Digital Innovation Supports Availability and Efficacy of World-First Treatment for Childhood Anxieties

“Virtual reality technology plays an increasingly important role in the delivery of phobia interventions. Innovative ideas on how to scale a low-cost solution would be enormously beneficial to the delivery of childhood anxiety intervention.” – Professor Lara Farrell

A five-year-old girl screams in distress, terrified as she sees a dog approach. However, the dog is being walked on a leash, over 10 metres away, and she is sitting safely in her family’s car. The girl is excessively afraid of dogs; she is suffering from a ‘childhood phobia.’

Childhood phobia is an anxiety disorder, and along with childhood OCD, forms the research focus of Professor Lara Farrell, Clinical Psychologist, Professor within the School of Applied Psychology, and Deputy Director for Centre for Mental Health at Griffith University on the Gold Coast. It is an important area of research because, without early intervention, childhood anxiety disorders can lead to more severe mental health problems in adulthood.

Professor Farrell and her research team have led the way to develop brief and intensive Cognitive-Behavioural Therapy (CBT) for specific phobias in very young children, aged three to six years. They have delivered successful, world-first clinical trials for child anxiety/phobias and OCD, including prevention trials, intensive treatments, and digital and virtual reality interventions.

She believes in harnessing the power of digital innovation to develop more accessible, higher-quality psychological interventions for children, and to ensure treatments that work can reach as many families as possible. The co-location of Griffith University to paediatric physicians and HealthTech entrepreneurs within the Lumina community provides exciting opportunities for Professor Farrell to elevate the future impact of her much-needed research.

Childhood phobias are extremely distressing for children and their parents and can lead to unsafe and even tragic outcomes

Most children experience fear of different things, whether it’s dogs or a monster under the bed. These are ‘normative’ fears and occur during the usual phases of early child development. A phobia however is an extreme and irrational fear of something specific that causes a panic or distress response, and extreme avoidance behaviours.

Children with phobias become extremely distressed and will avoid going to certain places or doing things where they may encounter their feared object or situation, causing significant interference in the lives of children and their families. Professor Farrell specialises in conducting clinical research in the field of childhood phobias and obsessive-compulsive spectrum disorders and has helped hundreds of children and their families in her clinic-based research trials.

“I’ve met families who can’t take a camping holiday in case other holiday makers brings their dogs. In some cases, phobias can be dangerous and have tragic outcomes. For example, a child with a phobia of storms, who has run from a playground across a busy freeway in bad weather, because their fear and associated fight or flight response is so pronounced” Professor Farrell explained.

“Children can be in positions that become very unsafe because they can’t tolerate the presence of these phobic situations, animals or objects.”

Childhood anxieties and phobias are an important area of mental health research – if left untreated they can continue into adulthood, becoming more severe, and more difficult to treat. Indeed, childhood phobias are considered a gateway disorder for a host of other serious adult mental health problems, if not treated early.

Moreover, research indicates that these phobias in early childhood are persistent over time – they usually don’t resolve themselves as children age.

“Over time, we see children with a specific phobia go on to develop generalised anxiety, social phobia, depression or OCD. All these different mental health conditions later in life, might be prevented if we intervene early in life and  treat specific phobias when they first onset,” Professor Farrell said.

“If we can offset this trajectory early, we will hopefully see children grow into higher functioning, emotionally intelligent adults, who are better equipped to manage the way they feel and think in challenging situations.”

The ‘earlier, the better’ hypothesis is so far proving successful – Professor Farrell and her team are excited by the positive outcomes from their current research trial with young children.

Investing in prevention and early intervention gives children with phobias the best opportunity for good mental health into adulthood, and Professor Farrell’s world-first clinical study ‘POP!’ is leading the way.

Professor Farrell’s team start phobia treatment sessions with children as young as three years old, as part of their ‘The Pre-schoolers Overcoming Phobias (POP!) Study.’ It is a world-first study funded by the National Health and Medical Research Council (NHMRC) to understand phobias in early childhood, testing new Cognitive Behavioural Therapy (CBT) interventions for childhood phobias in a randomised controlled trial.

In the POP! study, the most important component of CBT is exposure therapy. This means a young child gently ‘faces their fears’ – in a gradual, supported and controlled manner with a therapist. This technique allows the child to experience some level of fear and anxiety, which they have opportunity to learn to tolerate, and learn new information about the feared stimuli. For instance, they learn that their dreaded fears typically do not occur. For a child with dog phobias, they learn that a dog on a leash does not try and attack them when they safely approach. In addition to exposure therapy, children are provided with educational material about how to safely interact with their phobia stimuli (storms, dogs etc), and learn how to think differently about the object, animal or situation that are afraid of.

“If we do this in a repeated and controlled manner, gradually increasing the intensity of the exposure, we can reduce fear or extinguish fear, so that children are no longer overwhelmed by their fears, and no longer have to go to extreme lengths to avoid the stimuli. Instead, they learn mastery of fear,” she said.

“We have already had excellent outcomes for our CBT treatments for young children. We have evidence that we can efficiently treat phobias at preschool age, often in just one single 3-hour session, successfully mastering fears at this early age in life.”

Despite the success of the trial, getting families prompt access to CBT treatments is a major problem

Professor Farrell is passionate about improving the longer-term outcomes for children and families, however, one of her biggest challenges is helping families in the community gain access to treatment.

“There’s a lack of entry into appropriate high-quality interventions for families. We have a major issue in terms of low access, and then when there is access, often it’s poor-quality delivery of otherwise effective treatments, or a long wait time,” she said.

“The longer duration of illness, the poorer the prognosis, and the longer the treatment, the higher cost and burden to families. We tend to think we are in an era of youth mental health crisis, and I don’t think that’s overstating anything at all.”

Digital innovation plays an important role in ensuring more families have access to treatments, earlier.

With the support of digital technology, Dr Farrell’s team aims to support much more efficient and effective delivery of their evidence-based treatments.

“There is a whole wave of work occurring now using digital innovations to improve access. We’ve developed an online parent training program for childhood OCD, where we can engage parents nationally to access evidence-based therapies to deliver treatment to children where they are, and when they need it. Indeed, we’ve just received funding by Rotary Mental Health grant to conduct a randomised controlled trial of this novel treatment,” Professor Farrell explained.

“We aim to bypass the need for families to try to find a service, and wait many months for treatment, by having interventions that are accessible via digital technology. Our online interventions are supplemented with therapist support to ensure high-quality care for all families, including those with severe OCD. Using videoconferencing, parents can log in as a group and receive support in the implementation of the treatment strategies. This multi-modality digital intervention allows for greater scale, more efficient delivery of services, and good clinical care.”

Innovation ecosystems like Lumina, part of the Gold Coast Health and Knowledge Precinct (GCHKP) can support Professor Farrell’s research by forging connections with digital design and new technologies.

The Queensland Government’s 9.5-hectare Lumina hub is dedicated to growing health and technology-related businesses. The wider Precinct is anchored by Griffith University, where Professor Farrell’s research team is based. The vibrant innovation-based community of Lumina surrounding her brings opportunities for collaboration and co-creation.

There are opportunities to partner with tech organisations developing virtual reality software or hardware. Virtual reality technology plays an increasingly important role in the delivery of phobia interventions. However, the software and equipment needed to support virtual reality setups are expensive. Innovative ideas on how to scale a low-cost solution would be enormously beneficial to the delivery of childhood anxiety intervention.

There is also an opportunity to continually strengthen the stimulus content that is shown during treatment. “I would be interested in the expertise of digital designers creating more of our content, as well as film and television production experts, which is important in the development of 3D virtual reality experiences,” Professor Farrell said.

“Opportunities within Lumina and the wider Precinct will support us with our longer-term work through various stages of development. Having multidisciplined input helps us more rapidly translate our research in a way that’s going to be feasible, sustainable, and high-quality,” she said.

“There’s so much opportunity within the GCHKP for advancements in mental health research and service provision. It really is exciting, as Lumina comes together, to have innovation partners, community health services and education facilities just across the road.”

The Pre-schoolers Overcoming Phobias (POP!) study is a nationally-funded treatment study of young children (3 to 6 years) with specific phobias, run by Griffith Health. The program aims to learn more about the course of childhood fears in young children and involves testing a novel, brief intervention for childhood phobias. The study is currently open to new participants. Enquire here

Visit the Griffith University Centre for Mental Health here