WEBVTT NOTE duration: "01:01:43.696" NOTE Confidence: 0.94610417 00:00:01.920 --> 00:00:04.019 Hello, everybody. Hi. Good afternoon. NOTE Confidence: 0.9801456 00:00:05.359 --> 00:00:07.200 Hi, everybody. I'm I'm I'm NOTE Confidence: 0.9801456 00:00:07.200 --> 00:00:08.260 I'm Wendy Silverman. NOTE Confidence: 0.8144355 00:00:08.639 --> 00:00:10.820 I'm, I directed Ellie Leibovitz, NOTE Confidence: 0.9963465 00:00:11.440 --> 00:00:12.740 the anxiety program NOTE Confidence: 0.84595275 00:00:13.119 --> 00:00:14.320 here at the Charles Studies NOTE Confidence: 0.84595275 00:00:14.320 --> 00:00:15.460 Center, and I'm NOTE Confidence: 0.99810386 00:00:16.055 --> 00:00:19.175 so thrilled that a world NOTE Confidence: 0.99810386 00:00:19.175 --> 00:00:21.654 famous child anxiety researcher from NOTE Confidence: 0.99810386 00:00:21.654 --> 00:00:22.154 Australia NOTE Confidence: 0.9905989 00:00:23.015 --> 00:00:23.755 is here. NOTE Confidence: 0.9507741 00:00:24.055 --> 00:00:25.494 And, her name is the NOTE Confidence: 0.9507741 00:00:25.494 --> 00:00:27.175 professor Jenny Hudson. I know NOTE Confidence: 0.9507741 00:00:27.175 --> 00:00:28.454 Jenny for a long time NOTE Confidence: 0.9507741 00:00:28.454 --> 00:00:29.940 because of her excellent work, NOTE Confidence: 0.867345 00:00:30.580 --> 00:00:30.900 And, NOTE Confidence: 0.99952435 00:00:31.780 --> 00:00:32.280 she's NOTE Confidence: 0.97181237 00:00:32.900 --> 00:00:34.260 known all over the world, NOTE Confidence: 0.97181237 00:00:34.260 --> 00:00:35.800 and she's especially NOTE Confidence: 0.9527845 00:00:36.420 --> 00:00:37.460 a a rock star all NOTE Confidence: 0.9527845 00:00:37.460 --> 00:00:38.580 over, but a super rock NOTE Confidence: 0.9527845 00:00:38.580 --> 00:00:39.640 star in Australia, NOTE Confidence: 0.97812176 00:00:40.500 --> 00:00:41.460 where she is now I NOTE Confidence: 0.97812176 00:00:41.460 --> 00:00:42.600 have to take my glasses. NOTE Confidence: 0.99048966 00:00:43.300 --> 00:00:44.500 Where she is a fellow NOTE Confidence: 0.99048966 00:00:44.500 --> 00:00:45.159 of the NOTE Confidence: 0.99556446 00:00:45.495 --> 00:00:47.515 Australian Academy of Social Sciences NOTE Confidence: 0.96859425 00:00:48.055 --> 00:00:49.095 and the what would be NOTE Confidence: 0.96859425 00:00:49.095 --> 00:00:50.775 the equivalent of NIMH, the NOTE Confidence: 0.96859425 00:00:50.775 --> 00:00:52.534 National Health and Medical Research NOTE Confidence: 0.96859425 00:00:52.534 --> 00:00:53.034 Council. NOTE Confidence: 0.99820536 00:00:53.655 --> 00:00:55.655 And she is also very NOTE Confidence: 0.99820536 00:00:55.655 --> 00:00:57.915 heavily involved in Australian policy NOTE Confidence: 0.9174694 00:00:59.570 --> 00:01:00.690 with with regard to child NOTE Confidence: 0.9174694 00:01:00.690 --> 00:01:02.210 mental health. She chairs in NOTE Confidence: 0.9174694 00:01:02.210 --> 00:01:04.069 Australia the government policy, NOTE Confidence: 0.9427859 00:01:05.330 --> 00:01:07.409 committee of child mental health NOTE Confidence: 0.9427859 00:01:07.409 --> 00:01:08.390 research plan. NOTE Confidence: 0.9961794 00:01:08.850 --> 00:01:10.470 And she's also now participating NOTE Confidence: 0.9166666 00:01:10.930 --> 00:01:12.869 in the Young Minds Matter, NOTE Confidence: 0.9166666 00:01:13.165 --> 00:01:14.604 our future, which is also NOTE Confidence: 0.9166666 00:01:14.604 --> 00:01:16.924 a Australian government department of NOTE Confidence: 0.9166666 00:01:16.924 --> 00:01:17.424 health, NOTE Confidence: 0.99818134 00:01:17.965 --> 00:01:18.465 initiative. NOTE Confidence: 0.99008733 00:01:19.244 --> 00:01:20.704 So besides her incredible NOTE Confidence: 0.9997068 00:01:21.005 --> 00:01:22.465 work in the public NOTE Confidence: 0.9941225 00:01:22.765 --> 00:01:25.005 policy and sphere, she as NOTE Confidence: 0.9941225 00:01:25.005 --> 00:01:25.825 I said, she's NOTE Confidence: 0.98631567 00:01:26.290 --> 00:01:27.890 incredibly renowned in her work NOTE Confidence: 0.98631567 00:01:27.890 --> 00:01:28.870 in child anxiety NOTE Confidence: 0.74521214 00:01:29.490 --> 00:01:30.310 and developing, NOTE Confidence: 0.98372364 00:01:31.330 --> 00:01:33.650 innovative interventions that involve parents NOTE Confidence: 0.98372364 00:01:33.650 --> 00:01:34.869 and children and NOTE Confidence: 0.9668483 00:01:35.170 --> 00:01:36.770 is now moving in the NOTE Confidence: 0.9668483 00:01:36.770 --> 00:01:37.810 direction of, NOTE Confidence: 0.9827942 00:01:38.815 --> 00:01:40.975 digital mental health. So I NOTE Confidence: 0.9827942 00:01:40.975 --> 00:01:41.935 could go on and on, NOTE Confidence: 0.9827942 00:01:41.935 --> 00:01:43.135 but and I I also NOTE Confidence: 0.9827942 00:01:43.135 --> 00:01:44.035 just say she's NOTE Confidence: 0.99423736 00:01:44.415 --> 00:01:46.095 fabulous. And if I may NOTE Confidence: 0.99423736 00:01:46.095 --> 00:01:47.455 reveal a secret, she had NOTE Confidence: 0.99423736 00:01:47.455 --> 00:01:49.055 her first pastrami sandwich in NOTE Confidence: 0.99423736 00:01:49.055 --> 00:01:49.875 New York City NOTE Confidence: 0.9262062 00:01:50.255 --> 00:01:51.075 last night, NOTE Confidence: 0.9401965 00:01:51.900 --> 00:01:53.200 at Katz's Delicatessen NOTE Confidence: 0.93393743 00:01:53.500 --> 00:01:54.880 in the Lower East Side. NOTE Confidence: 0.898587 00:01:55.180 --> 00:01:55.500 So, NOTE Confidence: 0.99219924 00:01:56.939 --> 00:01:57.820 for those of you who NOTE Confidence: 0.99219924 00:01:57.820 --> 00:01:58.939 may not know that, I'll NOTE Confidence: 0.99219924 00:01:58.939 --> 00:02:00.700 take you also to, Katz's NOTE Confidence: 0.99219924 00:02:00.700 --> 00:02:01.200 Delicatessen NOTE Confidence: 0.96939766 00:02:01.500 --> 00:02:02.460 in the Lower East Side NOTE Confidence: 0.96939766 00:02:02.460 --> 00:02:04.540 of Manhattan. Okay. So and NOTE Confidence: 0.96939766 00:02:04.540 --> 00:02:06.159 and she's here to still NOTE Confidence: 0.97357064 00:02:06.619 --> 00:02:08.294 you know, eating a sandwich NOTE Confidence: 0.97357064 00:02:08.294 --> 00:02:09.334 like this is no easy NOTE Confidence: 0.97357064 00:02:09.334 --> 00:02:10.694 task because she's still able NOTE Confidence: 0.97357064 00:02:10.694 --> 00:02:11.915 to be with us now, NOTE Confidence: 0.99821895 00:02:12.375 --> 00:02:13.915 after this unbelievable NOTE Confidence: 0.9977585 00:02:14.215 --> 00:02:15.275 pastrami sandwich. NOTE Confidence: 0.8526176 00:02:15.735 --> 00:02:16.775 I'm not gonna talk about NOTE Confidence: 0.8526176 00:02:16.775 --> 00:02:17.895 the and the other stuff. NOTE Confidence: 0.8526176 00:02:17.895 --> 00:02:18.694 She could tell you about NOTE Confidence: 0.8526176 00:02:18.694 --> 00:02:19.194 that. NOTE Confidence: 0.9732261 00:02:25.660 --> 00:02:27.419 I can highly recommend the NOTE Confidence: 0.9732261 00:02:27.419 --> 00:02:29.100 Wendy Silverman tour of the NOTE Confidence: 0.9732261 00:02:29.100 --> 00:02:30.940 Lower East Side. It is NOTE Confidence: 0.9732261 00:02:30.940 --> 00:02:31.440 excellent. NOTE Confidence: 0.9857451 00:02:32.060 --> 00:02:33.180 We had a fun time, NOTE Confidence: 0.9857451 00:02:33.419 --> 00:02:34.860 over the weekend, so thank NOTE Confidence: 0.9857451 00:02:34.860 --> 00:02:35.360 you. NOTE Confidence: 0.99292266 00:02:35.675 --> 00:02:36.635 And a big thank you, NOTE Confidence: 0.99292266 00:02:36.635 --> 00:02:38.235 Wendy, for having me here NOTE Confidence: 0.99292266 00:02:38.235 --> 00:02:39.514 today. It's a pleasure to NOTE Confidence: 0.99292266 00:02:39.514 --> 00:02:41.835 be able to present to, NOTE Confidence: 0.9991298 00:02:42.315 --> 00:02:43.995 this incredible group of people NOTE Confidence: 0.9991298 00:02:43.995 --> 00:02:44.895 here at Yale NOTE Confidence: 0.90451986 00:02:45.195 --> 00:02:47.535 Child Study Centre. I've, admired NOTE Confidence: 0.9708088 00:02:47.860 --> 00:02:48.980 Wendy's work for a very NOTE Confidence: 0.9708088 00:02:48.980 --> 00:02:50.360 long time as well as, NOTE Confidence: 0.92384535 00:02:50.900 --> 00:02:51.400 Ellie's NOTE Confidence: 0.97270095 00:02:51.860 --> 00:02:53.540 and, Alan Kasdan as well. NOTE Confidence: 0.97270095 00:02:53.540 --> 00:02:55.060 So it's very, it's a NOTE Confidence: 0.97270095 00:02:55.060 --> 00:02:56.019 privilege for me to be NOTE Confidence: 0.97270095 00:02:56.019 --> 00:02:57.459 here and share with you NOTE Confidence: 0.97270095 00:02:57.459 --> 00:02:58.660 the work that I have NOTE Confidence: 0.97270095 00:02:58.660 --> 00:02:59.400 been doing. NOTE Confidence: 0.9290066 00:03:00.555 --> 00:03:01.755 So I'm kind of thinking NOTE Confidence: 0.9290066 00:03:01.755 --> 00:03:03.055 about what I wanted to NOTE Confidence: 0.9290066 00:03:03.275 --> 00:03:04.575 present today, NOTE Confidence: 0.9489165 00:03:05.514 --> 00:03:06.475 and thinking about kind of NOTE Confidence: 0.9489165 00:03:06.475 --> 00:03:07.275 the work that I've been NOTE Confidence: 0.9489165 00:03:07.275 --> 00:03:08.555 doing. This one question that's NOTE Confidence: 0.9489165 00:03:08.555 --> 00:03:09.835 been on my mind that NOTE Confidence: 0.9489165 00:03:09.835 --> 00:03:10.975 I thought I would NOTE Confidence: 0.956904 00:03:11.355 --> 00:03:12.395 spend the time kind of NOTE Confidence: 0.956904 00:03:12.395 --> 00:03:13.775 going through the data NOTE Confidence: 0.8638222 00:03:14.235 --> 00:03:15.055 and also, NOTE Confidence: 0.97562397 00:03:15.755 --> 00:03:17.549 I suppose, exploring this idea NOTE Confidence: 0.97562397 00:03:17.549 --> 00:03:19.150 whether or not there is NOTE Confidence: 0.97562397 00:03:19.150 --> 00:03:20.909 a future for precision mental NOTE Confidence: 0.97562397 00:03:20.909 --> 00:03:21.409 health NOTE Confidence: 0.9766747 00:03:21.870 --> 00:03:23.889 in anxiety disorders in children. NOTE Confidence: 0.99543667 00:03:25.230 --> 00:03:26.750 We've had there's been a NOTE Confidence: 0.99543667 00:03:26.750 --> 00:03:28.769 lot of talk around personalized NOTE Confidence: 0.9859003 00:03:29.069 --> 00:03:30.775 care and also precision NOTE Confidence: 0.94153583 00:03:31.075 --> 00:03:32.595 mental health. So I use NOTE Confidence: 0.94153583 00:03:32.595 --> 00:03:33.955 this kind of slightly different NOTE Confidence: 0.94153583 00:03:33.955 --> 00:03:35.015 term. So personalisation, NOTE Confidence: 0.99710613 00:03:35.394 --> 00:03:36.455 I think, can be NOTE Confidence: 0.9090999 00:03:36.915 --> 00:03:38.995 any adaptation really that a NOTE Confidence: 0.9090999 00:03:38.995 --> 00:03:40.775 person might make to therapy. NOTE Confidence: 0.96677434 00:03:42.035 --> 00:03:43.735 You know, maybe you're tailoring NOTE Confidence: 0.96677434 00:03:43.795 --> 00:03:45.415 something to a a specific NOTE Confidence: 0.95775497 00:03:45.930 --> 00:03:47.630 child because of their presentation NOTE Confidence: 0.95775497 00:03:47.690 --> 00:03:49.070 or maybe their interests. NOTE Confidence: 0.99729186 00:03:50.250 --> 00:03:50.750 But NOTE Confidence: 0.8513968 00:03:51.050 --> 00:03:52.110 that's kind of personalising NOTE Confidence: 0.9963732 00:03:52.570 --> 00:03:54.590 it's not really driven by NOTE Confidence: 0.9963732 00:03:54.650 --> 00:03:55.150 data. NOTE Confidence: 0.97770137 00:03:55.530 --> 00:03:56.990 So when I say precision NOTE Confidence: 0.97770137 00:03:57.050 --> 00:03:59.050 mental health or precision mental NOTE Confidence: 0.97770137 00:03:59.050 --> 00:04:01.275 health care, precision care, it's NOTE Confidence: 0.97770137 00:04:01.275 --> 00:04:01.775 about NOTE Confidence: 0.95674706 00:04:02.155 --> 00:04:04.335 personalization that's driven by data, NOTE Confidence: 0.83395016 00:04:04.715 --> 00:04:05.215 which, NOTE Confidence: 0.98237664 00:04:05.595 --> 00:04:06.875 they're they're both quite different NOTE Confidence: 0.98237664 00:04:06.875 --> 00:04:07.375 things. NOTE Confidence: 0.9852373 00:04:08.395 --> 00:04:08.895 So NOTE Confidence: 0.97971076 00:04:09.755 --> 00:04:11.355 I do think that that NOTE Confidence: 0.97971076 00:04:11.355 --> 00:04:12.255 kind of personalization, NOTE Confidence: 0.9822286 00:04:12.555 --> 00:04:13.595 there's always gonna be a NOTE Confidence: 0.9822286 00:04:13.595 --> 00:04:14.700 future for that because that's NOTE Confidence: 0.9822286 00:04:14.700 --> 00:04:16.060 how clinicians work. As a NOTE Confidence: 0.9822286 00:04:16.060 --> 00:04:17.279 clinician, you always NOTE Confidence: 0.99968624 00:04:17.980 --> 00:04:18.960 tailor your NOTE Confidence: 0.96165055 00:04:19.419 --> 00:04:20.779 approach and, you know, you're NOTE Confidence: 0.96165055 00:04:20.779 --> 00:04:22.779 not gonna approach a seven NOTE Confidence: 0.96165055 00:04:22.779 --> 00:04:23.820 year old in the same NOTE Confidence: 0.96165055 00:04:23.820 --> 00:04:24.880 way that you would approach NOTE Confidence: 0.96165055 00:04:24.940 --> 00:04:26.400 a sixteen year old boy, NOTE Confidence: 0.96165055 00:04:26.460 --> 00:04:27.580 seven year old girl, for NOTE Confidence: 0.96165055 00:04:27.580 --> 00:04:28.080 instance. NOTE Confidence: 0.9755811 00:04:28.475 --> 00:04:29.675 And you'll you'll have a NOTE Confidence: 0.9755811 00:04:29.675 --> 00:04:30.795 different style in the way NOTE Confidence: 0.9755811 00:04:30.795 --> 00:04:31.995 that you interact with the NOTE Confidence: 0.9755811 00:04:31.995 --> 00:04:33.295 child and with the family. NOTE Confidence: 0.9755811 00:04:33.514 --> 00:04:34.875 But that's based on kind NOTE Confidence: 0.9755811 00:04:34.875 --> 00:04:36.955 of your clinical judgment. It's NOTE Confidence: 0.9755811 00:04:36.955 --> 00:04:38.794 not necessarily based on getting NOTE Confidence: 0.9755811 00:04:38.794 --> 00:04:39.695 better outcomes. NOTE Confidence: 0.96920747 00:04:40.075 --> 00:04:41.435 So for me, the idea NOTE Confidence: 0.96920747 00:04:41.435 --> 00:04:42.955 of precision mental health care NOTE Confidence: 0.96920747 00:04:42.955 --> 00:04:45.490 is is more about personalising NOTE Confidence: 0.9897223 00:04:46.270 --> 00:04:48.350 that's going to improve treatment NOTE Confidence: 0.9897223 00:04:48.350 --> 00:04:48.850 outcomes. NOTE Confidence: 0.99765116 00:04:49.230 --> 00:04:50.110 So what is it that NOTE Confidence: 0.99765116 00:04:50.110 --> 00:04:51.010 you will do, NOTE Confidence: 0.9808047 00:04:52.110 --> 00:04:53.390 that will be better for NOTE Confidence: 0.9808047 00:04:53.390 --> 00:04:54.270 the seven year old as NOTE Confidence: 0.9808047 00:04:54.270 --> 00:04:55.310 opposed to the sixteen year NOTE Confidence: 0.9808047 00:04:55.310 --> 00:04:56.930 old that's based on data NOTE Confidence: 0.9808047 00:04:56.990 --> 00:04:58.690 that is gonna improve outcomes? NOTE Confidence: 0.94679666 00:05:00.085 --> 00:05:01.284 So the the slightly different NOTE Confidence: 0.94679666 00:05:01.284 --> 00:05:02.085 things, but I just wanna NOTE Confidence: 0.94679666 00:05:02.085 --> 00:05:03.284 make it clear they were NOTE Confidence: 0.94679666 00:05:03.284 --> 00:05:04.805 the different definitions that I NOTE Confidence: 0.94679666 00:05:04.805 --> 00:05:06.425 use. And it's the precision NOTE Confidence: 0.94679666 00:05:06.645 --> 00:05:07.145 medicine, NOTE Confidence: 0.9851714 00:05:07.525 --> 00:05:08.964 the precision mental health care NOTE Confidence: 0.9851714 00:05:08.964 --> 00:05:10.245 that I'm not a hundred NOTE Confidence: 0.9851714 00:05:10.245 --> 00:05:11.525 percent sure about. I'm not NOTE Confidence: 0.9851714 00:05:11.525 --> 00:05:12.724 sure whether there is a NOTE Confidence: 0.9851714 00:05:12.724 --> 00:05:13.960 future for it. So I'm NOTE Confidence: 0.9851714 00:05:13.960 --> 00:05:15.000 gonna take you through NOTE Confidence: 0.93253136 00:05:16.680 --> 00:05:17.639 as I would never have NOTE Confidence: 0.93253136 00:05:17.639 --> 00:05:19.080 said that maybe five or NOTE Confidence: 0.93253136 00:05:19.080 --> 00:05:21.000 ten years ago, as I NOTE Confidence: 0.93253136 00:05:21.000 --> 00:05:22.360 thought, for sure, this is NOTE Confidence: 0.93253136 00:05:22.360 --> 00:05:23.560 where where where we were NOTE Confidence: 0.93253136 00:05:23.560 --> 00:05:25.160 headed. But I've become a NOTE Confidence: 0.93253136 00:05:25.160 --> 00:05:26.540 little bit more skeptical, NOTE Confidence: 0.98601073 00:05:27.745 --> 00:05:29.044 and I'm not yet convinced. NOTE Confidence: 0.98601073 00:05:29.264 --> 00:05:30.625 I'm still hopeful, though. I'm NOTE Confidence: 0.98601073 00:05:30.625 --> 00:05:31.824 still very hopeful that there NOTE Confidence: 0.98601073 00:05:31.824 --> 00:05:32.865 there is a future, but NOTE Confidence: 0.98601073 00:05:32.865 --> 00:05:33.745 I wanna take you through NOTE Confidence: 0.98601073 00:05:33.745 --> 00:05:34.485 the data, NOTE Confidence: 0.9950811 00:05:35.185 --> 00:05:36.384 that I've been working on NOTE Confidence: 0.9950811 00:05:36.384 --> 00:05:37.425 and others around the world NOTE Confidence: 0.9950811 00:05:37.425 --> 00:05:38.305 have been working on as NOTE Confidence: 0.9950811 00:05:38.305 --> 00:05:39.264 well. I've even slipped in NOTE Confidence: 0.9950811 00:05:39.264 --> 00:05:40.724 a slide of Wendy's work. NOTE Confidence: 0.90915966 00:05:44.400 --> 00:05:45.300 Yeah. That's right. NOTE Confidence: 0.99318457 00:05:45.920 --> 00:05:46.900 Paying you back. NOTE Confidence: 0.97525465 00:05:47.760 --> 00:05:48.800 But, yeah, just to see NOTE Confidence: 0.97525465 00:05:48.800 --> 00:05:50.240 where where we're at. What NOTE Confidence: 0.97525465 00:05:50.240 --> 00:05:51.520 do we know in terms NOTE Confidence: 0.97525465 00:05:51.520 --> 00:05:53.060 of data driven decisions NOTE Confidence: 0.97586673 00:05:53.440 --> 00:05:54.960 about what is gonna improve NOTE Confidence: 0.97586673 00:05:54.960 --> 00:05:56.880 outcomes for children and young NOTE Confidence: 0.97586673 00:05:56.880 --> 00:05:57.380 people? NOTE Confidence: 0.99044573 00:05:58.645 --> 00:06:00.085 Alright. And then you can NOTE Confidence: 0.99044573 00:06:00.085 --> 00:06:01.205 make your own decisions about NOTE Confidence: 0.99044573 00:06:01.205 --> 00:06:01.925 it as well. I'd be NOTE Confidence: 0.99044573 00:06:01.925 --> 00:06:03.604 keen to hear from everyone NOTE Confidence: 0.99044573 00:06:03.604 --> 00:06:04.645 here what you what you NOTE Confidence: 0.99044573 00:06:04.645 --> 00:06:05.685 think about it, whether or NOTE Confidence: 0.99044573 00:06:05.685 --> 00:06:07.044 not there is a is NOTE Confidence: 0.99044573 00:06:07.044 --> 00:06:07.705 a future. NOTE Confidence: 0.9430122 00:06:08.005 --> 00:06:09.785 Am I too jaded already, NOTE Confidence: 0.9430122 00:06:10.085 --> 00:06:10.404 or, NOTE Confidence: 0.9802316 00:06:11.525 --> 00:06:12.645 am I not looking at, NOTE Confidence: 0.91745687 00:06:13.410 --> 00:06:13.910 yeah, NOTE Confidence: 0.98104703 00:06:14.370 --> 00:06:15.110 the possibilities? NOTE Confidence: 0.99373615 00:06:16.210 --> 00:06:17.330 Alright. So before I get NOTE Confidence: 0.99373615 00:06:17.330 --> 00:06:18.770 started, though, just wanted to NOTE Confidence: 0.99373615 00:06:18.770 --> 00:06:20.130 make sure that, you're aware NOTE Confidence: 0.99373615 00:06:20.130 --> 00:06:21.170 that I have no financial NOTE Confidence: 0.99373615 00:06:21.170 --> 00:06:22.450 interest to disclose that are NOTE Confidence: 0.99373615 00:06:22.450 --> 00:06:24.050 relevant to the what I'm NOTE Confidence: 0.99373615 00:06:24.050 --> 00:06:25.270 talking about today. NOTE Confidence: 0.9541096 00:06:28.985 --> 00:06:31.145 You already understand about anxiety NOTE Confidence: 0.9541096 00:06:31.145 --> 00:06:33.085 disorders and how common, NOTE Confidence: 0.93061113 00:06:33.625 --> 00:06:35.225 impairing they are because I'm NOTE Confidence: 0.93061113 00:06:35.225 --> 00:06:36.345 sure you hear Wendy talk NOTE Confidence: 0.93061113 00:06:36.345 --> 00:06:37.225 about it all the time NOTE Confidence: 0.93061113 00:06:37.225 --> 00:06:37.805 and, Ellie, NOTE Confidence: 0.9587037 00:06:38.985 --> 00:06:40.639 but I just wanted to NOTE Confidence: 0.9587037 00:06:40.639 --> 00:06:41.760 take you before I started NOTE Confidence: 0.9587037 00:06:41.760 --> 00:06:43.200 talking about the personalization a NOTE Confidence: 0.9587037 00:06:43.200 --> 00:06:44.419 little bit more about, NOTE Confidence: 0.9996336 00:06:46.400 --> 00:06:47.860 the fact that anxiety disorders NOTE Confidence: 0.9552547 00:06:48.160 --> 00:06:49.760 are still overlooked. And people NOTE Confidence: 0.9552547 00:06:49.760 --> 00:06:50.740 might not necessarily NOTE Confidence: 0.9556225 00:06:51.040 --> 00:06:52.020 think that anymore, NOTE Confidence: 0.9979809 00:06:52.480 --> 00:06:52.980 but NOTE Confidence: 0.9845829 00:06:53.525 --> 00:06:54.725 when you see what's happening NOTE Confidence: 0.9845829 00:06:54.725 --> 00:06:56.425 in the community and particularly NOTE Confidence: 0.9845829 00:06:56.565 --> 00:06:57.625 within children NOTE Confidence: 0.9780799 00:06:58.165 --> 00:06:59.765 and in Australia, they are NOTE Confidence: 0.9780799 00:06:59.765 --> 00:07:01.225 still very much overlooked, NOTE Confidence: 0.975269 00:07:02.005 --> 00:07:03.865 in terms of being considered, NOTE Confidence: 0.9946186 00:07:04.245 --> 00:07:05.765 a mental disorder or something NOTE Confidence: 0.9946186 00:07:05.765 --> 00:07:07.205 that's impairing and something that NOTE Confidence: 0.9946186 00:07:07.205 --> 00:07:08.505 we need to take seriously. NOTE Confidence: 0.95672923 00:07:09.500 --> 00:07:11.040 And I think in Australia, NOTE Confidence: 0.99939483 00:07:11.900 --> 00:07:13.580 this comes about because of NOTE Confidence: 0.99939483 00:07:13.580 --> 00:07:14.720 a common belief NOTE Confidence: 0.98467225 00:07:15.180 --> 00:07:17.260 that mental disorders don't start NOTE Confidence: 0.98467225 00:07:17.260 --> 00:07:18.860 until adolescence. I don't know NOTE Confidence: 0.98467225 00:07:18.860 --> 00:07:20.160 if that's something that NOTE Confidence: 0.88470495 00:07:20.540 --> 00:07:22.375 is is a common. You're NOTE Confidence: 0.88470495 00:07:22.375 --> 00:07:23.415 here in the child study NOTE Confidence: 0.88470495 00:07:23.415 --> 00:07:24.695 center, so you're kinda focusing NOTE Confidence: 0.88470495 00:07:24.695 --> 00:07:25.435 on kids. NOTE Confidence: 0.98105806 00:07:25.895 --> 00:07:27.335 But in Australia, there is NOTE Confidence: 0.98105806 00:07:27.335 --> 00:07:28.775 a lot of focus on NOTE Confidence: 0.98105806 00:07:28.775 --> 00:07:30.855 adolescents, and that is where NOTE Confidence: 0.98105806 00:07:30.855 --> 00:07:32.295 a lot of interventions and NOTE Confidence: 0.98105806 00:07:32.295 --> 00:07:33.495 a lot of government money NOTE Confidence: 0.98105806 00:07:33.495 --> 00:07:34.955 has been spent on improving NOTE Confidence: 0.98105806 00:07:35.015 --> 00:07:36.315 interventions for adolescents. NOTE Confidence: 0.9994482 00:07:36.889 --> 00:07:38.909 With the assumption that children NOTE Confidence: 0.99970794 00:07:39.289 --> 00:07:40.189 don't experience NOTE Confidence: 0.94832087 00:07:40.569 --> 00:07:42.490 disorders like anxiety or depression, NOTE Confidence: 0.94832087 00:07:42.490 --> 00:07:43.930 that it doesn't start until, NOTE Confidence: 0.7251487 00:07:44.250 --> 00:07:45.069 till adolescence. NOTE Confidence: 0.9959988 00:07:45.689 --> 00:07:47.129 And this really comes about NOTE Confidence: 0.9959988 00:07:47.129 --> 00:07:47.629 from, NOTE Confidence: 0.99252254 00:07:48.810 --> 00:07:49.629 Ron Kessler's NOTE Confidence: 0.89454424 00:07:50.250 --> 00:07:50.750 original, NOTE Confidence: 0.96672416 00:07:51.794 --> 00:07:53.014 age of onset paper, NOTE Confidence: 0.97501504 00:07:54.354 --> 00:07:56.035 which says the median age NOTE Confidence: 0.97501504 00:07:56.035 --> 00:07:56.995 of onset. So this is NOTE Confidence: 0.97501504 00:07:56.995 --> 00:07:58.595 kind of national prevalence data NOTE Confidence: 0.97501504 00:07:58.595 --> 00:08:00.035 from, the US and around NOTE Confidence: 0.97501504 00:08:00.035 --> 00:08:00.615 the world, NOTE Confidence: 0.9673756 00:08:01.875 --> 00:08:03.794 looking at you know, asking NOTE Confidence: 0.9673756 00:08:03.794 --> 00:08:05.095 people asking adults NOTE Confidence: 0.91975623 00:08:05.990 --> 00:08:07.190 when at what age did NOTE Confidence: 0.91975623 00:08:07.190 --> 00:08:08.390 they first start to experience NOTE Confidence: 0.91975623 00:08:08.390 --> 00:08:09.670 anxiety symptoms, or what age NOTE Confidence: 0.91975623 00:08:09.670 --> 00:08:10.890 did they first start experiencing NOTE Confidence: 0.9033967 00:08:11.350 --> 00:08:12.330 depressive symptoms. NOTE Confidence: 0.9891945 00:08:12.790 --> 00:08:13.830 And when you take the NOTE Confidence: 0.9891945 00:08:13.830 --> 00:08:15.430 median age of onset of NOTE Confidence: 0.9891945 00:08:15.430 --> 00:08:16.470 all of the disorders, so NOTE Confidence: 0.9891945 00:08:16.470 --> 00:08:17.350 it's kind of all the NOTE Confidence: 0.9891945 00:08:17.350 --> 00:08:18.570 high prevalence disorders, NOTE Confidence: 0.9938111 00:08:19.065 --> 00:08:20.185 you get this median age NOTE Confidence: 0.9938111 00:08:20.185 --> 00:08:21.565 of onset of fourteen. NOTE Confidence: 0.99823064 00:08:22.265 --> 00:08:23.325 But people misinterpret NOTE Confidence: 0.99847275 00:08:24.025 --> 00:08:25.305 what a median age of NOTE Confidence: 0.99847275 00:08:25.305 --> 00:08:26.285 onset is. NOTE Confidence: 0.93263656 00:08:26.905 --> 00:08:27.945 Like, for me as a NOTE Confidence: 0.93263656 00:08:27.945 --> 00:08:29.305 parent, if I was to NOTE Confidence: 0.93263656 00:08:29.305 --> 00:08:30.525 hear that in the literature NOTE Confidence: 0.93263656 00:08:30.665 --> 00:08:32.845 that in the community that NOTE Confidence: 0.9703645 00:08:33.640 --> 00:08:35.240 mental disorders start at fourteen. NOTE Confidence: 0.9703645 00:08:35.240 --> 00:08:36.279 That's when I'd start to NOTE Confidence: 0.9703645 00:08:36.279 --> 00:08:37.320 focus on, okay, I need NOTE Confidence: 0.9703645 00:08:37.320 --> 00:08:38.120 to I've got a fourteen NOTE Confidence: 0.9703645 00:08:38.120 --> 00:08:38.920 year old, this is when NOTE Confidence: 0.9703645 00:08:38.920 --> 00:08:40.360 I need to be concerned NOTE Confidence: 0.9703645 00:08:40.360 --> 00:08:41.320 about, when I need to NOTE Confidence: 0.9703645 00:08:41.320 --> 00:08:42.620 look out for mental disorders NOTE Confidence: 0.9703645 00:08:42.839 --> 00:08:44.059 or mental health symptoms. NOTE Confidence: 0.9872627 00:08:45.240 --> 00:08:46.360 But that's it's a median NOTE Confidence: 0.9872627 00:08:46.360 --> 00:08:47.559 age of onset. Right? So NOTE Confidence: 0.9872627 00:08:47.559 --> 00:08:48.380 by the time, NOTE Confidence: 0.9991609 00:08:48.855 --> 00:08:50.315 a child reaches fourteen, NOTE Confidence: 0.9547186 00:08:50.774 --> 00:08:51.654 if you were going to NOTE Confidence: 0.9547186 00:08:51.654 --> 00:08:52.955 develop a a disorder, NOTE Confidence: 0.99889076 00:08:53.495 --> 00:08:55.195 fifty percent of those people NOTE Confidence: 0.99889076 00:08:55.495 --> 00:08:56.714 will have already experienced NOTE Confidence: 0.98032445 00:08:57.175 --> 00:08:57.675 clinical NOTE Confidence: 0.9908462 00:08:58.054 --> 00:08:58.554 symptoms. NOTE Confidence: 0.9872913 00:08:59.415 --> 00:08:59.915 But NOTE Confidence: 0.9994443 00:09:00.535 --> 00:09:02.135 what's even more important about NOTE Confidence: 0.9994443 00:09:02.135 --> 00:09:03.274 this age of onset NOTE Confidence: 0.999561 00:09:03.779 --> 00:09:04.279 data NOTE Confidence: 0.911318 00:09:04.580 --> 00:09:05.959 is that it it's pulled NOTE Confidence: 0.9996221 00:09:06.260 --> 00:09:06.760 together NOTE Confidence: 0.99242896 00:09:07.300 --> 00:09:08.200 of all of NOTE Confidence: 0.99859214 00:09:08.740 --> 00:09:10.500 mental disorders. So when you NOTE Confidence: 0.99859214 00:09:10.500 --> 00:09:11.399 pull it out NOTE Confidence: 0.99510854 00:09:11.700 --> 00:09:12.500 a little bit more NOTE Confidence: 0.9688075 00:09:16.625 --> 00:09:17.425 There we go. I just NOTE Confidence: 0.9688075 00:09:17.425 --> 00:09:18.145 need to press a bit NOTE Confidence: 0.9688075 00:09:18.145 --> 00:09:19.585 harder. So the yellow line NOTE Confidence: 0.9688075 00:09:19.585 --> 00:09:21.105 is anxiety disorders, and that NOTE Confidence: 0.9688075 00:09:21.184 --> 00:09:22.545 the median age of onset NOTE Confidence: 0.9688075 00:09:22.545 --> 00:09:24.545 is actually eleven years. And NOTE Confidence: 0.9688075 00:09:24.545 --> 00:09:26.385 depression, mood disorders all lumped NOTE Confidence: 0.9688075 00:09:26.385 --> 00:09:28.465 together, is thirty years. And NOTE Confidence: 0.9688075 00:09:28.465 --> 00:09:30.890 fourteen is only there because NOTE Confidence: 0.9688075 00:09:30.890 --> 00:09:32.570 you're pooling data from eleven NOTE Confidence: 0.9688075 00:09:32.570 --> 00:09:34.029 and thirty. So it's actually NOTE Confidence: 0.9688075 00:09:34.089 --> 00:09:35.210 not very helpful as a NOTE Confidence: 0.9688075 00:09:35.210 --> 00:09:36.650 parent to think, okay. Well, NOTE Confidence: 0.9688075 00:09:36.650 --> 00:09:37.450 this is when I need NOTE Confidence: 0.9688075 00:09:37.450 --> 00:09:38.589 to start paying attention. NOTE Confidence: 0.9987105 00:09:39.290 --> 00:09:40.570 And if you dive even NOTE Confidence: 0.9987105 00:09:40.570 --> 00:09:42.429 deeper to the anxiety disorders, NOTE Confidence: 0.9960907 00:09:43.050 --> 00:09:43.950 age of onset, NOTE Confidence: 0.9984289 00:09:44.730 --> 00:09:45.230 starts NOTE Confidence: 0.94047296 00:09:45.985 --> 00:09:48.064 for specific phobia is five NOTE Confidence: 0.94047296 00:09:48.064 --> 00:09:49.824 years, separation is seven years. NOTE Confidence: 0.94047296 00:09:49.824 --> 00:09:50.324 So NOTE Confidence: 0.9712099 00:09:51.504 --> 00:09:53.365 interventions that start in adolescence NOTE Confidence: 0.9712099 00:09:53.504 --> 00:09:55.285 are completely missing the boat. NOTE Confidence: 0.9712099 00:09:55.345 --> 00:09:56.625 You know, these problems have NOTE Confidence: 0.9712099 00:09:56.625 --> 00:09:57.745 already been around for a NOTE Confidence: 0.9712099 00:09:57.745 --> 00:09:58.804 really long time. NOTE Confidence: 0.9978664 00:09:59.559 --> 00:10:01.240 But in Australia, this age NOTE Confidence: 0.9978664 00:10:01.240 --> 00:10:02.600 of onset of fourteen has NOTE Confidence: 0.9978664 00:10:02.600 --> 00:10:04.040 been used to argue for NOTE Confidence: 0.9978664 00:10:04.040 --> 00:10:05.500 interventions being delivered NOTE Confidence: 0.9692695 00:10:05.880 --> 00:10:07.559 in adolescence. So that's where NOTE Confidence: 0.9692695 00:10:07.559 --> 00:10:08.779 we have our services. NOTE Confidence: 0.9995804 00:10:09.160 --> 00:10:10.279 And if you're a child NOTE Confidence: 0.9995804 00:10:10.279 --> 00:10:12.380 presenting with anxiety and depression, NOTE Confidence: 0.9779151 00:10:12.834 --> 00:10:14.375 you don't get help until NOTE Confidence: 0.9779151 00:10:14.434 --> 00:10:15.255 you're a teenager. NOTE Confidence: 0.9716711 00:10:16.115 --> 00:10:18.035 Unless maybe there's suicidal risk NOTE Confidence: 0.9716711 00:10:18.035 --> 00:10:19.154 or self harm, then you NOTE Confidence: 0.9716711 00:10:19.154 --> 00:10:20.615 might get to see community, NOTE Confidence: 0.97085255 00:10:20.995 --> 00:10:23.475 care. Otherwise, you pretty much NOTE Confidence: 0.97085255 00:10:23.475 --> 00:10:24.915 wait until you're an adolescent NOTE Confidence: 0.97085255 00:10:24.915 --> 00:10:26.195 because that's when the services NOTE Confidence: 0.97085255 00:10:26.195 --> 00:10:27.360 are. And a lot of NOTE Confidence: 0.97085255 00:10:27.360 --> 00:10:28.640 kids age out of the NOTE Confidence: 0.97085255 00:10:28.640 --> 00:10:30.400 child services while they're waiting NOTE Confidence: 0.97085255 00:10:30.400 --> 00:10:31.280 because there is such a NOTE Confidence: 0.97085255 00:10:31.280 --> 00:10:33.780 huge demand because mental disorders NOTE Confidence: 0.97085255 00:10:33.840 --> 00:10:35.120 do not start in adolescence. NOTE Confidence: 0.97085255 00:10:35.120 --> 00:10:36.880 They're starting in childhood, and NOTE Confidence: 0.97085255 00:10:36.880 --> 00:10:38.559 then we're missing the boat. NOTE Confidence: 0.97085255 00:10:38.559 --> 00:10:39.059 So NOTE Confidence: 0.9712727 00:10:41.175 --> 00:10:42.615 the the other thing about NOTE Confidence: 0.9712727 00:10:42.615 --> 00:10:44.855 this data is that it's NOTE Confidence: 0.9712727 00:10:44.855 --> 00:10:45.755 all from NOTE Confidence: 0.98773646 00:10:46.375 --> 00:10:48.215 adults. There's no children or NOTE Confidence: 0.98773646 00:10:48.215 --> 00:10:49.654 adolescents included in this age NOTE Confidence: 0.98773646 00:10:49.654 --> 00:10:50.955 of onset data. NOTE Confidence: 0.9746096 00:10:51.654 --> 00:10:53.415 There is prevalence data around NOTE Confidence: 0.9746096 00:10:53.415 --> 00:10:54.295 that asks about age of NOTE Confidence: 0.9746096 00:10:54.295 --> 00:10:55.410 onset for kids, so we're NOTE Confidence: 0.9746096 00:10:55.410 --> 00:10:56.530 trying we're doing a meta NOTE Confidence: 0.9746096 00:10:56.530 --> 00:10:57.650 analysis at the moment, NOTE Confidence: 0.9957428 00:10:57.970 --> 00:10:59.030 systematic review, NOTE Confidence: 0.9783135 00:10:59.650 --> 00:11:01.030 pooling all of the data NOTE Confidence: 0.9783135 00:11:01.090 --> 00:11:01.590 for NOTE Confidence: 0.98505735 00:11:02.610 --> 00:11:05.330 children and adolescent prevalence studies NOTE Confidence: 0.98505735 00:11:05.330 --> 00:11:06.130 to see if there's a NOTE Confidence: 0.98505735 00:11:06.130 --> 00:11:07.425 difference in age of onset. NOTE Confidence: 0.98505735 00:11:07.505 --> 00:11:08.545 Obviously, there will be because NOTE Confidence: 0.98505735 00:11:08.545 --> 00:11:09.665 we won't have those kids, NOTE Confidence: 0.98505735 00:11:10.065 --> 00:11:10.964 who are developing NOTE Confidence: 0.9343894 00:11:11.425 --> 00:11:12.644 problems in adulthood. NOTE Confidence: 0.96472514 00:11:13.024 --> 00:11:14.245 But if we get closer NOTE Confidence: 0.96472514 00:11:14.304 --> 00:11:15.904 to the time and asking NOTE Confidence: 0.96472514 00:11:15.904 --> 00:11:17.265 parents as well, when did NOTE Confidence: 0.96472514 00:11:17.265 --> 00:11:18.945 these problems first begin? I NOTE Confidence: 0.96472514 00:11:18.945 --> 00:11:20.385 think we're gonna get a NOTE Confidence: 0.96472514 00:11:20.385 --> 00:11:21.445 very different picture. NOTE Confidence: 0.99451286 00:11:24.620 --> 00:11:25.120 Alright. NOTE Confidence: 0.948776 00:11:25.660 --> 00:11:27.100 So the work that we've NOTE Confidence: 0.948776 00:11:27.100 --> 00:11:28.559 real really been doing, NOTE Confidence: 0.9878433 00:11:29.019 --> 00:11:30.699 is trying to improve the NOTE Confidence: 0.9878433 00:11:30.699 --> 00:11:33.279 lives of children and teenagers NOTE Confidence: 0.9878433 00:11:33.500 --> 00:11:35.420 with anxiety disorders, not just NOTE Confidence: 0.9878433 00:11:35.420 --> 00:11:37.019 teenagers, but both kids and NOTE Confidence: 0.9878433 00:11:37.019 --> 00:11:37.519 teens. NOTE Confidence: 0.98908716 00:11:37.925 --> 00:11:38.804 And we've been doing a NOTE Confidence: 0.98908716 00:11:38.804 --> 00:11:40.004 lot of work on clinical NOTE Confidence: 0.98908716 00:11:40.004 --> 00:11:42.564 trials, trying to develop treatments NOTE Confidence: 0.98908716 00:11:42.564 --> 00:11:43.225 that work, NOTE Confidence: 0.95751977 00:11:44.725 --> 00:11:47.204 psychological treatments and medication treatments NOTE Confidence: 0.95751977 00:11:47.204 --> 00:11:49.125 as well, trying to reduce NOTE Confidence: 0.95751977 00:11:49.125 --> 00:11:50.404 the symptoms and the long NOTE Confidence: 0.95751977 00:11:50.404 --> 00:11:52.360 term impact that anxiety symptoms NOTE Confidence: 0.95751977 00:11:52.360 --> 00:11:53.800 and disorders might have on NOTE Confidence: 0.95751977 00:11:53.800 --> 00:11:55.100 a on a young person NOTE Confidence: 0.95751977 00:11:55.399 --> 00:11:56.779 and missing out on education, NOTE Confidence: 0.99379283 00:11:57.240 --> 00:11:58.860 missing out on social interactions. NOTE Confidence: 0.9807844 00:12:00.920 --> 00:12:01.420 But NOTE Confidence: 0.9981782 00:12:02.679 --> 00:12:04.520 the big question that we've NOTE Confidence: 0.9981782 00:12:04.520 --> 00:12:06.220 been really searching for, NOTE Confidence: 0.9711066 00:12:07.135 --> 00:12:08.575 not just in anxiety disorders, NOTE Confidence: 0.9711066 00:12:08.575 --> 00:12:10.015 but across mental health research, NOTE Confidence: 0.9711066 00:12:10.015 --> 00:12:11.535 is being able to answer NOTE Confidence: 0.9711066 00:12:11.535 --> 00:12:12.355 this question, NOTE Confidence: 0.94262177 00:12:12.975 --> 00:12:14.255 that was posed by Gordon NOTE Confidence: 0.94262177 00:12:14.255 --> 00:12:15.774 Paul quite a long time NOTE Confidence: 0.94262177 00:12:15.774 --> 00:12:17.615 ago, which is what treatment NOTE Confidence: 0.94262177 00:12:17.615 --> 00:12:18.115 works, NOTE Confidence: 0.99368954 00:12:18.654 --> 00:12:19.440 by whom, NOTE Confidence: 0.9330165 00:12:19.920 --> 00:12:21.600 for this individual with that NOTE Confidence: 0.9330165 00:12:21.600 --> 00:12:22.580 specific problem, NOTE Confidence: 0.95996064 00:12:22.960 --> 00:12:24.420 under which set of circumstances. NOTE Confidence: 0.94026387 00:12:25.360 --> 00:12:26.880 So this is really what NOTE Confidence: 0.94026387 00:12:26.880 --> 00:12:28.160 we've been striving for and NOTE Confidence: 0.94026387 00:12:28.160 --> 00:12:29.920 the holy grail, really, in NOTE Confidence: 0.94026387 00:12:29.920 --> 00:12:31.140 in terms of NOTE Confidence: 0.98062146 00:12:32.264 --> 00:12:34.425 personalised care or improving treatment NOTE Confidence: 0.98062146 00:12:34.425 --> 00:12:36.045 outcomes. We want a treatment NOTE Confidence: 0.98062146 00:12:36.184 --> 00:12:37.144 and we want to be NOTE Confidence: 0.98062146 00:12:37.144 --> 00:12:38.264 able to help children in NOTE Confidence: 0.98062146 00:12:38.264 --> 00:12:39.565 a way that really matches NOTE Confidence: 0.98062146 00:12:39.865 --> 00:12:40.684 their needs, NOTE Confidence: 0.98984814 00:12:41.304 --> 00:12:43.004 and choosing the right treatment. NOTE Confidence: 0.99302185 00:12:44.184 --> 00:12:46.200 But the kind of underlying NOTE Confidence: 0.99302185 00:12:46.260 --> 00:12:47.800 assumption of this particular NOTE Confidence: 0.98503196 00:12:48.420 --> 00:12:50.040 question or series of questions NOTE Confidence: 0.98503196 00:12:50.100 --> 00:12:52.260 is that personalization or precision NOTE Confidence: 0.98503196 00:12:52.260 --> 00:12:53.940 is possible, that it will NOTE Confidence: 0.98503196 00:12:53.940 --> 00:12:55.399 deliver different outcomes. NOTE Confidence: 0.9489337 00:12:56.339 --> 00:12:57.380 So that's what we've been NOTE Confidence: 0.9489337 00:12:57.380 --> 00:12:58.834 on this search for is NOTE Confidence: 0.9489337 00:12:58.834 --> 00:13:00.035 trying to find out is NOTE Confidence: 0.9489337 00:13:00.035 --> 00:13:01.154 there a treatment that might NOTE Confidence: 0.9489337 00:13:01.154 --> 00:13:02.915 work differently for different children NOTE Confidence: 0.9489337 00:13:02.915 --> 00:13:04.355 or does one work better NOTE Confidence: 0.9489337 00:13:04.355 --> 00:13:05.095 than another? NOTE Confidence: 0.9468298 00:13:05.635 --> 00:13:06.774 Under what circumstances? NOTE Confidence: 0.98815376 00:13:07.075 --> 00:13:08.035 So this is what we've NOTE Confidence: 0.98815376 00:13:08.035 --> 00:13:09.635 really been striving for for NOTE Confidence: 0.98815376 00:13:09.635 --> 00:13:10.695 quite some time. NOTE Confidence: 0.95815647 00:13:12.819 --> 00:13:14.899 But personalization itself, like with NOTE Confidence: 0.95815647 00:13:14.899 --> 00:13:16.339 this question, is not really NOTE Confidence: 0.95815647 00:13:16.339 --> 00:13:18.040 new. It is something that NOTE Confidence: 0.9896513 00:13:20.100 --> 00:13:22.199 use my arrow instead. Yeah. NOTE Confidence: 0.9175647 00:13:23.220 --> 00:13:24.420 The mouse does not like NOTE Confidence: 0.9175647 00:13:24.420 --> 00:13:25.160 my fingers. NOTE Confidence: 0.9809801 00:13:25.625 --> 00:13:27.304 Alright. So personalization, as I NOTE Confidence: 0.9809801 00:13:27.304 --> 00:13:28.425 said before, is not really NOTE Confidence: 0.9809801 00:13:28.425 --> 00:13:30.265 new. It's something that clinicians NOTE Confidence: 0.9809801 00:13:30.265 --> 00:13:31.404 have been doing forever, NOTE Confidence: 0.9802084 00:13:32.105 --> 00:13:33.304 but the the idea of NOTE Confidence: 0.9802084 00:13:33.304 --> 00:13:34.605 science driven personalization NOTE Confidence: 0.92837286 00:13:35.065 --> 00:13:36.045 is quite new. NOTE Confidence: 0.9084052 00:13:36.425 --> 00:13:37.165 In that, NOTE Confidence: 0.9302378 00:13:37.790 --> 00:13:39.070 at the moment even though NOTE Confidence: 0.9302378 00:13:39.070 --> 00:13:41.150 clinicians make these choices about NOTE Confidence: 0.9302378 00:13:41.150 --> 00:13:42.270 okay I'm gonna try this NOTE Confidence: 0.9302378 00:13:42.270 --> 00:13:43.230 instead of that or I'm NOTE Confidence: 0.9302378 00:13:43.230 --> 00:13:45.470 gonna, add this particular treatment NOTE Confidence: 0.9302378 00:13:45.470 --> 00:13:46.929 component at the moment NOTE Confidence: 0.9533077 00:13:47.790 --> 00:13:49.070 we don't have the science NOTE Confidence: 0.9533077 00:13:49.070 --> 00:13:50.370 to drive those decisions. NOTE Confidence: 0.9751878 00:13:51.335 --> 00:13:52.695 We have made some inroads NOTE Confidence: 0.9751878 00:13:52.695 --> 00:13:53.455 into this and I'm going NOTE Confidence: 0.9751878 00:13:53.455 --> 00:13:54.295 to take you through some NOTE Confidence: 0.9751878 00:13:54.295 --> 00:13:55.255 of the work that we NOTE Confidence: 0.9751878 00:13:55.255 --> 00:13:56.875 have been doing around this NOTE Confidence: 0.87133646 00:13:57.255 --> 00:13:58.054 space but, NOTE Confidence: 0.9802064 00:13:59.415 --> 00:14:00.455 yeah, I don't think we're NOTE Confidence: 0.9802064 00:14:00.455 --> 00:14:01.195 there yet. NOTE Confidence: 0.9773071 00:14:02.375 --> 00:14:03.895 So really I'll just backtrack NOTE Confidence: 0.9773071 00:14:03.895 --> 00:14:05.040 a little bit because the NOTE Confidence: 0.9773071 00:14:05.199 --> 00:14:06.160 most of the work that NOTE Confidence: 0.9773071 00:14:06.160 --> 00:14:07.759 we have been doing within NOTE Confidence: 0.9773071 00:14:07.759 --> 00:14:08.959 the child mental health space NOTE Confidence: 0.9773071 00:14:08.959 --> 00:14:10.720 and within anxiety disorders is NOTE Confidence: 0.9773071 00:14:10.720 --> 00:14:11.920 a one size fits all NOTE Confidence: 0.9773071 00:14:11.920 --> 00:14:13.920 approach. It's very different to NOTE Confidence: 0.9773071 00:14:13.920 --> 00:14:15.279 the what treatment works for NOTE Confidence: 0.9773071 00:14:15.279 --> 00:14:17.059 whom, under what circumstances. NOTE Confidence: 0.9351911 00:14:17.679 --> 00:14:19.199 It's if you present with NOTE Confidence: 0.9351911 00:14:19.199 --> 00:14:19.360 the, NOTE Confidence: 0.93872124 00:14:20.235 --> 00:14:22.075 with an anxiety disorder, it NOTE Confidence: 0.93872124 00:14:22.075 --> 00:14:22.955 can be any one of NOTE Confidence: 0.93872124 00:14:22.955 --> 00:14:25.535 them, generalized anxiety, separation anxiety, NOTE Confidence: 0.999431 00:14:26.075 --> 00:14:27.055 specific phobia, NOTE Confidence: 0.9989558 00:14:28.315 --> 00:14:29.295 social anxiety, NOTE Confidence: 0.89034534 00:14:30.714 --> 00:14:32.635 even OCD, that the treatment NOTE Confidence: 0.89034534 00:14:32.635 --> 00:14:33.775 would be very similar. NOTE Confidence: 0.99684185 00:14:34.110 --> 00:14:35.470 We have this one size NOTE Confidence: 0.99684185 00:14:35.470 --> 00:14:36.210 fits all. NOTE Confidence: 0.9634361 00:14:37.630 --> 00:14:38.589 It's different a little bit NOTE Confidence: 0.9634361 00:14:38.589 --> 00:14:40.110 from adult treatment if an NOTE Confidence: 0.9634361 00:14:40.110 --> 00:14:41.310 adult might be more likely NOTE Confidence: 0.9634361 00:14:41.310 --> 00:14:42.770 to present with a, NOTE Confidence: 0.9492562 00:14:43.390 --> 00:14:45.310 anxiety disorder, like social anxiety NOTE Confidence: 0.9492562 00:14:45.310 --> 00:14:46.270 disorder, and you might get NOTE Confidence: 0.9492562 00:14:46.270 --> 00:14:48.385 more disorder specific treatment there. NOTE Confidence: 0.9492562 00:14:48.685 --> 00:14:50.445 But really, it's, in the NOTE Confidence: 0.9492562 00:14:50.445 --> 00:14:52.045 child space, it's more a NOTE Confidence: 0.9492562 00:14:52.045 --> 00:14:53.165 one size fits all. And NOTE Confidence: 0.9492562 00:14:53.165 --> 00:14:54.285 this makes sense because of NOTE Confidence: 0.9492562 00:14:54.285 --> 00:14:55.825 high comorbidity between, NOTE Confidence: 0.98822767 00:14:56.365 --> 00:14:58.385 different symptoms and different disorders, NOTE Confidence: 0.99581885 00:14:59.085 --> 00:15:00.525 and it seems economical to NOTE Confidence: 0.99581885 00:15:00.525 --> 00:15:01.565 have this one size fits NOTE Confidence: 0.99581885 00:15:01.565 --> 00:15:02.305 all approach. NOTE Confidence: 0.9465245 00:15:03.569 --> 00:15:05.009 And it's true really for NOTE Confidence: 0.9465245 00:15:05.009 --> 00:15:06.709 both psychological and pharmacological, NOTE Confidence: 0.99974513 00:15:07.490 --> 00:15:07.990 interventions. NOTE Confidence: 0.97299236 00:15:09.810 --> 00:15:11.250 So this one size fits NOTE Confidence: 0.97299236 00:15:11.250 --> 00:15:12.550 all is kind of CBT NOTE Confidence: 0.97299236 00:15:12.610 --> 00:15:14.370 in this lumped package, and NOTE Confidence: 0.97299236 00:15:14.370 --> 00:15:15.350 we know that NOTE Confidence: 0.9600907 00:15:15.730 --> 00:15:16.185 it's, NOTE Confidence: 0.9715702 00:15:16.585 --> 00:15:18.265 it's been established as a, NOTE Confidence: 0.94270086 00:15:18.825 --> 00:15:20.825 efficacious treatment for anxiety disorders. NOTE Confidence: 0.94270086 00:15:20.825 --> 00:15:22.685 There's been many, many trials. NOTE Confidence: 0.99635655 00:15:23.625 --> 00:15:24.585 And when you look at NOTE Confidence: 0.99635655 00:15:24.585 --> 00:15:26.825 what those treatment components are, NOTE Confidence: 0.99635655 00:15:26.825 --> 00:15:28.904 there's lots of different components NOTE Confidence: 0.99635655 00:15:28.904 --> 00:15:29.805 that make up NOTE Confidence: 0.91518146 00:15:30.110 --> 00:15:31.950 cognitive behavior therapy. And if NOTE Confidence: 0.91518146 00:15:31.950 --> 00:15:32.430 you, NOTE Confidence: 0.95513403 00:15:32.910 --> 00:15:34.370 hear about a a CBT NOTE Confidence: 0.95513403 00:15:34.670 --> 00:15:35.710 therapy, it can have any NOTE Confidence: 0.95513403 00:15:35.710 --> 00:15:36.850 one of these components, NOTE Confidence: 0.97405875 00:15:37.390 --> 00:15:38.990 more emphasis on one over NOTE Confidence: 0.97405875 00:15:38.990 --> 00:15:40.030 another, but they tend to NOTE Confidence: 0.97405875 00:15:40.030 --> 00:15:40.850 have a psychoeducation, NOTE Confidence: 0.99939144 00:15:41.950 --> 00:15:43.010 cognitive restructuring, NOTE Confidence: 0.9962319 00:15:43.790 --> 00:15:44.850 gradual exposure, NOTE Confidence: 0.989323 00:15:45.905 --> 00:15:47.525 where the child faces gradually NOTE Confidence: 0.989323 00:15:47.585 --> 00:15:48.645 faces their fears, NOTE Confidence: 0.9789808 00:15:49.585 --> 00:15:51.105 parent training as well, where NOTE Confidence: 0.9789808 00:15:51.105 --> 00:15:53.205 parents are encouraged to reduce NOTE Confidence: 0.9789808 00:15:53.345 --> 00:15:53.845 accommodation NOTE Confidence: 0.8793868 00:15:54.785 --> 00:15:55.265 or, NOTE Confidence: 0.9931682 00:15:56.465 --> 00:15:57.605 reduce their overprotection NOTE Confidence: 0.9344034 00:15:58.145 --> 00:15:59.185 or kind of rushing in NOTE Confidence: 0.9344034 00:15:59.185 --> 00:15:59.730 to help, NOTE Confidence: 0.9327423 00:16:00.290 --> 00:16:02.050 and also a relaxation component NOTE Confidence: 0.9327423 00:16:02.050 --> 00:16:03.170 that goes onto that. But NOTE Confidence: 0.9327423 00:16:03.170 --> 00:16:04.389 that's kind of the standard NOTE Confidence: 0.9327423 00:16:04.449 --> 00:16:04.949 treatment, NOTE Confidence: 0.93090045 00:16:05.570 --> 00:16:06.070 package. NOTE Confidence: 0.97094184 00:16:06.610 --> 00:16:07.730 That'd be about right for NOTE Confidence: 0.97094184 00:16:07.730 --> 00:16:09.490 your program at the moment, NOTE Confidence: 0.97094184 00:16:09.490 --> 00:16:11.110 Wendy, or your standard CBT. NOTE Confidence: 0.9483535 00:16:11.490 --> 00:16:12.310 Sounds familiar. NOTE Confidence: 0.9682754 00:16:13.365 --> 00:16:14.645 And we know that CBT NOTE Confidence: 0.9682754 00:16:14.645 --> 00:16:15.765 works. Like, when you compare NOTE Confidence: 0.9682754 00:16:15.765 --> 00:16:16.985 it to a wait list, NOTE Confidence: 0.9682754 00:16:17.205 --> 00:16:18.485 yep. We get really strong NOTE Confidence: 0.9682754 00:16:18.485 --> 00:16:20.345 effects. Compared to doing nothing, NOTE Confidence: 0.9682754 00:16:20.565 --> 00:16:22.165 we know CBT works. When NOTE Confidence: 0.9682754 00:16:22.165 --> 00:16:23.125 we compare it to an NOTE Confidence: 0.9682754 00:16:23.125 --> 00:16:24.105 attention control, NOTE Confidence: 0.99646163 00:16:24.405 --> 00:16:26.085 it works better, but the NOTE Confidence: 0.99646163 00:16:26.085 --> 00:16:27.125 effects are a little bit NOTE Confidence: 0.99646163 00:16:27.125 --> 00:16:27.625 weaker. NOTE Confidence: 0.9821085 00:16:28.200 --> 00:16:29.240 When we compare it to NOTE Confidence: 0.9821085 00:16:29.240 --> 00:16:31.000 treatment as usual, so another NOTE Confidence: 0.9821085 00:16:31.000 --> 00:16:33.640 treatment, another psychological treatment, the NOTE Confidence: 0.9821085 00:16:33.640 --> 00:16:35.160 effects are a little bit NOTE Confidence: 0.9821085 00:16:35.160 --> 00:16:36.840 weaker again. They're there, but NOTE Confidence: 0.9821085 00:16:36.840 --> 00:16:37.740 not as consistent, NOTE Confidence: 0.9914763 00:16:38.200 --> 00:16:38.700 and, NOTE Confidence: 0.95867103 00:16:39.480 --> 00:16:40.520 there's a little bit more NOTE Confidence: 0.95867103 00:16:40.520 --> 00:16:41.960 limitation in those findings and NOTE Confidence: 0.95867103 00:16:41.960 --> 00:16:42.780 not as strong. NOTE Confidence: 0.99831295 00:16:44.165 --> 00:16:45.545 So keep this in mind NOTE Confidence: 0.9955984 00:16:46.005 --> 00:16:47.204 as I go through these, NOTE Confidence: 0.9955984 00:16:47.445 --> 00:16:48.805 the next sets of, NOTE Confidence: 0.99473906 00:16:50.324 --> 00:16:51.385 data as well. NOTE Confidence: 0.980323 00:16:52.084 --> 00:16:53.845 But importantly, I want to NOTE Confidence: 0.980323 00:16:53.845 --> 00:16:54.964 draw attention to the fact NOTE Confidence: 0.980323 00:16:54.964 --> 00:16:56.639 that these effects are all NOTE Confidence: 0.980323 00:16:56.639 --> 00:16:57.920 on average. So we've got NOTE Confidence: 0.980323 00:16:57.920 --> 00:16:59.540 an average treatment package, NOTE Confidence: 0.9912203 00:16:59.920 --> 00:17:01.360 and we look at means NOTE Confidence: 0.9912203 00:17:01.360 --> 00:17:03.459 and standard deviations. On average, NOTE Confidence: 0.99660474 00:17:03.760 --> 00:17:04.660 how does everybody NOTE Confidence: 0.997836 00:17:05.359 --> 00:17:07.059 how does the typical child NOTE Confidence: 0.997836 00:17:07.200 --> 00:17:08.260 within the sample NOTE Confidence: 0.683362 00:17:09.655 --> 00:17:10.155 fare? NOTE Confidence: 0.9359865 00:17:11.415 --> 00:17:12.375 And so we have we're NOTE Confidence: 0.9359865 00:17:12.375 --> 00:17:13.275 kinda lumping NOTE Confidence: 0.9936197 00:17:13.575 --> 00:17:14.935 all of the children that NOTE Confidence: 0.9936197 00:17:14.935 --> 00:17:15.435 present, NOTE Confidence: 0.985752 00:17:16.295 --> 00:17:17.595 and all of the variation NOTE Confidence: 0.985752 00:17:17.734 --> 00:17:19.575 that we do experience and NOTE Confidence: 0.985752 00:17:19.575 --> 00:17:20.855 we do see in treatment NOTE Confidence: 0.985752 00:17:20.855 --> 00:17:22.455 outcome studies, they're all lumped NOTE Confidence: 0.985752 00:17:22.455 --> 00:17:22.955 together. NOTE Confidence: 0.9962164 00:17:24.220 --> 00:17:25.340 But when we look at NOTE Confidence: 0.9962164 00:17:25.340 --> 00:17:26.700 that average, we know that, NOTE Confidence: 0.9962164 00:17:27.019 --> 00:17:28.619 fifty percent fifty to sixty NOTE Confidence: 0.9962164 00:17:28.619 --> 00:17:29.740 percent of kids are likely NOTE Confidence: 0.9962164 00:17:29.740 --> 00:17:30.399 to improve. NOTE Confidence: 0.9969551 00:17:31.659 --> 00:17:33.179 But we don't really have NOTE Confidence: 0.9969551 00:17:33.179 --> 00:17:33.679 any, NOTE Confidence: 0.9549354 00:17:34.139 --> 00:17:36.559 methods for predicting or, previously NOTE Confidence: 0.9549354 00:17:36.619 --> 00:17:37.934 hadn't had any methods for NOTE Confidence: 0.9549354 00:17:37.934 --> 00:17:39.154 predicting that variability. NOTE Confidence: 0.9965709 00:17:39.855 --> 00:17:40.975 How do we know who's NOTE Confidence: 0.9965709 00:17:40.975 --> 00:17:41.794 gonna respond? NOTE Confidence: 0.9974033 00:17:43.215 --> 00:17:43.715 So NOTE Confidence: 0.905416 00:17:44.414 --> 00:17:45.294 and our our, NOTE Confidence: 0.8921284 00:17:45.695 --> 00:17:47.475 our treatment approaches really NOTE Confidence: 0.9089111 00:17:47.855 --> 00:17:48.014 will NOTE Confidence: 0.93903226 00:17:48.894 --> 00:17:50.174 and in terms of guidelines, NOTE Confidence: 0.93903226 00:17:50.174 --> 00:17:51.299 I know we've got treatment NOTE Confidence: 0.93903226 00:17:51.299 --> 00:17:52.580 guidelines in Australia, but I NOTE Confidence: 0.93903226 00:17:52.580 --> 00:17:53.539 know you've also got them NOTE Confidence: 0.93903226 00:17:53.539 --> 00:17:54.039 here, NOTE Confidence: 0.975569 00:17:54.419 --> 00:17:54.919 that, NOTE Confidence: 0.9937929 00:17:55.700 --> 00:17:56.919 recommend CBT NOTE Confidence: 0.99856436 00:17:57.299 --> 00:17:58.500 for a child presenting with NOTE Confidence: 0.99856436 00:17:58.500 --> 00:17:59.639 an anxiety disorder. NOTE Confidence: 0.9867675 00:17:59.940 --> 00:18:01.220 But let's just say we've NOTE Confidence: 0.9867675 00:18:01.220 --> 00:18:02.440 got two different children. NOTE Confidence: 0.9935689 00:18:03.195 --> 00:18:04.034 We've got a, NOTE Confidence: 0.957053 00:18:04.475 --> 00:18:06.095 Keira, a nine year old. NOTE Confidence: 0.957053 00:18:06.154 --> 00:18:06.654 She's, NOTE Confidence: 0.9882956 00:18:08.315 --> 00:18:09.914 they're both, both of these NOTE Confidence: 0.9882956 00:18:09.914 --> 00:18:10.815 children are NOTE Confidence: 0.9911023 00:18:11.115 --> 00:18:13.054 medication naive. They've never had NOTE Confidence: 0.9911023 00:18:13.115 --> 00:18:13.434 any, NOTE Confidence: 0.6111844 00:18:13.994 --> 00:18:14.494 medications NOTE Confidence: 0.9993175 00:18:16.635 --> 00:18:17.135 before. NOTE Confidence: 0.954597 00:18:19.490 --> 00:18:20.690 Keira is a nine year NOTE Confidence: 0.954597 00:18:20.690 --> 00:18:22.210 old. She comes from her NOTE Confidence: 0.954597 00:18:22.210 --> 00:18:23.490 dad found her dad's family NOTE Confidence: 0.954597 00:18:23.490 --> 00:18:25.090 comes from a Polynesian island. NOTE Confidence: 0.954597 00:18:25.090 --> 00:18:26.390 Mum was born in India. NOTE Confidence: 0.954597 00:18:26.610 --> 00:18:27.890 She's very anxious about her NOTE Confidence: 0.954597 00:18:27.890 --> 00:18:29.910 schoolwork and getting things right. NOTE Confidence: 0.954597 00:18:30.050 --> 00:18:31.110 She's a bit perfectionistic. NOTE Confidence: 0.9338841 00:18:33.025 --> 00:18:34.885 She meets criteria for generalized NOTE Confidence: 0.9338841 00:18:35.025 --> 00:18:37.125 anxiety disorder and social anxiety NOTE Confidence: 0.9338841 00:18:37.185 --> 00:18:37.685 disorder. NOTE Confidence: 0.99733627 00:18:38.225 --> 00:18:39.045 Her parents, NOTE Confidence: 0.9417686 00:18:39.425 --> 00:18:40.865 particularly her dad, is very NOTE Confidence: 0.9417686 00:18:40.865 --> 00:18:41.365 anxious, NOTE Confidence: 0.99544907 00:18:41.665 --> 00:18:42.785 and she's also started to NOTE Confidence: 0.99544907 00:18:42.785 --> 00:18:44.725 experience some mild depressive symptoms. NOTE Confidence: 0.9935159 00:18:45.750 --> 00:18:46.710 Jay, on the other hand, NOTE Confidence: 0.9935159 00:18:46.710 --> 00:18:47.670 is a sixteen year old NOTE Confidence: 0.9935159 00:18:47.670 --> 00:18:49.590 boy. He hasn't previously had NOTE Confidence: 0.9935159 00:18:49.590 --> 00:18:51.030 huge amounts of anxiety. He's NOTE Confidence: 0.9935159 00:18:51.030 --> 00:18:52.630 been coping okay. He's just NOTE Confidence: 0.9935159 00:18:52.630 --> 00:18:54.650 started driving and started experiencing NOTE Confidence: 0.9997985 00:18:55.109 --> 00:18:55.609 regular NOTE Confidence: 0.98622346 00:18:56.070 --> 00:18:57.430 panic attacks that are now NOTE Confidence: 0.98622346 00:18:57.430 --> 00:18:58.650 coming out of the blue. NOTE Confidence: 0.98622346 00:18:58.695 --> 00:18:59.654 He comes from a a NOTE Confidence: 0.98622346 00:18:59.654 --> 00:19:01.034 single parent household, NOTE Confidence: 0.9807386 00:19:02.695 --> 00:19:03.734 and he's been having these NOTE Confidence: 0.9807386 00:19:03.734 --> 00:19:05.494 panic attacks regularly and seeking NOTE Confidence: 0.9807386 00:19:05.494 --> 00:19:05.994 treatment. NOTE Confidence: 0.95888364 00:19:07.174 --> 00:19:08.455 At the moment, our treatment NOTE Confidence: 0.95888364 00:19:08.455 --> 00:19:10.554 guidelines would say that the NOTE Confidence: 0.95888364 00:19:10.695 --> 00:19:11.195 CBT NOTE Confidence: 0.9971006 00:19:11.494 --> 00:19:12.875 treatment is the same. NOTE Confidence: 0.9709614 00:19:13.900 --> 00:19:14.940 All all we know from NOTE Confidence: 0.9709614 00:19:14.940 --> 00:19:15.900 science is that you would NOTE Confidence: 0.9709614 00:19:15.900 --> 00:19:17.420 apply the same approaches. But NOTE Confidence: 0.9709614 00:19:17.420 --> 00:19:18.460 as a clinician, you'd probably NOTE Confidence: 0.9709614 00:19:18.460 --> 00:19:19.500 think, well, I do something NOTE Confidence: 0.9709614 00:19:19.500 --> 00:19:20.960 differently with each of these. NOTE Confidence: 0.8821926 00:19:21.340 --> 00:19:22.619 But yet at the moment, NOTE Confidence: 0.8821926 00:19:22.619 --> 00:19:23.920 the science says NOTE Confidence: 0.87442416 00:19:24.380 --> 00:19:25.500 CBT or is that that's NOTE Confidence: 0.87442416 00:19:25.500 --> 00:19:26.160 the recommendation. NOTE Confidence: 0.9982822 00:19:28.994 --> 00:19:30.115 Alright. So we've been trying NOTE Confidence: 0.9982822 00:19:30.115 --> 00:19:31.234 to move away from this NOTE Confidence: 0.9982822 00:19:31.234 --> 00:19:32.934 one size fits all approach NOTE Confidence: 0.9405225 00:19:33.234 --> 00:19:35.554 and trying to understand whether NOTE Confidence: 0.9405225 00:19:35.554 --> 00:19:37.234 a personalized evidence based or NOTE Confidence: 0.9405225 00:19:37.234 --> 00:19:38.215 a precision medicine NOTE Confidence: 0.80779004 00:19:39.154 --> 00:19:39.654 approach NOTE Confidence: 0.971167 00:19:40.020 --> 00:19:41.060 might work a little bit NOTE Confidence: 0.971167 00:19:41.060 --> 00:19:42.740 better. So the goals of NOTE Confidence: 0.971167 00:19:42.740 --> 00:19:43.240 personalization NOTE Confidence: 0.9227245 00:19:43.619 --> 00:19:44.740 really, you've gotta be able NOTE Confidence: 0.9227245 00:19:44.740 --> 00:19:46.180 to make an accurate diagnosis NOTE Confidence: 0.9227245 00:19:46.180 --> 00:19:47.619 or an accurate picture or NOTE Confidence: 0.9227245 00:19:47.619 --> 00:19:49.300 profile. Doesn't necessarily have to NOTE Confidence: 0.9227245 00:19:49.300 --> 00:19:50.500 be diagnosis if you don't NOTE Confidence: 0.9227245 00:19:50.500 --> 00:19:51.619 come from a a medical NOTE Confidence: 0.9227245 00:19:51.619 --> 00:19:52.119 model. NOTE Confidence: 0.97483027 00:19:53.404 --> 00:19:54.684 Being able to predict what NOTE Confidence: 0.97483027 00:19:54.684 --> 00:19:56.605 that individual risk is, being NOTE Confidence: 0.97483027 00:19:56.605 --> 00:19:57.965 able to predict how likely NOTE Confidence: 0.97483027 00:19:57.965 --> 00:19:59.424 the child might be to NOTE Confidence: 0.97483027 00:19:59.644 --> 00:20:00.144 respond NOTE Confidence: 0.9486676 00:20:00.605 --> 00:20:02.065 suboptimally to treatment. NOTE Confidence: 0.9147947 00:20:03.005 --> 00:20:05.085 But the ultimate goal of NOTE Confidence: 0.9147947 00:20:05.085 --> 00:20:05.585 personalization NOTE Confidence: 0.99842304 00:20:06.044 --> 00:20:07.404 is really to achieve a NOTE Confidence: 0.99842304 00:20:07.404 --> 00:20:08.225 more effective NOTE Confidence: 0.9976238 00:20:09.960 --> 00:20:10.460 response. NOTE Confidence: 0.9609536 00:20:11.720 --> 00:20:12.600 There are a number of NOTE Confidence: 0.9609536 00:20:12.600 --> 00:20:14.760 ways to approach personalization or NOTE Confidence: 0.9609536 00:20:14.760 --> 00:20:16.460 precision medicine in this case. NOTE Confidence: 0.96199876 00:20:16.920 --> 00:20:18.520 You can adapt treatment for NOTE Confidence: 0.96199876 00:20:18.520 --> 00:20:19.720 subgroups. So if you've got NOTE Confidence: 0.96199876 00:20:19.720 --> 00:20:21.160 a child presenting with social NOTE Confidence: 0.96199876 00:20:21.160 --> 00:20:23.080 anxiety like Kira, in the NOTE Confidence: 0.96199876 00:20:23.080 --> 00:20:24.060 example before, NOTE Confidence: 0.9977423 00:20:24.565 --> 00:20:25.305 you may NOTE Confidence: 0.9907093 00:20:26.165 --> 00:20:28.005 deliver a different treatment and NOTE Confidence: 0.9907093 00:20:28.005 --> 00:20:29.305 adapt it for children NOTE Confidence: 0.82953215 00:20:29.765 --> 00:20:30.265 with, NOTE Confidence: 0.99716026 00:20:31.125 --> 00:20:32.905 particular in particular subgroups. NOTE Confidence: 0.957181 00:20:34.565 --> 00:20:36.405 Modular therapies are another kind NOTE Confidence: 0.957181 00:20:36.405 --> 00:20:38.700 of precision approach where depending NOTE Confidence: 0.957181 00:20:38.700 --> 00:20:40.300 on the presentation, you might NOTE Confidence: 0.957181 00:20:40.300 --> 00:20:42.720 add, or subtract different modules, NOTE Confidence: 0.965475 00:20:43.500 --> 00:20:44.240 of treatment, NOTE Confidence: 0.9858161 00:20:44.700 --> 00:20:45.200 components. NOTE Confidence: 0.9516245 00:20:46.460 --> 00:20:48.240 And there's also more individualized NOTE Confidence: 0.9408736 00:20:48.540 --> 00:20:50.940 metrics and predictive analytics that NOTE Confidence: 0.9408736 00:20:50.940 --> 00:20:52.559 are using kind of more, NOTE Confidence: 0.967161 00:20:53.355 --> 00:20:55.375 recent techniques to try and, NOTE Confidence: 0.9759594 00:20:56.155 --> 00:20:57.915 predict ahead of time based NOTE Confidence: 0.9759594 00:20:57.915 --> 00:20:59.775 on previous sets of data, NOTE Confidence: 0.9759594 00:20:59.915 --> 00:21:01.115 how likely is it that NOTE Confidence: 0.9759594 00:21:01.115 --> 00:21:03.275 this child is to respond NOTE Confidence: 0.9759594 00:21:03.275 --> 00:21:03.934 to treatment. NOTE Confidence: 0.99473065 00:21:04.795 --> 00:21:05.455 So using NOTE Confidence: 0.99940073 00:21:07.200 --> 00:21:07.859 predictive analytics NOTE Confidence: 0.9453192 00:21:08.320 --> 00:21:10.399 or previous datasets to be NOTE Confidence: 0.9453192 00:21:10.399 --> 00:21:11.220 able to predict NOTE Confidence: 0.98966223 00:21:11.679 --> 00:21:12.880 with the goal of being NOTE Confidence: 0.98966223 00:21:12.880 --> 00:21:13.840 of being able to get NOTE Confidence: 0.98966223 00:21:13.840 --> 00:21:15.220 a better treatment response. NOTE Confidence: 0.93969005 00:21:15.520 --> 00:21:16.559 And sorry. I should have NOTE Confidence: 0.93969005 00:21:16.559 --> 00:21:17.679 said this is, the work NOTE Confidence: 0.93969005 00:21:17.679 --> 00:21:19.200 of a PhD student who's NOTE Confidence: 0.93969005 00:21:19.200 --> 00:21:19.545 now NOTE Confidence: 0.9539783 00:21:20.265 --> 00:21:21.385 in the process of becoming NOTE Confidence: 0.9539783 00:21:21.385 --> 00:21:23.065 a postdoc, Liz Alberti, who NOTE Confidence: 0.9539783 00:21:23.065 --> 00:21:24.585 also had a pastrami sandwich NOTE Confidence: 0.9539783 00:21:24.585 --> 00:21:25.965 yesterday and loved it. NOTE Confidence: 0.99461323 00:21:27.545 --> 00:21:27.785 She's NOTE Confidence: 0.9903845 00:21:28.825 --> 00:21:30.285 unfortunately, the the NOTE Confidence: 0.95838374 00:21:30.585 --> 00:21:31.545 the pool of Yale was NOTE Confidence: 0.95838374 00:21:31.545 --> 00:21:32.505 not quite as strong as NOTE Confidence: 0.95838374 00:21:32.505 --> 00:21:33.885 New York City, so she's NOTE Confidence: 0.95838374 00:21:33.945 --> 00:21:35.160 staying in New York City. NOTE Confidence: 0.95838374 00:21:35.480 --> 00:21:36.619 Sorry to say, everyone. NOTE Confidence: 0.97191477 00:21:37.160 --> 00:21:37.400 But, NOTE Confidence: 0.9636513 00:21:38.119 --> 00:21:40.060 she's having fun driving around NOTE Confidence: 0.9636513 00:21:40.119 --> 00:21:41.880 Central Park today instead. It's NOTE Confidence: 0.9636513 00:21:41.880 --> 00:21:42.859 her first trip. NOTE Confidence: 0.9707905 00:21:43.800 --> 00:21:45.000 Anyway, she's been doing this NOTE Confidence: 0.9707905 00:21:45.000 --> 00:21:45.800 work as part of her NOTE Confidence: 0.9707905 00:21:45.800 --> 00:21:47.160 PhD in trying to look NOTE Confidence: 0.9707905 00:21:47.160 --> 00:21:47.475 at, NOTE Confidence: 0.99935514 00:21:48.035 --> 00:21:49.635 how we can shift the NOTE Confidence: 0.99935514 00:21:49.635 --> 00:21:50.135 field NOTE Confidence: 0.95154303 00:21:50.515 --> 00:21:51.335 more towards, NOTE Confidence: 0.9717434 00:21:51.875 --> 00:21:53.655 using science to drive personalization. NOTE Confidence: 0.9709885 00:21:54.515 --> 00:21:55.875 So the different methods that NOTE Confidence: 0.9709885 00:21:55.875 --> 00:21:56.914 you might want to use NOTE Confidence: 0.9709885 00:21:56.914 --> 00:21:57.815 to get towards NOTE Confidence: 0.96007264 00:21:58.674 --> 00:22:00.835 personalization or precision medicine, you NOTE Confidence: 0.96007264 00:22:00.835 --> 00:22:01.955 want to understand what the NOTE Confidence: 0.96007264 00:22:01.955 --> 00:22:04.000 predictors are, so which children NOTE Confidence: 0.96007264 00:22:04.000 --> 00:22:05.119 are likely to respond to NOTE Confidence: 0.96007264 00:22:05.119 --> 00:22:05.619 treatment. NOTE Confidence: 0.9474945 00:22:06.080 --> 00:22:07.619 And then also, really importantly, NOTE Confidence: 0.9474945 00:22:07.760 --> 00:22:08.740 what are the moderators? NOTE Confidence: 0.99314505 00:22:09.119 --> 00:22:10.880 Just knowing who's gonna have NOTE Confidence: 0.99314505 00:22:10.880 --> 00:22:11.380 suboptimal NOTE Confidence: 0.99867034 00:22:11.680 --> 00:22:12.180 responses NOTE Confidence: 0.99745476 00:22:12.720 --> 00:22:13.840 is not helpful if we NOTE Confidence: 0.99745476 00:22:13.840 --> 00:22:14.640 don't know anything NOTE Confidence: 0.95371896 00:22:15.119 --> 00:22:15.920 if we don't know what's NOTE Confidence: 0.95371896 00:22:15.920 --> 00:22:17.300 gonna work better for them. NOTE Confidence: 0.9565155 00:22:18.164 --> 00:22:19.764 And then mediators are also NOTE Confidence: 0.9565155 00:22:19.764 --> 00:22:20.264 important, NOTE Confidence: 0.9924183 00:22:20.884 --> 00:22:22.345 less so for the baseline, NOTE Confidence: 0.9903938 00:22:23.044 --> 00:22:23.544 predictors, NOTE Confidence: 0.9372522 00:22:24.725 --> 00:22:26.565 and predictive metrics, but it's NOTE Confidence: 0.9372522 00:22:26.565 --> 00:22:27.845 important in being able if NOTE Confidence: 0.9372522 00:22:27.845 --> 00:22:28.585 we're targeting NOTE Confidence: 0.99904096 00:22:28.965 --> 00:22:30.024 treatments that NOTE Confidence: 0.99666154 00:22:30.404 --> 00:22:31.945 actually work on the mechanisms NOTE Confidence: 0.95589906 00:22:32.520 --> 00:22:33.800 that that's perhaps what we NOTE Confidence: 0.95589906 00:22:33.800 --> 00:22:34.540 can target, NOTE Confidence: 0.8539559 00:22:35.000 --> 00:22:36.300 to personalize care. NOTE Confidence: 0.9975699 00:22:39.480 --> 00:22:40.540 Alright. So NOTE Confidence: 0.99685544 00:22:41.080 --> 00:22:42.280 I wanna focus just a NOTE Confidence: 0.99685544 00:22:42.280 --> 00:22:43.580 little bit on the predictors NOTE Confidence: 0.9646079 00:22:43.960 --> 00:22:44.920 aspects. That's some of the NOTE Confidence: 0.9646079 00:22:44.920 --> 00:22:46.035 work that we've been doing, NOTE Confidence: 0.9646079 00:22:46.355 --> 00:22:48.035 looking at what predicts treatment NOTE Confidence: 0.9646079 00:22:48.035 --> 00:22:49.015 outcomes. So NOTE Confidence: 0.99585515 00:22:49.315 --> 00:22:50.455 can we identify NOTE Confidence: 0.99431074 00:22:51.075 --> 00:22:52.275 ahead of time so when NOTE Confidence: 0.99431074 00:22:52.275 --> 00:22:54.055 a child presents to treatment, NOTE Confidence: 0.94728005 00:22:54.595 --> 00:22:56.755 can we identify who's which NOTE Confidence: 0.94728005 00:22:56.755 --> 00:22:57.795 one of them which which NOTE Confidence: 0.94728005 00:22:57.795 --> 00:22:58.835 of the children is not NOTE Confidence: 0.94728005 00:22:58.835 --> 00:23:00.215 gonna respond favorably? NOTE Confidence: 0.99643415 00:23:00.679 --> 00:23:01.980 So rather than this, NOTE Confidence: 0.95027727 00:23:03.559 --> 00:23:04.520 you know, kind of going NOTE Confidence: 0.95027727 00:23:04.520 --> 00:23:06.140 and treating everybody the same, NOTE Confidence: 0.95027727 00:23:06.359 --> 00:23:08.780 it's before that treatment starts, NOTE Confidence: 0.96313447 00:23:09.960 --> 00:23:11.559 what is it who's gonna NOTE Confidence: 0.96313447 00:23:11.559 --> 00:23:12.780 respond to that treatment? NOTE Confidence: 0.99905324 00:23:14.225 --> 00:23:15.185 And we're actually in a NOTE Confidence: 0.99905324 00:23:15.185 --> 00:23:16.325 pretty good place NOTE Confidence: 0.9600743 00:23:17.025 --> 00:23:18.245 in the last five years NOTE Confidence: 0.9600743 00:23:18.305 --> 00:23:19.505 in terms of answering that NOTE Confidence: 0.9600743 00:23:19.505 --> 00:23:21.105 question. The moderators not so NOTE Confidence: 0.9600743 00:23:21.105 --> 00:23:23.025 much but predictors we we NOTE Confidence: 0.9600743 00:23:23.025 --> 00:23:24.405 have a much better understanding NOTE Confidence: 0.9600743 00:23:24.625 --> 00:23:25.125 of. NOTE Confidence: 0.9904048 00:23:26.590 --> 00:23:27.549 One of the things that's NOTE Confidence: 0.9904048 00:23:27.549 --> 00:23:29.470 complicated this piece of work NOTE Confidence: 0.9904048 00:23:29.470 --> 00:23:30.929 is around the the, NOTE Confidence: 0.9360019 00:23:31.390 --> 00:23:33.090 the issues around methods, NOTE Confidence: 0.9986324 00:23:33.390 --> 00:23:34.190 that there are a lot NOTE Confidence: 0.9986324 00:23:34.190 --> 00:23:35.789 of different methods to look NOTE Confidence: 0.9986324 00:23:35.789 --> 00:23:36.850 at treatment effects. NOTE Confidence: 0.9664889 00:23:37.230 --> 00:23:38.029 So we have, NOTE Confidence: 0.91125834 00:23:39.345 --> 00:23:40.945 we also use in in NOTE Confidence: 0.91125834 00:23:40.945 --> 00:23:41.984 child work, we use the NOTE Confidence: 0.91125834 00:23:41.984 --> 00:23:43.905 clinicians report, we use parent NOTE Confidence: 0.91125834 00:23:43.905 --> 00:23:45.184 report, and we use child NOTE Confidence: 0.91125834 00:23:45.184 --> 00:23:45.684 report, NOTE Confidence: 0.9925255 00:23:46.544 --> 00:23:48.145 and you can get three NOTE Confidence: 0.9925255 00:23:48.145 --> 00:23:49.365 different treatment effects, NOTE Confidence: 0.9997842 00:23:50.225 --> 00:23:51.684 based on those three different NOTE Confidence: 0.9731983 00:23:52.770 --> 00:23:53.270 reports. NOTE Confidence: 0.88575655 00:23:53.570 --> 00:23:54.369 So it's then how do NOTE Confidence: 0.88575655 00:23:54.369 --> 00:23:55.570 you work out what treatment's NOTE Confidence: 0.88575655 00:23:55.570 --> 00:23:56.230 gonna work, NOTE Confidence: 0.9514376 00:23:56.770 --> 00:23:58.390 if you're using different methods? NOTE Confidence: 0.9774273 00:23:59.410 --> 00:24:00.369 You know, which one are NOTE Confidence: 0.9774273 00:24:00.369 --> 00:24:00.950 you gonna NOTE Confidence: 0.9419697 00:24:01.490 --> 00:24:02.869 give preference to a priority NOTE Confidence: 0.9419697 00:24:02.930 --> 00:24:04.290 to? We also have kind NOTE Confidence: 0.9419697 00:24:04.290 --> 00:24:05.730 of different methods of looking NOTE Confidence: 0.9419697 00:24:05.730 --> 00:24:06.230 at NOTE Confidence: 0.96657306 00:24:07.144 --> 00:24:08.505 at the effect. We can NOTE Confidence: 0.96657306 00:24:08.505 --> 00:24:10.125 use the end point. So NOTE Confidence: 0.96657306 00:24:10.264 --> 00:24:11.945 remission has the disorder that NOTE Confidence: 0.96657306 00:24:11.945 --> 00:24:13.304 they started treatment with. Is NOTE Confidence: 0.96657306 00:24:13.304 --> 00:24:14.524 that no longer there? NOTE Confidence: 0.9513376 00:24:14.984 --> 00:24:16.365 And that's an end point NOTE Confidence: 0.9513376 00:24:16.424 --> 00:24:17.625 where they they get to NOTE Confidence: 0.9513376 00:24:17.625 --> 00:24:18.764 at the end of treatment. NOTE Confidence: 0.9513376 00:24:18.825 --> 00:24:19.784 Or you can also look NOTE Confidence: 0.9513376 00:24:19.784 --> 00:24:20.825 at in terms of change NOTE Confidence: 0.9513376 00:24:20.825 --> 00:24:21.565 in severity. NOTE Confidence: 0.9429892 00:24:22.570 --> 00:24:24.030 And that change in severity NOTE Confidence: 0.968433 00:24:24.570 --> 00:24:26.490 really is determined by how NOTE Confidence: 0.968433 00:24:26.490 --> 00:24:27.609 high or how severe they NOTE Confidence: 0.968433 00:24:27.609 --> 00:24:28.570 were in the first place. NOTE Confidence: 0.968433 00:24:28.570 --> 00:24:29.310 So sometimes NOTE Confidence: 0.978637 00:24:29.850 --> 00:24:31.150 when you look at predictors NOTE Confidence: 0.978637 00:24:31.290 --> 00:24:33.130 of outcome or even treatment NOTE Confidence: 0.978637 00:24:33.130 --> 00:24:34.730 effects, those two different those NOTE Confidence: 0.978637 00:24:34.730 --> 00:24:36.090 things will be different in NOTE Confidence: 0.978637 00:24:36.090 --> 00:24:36.910 terms of, NOTE Confidence: 0.9933355 00:24:37.290 --> 00:24:37.935 in terms of NOTE Confidence: 0.98649454 00:24:39.535 --> 00:24:41.075 effects. Alright. So NOTE Confidence: 0.97890437 00:24:41.855 --> 00:24:43.295 now ten years ago, we NOTE Confidence: 0.97890437 00:24:43.295 --> 00:24:44.335 set out on this piece NOTE Confidence: 0.97890437 00:24:44.335 --> 00:24:45.295 of work looking at, well, NOTE Confidence: 0.97890437 00:24:45.295 --> 00:24:46.335 what does the literature say NOTE Confidence: 0.97890437 00:24:46.335 --> 00:24:47.215 so far? What do we NOTE Confidence: 0.97890437 00:24:47.215 --> 00:24:48.835 know about predictors of outcome? NOTE Confidence: 0.97633845 00:24:49.695 --> 00:24:51.330 And we did a systematic NOTE Confidence: 0.97633845 00:24:51.330 --> 00:24:52.210 review at the same time NOTE Confidence: 0.97633845 00:24:52.210 --> 00:24:53.490 as Michael Fassum did a, NOTE Confidence: 0.97633845 00:24:53.809 --> 00:24:55.250 systematic review, and we pretty NOTE Confidence: 0.97633845 00:24:55.250 --> 00:24:56.290 much came to the same NOTE Confidence: 0.97633845 00:24:56.290 --> 00:24:56.790 conclusion. NOTE Confidence: 0.9832048 00:24:57.170 --> 00:24:58.530 It's usually devastating when you NOTE Confidence: 0.9832048 00:24:58.530 --> 00:24:59.410 see that somebody else has NOTE Confidence: 0.9832048 00:24:59.410 --> 00:25:00.530 done a systematic review at NOTE Confidence: 0.9832048 00:25:00.530 --> 00:25:01.650 exactly the same time as NOTE Confidence: 0.9832048 00:25:01.650 --> 00:25:03.730 you, but always reassuring that NOTE Confidence: 0.9832048 00:25:03.730 --> 00:25:04.530 you come up with the NOTE Confidence: 0.9832048 00:25:04.530 --> 00:25:05.990 same as the same answer. NOTE Confidence: 0.9554209 00:25:06.365 --> 00:25:07.325 That's the whole purpose of NOTE Confidence: 0.9554209 00:25:07.325 --> 00:25:09.005 a systematic review. But, NOTE Confidence: 0.9871565 00:25:09.405 --> 00:25:11.085 that there were very few NOTE Confidence: 0.9871565 00:25:11.085 --> 00:25:12.145 consistent predictors. NOTE Confidence: 0.97924405 00:25:12.605 --> 00:25:13.565 Not that they were not NOTE Confidence: 0.97924405 00:25:13.565 --> 00:25:14.525 there, it's just that they NOTE Confidence: 0.97924405 00:25:14.525 --> 00:25:15.345 weren't consistent. NOTE Confidence: 0.9827861 00:25:16.045 --> 00:25:17.405 There was a few hints NOTE Confidence: 0.9827861 00:25:17.405 --> 00:25:18.225 in the literature. NOTE Confidence: 0.9520661 00:25:19.180 --> 00:25:21.580 Social anxiety disorder predicted poorer NOTE Confidence: 0.9520661 00:25:21.580 --> 00:25:23.119 outcomes and, in fact, generalised NOTE Confidence: 0.9520661 00:25:23.260 --> 00:25:25.359 anxiety predicted better outcomes. NOTE Confidence: 0.91430634 00:25:27.020 --> 00:25:29.420 Greater symptom severity predicted greater NOTE Confidence: 0.91430634 00:25:29.420 --> 00:25:31.040 change but poorer endpoints. NOTE Confidence: 0.9795754 00:25:32.125 --> 00:25:33.265 Comorbid disorders NOTE Confidence: 0.8753698 00:25:33.645 --> 00:25:34.705 like, having NOTE Confidence: 0.99054015 00:25:35.005 --> 00:25:36.145 comorbid depression, NOTE Confidence: 0.83760667 00:25:37.484 --> 00:25:39.025 in particular, so it wasn't NOTE Confidence: 0.83760667 00:25:39.164 --> 00:25:39.664 comorbidity NOTE Confidence: 0.9009088 00:25:40.205 --> 00:25:40.705 generally, NOTE Confidence: 0.99873775 00:25:41.484 --> 00:25:41.984 predicted NOTE Confidence: 0.95201963 00:25:42.684 --> 00:25:44.445 poorer treatment response. Although there NOTE Confidence: 0.95201963 00:25:44.445 --> 00:25:46.044 were some studies in this NOTE Confidence: 0.95201963 00:25:46.044 --> 00:25:47.640 review that was not just, NOTE Confidence: 0.95201963 00:25:47.960 --> 00:25:48.860 depression but NOTE Confidence: 0.9766949 00:25:49.400 --> 00:25:50.840 tended to be associated with NOTE Confidence: 0.9766949 00:25:50.840 --> 00:25:51.900 poor treatment response, NOTE Confidence: 0.92324114 00:25:53.560 --> 00:25:54.920 and parent symptoms as well. NOTE Confidence: 0.92324114 00:25:54.920 --> 00:25:56.200 If a parent also presented NOTE Confidence: 0.92324114 00:25:56.200 --> 00:25:57.960 with anxiety or depression that NOTE Confidence: 0.92324114 00:25:57.960 --> 00:25:59.640 the the child had poorer NOTE Confidence: 0.92324114 00:25:59.640 --> 00:26:00.140 endpoints. NOTE Confidence: 0.9909057 00:26:00.994 --> 00:26:02.595 But whenever we found a NOTE Confidence: 0.9909057 00:26:02.595 --> 00:26:03.655 study that showed NOTE Confidence: 0.9940519 00:26:04.515 --> 00:26:06.595 social phobia, social anxiety predicted NOTE Confidence: 0.9940519 00:26:06.595 --> 00:26:07.875 outcome, we found another study NOTE Confidence: 0.9940519 00:26:07.875 --> 00:26:08.755 that didn't show it. So NOTE Confidence: 0.9940519 00:26:08.755 --> 00:26:10.435 it was so inconsistent that NOTE Confidence: 0.9940519 00:26:10.435 --> 00:26:12.355 we really we concluded that NOTE Confidence: 0.9940519 00:26:12.355 --> 00:26:14.135 there was no consistent predictors. NOTE Confidence: 0.97117734 00:26:16.190 --> 00:26:17.470 But there were so many NOTE Confidence: 0.97117734 00:26:17.470 --> 00:26:19.230 limitations with the the work. NOTE Confidence: 0.97117734 00:26:19.230 --> 00:26:20.510 There was you know, we NOTE Confidence: 0.97117734 00:26:20.510 --> 00:26:21.550 we only ever power our NOTE Confidence: 0.97117734 00:26:21.550 --> 00:26:23.070 clinical trials to show a NOTE Confidence: 0.97117734 00:26:23.070 --> 00:26:25.390 treatment effect of, does treatment NOTE Confidence: 0.97117734 00:26:25.390 --> 00:26:26.670 a work better than treatment NOTE Confidence: 0.97117734 00:26:26.670 --> 00:26:27.869 b? We never power it NOTE Confidence: 0.97117734 00:26:27.869 --> 00:26:28.830 enough to be able to NOTE Confidence: 0.97117734 00:26:28.830 --> 00:26:29.475 look at, NOTE Confidence: 0.93475175 00:26:29.875 --> 00:26:31.875 predictors or moderators. So all NOTE Confidence: 0.93475175 00:26:31.875 --> 00:26:33.155 of the the studies in NOTE Confidence: 0.93475175 00:26:33.155 --> 00:26:33.655 this NOTE Confidence: 0.9986147 00:26:34.035 --> 00:26:35.635 review tended to be small NOTE Confidence: 0.9986147 00:26:35.635 --> 00:26:36.455 sample sizes. NOTE Confidence: 0.9320824 00:26:36.994 --> 00:26:38.994 There was limited power, hence NOTE Confidence: 0.9320824 00:26:38.994 --> 00:26:40.434 the reason why some studies NOTE Confidence: 0.9320824 00:26:40.434 --> 00:26:42.674 showed that depression predicted outcome NOTE Confidence: 0.9320824 00:26:42.674 --> 00:26:44.355 and other studies didn't. If NOTE Confidence: 0.9320824 00:26:44.355 --> 00:26:45.095 a one NOTE Confidence: 0.99017406 00:26:45.500 --> 00:26:46.859 sample of a hundred only NOTE Confidence: 0.99017406 00:26:46.859 --> 00:26:49.520 had five children with, comorbid NOTE Confidence: 0.99017406 00:26:49.580 --> 00:26:50.080 depression, NOTE Confidence: 0.99757934 00:26:50.780 --> 00:26:51.280 then, NOTE Confidence: 0.9996141 00:26:51.740 --> 00:26:52.560 the likelihood NOTE Confidence: 0.9948385 00:26:52.940 --> 00:26:54.700 of, that study being able NOTE Confidence: 0.9948385 00:26:54.700 --> 00:26:55.680 to show an effect NOTE Confidence: 0.9454731 00:26:55.980 --> 00:26:57.580 is very different from, you NOTE Confidence: 0.9454731 00:26:57.580 --> 00:26:58.934 know, study that had much NOTE Confidence: 0.9454731 00:26:58.934 --> 00:27:00.855 greater numbers. So we had NOTE Confidence: 0.9454731 00:27:00.855 --> 00:27:01.835 limited power, NOTE Confidence: 0.97035784 00:27:03.174 --> 00:27:05.174 different assessment methods, as I NOTE Confidence: 0.97035784 00:27:05.174 --> 00:27:06.855 talked about, different definitions of NOTE Confidence: 0.97035784 00:27:06.855 --> 00:27:07.355 outcome. NOTE Confidence: 0.8965207 00:27:08.054 --> 00:27:08.794 And also, NOTE Confidence: 0.98236716 00:27:09.095 --> 00:27:09.815 you know, if you look NOTE Confidence: 0.98236716 00:27:09.815 --> 00:27:11.494 at one variable relating to NOTE Confidence: 0.98236716 00:27:11.494 --> 00:27:13.640 another and it's only related NOTE Confidence: 0.98236716 00:27:13.640 --> 00:27:15.000 to it's only related to NOTE Confidence: 0.98236716 00:27:15.000 --> 00:27:16.919 outcome because of its relationship NOTE Confidence: 0.98236716 00:27:16.919 --> 00:27:17.980 with another variable, NOTE Confidence: 0.9592941 00:27:18.359 --> 00:27:19.240 you know, you're gonna get NOTE Confidence: 0.9592941 00:27:19.240 --> 00:27:20.840 inconsistency depending on whether or NOTE Confidence: 0.9592941 00:27:20.840 --> 00:27:21.880 not that variable has been NOTE Confidence: 0.9592941 00:27:21.880 --> 00:27:23.240 controlled for. So it was NOTE Confidence: 0.9592941 00:27:23.240 --> 00:27:24.039 a lot of mess in NOTE Confidence: 0.9592941 00:27:24.039 --> 00:27:25.160 the literature. And so we NOTE Confidence: 0.9592941 00:27:25.160 --> 00:27:26.774 thought, well, what about if NOTE Confidence: 0.9592941 00:27:26.774 --> 00:27:28.134 we try to address this NOTE Confidence: 0.9592941 00:27:28.134 --> 00:27:28.955 issue of NOTE Confidence: 0.9916407 00:27:29.575 --> 00:27:30.315 of limited NOTE Confidence: 0.9296947 00:27:30.615 --> 00:27:32.294 power and increased our sample NOTE Confidence: 0.9296947 00:27:32.294 --> 00:27:33.274 sizes? So, NOTE Confidence: 0.97390425 00:27:34.615 --> 00:27:35.894 Wendy was involved in this NOTE Confidence: 0.97390425 00:27:35.894 --> 00:27:37.014 work as well where we NOTE Confidence: 0.97390425 00:27:37.014 --> 00:27:38.615 were actually interested more in, NOTE Confidence: 0.97390425 00:27:39.014 --> 00:27:41.070 genetic predictors of treatment outcome, NOTE Confidence: 0.97390425 00:27:41.070 --> 00:27:42.510 which I will mention briefly. NOTE Confidence: 0.97390425 00:27:42.510 --> 00:27:44.430 But we needed for genetic NOTE Confidence: 0.97390425 00:27:44.430 --> 00:27:45.950 studies, we needed much larger NOTE Confidence: 0.97390425 00:27:45.950 --> 00:27:48.050 samples. So it was fantastic NOTE Confidence: 0.97390425 00:27:48.109 --> 00:27:49.470 because we got much bigger NOTE Confidence: 0.97390425 00:27:49.470 --> 00:27:49.970 samples, NOTE Confidence: 0.9449836 00:27:50.270 --> 00:27:51.470 and then we're able to, NOTE Confidence: 0.9449836 00:27:51.869 --> 00:27:53.234 to have potentially be NOTE Confidence: 0.99726254 00:27:53.695 --> 00:27:54.815 more power to be able NOTE Confidence: 0.99726254 00:27:54.815 --> 00:27:55.475 to detect, NOTE Confidence: 0.9997285 00:27:56.095 --> 00:27:56.595 predictors. NOTE Confidence: 0.93148744 00:27:56.975 --> 00:27:58.255 We also pulled by that NOTE Confidence: 0.93148744 00:27:58.255 --> 00:27:59.135 stage. We'd had a number NOTE Confidence: 0.93148744 00:27:59.135 --> 00:28:00.335 of clinical trials, so we NOTE Confidence: 0.93148744 00:28:00.335 --> 00:28:01.215 were able to pull the NOTE Confidence: 0.93148744 00:28:01.215 --> 00:28:02.654 data together. So it's like NOTE Confidence: 0.93148744 00:28:02.654 --> 00:28:04.015 when you pull data, can NOTE Confidence: 0.93148744 00:28:04.015 --> 00:28:05.154 we get more of NOTE Confidence: 0.9958132 00:28:07.250 --> 00:28:09.250 understanding of predictors through through NOTE Confidence: 0.9958132 00:28:09.250 --> 00:28:09.750 combining NOTE Confidence: 0.87495136 00:28:10.050 --> 00:28:10.550 RCTs? NOTE Confidence: 0.99723244 00:28:11.090 --> 00:28:12.230 So this is a study, NOTE Confidence: 0.9117526 00:28:12.609 --> 00:28:13.890 I did two thousand and NOTE Confidence: 0.9117526 00:28:13.890 --> 00:28:15.970 fifteen just with our samples NOTE Confidence: 0.9117526 00:28:15.970 --> 00:28:17.250 that we'd collected within our NOTE Confidence: 0.9117526 00:28:17.250 --> 00:28:17.910 own lab. NOTE Confidence: 0.9972687 00:28:18.450 --> 00:28:18.950 And NOTE Confidence: 0.989649 00:28:19.725 --> 00:28:21.005 we were able to really NOTE Confidence: 0.989649 00:28:21.005 --> 00:28:22.605 consistently show with this much NOTE Confidence: 0.989649 00:28:22.605 --> 00:28:24.525 larger sample that children with NOTE Confidence: 0.989649 00:28:24.525 --> 00:28:26.125 social anxiety disorder on the NOTE Confidence: 0.989649 00:28:26.125 --> 00:28:26.625 left NOTE Confidence: 0.98721397 00:28:27.244 --> 00:28:29.165 had much poorer outcomes. So NOTE Confidence: 0.98721397 00:28:29.165 --> 00:28:30.145 it's not that they NOTE Confidence: 0.96032226 00:28:30.924 --> 00:28:32.445 were not responding. They were NOTE Confidence: 0.96032226 00:28:32.445 --> 00:28:33.645 responding to treatment, but they NOTE Confidence: 0.96032226 00:28:33.645 --> 00:28:35.529 just weren't responding as well NOTE Confidence: 0.9988054 00:28:35.830 --> 00:28:37.770 as children with other presentations. NOTE Confidence: 0.9073944 00:28:38.309 --> 00:28:39.049 And interestingly, NOTE Confidence: 0.9454144 00:28:39.350 --> 00:28:41.270 OCD here often people separate NOTE Confidence: 0.9454144 00:28:41.270 --> 00:28:42.870 that as a separate you NOTE Confidence: 0.9454144 00:28:42.870 --> 00:28:43.830 know, have a different type NOTE Confidence: 0.9454144 00:28:43.830 --> 00:28:45.350 of treatment, but we consider NOTE Confidence: 0.9454144 00:28:45.350 --> 00:28:45.850 it NOTE Confidence: 0.9314667 00:28:46.470 --> 00:28:47.830 part of the anxiety disorders NOTE Confidence: 0.9314667 00:28:47.830 --> 00:28:49.110 and showed that actually our NOTE Confidence: 0.9314667 00:28:49.110 --> 00:28:51.795 CBT works, very well, much NOTE Confidence: 0.9314667 00:28:51.795 --> 00:28:53.075 better than it does for, NOTE Confidence: 0.9996855 00:28:53.395 --> 00:28:54.295 social anxiety. NOTE Confidence: 0.99734354 00:28:56.195 --> 00:28:57.495 We also looked at comorbidity NOTE Confidence: 0.9846454 00:28:57.795 --> 00:28:59.075 as well and showed that NOTE Confidence: 0.9846454 00:28:59.075 --> 00:29:01.315 children with comorbid mood disorder NOTE Confidence: 0.9846454 00:29:01.315 --> 00:29:02.115 had poorer NOTE Confidence: 0.8221534 00:29:02.515 --> 00:29:04.295 lower remission rates, poorer endpoints. NOTE Confidence: 0.9371817 00:29:05.560 --> 00:29:07.000 So pooling again this data NOTE Confidence: 0.9371817 00:29:07.000 --> 00:29:08.760 together was able to consistent NOTE Confidence: 0.9371817 00:29:08.920 --> 00:29:09.960 like, kind of have a NOTE Confidence: 0.9371817 00:29:09.960 --> 00:29:11.480 more robust finding and something NOTE Confidence: 0.9371817 00:29:11.480 --> 00:29:12.360 that we can be more NOTE Confidence: 0.9371817 00:29:12.360 --> 00:29:13.340 confident in. NOTE Confidence: 0.9664793 00:29:14.520 --> 00:29:15.260 We also, NOTE Confidence: 0.9992237 00:29:16.920 --> 00:29:17.160 looked NOTE Confidence: 0.96956927 00:29:18.034 --> 00:29:19.235 oh, this is the genetic NOTE Confidence: 0.96956927 00:29:19.235 --> 00:29:20.195 study. So this is an NOTE Confidence: 0.96956927 00:29:20.195 --> 00:29:21.475 even bigger sample size of NOTE Confidence: 0.96956927 00:29:21.475 --> 00:29:23.715 fifteen hundred. We looked at NOTE Confidence: 0.96956927 00:29:23.875 --> 00:29:24.615 this is including, NOTE Confidence: 0.8320294 00:29:25.955 --> 00:29:26.455 data, NOTE Confidence: 0.9994399 00:29:27.715 --> 00:29:28.215 from NOTE Confidence: 0.9510729 00:29:28.755 --> 00:29:30.135 Yale and Florida, NOTE Confidence: 0.9993437 00:29:31.635 --> 00:29:32.135 combining NOTE Confidence: 0.93503135 00:29:33.250 --> 00:29:34.690 the data sets from around NOTE Confidence: 0.93503135 00:29:34.690 --> 00:29:35.270 the world. NOTE Confidence: 0.9991714 00:29:35.970 --> 00:29:36.789 We had NOTE Confidence: 0.99661475 00:29:37.090 --> 00:29:39.350 samples from Oxford, from Groningen, NOTE Confidence: 0.99661475 00:29:39.570 --> 00:29:40.470 from Amsterdam, NOTE Confidence: 0.9274781 00:29:40.850 --> 00:29:42.950 Denmark, Norway, and Sydney, NOTE Confidence: 0.87412244 00:29:43.650 --> 00:29:44.630 pulling them together NOTE Confidence: 0.8897848 00:29:45.090 --> 00:29:46.470 and showed again NOTE Confidence: 0.9354626 00:29:46.955 --> 00:29:48.575 with social anxiety disorder. NOTE Confidence: 0.99649537 00:29:50.395 --> 00:29:51.135 This is NOTE Confidence: 0.8597795 00:29:51.515 --> 00:29:52.955 a change or a change NOTE Confidence: 0.8597795 00:29:52.955 --> 00:29:53.695 in severity NOTE Confidence: 0.95252323 00:29:54.155 --> 00:29:55.355 that the slope of the NOTE Confidence: 0.95252323 00:29:55.355 --> 00:29:57.035 line is it's it it's NOTE Confidence: 0.95252323 00:29:57.035 --> 00:29:57.855 still improving, NOTE Confidence: 0.9686511 00:29:58.395 --> 00:29:59.995 but not as well as NOTE Confidence: 0.9686511 00:29:59.995 --> 00:30:01.055 children with other, NOTE Confidence: 0.9962458 00:30:02.110 --> 00:30:03.650 primary anxiety disorders. NOTE Confidence: 0.9973463 00:30:06.270 --> 00:30:08.110 We also looked more closely NOTE Confidence: 0.9973463 00:30:08.110 --> 00:30:09.470 at parental mental health as NOTE Confidence: 0.9973463 00:30:09.470 --> 00:30:09.970 well NOTE Confidence: 0.8257244 00:30:10.270 --> 00:30:12.130 and pulling the data together. NOTE Confidence: 0.9566484 00:30:12.830 --> 00:30:13.330 And NOTE Confidence: 0.9700888 00:30:13.675 --> 00:30:15.435 parental psychopathology was also something NOTE Confidence: 0.9700888 00:30:15.435 --> 00:30:17.035 that was quite inconsistent in NOTE Confidence: 0.9700888 00:30:17.035 --> 00:30:18.635 the literature. Sometimes it showed NOTE Confidence: 0.9700888 00:30:18.635 --> 00:30:19.915 an effect and sometimes it NOTE Confidence: 0.9700888 00:30:19.915 --> 00:30:21.755 didn't. And when we pulled NOTE Confidence: 0.9700888 00:30:21.755 --> 00:30:23.515 this data together, it helped NOTE Confidence: 0.9700888 00:30:23.515 --> 00:30:24.335 really understand NOTE Confidence: 0.95704156 00:30:24.795 --> 00:30:25.995 why that might be is NOTE Confidence: 0.95704156 00:30:25.995 --> 00:30:27.720 that pre to post, you're NOTE Confidence: 0.95704156 00:30:27.720 --> 00:30:29.480 getting similar effects regardless of NOTE Confidence: 0.95704156 00:30:29.480 --> 00:30:30.700 whether or not the parent NOTE Confidence: 0.98528564 00:30:31.000 --> 00:30:33.240 also experiences anxiety, both mothers NOTE Confidence: 0.98528564 00:30:33.240 --> 00:30:33.900 and fathers. NOTE Confidence: 0.9837376 00:30:35.000 --> 00:30:35.500 But NOTE Confidence: 0.9820534 00:30:35.960 --> 00:30:37.100 the further you go NOTE Confidence: 0.9334253 00:30:37.560 --> 00:30:38.700 away from the treatment NOTE Confidence: 0.9409558 00:30:39.080 --> 00:30:40.140 that the clinic, NOTE Confidence: 0.9972944 00:30:41.044 --> 00:30:42.565 the more that the parental NOTE Confidence: 0.9972944 00:30:42.565 --> 00:30:43.065 psychopathology NOTE Confidence: 0.9996983 00:30:43.525 --> 00:30:44.585 impacts on NOTE Confidence: 0.996786 00:30:44.885 --> 00:30:46.404 the clinical severity rating of NOTE Confidence: 0.996786 00:30:46.404 --> 00:30:48.325 the child's anxiety. So when NOTE Confidence: 0.996786 00:30:48.325 --> 00:30:49.705 there's no parental psychopathology, NOTE Confidence: 0.9755304 00:30:50.885 --> 00:30:51.845 kids continue to, NOTE Confidence: 0.9642968 00:30:53.460 --> 00:30:54.740 have a lower level of NOTE Confidence: 0.9642968 00:30:54.740 --> 00:30:56.760 anxiety post treatment on average. NOTE Confidence: 0.9622176 00:30:57.380 --> 00:30:58.520 But on average, NOTE Confidence: 0.9987091 00:30:59.059 --> 00:31:00.740 kids who had parents that NOTE Confidence: 0.9987091 00:31:00.740 --> 00:31:01.860 were more likely to have NOTE Confidence: 0.9987091 00:31:01.860 --> 00:31:02.919 anxiety and depression, NOTE Confidence: 0.9356564 00:31:03.700 --> 00:31:05.059 their their symptom levels went NOTE Confidence: 0.9356564 00:31:05.059 --> 00:31:06.275 back up again. So this NOTE Confidence: 0.9356564 00:31:06.275 --> 00:31:07.635 pooling of data was really NOTE Confidence: 0.9356564 00:31:07.635 --> 00:31:09.075 exciting for us. We it NOTE Confidence: 0.9356564 00:31:09.075 --> 00:31:09.575 came NOTE Confidence: 0.970007 00:31:10.515 --> 00:31:13.415 with having a stronger understanding NOTE Confidence: 0.970007 00:31:13.475 --> 00:31:14.995 of what predicts poorer outcomes. NOTE Confidence: 0.970007 00:31:14.995 --> 00:31:15.875 So being at the point NOTE Confidence: 0.970007 00:31:15.875 --> 00:31:16.755 where we can say, okay. NOTE Confidence: 0.970007 00:31:16.755 --> 00:31:18.390 When a child presents for NOTE Confidence: 0.970007 00:31:18.390 --> 00:31:18.890 treatment, NOTE Confidence: 0.9946086 00:31:19.350 --> 00:31:20.730 we have a good understanding NOTE Confidence: 0.9946086 00:31:20.870 --> 00:31:21.850 of who's gonna NOTE Confidence: 0.995095 00:31:22.150 --> 00:31:23.530 do less well. NOTE Confidence: 0.9900075 00:31:24.150 --> 00:31:24.950 So if you have a NOTE Confidence: 0.9900075 00:31:24.950 --> 00:31:27.270 social anxiety disorder, comorbid mood NOTE Confidence: 0.9900075 00:31:27.270 --> 00:31:29.190 disorder, and if the parents NOTE Confidence: 0.9900075 00:31:29.190 --> 00:31:30.250 present with, NOTE Confidence: 0.9050358 00:31:30.790 --> 00:31:32.570 anxiety or, depression. NOTE Confidence: 0.9903334 00:31:35.405 --> 00:31:37.345 That's really helpful, but NOTE Confidence: 0.9907438 00:31:37.805 --> 00:31:38.605 we wanna know what to NOTE Confidence: 0.9907438 00:31:38.605 --> 00:31:39.725 do with it. Right? Like, NOTE Confidence: 0.9907438 00:31:39.725 --> 00:31:40.685 how do we we don't NOTE Confidence: 0.9907438 00:31:40.685 --> 00:31:42.125 wanna not offer them treatment NOTE Confidence: 0.9907438 00:31:42.125 --> 00:31:43.005 just because we know they're NOTE Confidence: 0.9907438 00:31:43.005 --> 00:31:44.285 not gonna do as well. NOTE Confidence: 0.9907438 00:31:44.285 --> 00:31:45.565 We wanna know what to NOTE Confidence: 0.9907438 00:31:45.565 --> 00:31:46.525 do, what else we can NOTE Confidence: 0.9907438 00:31:46.525 --> 00:31:47.645 do. So can we actually NOTE Confidence: 0.9907438 00:31:47.645 --> 00:31:48.045 use this, NOTE Confidence: 0.98803544 00:31:49.370 --> 00:31:51.370 knowledge to inform treatment decision NOTE Confidence: 0.98803544 00:31:51.370 --> 00:31:51.870 making? NOTE Confidence: 0.9872687 00:31:53.450 --> 00:31:54.650 And that's really, I suppose, NOTE Confidence: 0.9872687 00:31:54.650 --> 00:31:55.370 when we need to look NOTE Confidence: 0.9872687 00:31:55.370 --> 00:31:56.810 at moderators and what what NOTE Confidence: 0.9872687 00:31:56.810 --> 00:31:57.310 can NOTE Confidence: 0.95490056 00:31:57.690 --> 00:31:59.070 what can improve outcomes. NOTE Confidence: 0.99780774 00:31:59.850 --> 00:32:01.950 We we started on exploring NOTE Confidence: 0.99780774 00:32:02.250 --> 00:32:03.130 just whether or not we NOTE Confidence: 0.99780774 00:32:03.130 --> 00:32:04.395 can use this as a NOTE Confidence: 0.99780774 00:32:04.635 --> 00:32:05.135 precision NOTE Confidence: 0.99573517 00:32:05.435 --> 00:32:05.935 tool NOTE Confidence: 0.9852835 00:32:06.635 --> 00:32:07.135 to, NOTE Confidence: 0.9100312 00:32:08.315 --> 00:32:09.275 you use perhaps in the NOTE Confidence: 0.9100312 00:32:09.275 --> 00:32:10.555 clinic, not necessarily that will NOTE Confidence: 0.9100312 00:32:10.555 --> 00:32:12.895 shape your treatment decisions, but NOTE Confidence: 0.9100312 00:32:13.115 --> 00:32:14.335 in terms of NOTE Confidence: 0.99958515 00:32:14.955 --> 00:32:17.130 shaping your understanding of treatment NOTE Confidence: 0.99958515 00:32:17.130 --> 00:32:17.630 outcome NOTE Confidence: 0.93344796 00:32:17.930 --> 00:32:19.050 of kind of pulling all NOTE Confidence: 0.93344796 00:32:19.050 --> 00:32:20.650 of these predictors together. So NOTE Confidence: 0.93344796 00:32:20.650 --> 00:32:22.330 we with this data set, NOTE Confidence: 0.93344796 00:32:22.330 --> 00:32:23.930 the genetic data set I NOTE Confidence: 0.93344796 00:32:23.930 --> 00:32:25.550 was talking about before, we NOTE Confidence: 0.93344796 00:32:25.850 --> 00:32:27.290 looked at the idea or NOTE Confidence: 0.93344796 00:32:27.290 --> 00:32:28.490 kind of explored the idea NOTE Confidence: 0.93344796 00:32:28.490 --> 00:32:28.990 of NOTE Confidence: 0.9996284 00:32:29.535 --> 00:32:30.035 developing NOTE Confidence: 0.73507184 00:32:30.495 --> 00:32:32.995 a a a risk index NOTE Confidence: 0.9996654 00:32:33.295 --> 00:32:34.515 that might help us NOTE Confidence: 0.9800499 00:32:34.815 --> 00:32:35.935 be able to make those, NOTE Confidence: 0.9894141 00:32:36.415 --> 00:32:37.615 decisions and be able to NOTE Confidence: 0.9894141 00:32:37.615 --> 00:32:39.075 know who's not gonna respond, NOTE Confidence: 0.9919078 00:32:39.935 --> 00:32:40.915 well to treatment. NOTE Confidence: 0.96308947 00:32:41.390 --> 00:32:42.190 So I'm not quite at NOTE Confidence: 0.96308947 00:32:42.190 --> 00:32:43.650 the moderators yet. So we're NOTE Confidence: 0.86526155 00:32:44.030 --> 00:32:45.470 changing treatment still back at NOTE Confidence: 0.86526155 00:32:45.470 --> 00:32:45.970 predictors, NOTE Confidence: 0.97501576 00:32:46.430 --> 00:32:48.110 just to clarify. So we NOTE Confidence: 0.97501576 00:32:48.110 --> 00:32:48.850 we created, NOTE Confidence: 0.8943349 00:32:49.390 --> 00:32:51.170 we we're just using regression NOTE Confidence: 0.9151475 00:32:51.710 --> 00:32:52.210 methods, NOTE Confidence: 0.95397586 00:32:53.390 --> 00:32:54.670 and we looked at all NOTE Confidence: 0.95397586 00:32:54.670 --> 00:32:55.950 the predictors in our data NOTE Confidence: 0.95397586 00:32:55.950 --> 00:32:56.450 set NOTE Confidence: 0.83836293 00:32:56.785 --> 00:32:57.285 and, NOTE Confidence: 0.9577449 00:32:58.785 --> 00:33:00.945 chose those variables that were NOTE Confidence: 0.9577449 00:33:00.945 --> 00:33:03.025 strong predictors, and then we NOTE Confidence: 0.9577449 00:33:03.025 --> 00:33:04.225 developed a score. So if NOTE Confidence: 0.9577449 00:33:04.225 --> 00:33:05.585 a child presented with social NOTE Confidence: 0.9577449 00:33:05.585 --> 00:33:06.625 anxiety, they got a risk NOTE Confidence: 0.9577449 00:33:06.625 --> 00:33:07.505 score of one. It was NOTE Confidence: 0.9577449 00:33:07.505 --> 00:33:09.330 kinda rounded beta weights. They NOTE Confidence: 0.9577449 00:33:09.409 --> 00:33:11.169 got parental anxiety. If the NOTE Confidence: 0.9577449 00:33:11.169 --> 00:33:13.169 the either parent had anxiety, NOTE Confidence: 0.9577449 00:33:13.169 --> 00:33:14.049 we'd give them a risk NOTE Confidence: 0.9577449 00:33:14.049 --> 00:33:14.950 score of one. NOTE Confidence: 0.96860343 00:33:15.730 --> 00:33:16.929 And low mood was actually, NOTE Confidence: 0.96860343 00:33:16.929 --> 00:33:18.289 in this particular model, had NOTE Confidence: 0.96860343 00:33:18.289 --> 00:33:19.669 a a high beta weight. NOTE Confidence: 0.96860343 00:33:19.890 --> 00:33:21.570 We're also looking at, genetic NOTE Confidence: 0.96860343 00:33:21.570 --> 00:33:22.769 predictors as well. I'm not NOTE Confidence: 0.96860343 00:33:22.769 --> 00:33:23.730 gonna go into that too NOTE Confidence: 0.96860343 00:33:23.730 --> 00:33:25.075 much today because it was NOTE Confidence: 0.96860343 00:33:25.075 --> 00:33:25.975 a really exciting NOTE Confidence: 0.9247859 00:33:26.355 --> 00:33:28.035 initial finding. But as with NOTE Confidence: 0.9247859 00:33:28.035 --> 00:33:29.255 all genetic studies, NOTE Confidence: 0.90868556 00:33:29.555 --> 00:33:30.695 or not all of them, NOTE Confidence: 0.9837527 00:33:31.315 --> 00:33:32.355 almost all of them, it NOTE Confidence: 0.9837527 00:33:32.355 --> 00:33:33.095 never replicated. NOTE Confidence: 0.9936897 00:33:33.555 --> 00:33:34.915 So we we did show NOTE Confidence: 0.9936897 00:33:34.915 --> 00:33:35.315 that, NOTE Confidence: 0.87999326 00:33:35.875 --> 00:33:37.555 the SS allele looking at NOTE Confidence: 0.87999326 00:33:37.555 --> 00:33:38.055 differential NOTE Confidence: 0.99497175 00:33:38.460 --> 00:33:39.520 susceptibility predicted NOTE Confidence: 0.8810118 00:33:39.980 --> 00:33:41.840 better outcomes that if you NOTE Confidence: 0.99145883 00:33:42.140 --> 00:33:43.659 were more responsive to your NOTE Confidence: 0.99145883 00:33:43.659 --> 00:33:44.159 environment, NOTE Confidence: 0.96698016 00:33:44.620 --> 00:33:45.820 then you responded better to NOTE Confidence: 0.96698016 00:33:45.820 --> 00:33:46.940 CVT, but we haven't been NOTE Confidence: 0.96698016 00:33:46.940 --> 00:33:48.480 able to replicate that. So, NOTE Confidence: 0.9948018 00:33:49.179 --> 00:33:50.620 waiting till the data can NOTE Confidence: 0.9948018 00:33:50.620 --> 00:33:51.840 catch up to that one. NOTE Confidence: 0.9665111 00:33:52.380 --> 00:33:53.865 But, anyway, this was just NOTE Confidence: 0.9665111 00:33:53.865 --> 00:33:55.465 an example of how we NOTE Confidence: 0.9665111 00:33:55.465 --> 00:33:56.685 added the predictors, NOTE Confidence: 0.9334264 00:33:57.065 --> 00:33:58.585 the potential risk together to NOTE Confidence: 0.9334264 00:33:58.585 --> 00:34:00.185 create a score. And then NOTE Confidence: 0.9334264 00:34:00.185 --> 00:34:01.385 we looked at using that NOTE Confidence: 0.9334264 00:34:01.385 --> 00:34:03.405 score in another dataset how NOTE Confidence: 0.9873384 00:34:03.865 --> 00:34:05.400 how likely it is that NOTE Confidence: 0.9873384 00:34:05.400 --> 00:34:06.760 the child will respond to NOTE Confidence: 0.9873384 00:34:06.760 --> 00:34:08.440 treatment. So on the left NOTE Confidence: 0.9873384 00:34:08.440 --> 00:34:09.739 hand side of the graph, NOTE Confidence: 0.9873384 00:34:09.880 --> 00:34:11.080 children with a score of NOTE Confidence: 0.9873384 00:34:11.080 --> 00:34:12.060 zero to two, NOTE Confidence: 0.99787116 00:34:13.000 --> 00:34:13.660 so that's NOTE Confidence: 0.97113764 00:34:14.040 --> 00:34:15.160 not very many of these NOTE Confidence: 0.97113764 00:34:15.160 --> 00:34:16.520 predictors. So they had either NOTE Confidence: 0.97113764 00:34:16.520 --> 00:34:17.400 none of them or maybe NOTE Confidence: 0.97113764 00:34:17.400 --> 00:34:18.745 just one or two. And NOTE Confidence: 0.97113764 00:34:18.745 --> 00:34:20.265 you can see response rates NOTE Confidence: 0.97113764 00:34:20.265 --> 00:34:21.545 are much higher. They're closer NOTE Confidence: 0.97113764 00:34:21.545 --> 00:34:22.985 to eighty percent. So if NOTE Confidence: 0.97113764 00:34:22.985 --> 00:34:24.105 you only had this small NOTE Confidence: 0.97113764 00:34:24.105 --> 00:34:25.565 number of risks risks, NOTE Confidence: 0.9745301 00:34:26.025 --> 00:34:26.925 then your, NOTE Confidence: 0.9827691 00:34:27.545 --> 00:34:28.045 your NOTE Confidence: 0.9552474 00:34:29.225 --> 00:34:30.925 chance of responding to CBT NOTE Confidence: 0.9552474 00:34:30.985 --> 00:34:32.745 was much higher. Whereas, it NOTE Confidence: 0.9552474 00:34:32.745 --> 00:34:33.969 was kind of this cumulative NOTE Confidence: 0.9552474 00:34:33.969 --> 00:34:35.330 risk. The more of these NOTE Confidence: 0.9552474 00:34:35.330 --> 00:34:36.870 risk factors that you had, NOTE Confidence: 0.9602311 00:34:37.170 --> 00:34:39.090 the less likely. So if NOTE Confidence: 0.9602311 00:34:39.090 --> 00:34:40.930 you had a a score NOTE Confidence: 0.9602311 00:34:40.930 --> 00:34:42.070 of more than five, NOTE Confidence: 0.9267048 00:34:42.850 --> 00:34:44.610 your chances of remission were NOTE Confidence: 0.9267048 00:34:44.610 --> 00:34:45.810 really low, kinda dropped to NOTE Confidence: 0.9267048 00:34:45.810 --> 00:34:47.750 under, you know, forty percent. NOTE Confidence: 0.9991165 00:34:48.385 --> 00:34:49.505 So we're getting quite a NOTE Confidence: 0.9991165 00:34:49.505 --> 00:34:51.205 lot of variability in treatment NOTE Confidence: 0.9991165 00:34:51.345 --> 00:34:51.845 outcome NOTE Confidence: 0.9943309 00:34:52.305 --> 00:34:54.085 based on baseline predictors. NOTE Confidence: 0.9972989 00:34:57.265 --> 00:34:57.765 But NOTE Confidence: 0.9881971 00:35:01.550 --> 00:35:02.910 the really important thing is NOTE Confidence: 0.9881971 00:35:02.910 --> 00:35:03.950 what works better for them. NOTE Confidence: 0.9881971 00:35:03.950 --> 00:35:04.450 Right? NOTE Confidence: 0.9969344 00:35:05.070 --> 00:35:05.790 If we know they're not NOTE Confidence: 0.9969344 00:35:05.790 --> 00:35:06.770 gonna do well, NOTE Confidence: 0.99982834 00:35:07.070 --> 00:35:08.050 we need to know NOTE Confidence: 0.9974996 00:35:08.830 --> 00:35:10.270 what else to do. Do NOTE Confidence: 0.9974996 00:35:10.270 --> 00:35:12.030 we do CBT plus something? NOTE Confidence: 0.9974996 00:35:12.030 --> 00:35:12.770 Do we do NOTE Confidence: 0.9264635 00:35:13.114 --> 00:35:14.714 you know, modular therapy? Do NOTE Confidence: 0.9264635 00:35:14.714 --> 00:35:16.414 we adapt it for for, NOTE Confidence: 0.99926406 00:35:17.194 --> 00:35:18.255 these different presentations NOTE Confidence: 0.99546903 00:35:18.555 --> 00:35:19.694 for social anxiety? NOTE Confidence: 0.94801575 00:35:22.875 --> 00:35:24.155 But I'm gonna kinda spoil NOTE Confidence: 0.94801575 00:35:24.155 --> 00:35:24.655 the NOTE Confidence: 0.9586078 00:35:25.530 --> 00:35:26.570 surprise. I kind of already NOTE Confidence: 0.9586078 00:35:26.570 --> 00:35:28.489 have, really, that our efforts NOTE Confidence: 0.9586078 00:35:28.489 --> 00:35:30.750 to identify better treatment alternatives NOTE Confidence: 0.9660586 00:35:31.370 --> 00:35:33.530 for likely non responders have NOTE Confidence: 0.9660586 00:35:33.530 --> 00:35:34.590 been really limited. NOTE Confidence: 0.98743033 00:35:34.890 --> 00:35:36.170 We haven't really got to NOTE Confidence: 0.98743033 00:35:36.170 --> 00:35:37.290 the point where we can NOTE Confidence: 0.98743033 00:35:37.290 --> 00:35:39.210 say one treatment works better NOTE Confidence: 0.98743033 00:35:39.210 --> 00:35:40.765 than another. We've I've been NOTE Confidence: 0.98743033 00:35:40.765 --> 00:35:41.905 spending the last NOTE Confidence: 0.9962979 00:35:42.765 --> 00:35:43.265 fifteen NOTE Confidence: 0.9967359 00:35:43.885 --> 00:35:45.344 years trying to NOTE Confidence: 0.96996456 00:35:45.805 --> 00:35:47.325 develop a treatment that might NOTE Confidence: 0.96996456 00:35:47.325 --> 00:35:47.985 be better, NOTE Confidence: 0.96926224 00:35:49.405 --> 00:35:50.364 and it has not led NOTE Confidence: 0.96926224 00:35:50.364 --> 00:35:51.745 to anything very fruitful, NOTE Confidence: 0.9633487 00:35:52.299 --> 00:35:53.900 which is really disappointing. A NOTE Confidence: 0.9633487 00:35:53.900 --> 00:35:55.019 lot of grant money that's NOTE Confidence: 0.9633487 00:35:55.019 --> 00:35:56.380 gone into looking at does NOTE Confidence: 0.9633487 00:35:56.380 --> 00:35:57.660 this treatment work better than NOTE Confidence: 0.9633487 00:35:57.660 --> 00:35:58.940 that, but we haven't got NOTE Confidence: 0.9633487 00:35:58.940 --> 00:35:59.839 to that point. NOTE Confidence: 0.9572074 00:36:00.700 --> 00:36:01.819 There's a couple of hints NOTE Confidence: 0.9572074 00:36:01.819 --> 00:36:03.019 though, so I haven't lost NOTE Confidence: 0.9572074 00:36:03.019 --> 00:36:03.920 sight entirely. NOTE Confidence: 0.93050116 00:36:04.875 --> 00:36:05.755 I'm gonna take you through NOTE Confidence: 0.93050116 00:36:05.755 --> 00:36:06.815 the journey anyway. NOTE Confidence: 0.9677088 00:36:07.195 --> 00:36:08.015 So, just NOTE Confidence: 0.9952922 00:36:09.114 --> 00:36:10.255 I'll take you through NOTE Confidence: 0.9978803 00:36:11.435 --> 00:36:12.495 the number of NOTE Confidence: 0.9823359 00:36:13.035 --> 00:36:14.795 clinical trials that have had NOTE Confidence: 0.9823359 00:36:14.795 --> 00:36:16.475 a negative outcome or not NOTE Confidence: 0.9823359 00:36:16.475 --> 00:36:17.594 the outcome we were expecting, NOTE Confidence: 0.9823359 00:36:17.594 --> 00:36:18.750 not negative, I should say. NOTE Confidence: 0.9823359 00:36:18.750 --> 00:36:19.989 Alright. So we started on NOTE Confidence: 0.9823359 00:36:19.989 --> 00:36:21.670 social anxiety disorder. So if NOTE Confidence: 0.9823359 00:36:21.670 --> 00:36:23.190 we know that children with NOTE Confidence: 0.9823359 00:36:23.190 --> 00:36:24.710 social anxiety disorder are not NOTE Confidence: 0.9823359 00:36:24.710 --> 00:36:26.309 likely to not as likely NOTE Confidence: 0.9823359 00:36:26.309 --> 00:36:27.910 to improve, maybe we need NOTE Confidence: 0.9823359 00:36:27.910 --> 00:36:29.589 a disorder specific approach for NOTE Confidence: 0.9823359 00:36:29.589 --> 00:36:31.190 those kids. Maybe this one NOTE Confidence: 0.9823359 00:36:31.190 --> 00:36:32.549 size fits all is not NOTE Confidence: 0.9823359 00:36:32.549 --> 00:36:33.210 the best NOTE Confidence: 0.98035234 00:36:33.510 --> 00:36:34.125 best approach. NOTE Confidence: 0.98639137 00:36:34.685 --> 00:36:35.565 So we looked at the NOTE Confidence: 0.98639137 00:36:35.565 --> 00:36:36.685 adult literature, and there was NOTE Confidence: 0.98639137 00:36:36.685 --> 00:36:37.565 some hint of this in NOTE Confidence: 0.98639137 00:36:37.565 --> 00:36:39.005 the adult literature as well NOTE Confidence: 0.98639137 00:36:39.005 --> 00:36:41.025 for social anxiety disorder that, NOTE Confidence: 0.89044255 00:36:42.844 --> 00:36:43.344 approach NOTE Confidence: 0.99532175 00:36:43.805 --> 00:36:45.585 that focuses more on behavioral NOTE Confidence: 0.99532175 00:36:45.645 --> 00:36:46.145 experiments, NOTE Confidence: 0.99936 00:36:47.005 --> 00:36:48.385 giving video feedback, NOTE Confidence: 0.9965506 00:36:48.840 --> 00:36:50.060 more safety behaviors, NOTE Confidence: 0.9457789 00:36:50.440 --> 00:36:52.280 attention training, and exposure to NOTE Confidence: 0.9457789 00:36:52.280 --> 00:36:52.780 costs. NOTE Confidence: 0.69668347 00:36:53.239 --> 00:36:53.980 But that, NOTE Confidence: 0.9320654 00:36:55.320 --> 00:36:56.520 so kind of, what I NOTE Confidence: 0.9320654 00:36:56.520 --> 00:36:57.800 mean by exposure to costs NOTE Confidence: 0.9320654 00:36:57.800 --> 00:36:58.300 is, NOTE Confidence: 0.99172676 00:36:59.720 --> 00:37:01.935 facing, like, an exposure where NOTE Confidence: 0.99172676 00:37:01.935 --> 00:37:03.315 a child has to deliberately NOTE Confidence: 0.99172676 00:37:03.375 --> 00:37:04.335 get laughed at in front NOTE Confidence: 0.99172676 00:37:04.335 --> 00:37:05.215 of others or, NOTE Confidence: 0.9555649 00:37:06.095 --> 00:37:06.975 you know, kind of that NOTE Confidence: 0.9555649 00:37:06.975 --> 00:37:07.475 exposure NOTE Confidence: 0.97228706 00:37:07.935 --> 00:37:09.695 to the dreaded the dreaded NOTE Confidence: 0.97228706 00:37:09.695 --> 00:37:11.155 situation. But that idea NOTE Confidence: 0.99898016 00:37:11.614 --> 00:37:12.995 that we're trying to make NOTE Confidence: 0.99813545 00:37:13.610 --> 00:37:15.370 targeting the mechanisms of social NOTE Confidence: 0.99813545 00:37:15.370 --> 00:37:16.830 anxiety more specifically. NOTE Confidence: 0.98320967 00:37:19.530 --> 00:37:20.030 And NOTE Confidence: 0.98530936 00:37:22.010 --> 00:37:23.130 Sue Spence did a study NOTE Confidence: 0.98530936 00:37:23.130 --> 00:37:24.430 on this also from Australia NOTE Confidence: 0.98530936 00:37:24.489 --> 00:37:24.969 showing, NOTE Confidence: 0.8755023 00:37:25.290 --> 00:37:26.170 kind of, it was an NOTE Confidence: 0.8755023 00:37:26.170 --> 00:37:27.469 online version transdiagnostic NOTE Confidence: 0.97887355 00:37:27.930 --> 00:37:29.775 versus disorder specific. So kind NOTE Confidence: 0.97887355 00:37:29.775 --> 00:37:30.855 of a one size fits NOTE Confidence: 0.97887355 00:37:30.855 --> 00:37:32.614 all to the disorder specific NOTE Confidence: 0.97887355 00:37:32.614 --> 00:37:34.215 approach and found very little NOTE Confidence: 0.97887355 00:37:34.215 --> 00:37:35.594 difference between the two. NOTE Confidence: 0.93212813 00:37:36.614 --> 00:37:37.694 No difference, but there was NOTE Confidence: 0.93212813 00:37:37.694 --> 00:37:39.175 a highlight of dropout because NOTE Confidence: 0.93212813 00:37:39.175 --> 00:37:40.875 of the was the online, NOTE Confidence: 0.9966789 00:37:41.335 --> 00:37:42.475 attrition in this NOTE Confidence: 0.96059656 00:37:42.775 --> 00:37:44.215 particular study, and she didn't NOTE Confidence: 0.96059656 00:37:44.215 --> 00:37:46.049 have the video feedback aspect. NOTE Confidence: 0.9461249 00:37:46.510 --> 00:37:47.230 So we, NOTE Confidence: 0.99777174 00:37:48.029 --> 00:37:48.529 misguidedly NOTE Confidence: 0.92677754 00:37:49.150 --> 00:37:50.430 embarked on a new clinical NOTE Confidence: 0.92677754 00:37:50.430 --> 00:37:51.950 trial where we, which we NOTE Confidence: 0.92677754 00:37:51.950 --> 00:37:53.309 targeted those a little bit NOTE Confidence: 0.92677754 00:37:53.309 --> 00:37:54.130 more specifically, NOTE Confidence: 0.9873538 00:37:54.750 --> 00:37:55.250 but, NOTE Confidence: 0.8227603 00:37:55.789 --> 00:37:57.150 there was some effects that NOTE Confidence: 0.8227603 00:37:57.150 --> 00:37:57.650 follow-up, NOTE Confidence: 0.9974262 00:37:59.195 --> 00:38:00.255 kids were slightly NOTE Confidence: 0.9784869 00:38:00.875 --> 00:38:01.375 better, NOTE Confidence: 0.9864775 00:38:02.075 --> 00:38:03.675 with the disorder specific treatment, NOTE Confidence: 0.9864775 00:38:03.675 --> 00:38:05.775 but it wasn't robust across NOTE Confidence: 0.9718369 00:38:06.315 --> 00:38:07.375 across measures, NOTE Confidence: 0.99281657 00:38:08.475 --> 00:38:09.755 and it was a very NOTE Confidence: 0.99281657 00:38:09.755 --> 00:38:11.195 weak effect. And if you're NOTE Confidence: 0.99281657 00:38:11.195 --> 00:38:12.875 making decisions at a policy NOTE Confidence: 0.99281657 00:38:12.875 --> 00:38:15.059 level, what treatment to deliver, NOTE Confidence: 0.98351616 00:38:16.239 --> 00:38:17.599 yeah, there wouldn't be much NOTE Confidence: 0.98351616 00:38:17.599 --> 00:38:18.099 justification NOTE Confidence: 0.99554986 00:38:18.400 --> 00:38:20.339 for this disorder specific treatment. NOTE Confidence: 0.9128539 00:38:22.000 --> 00:38:22.980 That's the same. NOTE Confidence: 0.9399796 00:38:24.000 --> 00:38:24.799 So that was a little NOTE Confidence: 0.9399796 00:38:24.799 --> 00:38:26.480 bit disappointing that the idea NOTE Confidence: 0.9399796 00:38:26.480 --> 00:38:28.480 of disorder specific treatment might NOTE Confidence: 0.9399796 00:38:28.480 --> 00:38:30.020 not be the solution for NOTE Confidence: 0.9399796 00:38:30.265 --> 00:38:31.565 social anxiety disorder. NOTE Confidence: 0.9484122 00:38:32.105 --> 00:38:33.385 I wanted to also present NOTE Confidence: 0.9484122 00:38:33.385 --> 00:38:34.665 some work that has not NOTE Confidence: 0.9484122 00:38:34.665 --> 00:38:36.265 come out of, my lab, NOTE Confidence: 0.9484122 00:38:36.265 --> 00:38:37.705 but, John Weiss and Bruce NOTE Confidence: 0.9484122 00:38:37.705 --> 00:38:38.984 Chorpedo have been using this NOTE Confidence: 0.9484122 00:38:38.984 --> 00:38:39.965 modular approach NOTE Confidence: 0.9297511 00:38:40.665 --> 00:38:42.105 to depending on how the NOTE Confidence: 0.9297511 00:38:42.105 --> 00:38:43.065 child presents, if I had NOTE Confidence: 0.9297511 00:38:43.065 --> 00:38:44.265 to present with anxiety, they NOTE Confidence: 0.9297511 00:38:44.265 --> 00:38:45.785 give them an anxiety module. NOTE Confidence: 0.9297511 00:38:45.785 --> 00:38:46.960 If they present with depression, NOTE Confidence: 0.9297511 00:38:46.960 --> 00:38:48.080 they get a depression module. NOTE Confidence: 0.9297511 00:38:48.080 --> 00:38:49.520 It's that match treatment if NOTE Confidence: 0.9297511 00:38:49.520 --> 00:38:50.739 you're familiar with it. NOTE Confidence: 0.98969114 00:38:51.520 --> 00:38:52.020 And NOTE Confidence: 0.75092566 00:38:52.719 --> 00:38:53.219 here, NOTE Confidence: 0.98616666 00:38:54.239 --> 00:38:55.360 you can see the effects NOTE Confidence: 0.98616666 00:38:55.360 --> 00:38:57.380 for the modular treatment on, NOTE Confidence: 0.99210995 00:38:58.494 --> 00:39:00.515 internalizing symptoms are much better. NOTE Confidence: 0.9604591 00:39:00.974 --> 00:39:02.094 But, again, it's not a NOTE Confidence: 0.9604591 00:39:02.094 --> 00:39:04.015 consistent finding. It's not across. NOTE Confidence: 0.9604591 00:39:04.015 --> 00:39:05.775 It's only in this symptom NOTE Confidence: 0.9604591 00:39:05.775 --> 00:39:07.234 measure. It's not in remission NOTE Confidence: 0.9604591 00:39:07.295 --> 00:39:07.795 rates. NOTE Confidence: 0.92791814 00:39:08.255 --> 00:39:09.855 And, it hasn't been able NOTE Confidence: 0.92791814 00:39:09.855 --> 00:39:11.560 to be replicated either. NOTE Confidence: 0.99154025 00:39:11.860 --> 00:39:13.700 So I'm not necessarily convinced NOTE Confidence: 0.99154025 00:39:13.700 --> 00:39:15.080 that this modular approach, NOTE Confidence: 0.98910415 00:39:16.580 --> 00:39:17.960 is working. You could, NOTE Confidence: 0.99892694 00:39:18.420 --> 00:39:20.920 consider adding a depression module NOTE Confidence: 0.76317465 00:39:21.219 --> 00:39:21.620 for, NOTE Confidence: 0.95931166 00:39:22.100 --> 00:39:23.140 you know, with a standard NOTE Confidence: 0.95931166 00:39:23.140 --> 00:39:24.980 anxiety protocol, it may lead NOTE Confidence: 0.95931166 00:39:24.980 --> 00:39:26.235 to better outcomes. But at NOTE Confidence: 0.95931166 00:39:26.235 --> 00:39:28.175 this stage, I'm not necessarily NOTE Confidence: 0.95931166 00:39:28.235 --> 00:39:29.355 convinced by the data. And NOTE Confidence: 0.95931166 00:39:29.355 --> 00:39:30.395 I can see Wendy shaking NOTE Confidence: 0.95931166 00:39:30.395 --> 00:39:31.695 her head. She's not either. NOTE Confidence: 0.9374746 00:39:35.035 --> 00:39:36.475 So we also tried Okay. NOTE Confidence: 0.9374746 00:39:36.475 --> 00:39:38.075 Well, if parents who have NOTE Confidence: 0.9374746 00:39:38.075 --> 00:39:38.575 anxiety, NOTE Confidence: 0.9617235 00:39:39.219 --> 00:39:40.420 and those children are less NOTE Confidence: 0.9617235 00:39:40.420 --> 00:39:41.300 likely to do well, what NOTE Confidence: 0.9617235 00:39:41.300 --> 00:39:42.820 if we add treatment for NOTE Confidence: 0.9617235 00:39:42.820 --> 00:39:44.180 parents at the same time NOTE Confidence: 0.9617235 00:39:44.180 --> 00:39:45.800 and give parents more skills, NOTE Confidence: 0.9781342 00:39:46.260 --> 00:39:47.060 to be able to manage NOTE Confidence: 0.9781342 00:39:47.060 --> 00:39:48.420 their own anxiety? Would that NOTE Confidence: 0.9781342 00:39:48.420 --> 00:39:50.420 have better longer term outcomes NOTE Confidence: 0.9781342 00:39:50.420 --> 00:39:51.540 for kids? Do you know NOTE Confidence: 0.9781342 00:39:51.540 --> 00:39:53.000 what the answer's gonna be? NOTE Confidence: 0.8922119 00:39:53.625 --> 00:39:54.844 No. It does not. NOTE Confidence: 0.8933665 00:39:56.185 --> 00:39:57.965 Alright. So additional treatment. NOTE Confidence: 0.9510387 00:39:58.425 --> 00:40:00.105 There was maybe a weak NOTE Confidence: 0.9510387 00:40:00.105 --> 00:40:01.545 effect at post, but it NOTE Confidence: 0.9510387 00:40:01.545 --> 00:40:03.145 was washed out by three NOTE Confidence: 0.9510387 00:40:03.145 --> 00:40:03.965 months later. NOTE Confidence: 0.907354 00:40:04.985 --> 00:40:07.130 And it yeah. It Again, NOTE Confidence: 0.907354 00:40:07.190 --> 00:40:08.549 with quite a good sample NOTE Confidence: 0.907354 00:40:08.549 --> 00:40:09.849 of two zero nine, NOTE Confidence: 0.91570896 00:40:10.309 --> 00:40:11.349 a hundred and something in NOTE Confidence: 0.91570896 00:40:11.349 --> 00:40:12.170 each condition, NOTE Confidence: 0.9995153 00:40:12.630 --> 00:40:13.609 there was no NOTE Confidence: 0.9985503 00:40:14.230 --> 00:40:15.750 strong evidence that we should NOTE Confidence: 0.9985503 00:40:15.750 --> 00:40:17.829 be giving one treatment to NOTE Confidence: 0.9985503 00:40:17.829 --> 00:40:19.049 a child over another. NOTE Confidence: 0.9522459 00:40:23.325 --> 00:40:24.605 Cathy Cresswell did a very NOTE Confidence: 0.9522459 00:40:24.605 --> 00:40:26.445 similar trial to the one NOTE Confidence: 0.9522459 00:40:26.445 --> 00:40:27.565 that we did looking at NOTE Confidence: 0.9522459 00:40:27.565 --> 00:40:29.425 treatments for anxious parents, tested NOTE Confidence: 0.9522459 00:40:29.645 --> 00:40:30.864 all sorts of different, NOTE Confidence: 0.95720786 00:40:31.725 --> 00:40:33.245 methods either focusing on the NOTE Confidence: 0.95720786 00:40:33.245 --> 00:40:35.485 parenting or focusing on parent NOTE Confidence: 0.95720786 00:40:35.485 --> 00:40:36.305 child interaction NOTE Confidence: 0.92847776 00:40:36.969 --> 00:40:38.489 versus a standard CBT, and, NOTE Confidence: 0.92847776 00:40:38.489 --> 00:40:39.870 again, no difference. NOTE Confidence: 0.9629965 00:40:40.570 --> 00:40:41.850 So this kind of search NOTE Confidence: 0.9629965 00:40:41.850 --> 00:40:42.350 for, NOTE Confidence: 0.9939166 00:40:43.930 --> 00:40:45.530 an enhanced treatment or a NOTE Confidence: 0.9939166 00:40:45.530 --> 00:40:46.350 better treatment, NOTE Confidence: 0.9919739 00:40:46.730 --> 00:40:48.350 we're just not finding it. NOTE Confidence: 0.9486553 00:40:48.650 --> 00:40:49.850 So and particularly with the NOTE Confidence: 0.9486553 00:40:49.850 --> 00:40:51.050 answer to prayer and anxiety, NOTE Confidence: 0.9486553 00:40:51.050 --> 00:40:52.090 we haven't really solved that. NOTE Confidence: 0.9486553 00:40:52.090 --> 00:40:53.025 There's, you know, perhaps perhaps NOTE Confidence: 0.9486553 00:40:53.025 --> 00:40:54.385 some hint around the modular NOTE Confidence: 0.9486553 00:40:54.385 --> 00:40:56.224 treatment, but we haven't really NOTE Confidence: 0.9486553 00:40:56.224 --> 00:40:57.664 solved the problem of what NOTE Confidence: 0.9486553 00:40:57.664 --> 00:40:58.545 to do with it if NOTE Confidence: 0.9486553 00:40:58.545 --> 00:41:00.085 a family presents with, NOTE Confidence: 0.9939769 00:41:01.025 --> 00:41:02.785 the parent experiencing anxiety as NOTE Confidence: 0.9939769 00:41:02.785 --> 00:41:03.844 well as the child. NOTE Confidence: 0.968464 00:41:06.830 --> 00:41:07.950 I swore I wasn't gonna NOTE Confidence: 0.968464 00:41:07.950 --> 00:41:09.070 come back to this genetic NOTE Confidence: 0.968464 00:41:09.070 --> 00:41:09.969 stuff, but I NOTE Confidence: 0.9900577 00:41:10.270 --> 00:41:11.310 forgot I had this slide NOTE Confidence: 0.9900577 00:41:11.310 --> 00:41:12.210 in here. So, NOTE Confidence: 0.9423218 00:41:13.070 --> 00:41:14.430 I'll just briefly touch on NOTE Confidence: 0.9423218 00:41:14.430 --> 00:41:15.469 it because we did this NOTE Confidence: 0.9423218 00:41:15.469 --> 00:41:16.450 hasn't been replicated. NOTE Confidence: 0.9770391 00:41:16.750 --> 00:41:17.230 So, NOTE Confidence: 0.82469815 00:41:18.405 --> 00:41:18.905 yeah, NOTE Confidence: 0.9424287 00:41:19.525 --> 00:41:21.525 hold your judgment of it. NOTE Confidence: 0.9424287 00:41:21.525 --> 00:41:23.385 But, we actually found, NOTE Confidence: 0.9933937 00:41:23.765 --> 00:41:25.705 a moderation based on polygenic NOTE Confidence: 0.9933937 00:41:25.925 --> 00:41:26.745 risk scores. NOTE Confidence: 0.9938893 00:41:27.605 --> 00:41:29.045 In one sample, we looked NOTE Confidence: 0.9938893 00:41:29.045 --> 00:41:29.545 at, NOTE Confidence: 0.9441293 00:41:30.165 --> 00:41:31.225 differential susceptibility. NOTE Confidence: 0.99949455 00:41:31.685 --> 00:41:32.905 So we looked at genetic NOTE Confidence: 0.99949455 00:41:32.965 --> 00:41:33.465 markers NOTE Confidence: 0.9954403 00:41:34.040 --> 00:41:35.900 or a polygenic risk score NOTE Confidence: 0.9604784 00:41:36.280 --> 00:41:37.020 for susceptibility. NOTE Confidence: 0.9728968 00:41:37.320 --> 00:41:38.520 So it's those children who NOTE Confidence: 0.9728968 00:41:38.520 --> 00:41:39.800 were more likely to respond NOTE Confidence: 0.9728968 00:41:39.800 --> 00:41:41.080 to their environment. So I NOTE Confidence: 0.9728968 00:41:41.080 --> 00:41:41.719 don't know if you know NOTE Confidence: 0.9728968 00:41:41.719 --> 00:41:43.340 about the orchids and dandelion, NOTE Confidence: 0.9539736 00:41:44.520 --> 00:41:46.440 child, that that idea where NOTE Confidence: 0.9539736 00:41:46.440 --> 00:41:48.280 differential susceptibility is about, that NOTE Confidence: 0.9539736 00:41:48.280 --> 00:41:49.905 there's kids that are very NOTE Confidence: 0.9539736 00:41:49.905 --> 00:41:51.425 responsive to their environment. They NOTE Confidence: 0.9539736 00:41:51.425 --> 00:41:52.864 can thrive in the right NOTE Confidence: 0.9539736 00:41:52.864 --> 00:41:54.305 conditions, but in the wrong NOTE Confidence: 0.9539736 00:41:54.305 --> 00:41:55.985 conditions, they will not thrive NOTE Confidence: 0.9539736 00:41:55.985 --> 00:41:57.185 like most of the orchids NOTE Confidence: 0.9539736 00:41:57.185 --> 00:41:58.625 in my that I have NOTE Confidence: 0.9539736 00:41:58.625 --> 00:41:59.425 attempted to, NOTE Confidence: 0.99364775 00:42:00.225 --> 00:42:01.125 to raise. NOTE Confidence: 0.94614524 00:42:01.850 --> 00:42:03.130 They tend to just never NOTE Confidence: 0.94614524 00:42:03.130 --> 00:42:04.730 survive. Whereas the dandelion is NOTE Confidence: 0.94614524 00:42:04.730 --> 00:42:05.610 the idea. It doesn't matter NOTE Confidence: 0.94614524 00:42:05.610 --> 00:42:06.730 what kind of environment. They NOTE Confidence: 0.94614524 00:42:06.730 --> 00:42:08.250 can grow inside the road, NOTE Confidence: 0.9830888 00:42:08.570 --> 00:42:10.190 anywhere. They'll be they'll thrive. NOTE Confidence: 0.9830888 00:42:10.250 --> 00:42:11.370 So that's the idea of NOTE Confidence: 0.9830888 00:42:11.370 --> 00:42:13.050 differential susceptibility. So we were NOTE Confidence: 0.9830888 00:42:13.050 --> 00:42:14.489 interested in, first of all, NOTE Confidence: 0.9830888 00:42:14.489 --> 00:42:15.370 whether or not that would NOTE Confidence: 0.9830888 00:42:15.370 --> 00:42:16.670 predict treatment outcome, NOTE Confidence: 0.93882984 00:42:17.744 --> 00:42:19.105 as a predictor. But then NOTE Confidence: 0.93882984 00:42:19.105 --> 00:42:20.305 we also started to play NOTE Confidence: 0.93882984 00:42:20.305 --> 00:42:21.744 around with, you know, was NOTE Confidence: 0.93882984 00:42:21.744 --> 00:42:23.285 there any moderators. So NOTE Confidence: 0.9635973 00:42:23.585 --> 00:42:24.545 as I said, we haven't NOTE Confidence: 0.9635973 00:42:24.545 --> 00:42:26.484 been able to replicate the, NOTE Confidence: 0.999788 00:42:26.944 --> 00:42:27.444 prediction NOTE Confidence: 0.9687309 00:42:27.984 --> 00:42:29.265 and also haven't been able NOTE Confidence: 0.9687309 00:42:29.265 --> 00:42:31.210 to replicate this finding, but NOTE Confidence: 0.9687309 00:42:31.210 --> 00:42:33.070 it's still very interesting from NOTE Confidence: 0.6510051 00:42:33.610 --> 00:42:34.750 a a personalization NOTE Confidence: 0.95771325 00:42:35.050 --> 00:42:35.370 or, NOTE Confidence: 0.9921689 00:42:35.850 --> 00:42:36.750 trying to understand NOTE Confidence: 0.9127644 00:42:37.130 --> 00:42:39.210 can we experience can we NOTE Confidence: 0.9127644 00:42:39.210 --> 00:42:39.710 detect NOTE Confidence: 0.8857634 00:42:40.170 --> 00:42:41.390 differential effects. NOTE Confidence: 0.9626709 00:42:41.930 --> 00:42:44.205 So this was the large, NOTE Confidence: 0.9569098 00:42:45.245 --> 00:42:47.665 genetic samples, fifteen hundred children. NOTE Confidence: 0.9569098 00:42:47.805 --> 00:42:49.905 They either received individual CBT, NOTE Confidence: 0.9569098 00:42:50.045 --> 00:42:51.325 they might have received group NOTE Confidence: 0.9569098 00:42:51.325 --> 00:42:51.825 CBT, NOTE Confidence: 0.97871125 00:42:52.205 --> 00:42:53.665 or parent led CBT. NOTE Confidence: 0.9536846 00:42:54.125 --> 00:42:55.645 So they kind of vary NOTE Confidence: 0.9536846 00:42:55.645 --> 00:42:56.925 in intensity in a way. NOTE Confidence: 0.9536846 00:42:56.925 --> 00:42:59.280 Individual is one therapist with NOTE Confidence: 0.9536846 00:42:59.280 --> 00:43:01.300 one family or one child. NOTE Confidence: 0.9134027 00:43:01.840 --> 00:43:03.520 Group is kind of less NOTE Confidence: 0.9134027 00:43:03.520 --> 00:43:04.980 intense in that you've got NOTE Confidence: 0.9134027 00:43:05.120 --> 00:43:06.960 one therapist to five or NOTE Confidence: 0.9134027 00:43:06.960 --> 00:43:08.239 six kids. And then parent NOTE Confidence: 0.9134027 00:43:08.239 --> 00:43:09.280 led is that there's no NOTE Confidence: 0.9134027 00:43:09.280 --> 00:43:11.120 therapist. That's really the parent NOTE Confidence: 0.9134027 00:43:11.120 --> 00:43:11.860 as a therapist. NOTE Confidence: 0.95439655 00:43:13.745 --> 00:43:15.185 And we actually found what NOTE Confidence: 0.95439655 00:43:15.185 --> 00:43:16.245 we would have expected NOTE Confidence: 0.96410656 00:43:16.625 --> 00:43:17.364 in that, NOTE Confidence: 0.97886246 00:43:18.545 --> 00:43:19.825 those kids who are high NOTE Confidence: 0.97886246 00:43:19.825 --> 00:43:21.125 on differential susceptibility, NOTE Confidence: 0.8935891 00:43:21.505 --> 00:43:23.045 so the orchid children, NOTE Confidence: 0.94626 00:43:23.505 --> 00:43:24.465 that's I know that's a NOTE Confidence: 0.94626 00:43:24.465 --> 00:43:25.985 terrible label. I suppose it's NOTE Confidence: 0.94626 00:43:25.985 --> 00:43:27.344 better than a diagnostic label, NOTE Confidence: 0.94626 00:43:27.344 --> 00:43:28.645 isn't it? Orchid children, NOTE Confidence: 0.9948519 00:43:29.770 --> 00:43:30.489 were more NOTE Confidence: 0.9515971 00:43:30.969 --> 00:43:32.569 had better remission rates if NOTE Confidence: 0.9515971 00:43:32.569 --> 00:43:34.349 they received individual therapy, NOTE Confidence: 0.9907778 00:43:36.250 --> 00:43:37.309 compared to NOTE Confidence: 0.9756618 00:43:37.770 --> 00:43:38.989 children who were NOTE Confidence: 0.93253666 00:43:40.489 --> 00:43:41.469 high in differential NOTE Confidence: 0.98194396 00:43:41.844 --> 00:43:43.205 susceptibility, but if they received NOTE Confidence: 0.98194396 00:43:43.205 --> 00:43:44.565 parent led CBT. So if NOTE Confidence: 0.98194396 00:43:44.565 --> 00:43:45.525 they didn't have the the NOTE Confidence: 0.98194396 00:43:45.525 --> 00:43:47.225 treatment that wasn't as intensive NOTE Confidence: 0.89216274 00:43:47.605 --> 00:43:48.565 and was led by the NOTE Confidence: 0.89216274 00:43:48.565 --> 00:43:49.065 parent, NOTE Confidence: 0.9986382 00:43:49.525 --> 00:43:50.825 then they were NOTE Confidence: 0.9278129 00:43:51.125 --> 00:43:52.805 they had lower likelihood of NOTE Confidence: 0.9278129 00:43:52.805 --> 00:43:53.305 remission. NOTE Confidence: 0.85799867 00:43:55.840 --> 00:43:56.340 Potentially, NOTE Confidence: 0.9992572 00:43:56.880 --> 00:43:57.540 a genetic NOTE Confidence: 0.9009729 00:43:58.080 --> 00:43:58.580 moderation, NOTE Confidence: 0.97108704 00:44:00.880 --> 00:44:02.420 but it hasn't been replicated NOTE Confidence: 0.97108704 00:44:02.560 --> 00:44:04.320 yet. And, actually, I don't NOTE Confidence: 0.97108704 00:44:04.320 --> 00:44:05.060 know whether, NOTE Confidence: 0.9445221 00:44:05.520 --> 00:44:06.820 at least in my lifetime, NOTE Confidence: 0.9445221 00:44:06.960 --> 00:44:08.400 it would be replicated because NOTE Confidence: 0.9445221 00:44:08.400 --> 00:44:09.855 it's it's a very difficult NOTE Confidence: 0.9445221 00:44:09.855 --> 00:44:10.594 study to NOTE Confidence: 0.92249525 00:44:10.895 --> 00:44:11.795 run and, NOTE Confidence: 0.96529835 00:44:13.135 --> 00:44:14.175 yeah. It's a it's a NOTE Confidence: 0.96529835 00:44:14.175 --> 00:44:15.135 hint that there may be NOTE Confidence: 0.96529835 00:44:15.135 --> 00:44:16.035 something there. NOTE Confidence: 0.98803943 00:44:18.495 --> 00:44:19.955 Alright. In terms of improving NOTE Confidence: 0.98803943 00:44:20.015 --> 00:44:20.515 outcomes, NOTE Confidence: 0.9871122 00:44:21.775 --> 00:44:22.015 we NOTE Confidence: 0.9602391 00:44:23.940 --> 00:44:25.540 there's a study not me. NOTE Confidence: 0.9602391 00:44:25.540 --> 00:44:26.040 Sorry. NOTE Confidence: 0.8794691 00:44:26.820 --> 00:44:28.040 Walkup and colleagues NOTE Confidence: 0.98255736 00:44:28.420 --> 00:44:29.540 did in two thousand and NOTE Confidence: 0.98255736 00:44:29.540 --> 00:44:30.579 seven looking at, well, what NOTE Confidence: 0.98255736 00:44:30.579 --> 00:44:32.180 about if we added medication NOTE Confidence: 0.98255736 00:44:32.180 --> 00:44:33.380 to CBT? Could we get NOTE Confidence: 0.98255736 00:44:33.380 --> 00:44:34.200 better outcomes? NOTE Confidence: 0.979321 00:44:34.739 --> 00:44:36.099 And it was very exciting NOTE Confidence: 0.979321 00:44:36.099 --> 00:44:37.239 in the in the literature. NOTE Confidence: 0.979321 00:44:37.300 --> 00:44:38.920 It was pretty robust finding NOTE Confidence: 0.979321 00:44:38.980 --> 00:44:39.480 that, NOTE Confidence: 0.93343645 00:44:40.445 --> 00:44:42.285 across all measures, pretty much NOTE Confidence: 0.93343645 00:44:42.285 --> 00:44:43.905 that if you got CBT NOTE Confidence: 0.93343645 00:44:43.965 --> 00:44:44.785 plus sertraline, NOTE Confidence: 0.9858904 00:44:45.725 --> 00:44:47.085 that those kids had much NOTE Confidence: 0.9858904 00:44:47.085 --> 00:44:49.085 better outcomes compared to CBT NOTE Confidence: 0.9858904 00:44:49.085 --> 00:44:50.765 alone or sertraline alone, NOTE Confidence: 0.9479296 00:44:52.830 --> 00:44:53.790 and a lot better than NOTE Confidence: 0.9479296 00:44:53.790 --> 00:44:55.330 placebo. So that's pretty convincing. NOTE Confidence: 0.9479296 00:44:55.390 --> 00:44:56.110 And I think in the NOTE Confidence: 0.9479296 00:44:56.110 --> 00:44:57.150 in the US, at least, NOTE Confidence: 0.9479296 00:44:57.150 --> 00:44:58.270 there was a big shift NOTE Confidence: 0.9479296 00:44:58.270 --> 00:44:59.950 in treatment that kids were NOTE Confidence: 0.9479296 00:44:59.950 --> 00:45:01.710 getting this combination of of NOTE Confidence: 0.9479296 00:45:01.710 --> 00:45:02.210 treatment. NOTE Confidence: 0.98596025 00:45:02.750 --> 00:45:03.950 But when I saw these NOTE Confidence: 0.98596025 00:45:03.950 --> 00:45:05.950 findings, I wasn't particularly convinced NOTE Confidence: 0.98596025 00:45:05.950 --> 00:45:06.850 about it because NOTE Confidence: 0.99464536 00:45:07.194 --> 00:45:07.855 if you, NOTE Confidence: 0.966329 00:45:08.395 --> 00:45:09.515 as a as a parent, NOTE Confidence: 0.966329 00:45:09.515 --> 00:45:10.255 as a child, NOTE Confidence: 0.9805465 00:45:10.714 --> 00:45:11.674 going in to see a NOTE Confidence: 0.9805465 00:45:11.674 --> 00:45:13.594 psychiatrist and a psychologist, you NOTE Confidence: 0.9805465 00:45:13.594 --> 00:45:14.635 know you're getting the best NOTE Confidence: 0.9805465 00:45:14.635 --> 00:45:15.934 treatment. And NOTE Confidence: 0.9577274 00:45:16.234 --> 00:45:18.015 compared to kids just receiving NOTE Confidence: 0.9577274 00:45:18.075 --> 00:45:19.375 a treatment from a psychologist NOTE Confidence: 0.9577274 00:45:19.515 --> 00:45:20.734 or receiving treatment, NOTE Confidence: 0.81477326 00:45:21.250 --> 00:45:21.989 a medication treatment. NOTE Confidence: 0.9857232 00:45:22.450 --> 00:45:24.290 So those families that were NOTE Confidence: 0.9857232 00:45:24.290 --> 00:45:26.870 receiving double care were actually, NOTE Confidence: 0.660515 00:45:27.250 --> 00:45:28.690 that they they weren't, NOTE Confidence: 0.8371609 00:45:29.090 --> 00:45:30.710 they were aware of their NOTE Confidence: 0.958699 00:45:31.170 --> 00:45:32.770 superiority of their treatment. So NOTE Confidence: 0.958699 00:45:32.770 --> 00:45:33.989 maybe they had an impact. NOTE Confidence: 0.958699 00:45:34.210 --> 00:45:35.410 So I went about doing NOTE Confidence: 0.958699 00:45:35.410 --> 00:45:35.910 a, NOTE Confidence: 0.9303795 00:45:36.744 --> 00:45:38.285 oh, yeah, not adequately controlled. NOTE Confidence: 0.9668093 00:45:38.905 --> 00:45:40.344 So I did a it's NOTE Confidence: 0.9668093 00:45:40.344 --> 00:45:41.545 a smaller study, but it NOTE Confidence: 0.9668093 00:45:41.545 --> 00:45:42.685 was just two groups, NOTE Confidence: 0.91822714 00:45:43.224 --> 00:45:45.145 CBT and sertraline and CBT NOTE Confidence: 0.91822714 00:45:45.145 --> 00:45:46.425 in a sugar pill, and NOTE Confidence: 0.91822714 00:45:46.425 --> 00:45:47.244 no difference. NOTE Confidence: 0.9880899 00:45:48.105 --> 00:45:49.385 This study doesn't get cited NOTE Confidence: 0.9880899 00:45:49.385 --> 00:45:50.844 because it's nowhere near as NOTE Confidence: 0.9962042 00:45:51.560 --> 00:45:53.500 palatable to the drug companies NOTE Confidence: 0.9430541 00:45:54.280 --> 00:45:55.560 that we and also, you NOTE Confidence: 0.9430541 00:45:55.560 --> 00:45:56.920 know, not particularly useful in NOTE Confidence: 0.9430541 00:45:56.920 --> 00:45:57.900 terms of implications NOTE Confidence: 0.97423077 00:45:58.520 --> 00:45:59.480 that we just need to NOTE Confidence: 0.97423077 00:45:59.480 --> 00:46:00.760 give kids sugar pills. That's NOTE Confidence: 0.97423077 00:46:00.760 --> 00:46:02.119 not the answer. But the NOTE Confidence: 0.97423077 00:46:02.119 --> 00:46:03.180 idea that maybe NOTE Confidence: 0.9975796 00:46:03.480 --> 00:46:04.140 the expectations NOTE Confidence: 0.9993808 00:46:04.440 --> 00:46:05.100 of medication NOTE Confidence: 0.99651843 00:46:05.480 --> 00:46:07.155 might work to enhance our NOTE Confidence: 0.9954004 00:46:08.114 --> 00:46:09.875 outcomes. Alright. So there's also NOTE Confidence: 0.9954004 00:46:09.875 --> 00:46:10.915 some other hints in the NOTE Confidence: 0.9954004 00:46:10.915 --> 00:46:12.614 literature about what might improve NOTE Confidence: 0.9954004 00:46:12.755 --> 00:46:14.355 treatment outcomes for kids. We NOTE Confidence: 0.9954004 00:46:14.355 --> 00:46:15.975 know that the more exposures NOTE Confidence: 0.9954004 00:46:16.035 --> 00:46:17.235 that happen in a treatment, NOTE Confidence: 0.9954004 00:46:17.235 --> 00:46:18.275 so the, NOTE Confidence: 0.95933694 00:46:19.155 --> 00:46:20.375 therapist led exposures NOTE Confidence: 0.9115813 00:46:20.675 --> 00:46:22.035 and also more exposures at NOTE Confidence: 0.9115813 00:46:22.035 --> 00:46:22.535 home, NOTE Confidence: 0.9758404 00:46:22.850 --> 00:46:24.310 and also the more challenging NOTE Confidence: 0.9758404 00:46:24.450 --> 00:46:26.150 exposures. So rather than just, NOTE Confidence: 0.97347564 00:46:26.850 --> 00:46:28.450 small tasks where a child NOTE Confidence: 0.97347564 00:46:28.450 --> 00:46:29.650 has to raise their quest NOTE Confidence: 0.97347564 00:46:30.050 --> 00:46:31.170 raise their hand in class, NOTE Confidence: 0.97347564 00:46:31.170 --> 00:46:32.690 but actually doing something really NOTE Confidence: 0.97347564 00:46:32.690 --> 00:46:34.610 challenging, like deliberately making a NOTE Confidence: 0.97347564 00:46:34.610 --> 00:46:35.890 mistake in front of the NOTE Confidence: 0.97347564 00:46:35.890 --> 00:46:36.710 school assembly, NOTE Confidence: 0.9880251 00:46:37.010 --> 00:46:38.895 that the more challenging the NOTE Confidence: 0.9880251 00:46:38.895 --> 00:46:40.355 exposures are, the better outcomes. NOTE Confidence: 0.9880251 00:46:40.415 --> 00:46:42.114 So this was really helpful NOTE Confidence: 0.9469962 00:46:42.735 --> 00:46:43.695 for me. I kind of NOTE Confidence: 0.9469962 00:46:43.695 --> 00:46:45.555 shifted after seeing this literature NOTE Confidence: 0.91620505 00:46:46.015 --> 00:46:47.614 thinking, okay. Well, we really NOTE Confidence: 0.91620505 00:46:47.614 --> 00:46:49.155 need to focus more on, NOTE Confidence: 0.977426 00:46:50.495 --> 00:46:51.475 exposures and NOTE Confidence: 0.99322575 00:46:54.400 --> 00:46:54.900 improving NOTE Confidence: 0.99937683 00:46:55.760 --> 00:46:56.260 that NOTE Confidence: 0.9940383 00:46:56.880 --> 00:46:58.160 component in the in the NOTE Confidence: 0.9940383 00:46:58.160 --> 00:46:58.660 treatment. NOTE Confidence: 0.9854463 00:47:01.760 --> 00:47:02.640 But when you look at NOTE Confidence: 0.9854463 00:47:02.640 --> 00:47:04.480 what actually clinicians do in NOTE Confidence: 0.9854463 00:47:04.480 --> 00:47:06.660 the community, very few receive NOTE Confidence: 0.4316634 00:47:07.120 --> 00:47:07.360 or, NOTE Confidence: 0.9673154 00:47:08.815 --> 00:47:10.575 they're less likely to favor NOTE Confidence: 0.9673154 00:47:10.575 --> 00:47:11.775 exposure techniques. This is a NOTE Confidence: 0.9673154 00:47:11.775 --> 00:47:12.575 bit of a hard graph NOTE Confidence: 0.9673154 00:47:12.575 --> 00:47:13.935 to read, but this we NOTE Confidence: 0.9673154 00:47:13.935 --> 00:47:15.614 asked the clinicians in Australia NOTE Confidence: 0.9673154 00:47:15.614 --> 00:47:16.735 what techniques they use to NOTE Confidence: 0.9673154 00:47:16.735 --> 00:47:18.335 treat children with anxiety disorders. NOTE Confidence: 0.9673154 00:47:18.335 --> 00:47:19.375 We had a whole list, NOTE Confidence: 0.9673154 00:47:19.375 --> 00:47:20.575 and then we, had a NOTE Confidence: 0.9673154 00:47:20.575 --> 00:47:22.114 look at it. And, actually, NOTE Confidence: 0.995083 00:47:22.770 --> 00:47:23.489 I've cut it off at NOTE Confidence: 0.995083 00:47:23.489 --> 00:47:24.370 the top of the graph, NOTE Confidence: 0.995083 00:47:24.370 --> 00:47:25.810 but exposure was up there NOTE Confidence: 0.995083 00:47:25.810 --> 00:47:26.469 with psychodynamic NOTE Confidence: 0.89754975 00:47:27.010 --> 00:47:28.610 techniques that people are likely NOTE Confidence: 0.89754975 00:47:28.610 --> 00:47:29.670 to use in terms of, NOTE Confidence: 0.9944997 00:47:30.610 --> 00:47:31.110 the NOTE Confidence: 0.95862395 00:47:31.890 --> 00:47:33.650 one to five scale frequency NOTE Confidence: 0.95862395 00:47:33.650 --> 00:47:34.930 of use. But people are NOTE Confidence: 0.95862395 00:47:34.930 --> 00:47:36.130 much more likely to use NOTE Confidence: 0.95862395 00:47:36.130 --> 00:47:36.630 psychoeducation, NOTE Confidence: 0.96998197 00:47:37.434 --> 00:47:38.795 much less likely to use NOTE Confidence: 0.96998197 00:47:38.795 --> 00:47:39.295 exposure. NOTE Confidence: 0.9708186 00:47:39.755 --> 00:47:41.355 We did another study asking NOTE Confidence: 0.9708186 00:47:41.355 --> 00:47:42.795 kids in the community who NOTE Confidence: 0.9708186 00:47:42.795 --> 00:47:43.535 had anxiety, NOTE Confidence: 0.9266295 00:47:43.994 --> 00:47:45.114 what type of treatment did NOTE Confidence: 0.9266295 00:47:45.114 --> 00:47:46.795 you receive? And actually, very NOTE Confidence: 0.9266295 00:47:46.795 --> 00:47:48.094 few children reported NOTE Confidence: 0.99923396 00:47:48.875 --> 00:47:50.234 using this technique that we NOTE Confidence: 0.99923396 00:47:50.234 --> 00:47:51.614 think is really critical. NOTE Confidence: 0.94614184 00:47:52.350 --> 00:47:53.790 So there's limited research on NOTE Confidence: 0.94614184 00:47:53.790 --> 00:47:55.390 the technique specifically in young NOTE Confidence: 0.94614184 00:47:55.390 --> 00:47:56.430 people. So that's the some NOTE Confidence: 0.94614184 00:47:56.430 --> 00:47:57.070 of the work that I've NOTE Confidence: 0.94614184 00:47:57.070 --> 00:47:58.270 been doing, which I'm not NOTE Confidence: 0.94614184 00:47:58.270 --> 00:47:59.630 gonna go too much into NOTE Confidence: 0.94614184 00:47:59.630 --> 00:48:00.830 today because we're running out NOTE Confidence: 0.94614184 00:48:00.830 --> 00:48:01.550 of time. I wanna make NOTE Confidence: 0.94614184 00:48:01.550 --> 00:48:02.510 sure we've got time for NOTE Confidence: 0.94614184 00:48:02.510 --> 00:48:03.870 questions, but I'm on this NOTE Confidence: 0.94614184 00:48:03.870 --> 00:48:04.815 mission to try and make NOTE Confidence: 0.94614184 00:48:04.815 --> 00:48:06.815 expo exposure cool again because NOTE Confidence: 0.94614184 00:48:06.815 --> 00:48:08.035 nobody is using it, NOTE Confidence: 0.9582617 00:48:08.575 --> 00:48:09.055 and, NOTE Confidence: 0.9979917 00:48:09.614 --> 00:48:10.594 trying to NOTE Confidence: 0.97702116 00:48:10.895 --> 00:48:12.175 use it more effectively. And NOTE Confidence: 0.97702116 00:48:12.175 --> 00:48:13.214 so we're doing some work. NOTE Confidence: 0.97702116 00:48:13.214 --> 00:48:14.734 We've done a developed a NOTE Confidence: 0.97702116 00:48:14.734 --> 00:48:16.655 parent led digital intervention called NOTE Confidence: 0.97702116 00:48:16.655 --> 00:48:17.555 Courage Quest, NOTE Confidence: 0.98355013 00:48:18.175 --> 00:48:20.094 where parents can take their NOTE Confidence: 0.98355013 00:48:20.094 --> 00:48:21.750 their kids through this quest NOTE Confidence: 0.98355013 00:48:21.750 --> 00:48:22.890 of trying to, NOTE Confidence: 0.982572 00:48:25.510 --> 00:48:26.630 face their fears and use NOTE Confidence: 0.982572 00:48:26.630 --> 00:48:28.230 exposure. We're actually doing a NOTE Confidence: 0.982572 00:48:28.230 --> 00:48:29.510 factorial design. I'm not gonna NOTE Confidence: 0.982572 00:48:29.510 --> 00:48:30.230 spend too much time on NOTE Confidence: 0.982572 00:48:30.230 --> 00:48:30.870 it because it's a little NOTE Confidence: 0.982572 00:48:30.870 --> 00:48:31.690 bit of a sidetrack, NOTE Confidence: 0.95069027 00:48:32.070 --> 00:48:33.204 but we're looking at five NOTE Confidence: 0.95069027 00:48:33.204 --> 00:48:35.385 different features trying to test, NOTE Confidence: 0.9836319 00:48:36.325 --> 00:48:38.085 what might make exposure work NOTE Confidence: 0.9836319 00:48:38.085 --> 00:48:39.285 more effectively and to be NOTE Confidence: 0.9836319 00:48:39.285 --> 00:48:40.724 able to give clinicians a NOTE Confidence: 0.9836319 00:48:40.724 --> 00:48:42.665 little bit more information about, NOTE Confidence: 0.9984352 00:48:43.285 --> 00:48:44.905 how to use exposure effectively NOTE Confidence: 0.9984352 00:48:44.964 --> 00:48:46.005 and what might make it NOTE Confidence: 0.9984352 00:48:46.005 --> 00:48:46.744 work better. NOTE Confidence: 0.9331233 00:48:48.450 --> 00:48:49.170 Alright. That was a bit NOTE Confidence: 0.9331233 00:48:49.170 --> 00:48:49.969 of a bit of a NOTE Confidence: 0.9331233 00:48:49.969 --> 00:48:51.250 tangent. I wanna come back NOTE Confidence: 0.9331233 00:48:51.250 --> 00:48:51.750 to, NOTE Confidence: 0.97135717 00:48:52.930 --> 00:48:54.869 differential treatment effects and moderators. NOTE Confidence: 0.96879685 00:48:55.410 --> 00:48:57.010 We did another systematic review NOTE Confidence: 0.96879685 00:48:57.010 --> 00:48:58.469 that Lizelle's just submitted, NOTE Confidence: 0.93519443 00:48:59.410 --> 00:49:00.930 for publication trying to look NOTE Confidence: 0.93519443 00:49:00.930 --> 00:49:01.430 at NOTE Confidence: 0.979876 00:49:01.785 --> 00:49:03.224 moderators. Do we know what's NOTE Confidence: 0.979876 00:49:03.224 --> 00:49:04.344 gonna work better for these NOTE Confidence: 0.979876 00:49:04.344 --> 00:49:04.844 kids? NOTE Confidence: 0.9740185 00:49:05.944 --> 00:49:07.864 There was fifty five studies NOTE Confidence: 0.9740185 00:49:07.864 --> 00:49:09.005 that looked at moderators NOTE Confidence: 0.9979881 00:49:09.305 --> 00:49:10.605 on thirty eight trials NOTE Confidence: 0.8789287 00:49:11.305 --> 00:49:11.805 and NOTE Confidence: 0.9337125 00:49:12.344 --> 00:49:14.364 lots of different control conditions, NOTE Confidence: 0.9866364 00:49:15.420 --> 00:49:16.859 and you can predict the NOTE Confidence: 0.9866364 00:49:16.859 --> 00:49:19.020 outcome. No definitive effects were NOTE Confidence: 0.9866364 00:49:19.020 --> 00:49:19.520 identified. NOTE Confidence: 0.8787877 00:49:21.900 --> 00:49:23.900 No clear moderation or differential NOTE Confidence: 0.8787877 00:49:23.900 --> 00:49:26.060 treatment effects. So we know NOTE Confidence: 0.8787877 00:49:26.140 --> 00:49:27.339 let's say say that social NOTE Confidence: 0.8787877 00:49:27.339 --> 00:49:27.839 anxiety NOTE Confidence: 0.99550533 00:49:28.665 --> 00:49:30.265 children children with social anxiety NOTE Confidence: 0.99550533 00:49:30.265 --> 00:49:31.864 don't do as well. There's NOTE Confidence: 0.99550533 00:49:31.864 --> 00:49:33.485 no effects that show NOTE Confidence: 0.9997922 00:49:33.785 --> 00:49:35.065 what might work better for NOTE Confidence: 0.9997922 00:49:35.065 --> 00:49:35.885 those children. NOTE Confidence: 0.9933156 00:49:36.505 --> 00:49:37.545 There were a couple of NOTE Confidence: 0.9933156 00:49:37.545 --> 00:49:38.985 hints in the literature again. NOTE Confidence: 0.9933156 00:49:38.985 --> 00:49:40.685 We had four moderator variables NOTE Confidence: 0.9933156 00:49:40.825 --> 00:49:42.680 of interest that were consistent NOTE Confidence: 0.9819145 00:49:43.140 --> 00:49:44.839 across those fifty five studies. NOTE Confidence: 0.9318261 00:49:45.940 --> 00:49:47.719 Interestingly, Hispanic ethnicity. NOTE Confidence: 0.9694571 00:49:48.260 --> 00:49:49.780 I'm not necessarily convinced by NOTE Confidence: 0.9694571 00:49:49.780 --> 00:49:50.820 that, though, because that really NOTE Confidence: 0.9694571 00:49:50.820 --> 00:49:52.040 came from one trial, NOTE Confidence: 0.9529264 00:49:54.025 --> 00:49:54.985 so I'm not so sure NOTE Confidence: 0.9529264 00:49:54.985 --> 00:49:56.105 how robust it is, but NOTE Confidence: 0.9529264 00:49:56.105 --> 00:49:56.685 at least, NOTE Confidence: 0.9989822 00:49:57.305 --> 00:49:57.965 it came NOTE Confidence: 0.92575556 00:49:58.744 --> 00:50:00.185 it emerged in more than, NOTE Confidence: 0.92575556 00:50:00.505 --> 00:50:01.325 one study. NOTE Confidence: 0.96740896 00:50:01.785 --> 00:50:03.165 Age was also a predictor, NOTE Confidence: 0.8897395 00:50:03.705 --> 00:50:04.445 a moderator, NOTE Confidence: 0.9571748 00:50:05.545 --> 00:50:07.805 social anxiety and parental psychopathology. NOTE Confidence: 0.99937797 00:50:08.580 --> 00:50:09.080 But NOTE Confidence: 0.97772324 00:50:10.980 --> 00:50:13.320 importantly, even though those variables NOTE Confidence: 0.97772324 00:50:13.380 --> 00:50:14.920 came up as important moderators, NOTE Confidence: 0.97772324 00:50:15.140 --> 00:50:16.340 in one study, there was NOTE Confidence: 0.97772324 00:50:16.340 --> 00:50:17.780 a moderation effect one way, NOTE Confidence: 0.97772324 00:50:17.780 --> 00:50:18.900 and in another study, there NOTE Confidence: 0.97772324 00:50:18.900 --> 00:50:20.180 was a moderation effect in NOTE Confidence: 0.97772324 00:50:20.180 --> 00:50:21.620 another way. So for social NOTE Confidence: 0.97772324 00:50:21.620 --> 00:50:23.300 anxiety disorder, one study showed NOTE Confidence: 0.97772324 00:50:23.300 --> 00:50:25.035 group worked better, and another NOTE Confidence: 0.97772324 00:50:25.035 --> 00:50:25.515 study showed, NOTE Confidence: 0.9855808 00:50:27.114 --> 00:50:28.635 group CBT didn't work as NOTE Confidence: 0.9855808 00:50:28.635 --> 00:50:30.395 well as individual therapy. So NOTE Confidence: 0.9855808 00:50:30.395 --> 00:50:32.155 we had moderation, but completely NOTE Confidence: 0.9855808 00:50:32.155 --> 00:50:33.135 opposing effects. NOTE Confidence: 0.9963444 00:50:33.994 --> 00:50:35.755 So each result really points NOTE Confidence: 0.9963444 00:50:35.755 --> 00:50:37.594 to something different about the NOTE Confidence: 0.9963444 00:50:37.594 --> 00:50:38.335 the direction. NOTE Confidence: 0.9914187 00:50:39.270 --> 00:50:40.469 A study that didn't go NOTE Confidence: 0.9914187 00:50:40.469 --> 00:50:41.370 into the NOTE Confidence: 0.9696511 00:50:41.910 --> 00:50:43.030 systematic review that I just NOTE Confidence: 0.9696511 00:50:43.030 --> 00:50:43.910 wanted to point to because NOTE Confidence: 0.9696511 00:50:43.910 --> 00:50:44.950 this is still leaving me NOTE Confidence: 0.9696511 00:50:44.950 --> 00:50:45.910 with a little bit of NOTE Confidence: 0.9696511 00:50:45.910 --> 00:50:47.110 hope. And this is one NOTE Confidence: 0.9696511 00:50:47.110 --> 00:50:47.770 of Wendy's, NOTE Confidence: 0.9939863 00:50:48.150 --> 00:50:49.690 papers that she's just published, NOTE Confidence: 0.9993206 00:50:50.710 --> 00:50:52.570 showing a moderation effect NOTE Confidence: 0.99938107 00:50:53.155 --> 00:50:54.695 for two parent variables NOTE Confidence: 0.95440364 00:50:55.395 --> 00:50:55.715 that, NOTE Confidence: 0.9949663 00:50:56.355 --> 00:50:57.975 compared CBT versus NOTE Confidence: 0.9576254 00:50:58.595 --> 00:51:00.695 CBT plus relationship training, NOTE Confidence: 0.99414074 00:51:01.795 --> 00:51:03.735 was moderated by parental acceptance. NOTE Confidence: 0.99414074 00:51:03.795 --> 00:51:06.030 So child outcomes were better NOTE Confidence: 0.9931022 00:51:06.510 --> 00:51:08.510 for families where there was NOTE Confidence: 0.9931022 00:51:08.510 --> 00:51:09.810 high parental acceptance, NOTE Confidence: 0.9929064 00:51:11.150 --> 00:51:13.070 when CBT included more of NOTE Confidence: 0.9929064 00:51:13.070 --> 00:51:15.410 a focus on, increased acceptance NOTE Confidence: 0.98774654 00:51:15.790 --> 00:51:17.550 and decreasing control compared to NOTE Confidence: 0.98774654 00:51:17.550 --> 00:51:19.150 CBT. So that gives us NOTE Confidence: 0.98774654 00:51:19.150 --> 00:51:21.150 an idea of what could NOTE Confidence: 0.98774654 00:51:21.150 --> 00:51:21.735 be done, NOTE Confidence: 0.91523075 00:51:22.614 --> 00:51:24.215 what how we might wanna NOTE Confidence: 0.91523075 00:51:24.215 --> 00:51:24.955 shape treatment, NOTE Confidence: 0.9853452 00:51:26.055 --> 00:51:27.335 that if a child presents NOTE Confidence: 0.9853452 00:51:27.335 --> 00:51:28.775 with high with parents with NOTE Confidence: 0.9853452 00:51:28.775 --> 00:51:30.215 high acceptance, then this is NOTE Confidence: 0.9853452 00:51:30.215 --> 00:51:31.175 the type of treatment that NOTE Confidence: 0.9853452 00:51:31.175 --> 00:51:32.375 we might that might produce NOTE Confidence: 0.9853452 00:51:32.375 --> 00:51:33.114 better outcomes, NOTE Confidence: 0.99736005 00:51:33.975 --> 00:51:34.795 and a similar NOTE Confidence: 0.81760645 00:51:35.095 --> 00:51:36.215 effect for, NOTE Confidence: 0.97318244 00:51:37.175 --> 00:51:39.070 parental or negative reinforcement as NOTE Confidence: 0.97318244 00:51:39.070 --> 00:51:40.510 well. So there's a hint NOTE Confidence: 0.97318244 00:51:40.510 --> 00:51:41.469 there, but it still needs NOTE Confidence: 0.97318244 00:51:41.469 --> 00:51:42.290 to be replicated. NOTE Confidence: 0.90523 00:51:43.070 --> 00:51:43.570 And, NOTE Confidence: 0.845958 00:51:47.230 --> 00:51:48.750 it's also kind of, NOTE Confidence: 0.956918 00:51:49.310 --> 00:51:50.349 I think the study wasn't NOTE Confidence: 0.956918 00:51:50.349 --> 00:51:52.515 designed right to to find NOTE Confidence: 0.956918 00:51:52.515 --> 00:51:53.875 these moderation effects, but they NOTE Confidence: 0.956918 00:51:53.875 --> 00:51:55.714 were there. So in designing NOTE Confidence: 0.956918 00:51:55.714 --> 00:51:56.214 studies NOTE Confidence: 0.9372487 00:51:57.155 --> 00:51:58.515 for moderation is a very NOTE Confidence: 0.9372487 00:51:58.515 --> 00:52:00.035 different approach to kind of NOTE Confidence: 0.9372487 00:52:00.035 --> 00:52:00.614 the normal, NOTE Confidence: 0.9994199 00:52:01.315 --> 00:52:02.295 treatment design. NOTE Confidence: 0.9968039 00:52:04.194 --> 00:52:05.815 Alright. So can we enhance NOTE Confidence: 0.98664755 00:52:06.690 --> 00:52:07.890 outcomes in answer to that NOTE Confidence: 0.98664755 00:52:07.890 --> 00:52:08.930 question? At the moment, I'm NOTE Confidence: 0.98664755 00:52:08.930 --> 00:52:09.969 not really convinced by it. NOTE Confidence: 0.98664755 00:52:09.969 --> 00:52:11.170 I'd be curious to see NOTE Confidence: 0.98664755 00:52:11.170 --> 00:52:12.849 after being being presented with NOTE Confidence: 0.98664755 00:52:12.849 --> 00:52:13.750 all that data. NOTE Confidence: 0.9950032 00:52:15.089 --> 00:52:16.469 To me, there's pretty limited NOTE Confidence: 0.9950032 00:52:16.530 --> 00:52:18.630 differential treatment effects so far NOTE Confidence: 0.9868348 00:52:19.155 --> 00:52:20.275 In being able to answer NOTE Confidence: 0.9868348 00:52:20.275 --> 00:52:22.114 this question, what works by NOTE Confidence: 0.9868348 00:52:22.114 --> 00:52:23.475 whom for this individual with NOTE Confidence: 0.9868348 00:52:23.475 --> 00:52:25.075 that specific problem, apart from NOTE Confidence: 0.9868348 00:52:25.075 --> 00:52:25.955 the fact that we're honing NOTE Confidence: 0.9868348 00:52:25.955 --> 00:52:27.335 in on anxiety disorders, NOTE Confidence: 0.998056 00:52:28.035 --> 00:52:29.815 we've got very limited information NOTE Confidence: 0.998056 00:52:29.955 --> 00:52:30.455 about, NOTE Confidence: 0.9987269 00:52:30.915 --> 00:52:31.620 what works. NOTE Confidence: 0.9457178 00:52:32.100 --> 00:52:33.220 So this could be either NOTE Confidence: 0.9457178 00:52:33.220 --> 00:52:34.660 there are no differential treatment NOTE Confidence: 0.9457178 00:52:34.660 --> 00:52:36.580 effects, doesn't matter, evidence based NOTE Confidence: 0.9457178 00:52:36.580 --> 00:52:37.080 personalisation NOTE Confidence: 0.9952055 00:52:37.380 --> 00:52:38.840 doesn't lead to better outcomes, NOTE Confidence: 0.9604136 00:52:39.460 --> 00:52:40.840 there is no holy grail, NOTE Confidence: 0.9604136 00:52:41.060 --> 00:52:42.520 or it could be that, NOTE Confidence: 0.9990685 00:52:43.795 --> 00:52:44.535 these effects NOTE Confidence: 0.99187946 00:52:45.075 --> 00:52:46.594 are there they're there, but NOTE Confidence: 0.99187946 00:52:46.594 --> 00:52:47.475 we just haven't been able NOTE Confidence: 0.99187946 00:52:47.475 --> 00:52:48.675 to detect them because our NOTE Confidence: 0.99187946 00:52:48.675 --> 00:52:50.195 methods haven't been rigorous enough. NOTE Confidence: 0.99187946 00:52:50.195 --> 00:52:51.635 We still haven't designed our NOTE Confidence: 0.99187946 00:52:51.635 --> 00:52:53.495 studies in a way that, NOTE Confidence: 0.9749038 00:52:54.355 --> 00:52:55.175 can consistently, NOTE Confidence: 0.962814 00:52:56.369 --> 00:52:57.910 show these robust findings. NOTE Confidence: 0.9839365 00:52:58.210 --> 00:52:59.329 I'm not quite ready to NOTE Confidence: 0.9839365 00:52:59.329 --> 00:53:00.849 swallow this bitter pill of NOTE Confidence: 0.9839365 00:53:00.849 --> 00:53:02.289 every every treatment works for NOTE Confidence: 0.9839365 00:53:02.289 --> 00:53:03.750 everybody the same amount. NOTE Confidence: 0.97009903 00:53:05.010 --> 00:53:06.369 I'm still hoping and holding NOTE Confidence: 0.97009903 00:53:06.369 --> 00:53:07.250 on to the fact that NOTE Confidence: 0.97009903 00:53:07.250 --> 00:53:08.789 we may actually have, NOTE Confidence: 0.98967224 00:53:09.435 --> 00:53:10.715 there may be differential treatment NOTE Confidence: 0.98967224 00:53:10.715 --> 00:53:11.675 effects there, but we just NOTE Confidence: 0.98967224 00:53:11.675 --> 00:53:12.175 haven't, NOTE Confidence: 0.9654759 00:53:12.795 --> 00:53:13.915 we haven't got there yet. NOTE Confidence: 0.9654759 00:53:13.915 --> 00:53:14.955 So we've been doing some NOTE Confidence: 0.9654759 00:53:14.955 --> 00:53:16.815 individual patient data meta analysis. NOTE Confidence: 0.9654759 00:53:16.875 --> 00:53:18.075 I'm just gonna finish up. NOTE Confidence: 0.9654759 00:53:18.075 --> 00:53:18.575 Yep. NOTE Confidence: 0.97841054 00:53:19.114 --> 00:53:20.094 Where we're combining NOTE Confidence: 0.9766429 00:53:20.555 --> 00:53:21.515 data from a whole lot NOTE Confidence: 0.9766429 00:53:21.515 --> 00:53:23.135 of clinical trials together, NOTE Confidence: 0.9813665 00:53:24.110 --> 00:53:25.550 so kind of advancing the NOTE Confidence: 0.9813665 00:53:25.550 --> 00:53:26.590 previous work that we've done, NOTE Confidence: 0.9813665 00:53:26.590 --> 00:53:27.390 but we're doing it in NOTE Confidence: 0.9813665 00:53:27.390 --> 00:53:28.670 a systematic way now. We're NOTE Confidence: 0.9813665 00:53:28.670 --> 00:53:30.530 developing this topic based living, NOTE Confidence: 0.96751434 00:53:31.390 --> 00:53:33.550 repository of data. We're storing NOTE Confidence: 0.96751434 00:53:33.550 --> 00:53:34.930 it on a secure server. NOTE Confidence: 0.96751434 00:53:35.150 --> 00:53:36.585 At the moment, I'm very NOTE Confidence: 0.96751434 00:53:36.585 --> 00:53:38.825 excited. The first time last NOTE Confidence: 0.96751434 00:53:38.825 --> 00:53:39.945 week, I got my first NOTE Confidence: 0.96751434 00:53:39.945 --> 00:53:41.625 data set of seven thousand NOTE Confidence: 0.96751434 00:53:41.625 --> 00:53:42.585 one hundred and twenty three NOTE Confidence: 0.96751434 00:53:42.585 --> 00:53:43.965 kids from around the world. NOTE Confidence: 0.96751434 00:53:44.105 --> 00:53:44.605 And NOTE Confidence: 0.9400491 00:53:45.785 --> 00:53:46.825 I haven't even put the NOTE Confidence: 0.9400491 00:53:46.825 --> 00:53:48.525 arrow in the right spot NOTE Confidence: 0.9400491 00:53:48.710 --> 00:53:49.910 for Yale. But, anyway, you NOTE Confidence: 0.9400491 00:53:50.069 --> 00:53:51.509 there is Yale data in NOTE Confidence: 0.9400491 00:53:51.509 --> 00:53:52.009 there. NOTE Confidence: 0.99457175 00:53:53.430 --> 00:53:54.250 But yes. NOTE Confidence: 0.89074934 00:53:54.950 --> 00:53:56.489 I don't know geography, clearly. NOTE Confidence: 0.97006357 00:53:57.989 --> 00:53:58.869 I don't know where that's NOTE Confidence: 0.97006357 00:53:58.869 --> 00:53:59.829 going to. But yeah. So NOTE Confidence: 0.97006357 00:53:59.829 --> 00:54:00.869 that's what we're working on NOTE Confidence: 0.97006357 00:54:00.869 --> 00:54:01.369 now, NOTE Confidence: 0.96103364 00:54:02.285 --> 00:54:03.565 that seven thousand. And it'll NOTE Confidence: 0.96103364 00:54:03.565 --> 00:54:04.445 hopefully give us a lot NOTE Confidence: 0.96103364 00:54:04.445 --> 00:54:06.225 more variability in the studies. NOTE Confidence: 0.96103364 00:54:06.285 --> 00:54:07.025 We've got NOTE Confidence: 0.99358314 00:54:07.325 --> 00:54:08.785 a lot of different variation NOTE Confidence: 0.99358314 00:54:09.085 --> 00:54:09.905 in treatments NOTE Confidence: 0.9883585 00:54:10.605 --> 00:54:11.485 that, you know, we might NOTE Confidence: 0.9883585 00:54:11.485 --> 00:54:12.285 not have been able to NOTE Confidence: 0.9883585 00:54:12.285 --> 00:54:13.565 predict before, but now we'll NOTE Confidence: 0.9883585 00:54:13.565 --> 00:54:15.565 have much more, information and NOTE Confidence: 0.9883585 00:54:15.565 --> 00:54:16.445 be at a be at NOTE Confidence: 0.9883585 00:54:16.445 --> 00:54:17.800 a better point where we NOTE Confidence: 0.9883585 00:54:17.800 --> 00:54:19.099 can recommend NOTE Confidence: 0.9799326 00:54:19.400 --> 00:54:21.299 treatment and be able to, NOTE Confidence: 0.9719402 00:54:21.719 --> 00:54:23.160 match treatments hopefully in the NOTE Confidence: 0.9719402 00:54:23.160 --> 00:54:24.599 future, but we're not there NOTE Confidence: 0.9719402 00:54:24.599 --> 00:54:25.099 yet. NOTE Confidence: 0.97163886 00:54:25.719 --> 00:54:27.000 So thank you very much NOTE Confidence: 0.97163886 00:54:27.000 --> 00:54:27.960 for letting me take you NOTE Confidence: 0.97163886 00:54:27.960 --> 00:54:29.500 through that. I'm much appreciated. NOTE Confidence: 0.9839357 00:54:35.375 --> 00:54:35.875 What NOTE Confidence: 0.57326436 00:54:36.255 --> 00:54:37.695 a well, I'll clear your NOTE Confidence: 0.57326436 00:54:37.695 --> 00:54:38.195 presentation, NOTE Confidence: 0.9497556 00:54:38.495 --> 00:54:39.695 Jenny. It was fantastic. So NOTE Confidence: 0.9497556 00:54:39.695 --> 00:54:40.495 we we do have, like, NOTE Confidence: 0.9497556 00:54:40.495 --> 00:54:41.775 five minutes for some questions NOTE Confidence: 0.9497556 00:54:41.775 --> 00:54:42.815 that people would like to NOTE Confidence: 0.9497556 00:54:42.815 --> 00:54:43.555 ask questions. NOTE Confidence: 0.9996536 00:54:51.469 --> 00:54:52.670 Hi. Thank you for coming NOTE Confidence: 0.9996536 00:54:52.670 --> 00:54:53.809 to speak to us. NOTE Confidence: 0.9037764 00:54:55.230 --> 00:54:56.609 My question is that, NOTE Confidence: 0.99250275 00:54:57.565 --> 00:54:58.945 in addition to, NOTE Confidence: 0.99985445 00:54:59.485 --> 00:55:00.225 looking at NOTE Confidence: 0.9986251 00:55:00.605 --> 00:55:02.945 differential responses to treatment and NOTE Confidence: 0.98385537 00:55:03.405 --> 00:55:04.145 and prognostic NOTE Confidence: 0.9882145 00:55:04.445 --> 00:55:04.945 factors, NOTE Confidence: 0.9607328 00:55:06.125 --> 00:55:07.885 are others interested? And or NOTE Confidence: 0.9607328 00:55:07.885 --> 00:55:09.105 do you think there's utility NOTE Confidence: 0.75068223 00:55:09.405 --> 00:55:09.905 in, NOTE Confidence: 0.94149613 00:55:11.580 --> 00:55:13.520 using these or related predictive NOTE Confidence: 0.94149613 00:55:13.660 --> 00:55:14.160 measures NOTE Confidence: 0.91260135 00:55:14.460 --> 00:55:14.960 to, NOTE Confidence: 0.999738 00:55:16.060 --> 00:55:17.120 for early detection NOTE Confidence: 0.96195734 00:55:17.420 --> 00:55:18.219 or for, NOTE Confidence: 0.9244149 00:55:19.100 --> 00:55:19.840 like, stratifying NOTE Confidence: 0.6759095 00:55:20.620 --> 00:55:20.860 of, NOTE Confidence: 0.8328409 00:55:21.739 --> 00:55:22.960 Of anxiety disorders. NOTE Confidence: 0.98920137 00:55:23.340 --> 00:55:24.700 Yeah. So we haven't really NOTE Confidence: 0.98920137 00:55:24.700 --> 00:55:26.400 been looking at risk of NOTE Confidence: 0.9833438 00:55:27.385 --> 00:55:28.505 disorder in the first place NOTE Confidence: 0.9833438 00:55:28.505 --> 00:55:29.785 because all of the samples NOTE Confidence: 0.9833438 00:55:29.785 --> 00:55:30.985 already have a disorder. So NOTE Confidence: 0.9833438 00:55:30.985 --> 00:55:32.505 we're looking at risk, and NOTE Confidence: 0.9833438 00:55:32.505 --> 00:55:33.705 risk gets used in different NOTE Confidence: 0.9833438 00:55:33.705 --> 00:55:35.065 ways. So risk we're looking NOTE Confidence: 0.9833438 00:55:35.065 --> 00:55:36.265 at risk in terms of NOTE Confidence: 0.9833438 00:55:36.265 --> 00:55:36.765 predicting NOTE Confidence: 0.7747522 00:55:37.145 --> 00:55:38.045 poorer outcome. NOTE Confidence: 0.99923754 00:55:38.665 --> 00:55:39.165 So NOTE Confidence: 0.9774031 00:55:39.545 --> 00:55:40.665 I do think there is NOTE Confidence: 0.9774031 00:55:40.665 --> 00:55:41.165 utility, NOTE Confidence: 0.9461233 00:55:42.520 --> 00:55:44.460 in well, also in detection. NOTE Confidence: 0.9897865 00:55:45.160 --> 00:55:46.360 But at the moment, the NOTE Confidence: 0.9897865 00:55:46.360 --> 00:55:47.880 idea of what else to NOTE Confidence: 0.9897865 00:55:47.880 --> 00:55:48.840 do with them, that's where NOTE Confidence: 0.9897865 00:55:48.840 --> 00:55:49.500 we're stuck. NOTE Confidence: 0.99889666 00:55:50.360 --> 00:55:52.040 But clinicians have been doing NOTE Confidence: 0.99889666 00:55:52.040 --> 00:55:52.540 this NOTE Confidence: 0.76296806 00:55:52.920 --> 00:55:53.820 for as NOTE Confidence: 0.91926956 00:55:54.474 --> 00:55:55.675 forever long that there's been NOTE Confidence: 0.91926956 00:55:55.675 --> 00:55:57.375 clinical practice. So we adapt NOTE Confidence: 0.9446512 00:55:57.835 --> 00:55:59.114 treatments based on what we NOTE Confidence: 0.9446512 00:55:59.114 --> 00:56:00.315 think should work based on NOTE Confidence: 0.9446512 00:56:00.315 --> 00:56:01.454 our treatment formulation, NOTE Confidence: 0.9981427 00:56:01.994 --> 00:56:03.594 and we expect that if NOTE Confidence: 0.9981427 00:56:03.594 --> 00:56:04.255 we adapt NOTE Confidence: 0.98196584 00:56:04.795 --> 00:56:05.855 based on risk, NOTE Confidence: 0.99713826 00:56:07.435 --> 00:56:07.860 that NOTE Confidence: 0.98912567 00:56:08.420 --> 00:56:09.620 there might be better outcomes. NOTE Confidence: 0.98912567 00:56:09.620 --> 00:56:10.420 But at the moment, we NOTE Confidence: 0.98912567 00:56:10.420 --> 00:56:11.700 just haven't got that bit NOTE Confidence: 0.98912567 00:56:11.700 --> 00:56:12.660 to say that they're gonna NOTE Confidence: 0.98912567 00:56:12.660 --> 00:56:13.320 do better. NOTE Confidence: 0.9833637 00:56:14.260 --> 00:56:15.300 But I I do think NOTE Confidence: 0.9833637 00:56:15.300 --> 00:56:16.820 there's value in the risk NOTE Confidence: 0.9833637 00:56:16.820 --> 00:56:17.620 index and, NOTE Confidence: 0.9596741 00:56:18.260 --> 00:56:19.700 that we that's our next NOTE Confidence: 0.9596741 00:56:19.700 --> 00:56:21.060 step is to actually take NOTE Confidence: 0.9596741 00:56:21.060 --> 00:56:22.145 it at least that far NOTE Confidence: 0.9596741 00:56:22.145 --> 00:56:24.005 as developing a platform for NOTE Confidence: 0.9596741 00:56:24.224 --> 00:56:26.145 clinicians to enter in that NOTE Confidence: 0.9596741 00:56:26.145 --> 00:56:27.585 risk data to see, okay. NOTE Confidence: 0.9596741 00:56:27.585 --> 00:56:29.025 Well, based on this massive NOTE Confidence: 0.9596741 00:56:29.025 --> 00:56:29.525 dataset, NOTE Confidence: 0.9951202 00:56:29.984 --> 00:56:31.185 how likely is it that NOTE Confidence: 0.9951202 00:56:31.185 --> 00:56:32.224 the child that I'm about NOTE Confidence: 0.9951202 00:56:32.224 --> 00:56:33.685 to see with these particular NOTE Confidence: 0.9951202 00:56:33.744 --> 00:56:34.244 profiles, NOTE Confidence: 0.9538902 00:56:35.190 --> 00:56:37.190 these particular variables, how likely NOTE Confidence: 0.9538902 00:56:37.190 --> 00:56:38.550 is it that this standard NOTE Confidence: 0.9538902 00:56:38.550 --> 00:56:39.930 CBT is gonna work? NOTE Confidence: 0.99216896 00:56:40.550 --> 00:56:41.750 I wouldn't want to see NOTE Confidence: 0.99216896 00:56:41.750 --> 00:56:43.290 it being used for, NOTE Confidence: 0.9996997 00:56:44.150 --> 00:56:44.650 if NOTE Confidence: 0.9585719 00:56:44.950 --> 00:56:46.469 okay. It comes out that NOTE Confidence: 0.9585719 00:56:46.469 --> 00:56:48.070 the likelihood of response is NOTE Confidence: 0.9585719 00:56:48.070 --> 00:56:48.890 very low, NOTE Confidence: 0.9977244 00:56:49.415 --> 00:56:50.295 then I wouldn't want them NOTE Confidence: 0.9977244 00:56:50.295 --> 00:56:52.135 to start some completely different NOTE Confidence: 0.9977244 00:56:52.135 --> 00:56:53.435 treatment. Right? It's, NOTE Confidence: 0.97293496 00:56:54.295 --> 00:56:55.515 yeah. So it's it's NOTE Confidence: 0.97054297 00:56:55.815 --> 00:56:56.855 I I do think there's NOTE Confidence: 0.97054297 00:56:56.855 --> 00:56:58.135 utility, but I think there's NOTE Confidence: 0.97054297 00:56:58.135 --> 00:56:59.515 a bit of concern around NOTE Confidence: 0.91812634 00:56:59.895 --> 00:57:01.335 then saying, okay. Well, CBT NOTE Confidence: 0.91812634 00:57:01.335 --> 00:57:02.695 doesn't work, then let's do NOTE Confidence: 0.91812634 00:57:02.855 --> 00:57:03.994 let's, you know, NOTE Confidence: 0.9406992 00:57:04.730 --> 00:57:05.549 do some, NOTE Confidence: 0.9465106 00:57:06.809 --> 00:57:08.170 something entirely different that there's NOTE Confidence: 0.9465106 00:57:08.170 --> 00:57:09.549 no evidence base for. NOTE Confidence: 0.9953071 00:57:10.650 --> 00:57:11.690 Yeah. It seems like it's NOTE Confidence: 0.9953071 00:57:11.690 --> 00:57:13.130 at least low hanging fruit NOTE Confidence: 0.9953071 00:57:13.130 --> 00:57:14.489 to say Yeah. I'll start NOTE Confidence: 0.9953071 00:57:14.489 --> 00:57:16.029 CBT or start the SSRI NOTE Confidence: 0.9953071 00:57:16.089 --> 00:57:18.215 earlier. Yes. Yeah. Yeah. Yeah. NOTE Confidence: 0.9953071 00:57:18.215 --> 00:57:18.715 Definitely. NOTE Confidence: 0.99731517 00:57:19.255 --> 00:57:19.755 Yeah. NOTE Confidence: 0.9286373 00:57:20.615 --> 00:57:21.675 Yeah. And if NOTE Confidence: 0.9717495 00:57:22.535 --> 00:57:23.815 yeah. Given that there has NOTE Confidence: 0.9717495 00:57:23.815 --> 00:57:24.855 been some hint in the NOTE Confidence: 0.9717495 00:57:24.855 --> 00:57:26.615 literature around that we get NOTE Confidence: 0.9717495 00:57:26.615 --> 00:57:28.455 better effects for CBT and NOTE Confidence: 0.9717495 00:57:28.455 --> 00:57:30.215 sertraline that if there is NOTE Confidence: 0.9717495 00:57:30.215 --> 00:57:31.115 a poor risk NOTE Confidence: 0.8236288 00:57:31.569 --> 00:57:32.309 for treatment, NOTE Confidence: 0.99546456 00:57:33.170 --> 00:57:34.549 outcome being favorable, NOTE Confidence: 0.92468244 00:57:35.010 --> 00:57:37.109 then, yes, starting the CBT NOTE Confidence: 0.92468244 00:57:37.170 --> 00:57:37.670 earlier. NOTE Confidence: 0.9540879 00:57:38.609 --> 00:57:40.630 As, yeah, the combined treatment NOTE Confidence: 0.9540879 00:57:40.690 --> 00:57:41.829 earlier. Yeah. NOTE Confidence: 0.9861215 00:57:42.609 --> 00:57:43.730 Thank you. That was really NOTE Confidence: 0.9861215 00:57:43.730 --> 00:57:45.174 interesting. I was just wondering NOTE Confidence: 0.9861215 00:57:45.174 --> 00:57:46.375 what you, could tell us NOTE Confidence: 0.9861215 00:57:46.375 --> 00:57:48.234 about the differences between Australia NOTE Confidence: 0.9861215 00:57:48.375 --> 00:57:49.835 and here in the US NOTE Confidence: 0.9861215 00:57:49.895 --> 00:57:50.635 in anxiety, NOTE Confidence: 0.8885986 00:57:52.454 --> 00:57:53.895 in kids. What what makes NOTE Confidence: 0.8885986 00:57:53.895 --> 00:57:55.915 kids anxious and how differentially NOTE Confidence: 0.8885986 00:57:56.135 --> 00:57:57.194 parents respond? NOTE Confidence: 0.9987054 00:57:58.800 --> 00:58:00.180 Yeah. It's a good question. NOTE Confidence: 0.980758 00:58:00.720 --> 00:58:02.420 I'm gonna be talking anecdotally. NOTE Confidence: 0.9258892 00:58:04.560 --> 00:58:05.920 Very similar. I have worked NOTE Confidence: 0.9258892 00:58:05.920 --> 00:58:06.960 in the clinic in the NOTE Confidence: 0.9258892 00:58:06.960 --> 00:58:08.560 US, in Philadelphia, as well NOTE Confidence: 0.9258892 00:58:08.560 --> 00:58:10.580 as in Australia. But Philadelphia NOTE Confidence: 0.9258892 00:58:10.640 --> 00:58:11.780 was a long time ago, NOTE Confidence: 0.9819401 00:58:12.560 --> 00:58:13.505 and it was NOTE Confidence: 0.9709293 00:58:13.885 --> 00:58:14.785 before cell phones. NOTE Confidence: 0.95071125 00:58:16.444 --> 00:58:17.904 Very similar things, though, NOTE Confidence: 0.97028524 00:58:18.285 --> 00:58:19.244 that they worry about. A NOTE Confidence: 0.97028524 00:58:19.244 --> 00:58:20.684 lot of you know, depending NOTE Confidence: 0.97028524 00:58:20.684 --> 00:58:21.984 on the type of presentation, NOTE Confidence: 0.9840155 00:58:22.525 --> 00:58:23.484 but there's NOTE Confidence: 0.98313713 00:58:24.125 --> 00:58:26.224 I've seen this increase in NOTE Confidence: 0.98313713 00:58:26.410 --> 00:58:28.030 concern around academic pressure, NOTE Confidence: 0.95705545 00:58:28.970 --> 00:58:29.470 particularly, NOTE Confidence: 0.9679989 00:58:31.450 --> 00:58:33.130 yeah, even in primary school NOTE Confidence: 0.9679989 00:58:33.130 --> 00:58:34.970 ages, kids worrying about how NOTE Confidence: 0.9679989 00:58:34.970 --> 00:58:36.170 they're gonna perform in the NOTE Confidence: 0.9679989 00:58:36.170 --> 00:58:37.950 future and more parental pressure NOTE Confidence: 0.9679989 00:58:38.010 --> 00:58:38.890 than I think we've seen NOTE Confidence: 0.9679989 00:58:38.890 --> 00:58:40.910 in previous year previous generations. NOTE Confidence: 0.949873 00:58:44.654 --> 00:58:45.934 And in terms of types NOTE Confidence: 0.949873 00:58:45.934 --> 00:58:46.674 of anxiety, NOTE Confidence: 0.8773216 00:58:49.855 --> 00:58:50.815 we have a lot more NOTE Confidence: 0.8773216 00:58:50.815 --> 00:58:52.815 spiders. Yeah. Yeah. Yeah. Put NOTE Confidence: 0.8773216 00:58:52.815 --> 00:58:53.315 eyes. NOTE Confidence: 0.89656276 00:58:53.615 --> 00:58:55.454 No. There's a koala. Yeah. NOTE Confidence: 0.89656276 00:58:55.454 --> 00:58:56.755 No. I don't I mean, NOTE Confidence: 0.98847234 00:58:57.430 --> 00:58:58.630 we don't we don't get NOTE Confidence: 0.98847234 00:58:58.790 --> 00:58:59.910 I've never seen a phobia NOTE Confidence: 0.98847234 00:58:59.910 --> 00:59:01.050 of a koala before. NOTE Confidence: 0.9707151 00:59:02.710 --> 00:59:03.830 But we do have, NOTE Confidence: 0.97394776 00:59:04.390 --> 00:59:05.110 you know, a lot of NOTE Confidence: 0.97394776 00:59:05.110 --> 00:59:06.710 spider phobias, but not more NOTE Confidence: 0.97394776 00:59:06.710 --> 00:59:07.990 than in other countries, but NOTE Confidence: 0.97394776 00:59:07.990 --> 00:59:08.870 yet we've got a lot NOTE Confidence: 0.97394776 00:59:08.870 --> 00:59:09.690 more risk. NOTE Confidence: 0.79801047 00:59:10.295 --> 00:59:11.335 I found a couple of, NOTE Confidence: 0.9937237 00:59:12.535 --> 00:59:14.295 deadly spiders in my one NOTE Confidence: 0.9937237 00:59:14.295 --> 00:59:15.495 in my bedroom and one NOTE Confidence: 0.9937237 00:59:15.495 --> 00:59:16.715 in my swimming pool, NOTE Confidence: 0.8958637 00:59:17.415 --> 00:59:19.115 a while ago. But yet NOTE Confidence: 0.88119394 00:59:19.495 --> 00:59:20.615 even though the risk is NOTE Confidence: 0.88119394 00:59:20.615 --> 00:59:21.115 higher, NOTE Confidence: 0.976609 00:59:22.150 --> 00:59:23.450 more yeah. Exactly. NOTE Confidence: 0.83796424 00:59:24.710 --> 00:59:26.250 Yeah. Yeah. But, NOTE Confidence: 0.99930006 00:59:27.590 --> 00:59:28.570 not in terms NOTE Confidence: 0.98326576 00:59:29.030 --> 00:59:30.710 of presentations being different in NOTE Confidence: 0.98326576 00:59:30.710 --> 00:59:32.250 terms of prevalence of disorders. NOTE Confidence: 0.98862326 00:59:39.194 --> 00:59:40.795 Oh, thank you. Thanks for NOTE Confidence: 0.98862326 00:59:40.795 --> 00:59:42.154 such a beautiful talk, Jenny. NOTE Confidence: 0.97741187 00:59:42.555 --> 00:59:44.075 I was fascinated by this NOTE Confidence: 0.97741187 00:59:44.075 --> 00:59:45.434 finding, the JCAP one, where NOTE Confidence: 0.97741187 00:59:45.434 --> 00:59:46.635 you show that, you know, NOTE Confidence: 0.97741187 00:59:46.635 --> 00:59:47.914 kids with parents with severe NOTE Confidence: 0.97741187 00:59:47.914 --> 00:59:50.154 psychopathology or psychopathology are similar NOTE Confidence: 0.97741187 00:59:50.154 --> 00:59:51.194 at post, but then you NOTE Confidence: 0.97741187 00:59:51.194 --> 00:59:52.474 see these longer term effects. NOTE Confidence: 0.97741187 00:59:52.474 --> 00:59:53.730 And I'm wondering if you NOTE Confidence: 0.97741187 00:59:53.730 --> 00:59:54.690 can speak to, you know, NOTE Confidence: 0.97741187 00:59:54.690 --> 00:59:55.410 what do you think is NOTE Confidence: 0.97741187 00:59:55.410 --> 00:59:56.950 driving that? What's the mechanism? NOTE Confidence: 0.9796099 00:59:58.610 --> 00:59:59.910 Yeah. I NOTE Confidence: 0.99707264 01:00:00.770 --> 01:00:02.530 my gut feeling about it NOTE Confidence: 0.99707264 01:00:02.530 --> 01:00:03.670 is that parents NOTE Confidence: 0.97757876 01:00:04.770 --> 01:00:05.270 who NOTE Confidence: 0.9548795 01:00:05.915 --> 01:00:06.955 are more likely to be NOTE Confidence: 0.9548795 01:00:06.955 --> 01:00:07.455 anxious NOTE Confidence: 0.92984843 01:00:08.075 --> 01:00:08.575 and NOTE Confidence: 0.9283616 01:00:08.875 --> 01:00:10.395 who have maybe learnt some NOTE Confidence: 0.9283616 01:00:10.395 --> 01:00:11.515 of the skills than when NOTE Confidence: 0.9283616 01:00:11.515 --> 01:00:12.395 they get back in their NOTE Confidence: 0.9283616 01:00:12.395 --> 01:00:14.255 environment with the young person NOTE Confidence: 0.8344589 01:00:14.795 --> 01:00:15.295 that, NOTE Confidence: 0.9880352 01:00:16.714 --> 01:00:17.915 because they've had a really NOTE Confidence: 0.9880352 01:00:17.915 --> 01:00:19.515 long time of being anxious, NOTE Confidence: 0.9880352 01:00:19.515 --> 01:00:20.335 most likely NOTE Confidence: 0.8718226 01:00:20.690 --> 01:00:22.150 that that in interaction NOTE Confidence: 0.89230484 01:00:23.010 --> 01:00:24.790 kinda goes back to normal. NOTE Confidence: 0.89230484 01:00:24.930 --> 01:00:26.370 And that particularly for the NOTE Confidence: 0.89230484 01:00:26.370 --> 01:00:26.870 child, NOTE Confidence: 0.90630096 01:00:27.250 --> 01:00:28.950 that they're exposed to this NOTE Confidence: 0.90630096 01:00:29.090 --> 01:00:30.930 more modeling. Like, in those NOTE Confidence: 0.90630096 01:00:31.250 --> 01:00:32.150 in that graph, NOTE Confidence: 0.94172746 01:00:33.335 --> 01:00:34.934 that wasn't the parents didn't NOTE Confidence: 0.94172746 01:00:34.934 --> 01:00:36.694 also receive treatment. So they NOTE Confidence: 0.94172746 01:00:36.694 --> 01:00:37.895 they received it in terms NOTE Confidence: 0.94172746 01:00:37.895 --> 01:00:39.575 of through their child, and NOTE Confidence: 0.94172746 01:00:39.575 --> 01:00:41.035 they learned about the strategies. NOTE Confidence: 0.99702644 01:00:41.335 --> 01:00:42.454 And so we do get NOTE Confidence: 0.99702644 01:00:42.615 --> 01:00:43.734 even when we don't target NOTE Confidence: 0.99702644 01:00:43.734 --> 01:00:45.015 it specifically, we do get NOTE Confidence: 0.99702644 01:00:45.015 --> 01:00:47.035 a reduction in parental anxiety, NOTE Confidence: 0.9921242 01:00:47.970 --> 01:00:49.270 even when it's not targeted. NOTE Confidence: 0.93906415 01:00:49.730 --> 01:00:50.609 So there would have been NOTE Confidence: 0.93906415 01:00:50.609 --> 01:00:52.310 a reduction in parental anxiety NOTE Confidence: 0.93906415 01:00:52.369 --> 01:00:53.270 at post treatment, NOTE Confidence: 0.99582714 01:00:54.050 --> 01:00:55.510 but that wasn't, NOTE Confidence: 0.9404536 01:00:55.970 --> 01:00:57.490 you know, enough really to NOTE Confidence: 0.9404536 01:00:57.490 --> 01:00:58.950 stop the child being exposed NOTE Confidence: 0.9404536 01:00:59.090 --> 01:01:01.270 to increased anxiety and modeling NOTE Confidence: 0.99237835 01:01:01.655 --> 01:01:03.175 and avoidance behavior. So I NOTE Confidence: 0.99237835 01:01:03.175 --> 01:01:04.135 think they just go back NOTE Confidence: 0.99237835 01:01:04.135 --> 01:01:05.815 into an environment where there's NOTE Confidence: 0.99237835 01:01:05.815 --> 01:01:07.355 continued avoidance and, NOTE Confidence: 0.99097556 01:01:08.375 --> 01:01:10.395 modeling of anxiety and accommodation. NOTE Confidence: 0.93486905 01:01:12.055 --> 01:01:14.135 Well, thank you again, Jenny. NOTE Confidence: 0.93486905 01:01:14.135 --> 01:01:15.630 I we've that's we NOTE Confidence: 0.96951896 01:01:16.109 --> 01:01:17.630 we're ending now. But thank NOTE Confidence: 0.96951896 01:01:17.630 --> 01:01:18.750 you all very much for NOTE Confidence: 0.96951896 01:01:18.750 --> 01:01:20.670 attending. However, the trainees have NOTE Confidence: 0.96951896 01:01:20.670 --> 01:01:22.349 an opportunity now to meet NOTE Confidence: 0.96951896 01:01:22.349 --> 01:01:23.950 with Jenny. Right now, the NOTE Confidence: 0.96951896 01:01:23.950 --> 01:01:25.069 room is over there in NOTE Confidence: 0.96951896 01:01:25.069 --> 01:01:26.670 the Giselle. I believe that's NOTE Confidence: 0.96951896 01:01:26.670 --> 01:01:27.950 what we have scheduled if NOTE Confidence: 0.96951896 01:01:27.950 --> 01:01:28.269 that's, NOTE Confidence: 0.9071862 01:01:28.995 --> 01:01:29.955 so that's what it is. NOTE Confidence: 0.9071862 01:01:29.955 --> 01:01:30.835 And there might be some NOTE Confidence: 0.9071862 01:01:30.915 --> 01:01:31.955 I will see you next NOTE Confidence: 0.9071862 01:01:31.955 --> 01:01:33.155 door. You stay here for NOTE Confidence: 0.9071862 01:01:33.155 --> 01:01:34.275 now. But if you get NOTE Confidence: 0.9071862 01:01:34.275 --> 01:01:35.315 kicked out, go there. Is NOTE Confidence: 0.9071862 01:01:35.315 --> 01:01:36.275 that okay? Oh, okay. Yeah. NOTE Confidence: 0.9071862 01:01:36.275 --> 01:01:37.555 Let's do that. Okay. So NOTE Confidence: 0.9071862 01:01:37.555 --> 01:01:38.675 thank you all so much NOTE Confidence: 0.9071862 01:01:38.675 --> 01:01:39.795 for having me. Jenny with NOTE Confidence: 0.9071862 01:01:39.795 --> 01:01:41.315 a wonderful talk. It's thank NOTE Confidence: 0.9071862 01:01:41.315 --> 01:01:42.775 you so much. Thank you.