomes based on a history of NSSI or suicidal thoughts and behaviors (STBs). Results demonstrated significant improvements across the entire sample, including reductions in anxiety severity, anxiety impact, and depression symptoms. However, adolescents with a history of NSSI/STBs demonstrated higher symptom severity at both admission and discharge compared to those without such a history and showed less change in anxiety and depression scores over the course of treatment compared with the non-NSSI/STB group. The study underscores the effectiveness of ERP for youth with complex mental health presentations. These findings have critical implications for clinical practice, supporting the inclusion of ERP in treatment plans for youth with comorbid anxiety and NSSI/STBs, while emphasizing the need for adapted approaches as well as further research to improve outcomes for those with a history of NSSI/STBs.