Category: Child / Adolescent - Anxiety
The measurement of avoidance behavior in youth with anxiety and phobia is essential. Historically, the behavioral avoidance task (BAT) has been used as a measure of avoidance that can be tailored to a youth’s particular fear. Although used for over 90 years, there has yet to be a systematic review of its use, properties, etc. Here we examine the use of the BAT with youth as a measure of avoidance over the past 30 years. Studies have used the BAT as a measure of treatment outcome, to explore theories of avoidance, and to provide evidence for the psychometrics of phobia questionnaires. We compare the results of these studies, the purposes of the BAT, and the types of data collected.
We aimed to include all studies meeting the following inclusion criteria: Studies were eligible when they (a) included the behavior avoidance task (BAT) in an experimental study, (b) were conducted in youth (i.e., between the ages of 0-17), (c) measured anxiety or fear, (d) were published between the years of 1986 and February 2016, and (e) were published in an academic peer-reviewed journal (f) in English. Primary outcome data included percentage of steps completed or number of steps, as well as measures of subjective distress (e.g., SUDS, visual analog scales, etc.). Both measures (i.e., steps, subjective distress) varied in scale length, therefore, scores were transformed using the percent of maximum possible (POMP) method (Cohen et al. 1999). The POMP method transformed all scales to range from 0 (minimum possible) to 100 (maximum possible).
31 studies spanning from 1986 to 2016 have conducted a BAT with youth in an effort to measure fear or anxiety. The purposes of the studies that conducted these BATs fell into three categories: treatment outcome, theory examination, and psychometric measurement. Results indicated that the BAT might be particularly sensitive to treatment effects; youth with specific phobias can be expected to complete an average of thirty percent of the BAT at pre-treatment and sixty percent at post-treatment. These effects have generally been maintained at six-month follow-ups. Measures of subjective units of distress (SUDS) proved more consistent than steps completed, but more resistant to treatment effects; researchers can expect a SUDS rating of approximately fifty-five percent at pre-treatment and forty percent at post-treatment.
We review the properties and procedures that are used within these studies and provide a critical review. Overall, the BAT is in need of a standardized procedure to allow for psychometric studies to provide evidence of the task’s reliability and validity.