A Russian-language exposure guide for childhood anxiety, with the parents inside the plan
- Writing in Counseling Psychology and Psychotherapy, a Russian journal, the authors set out a four-stage exposure programme for childhood anxiety: preparation and assessment with the parents, a fear hierarchy rated on SUDS, steps carried out from the lowest rating upward, and a closing review. They cite 8–16 sessions as the recommended range, with a standard 50-minute session that can run up to 120 minutes.
- The case is K., a girl first seen at 11 in 2021: 12 online Coping Cat sessions in 2021–2022, a return a year later with worse anxiety, 7 more sessions, then five days of in-person exposure with a morning and an evening session of 90 to 120 minutes. Relaxation and distraction were not encouraged.
- On K.'s own RCADS ratings over the five days, T-scores fell for panic from 61 to 47, depression from 48 to 34, separation anxiety from 59 to 48, generalised anxiety from 61 to 45 and OCD from 66 to 40.
- The mother's RCADS ratings fell during exposure but at two months returned to in-programme levels, or higher for social phobia. On FASA at two months, the authors report that the mother's response to her daughter's anxiety symptoms had decreased considerably.
The authors start from a gap: Russian-language literature has no manualised protocol or systematic guidance for exposure with children. Their paper is a practitioner guide in Russian – four stages, three models of family involvement, a worked hierarchy – illustrated by one adolescent's treatment, which the authors present as an example of the protocol rather than a test of it.
The girl, the ride and the parents
K. came to a psychologist a month after a YouTube video about an amusement ride where people supposedly disappear. Online Coping Cat sessions met their goals; a year later the family returned. The intensive week followed, aimed at tolerating anxiety without avoiding the stimulus.
Before the first session the psychologist met the parents. FASA showed that the mother helped K. avoid whatever raised her anxiety, and that the family adjusted daily routines, work schedules and free-time plans around it. The parents were taught to encourage rather than reassure, and their roles in therapy were agreed. During exposure the ride turned out to be a cover. The highest-rated item was her parents vanishing on it, and the core fear was that someone in the family would disappear.
Two reports from one family
K.'s self-report fell on every scale. Her mother's ratings fell too, then at two months moved back up; the authors suggest regression to the mean or measurement error. Her accommodation, by FASA, had dropped.
I would treat the mother's accommodation as a target of the exposure plan, not its background. Each step the child takes in session has a counterpart at home – a reassurance given, a plan changed – that can quietly undo it. Write parent steps into the hierarchy, measure them with FASA at baseline, midpoint and follow-up, and decide with the family beforehand what happens when the child's and the parent's scores diverge. A mother whose ratings go back up is telling you something worth asking about.
Each step the child takes in session has a counterpart at home – a reassurance given, a plan changed – that can quietly undo it.
This is a single case described by its own therapists. RCADS and FASA were translated by the research team and back-translated but not validated on a Russian-speaking sample, so T-scores rest on US norms. Cognitive restructuring and a coping card were also used at the end of the intensive week, and the fifth session took place during an EEG recording described elsewhere.