Are changes in children's communication patterns predictive of treatment outcomes for children with anxiety?

Association Between Physical Fitness and Anxiety in Children: A Moderated Mediation Model of Agility and Resilience

Background: Anxiety is one of the most prevalent mental health problems in children. Although physical fitness as a predictor of mental health, the mechanisms underlying any association between physical fitness and anxiety in children have been understudied. Thus, the aim of the present study was to determine whether an association exists between physical fitness and anxiety and to explore the roles of agility and resilience in such an association. Methods: This cross-sectional study investigated 269 children aged 7 to 12 years from three public primary schools in Shanghai (China). Physical fitness and agility were objectively measured, and resilience and anxiety were assessed using self-reported questionnaires. The moderated mediation model was examined using the SPSS PROCESS macro, in which the moderator variable was agility, and the mediator variable was resilience. Results: Physical fitness was inversely associated with anxiety. Resilience partially and indirectly mediated this association, and agility moderated the association between physical fitness and resilience. Physical fitness had a greater impact on resilience in children with higher agility levels. Conclusions: Agility moderated the mediation of resilience on the indirect, inverse association between physical fitness and anxiety; thus, incorporating methods to develop agility and resilience may lead to better outcomes for physical fitness programs designed to prevent or alleviate anxiety in children.

A complex systems approach to the study of change in psychotherapy

BACKGROUND

A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presented from subdisciplines of complexity science that are particularly relevant to psychotherapy: dynamical systems theory, synergetics, and network theory. Two early warning signs of system transition that have been identified across sciences (critical fluctuations and critical slowing) are also described. The network destabilization and transition (NDT) model of therapeutic change is presented as a conceptual framework to import these principles to psychotherapy research and to suggest future research directions.

DISCUSSION

A complex systems approach has a number of implications for psychotherapy research. We describe important design considerations, targets for research, and analytic tools that can be used to conduct this type of research.

CONCLUSIONS

A complex systems approach to psychotherapy research is both viable and necessary to more fully capture the dynamics of human change processes. Research to date suggests that the process of change in psychotherapy can be nonlinear and that periods of increased variability and critical slowing might be early warning signals of transition in psychotherapy, as they are in other systems in nature. Psychotherapy research has been limited by small samples and infrequent assessment, but ambulatory and electronic methods now allow researchers to more fully realize the potential of concepts and methods from complexity science.

Are changes in children's communication patterns predictive of treatment outcomes for children with anxiety?

Anxiety is the most prevalent childhood psychopathology. Cognitive behavioural therapy is considered the most effective treatment, but outcomes remain variable. This study investigated children's communication patterns in child-therapist conversations and whether changes in these patterns, from rigid to more flexible, were associated with better treatment outcomes. Fifty-three children (31% boys), with a mean age in years of M = 9.68 (SD = 1.85), completed a 12-week cognitive behavioural therapy program. Maternal as well as children's reports of children's anxiety were assessed pretreatment and posttreatment. Additionally, 15-min segments of two therapy sessions were audiotaped and children's conversational turns were coded for properties of response and initiative. The structure of children's communication patterns was further quantified using recurrence quantification analysis. As expected children entering treatment were characterised by rigid and inhibited conversational behaviour. Children who became less repetitive and deterministic over time had better maternal-rated treatment outcomes. These findings did not generalize to child reports. Last, the hypothesis that the positive relation between the breaking of rigid communication patterns and treatment outcome would be mediated by increases in proactive conversational behaviours of the child was only partly supported. These study findings contribute to the emergent literature on processes of change in childhood anxiety treatment by providing initial support for the hypothesis that breaking rigid (communication) patterns may be a prerequisite of clinical change.