As some reports suggest that anxiety disorders may have more than doubled during the pandemic, the McLean Anxiety Mastery Program (MAMP) has been at the vanguard of treating children and adolescents who struggle with a wide range of disorders, including social anxiety, panic attacks, agoraphobia, separation anxiety, and specific phobias.
MAMP also treats obsessive compulsive disorder, which often co-occurs with anxiety disorders and responds to some of the same types of treatment.
Soaring rates of anxiety and the return to school have been particularly difficult for many children. That may, in part, be because remote learning allowed them to avoid many of the situations that trigger their symptoms.
“Many children who have come to our clinic have reported that they attempted to go back to school, but experienced overwhelming anxiety symptoms due to a range of fears, including that they might have a panic attack or embarrass themselves in front of their peers,” explained Program Co-Director R. Meredith Elkins, PhD, who leads MAMP together with Jacqueline Sperling, PhD.
“And they may struggle to maintain pace academically, often because they feel they’re ‘behind’ due to prolonged remote learning.”
Not surprisingly, MAMP has seen an increase in patients who refuse to go to school.
“You have this confluence of standard stressors—peers, anxiety symptoms, academic work—that have been amplified because kids have had limited opportunities to naturally engage with, and possibly overcome, their fears during the pandemic,” added Elkins.
The MAMP program itself was transformed during the pandemic, going completely virtual at the beginning, and transitioning to a hybrid model this summer, with one programming day in-person.
Children and teens ages 6-19 attend the intensive, group-based program four days a week from 2-4:30pm, for a minimum of four weeks and an average duration of six-and-a-half weeks.
Philanthropy has been critical to MAMP, as a portion of the program’s cost is not covered by insurance. Gifts from donors have created a scholarship fund that helps offset these out-of-pocket expenses.
“We can offer treatment to families with limited financial resources thanks to the generosity of donors,” said Elkins. “And we’d like nothing more than to be able to increase the number of scholarships we offer and broaden the reach of our services.”
Added Sperling, “We want mental health treatment to be a right, not a privilege, and we’re so grateful to the donors who have allowed us to take steps in that direction.”
“Three months at MAMP was life-changing for our daughter who entered the program at age 11 with severe OCD and anxiety,” said donors Jeff and Tori Constantino.
“The combination of highly trained clinicians at the program, as well as the individual and group therapy it provided, was just the help she needed to manage her symptoms. She has thrived since participating in the program and is headed to college this year. We will be forever grateful to McLean and MAMP and are delighted to support the program.”
Exposure and Response Prevention
The centerpiece of MAMP’s treatment is exposure and response prevention (ERP) therapy, which puts participants in situations that induce and challenge their anxiety or compulsive behaviors.
“The exposures are designed to help children gradually approach previously avoided experiences and learn that they can manage them,” explained Sperling.
One advantage of a virtual treatment format is that the exposures are performed in home environments, where many fears originate.
For example, if a child has separation anxiety, the therapist might ask the parent to take a walk around the block during the session. A youngster with a fear of vomiting may be tasked with finding an unsavory leftover in the refrigerator and taking a bite. And those with contamination concerns could be asked to refrain from washing their hands after touching a pet.
The Coping Toolkit
After the exposures, patients do a mindfulness exercise, such as slowly savoring a piece of candy, using all their senses.
“Anxiety is often future-oriented—we’re worried about what will happen in the future,” explained Elkins. “Mindfulness helps kids focus on the present moment without judgment, rather than focusing on what happens next.”
Next comes the education piece, when kids learn more about their symptoms and acquire a “coping toolkit,” as Elkins calls it. That might involve teaching them how to notice and change unhelpful thought patterns, learning relaxation skills, or developing “cope-ahead plans” for future stresses.
“Not every skill will be every kid’s favorite, so we give them many different options,” observed Elkins.
Each patient and family also meet with a psychiatrist for intake and weekly visits. These sessions incorporate education about medication treatments, discussion about the complexities of coexisting conditions, as well as active adjustment of medications to target psychological symptoms.
Family work has become an increasingly important part of the program and, every Tuesday, parents and kids meet with clinicians to focus on family support—including learning what behaviors from parents are not helpful.
Well-intentioned parental actions like buying certain foods or being in constant text communication may temporarily soothe a child’s anxiety, but in the long run may maintain and even worsen it.
“A big part of the family meetings is helping caregivers gradually reduce some of these accommodation behaviors,” said Elkins. Staff also work with parents to create exposures outside of clinic time, for example a sleepover at a grandparent’s home for the child with separation anxiety.
The weekly psychiatry visits are a great opportunity to review common areas where patients often struggle, including sleep, nutrition, or exercise. MAMP psychiatrists collaborate with caregivers and patients to help improve these habits in support of their overall mental health and treatment goals.
The meetings are also an opportunity to learn more about families’ cultures and values.
“We want to make sure that the tools we implement are in line with what’s important to them,” explained Sperling. The virtual format has made it much easier for parents to attend these sessions.
And convenience is not the only advantage of taking MAMP online, according to Elkins and Sperling. They are about to submit a research paper with data demonstrating that kids who have participated in MAMP’s telehealth-based treatment are doing just as well as those who previously were receiving only in-person care.
“This is particularly exciting research because we’ve documented that kids have been coming in with more acute symptoms at intake, but have been improving just as much as those who received care in person,” said Elkins.
“That has given us the confidence to be thoughtful about retaining certain remote features of the program that circumvent some traditional barriers to care and increase accessibility for many families in need of services.”
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