Does Cognitive-Behavioral Therapy for Youth Anxiety Disorders Improve Social Functioning and Peer Relationships?

Considering Historical Context, Current Societal Trends, and Implications for Understanding Harm in Youth Mental Health Treatment: A Broader Lens to the Primum Non Nocere Special Issue

Potential for harm or non-beneficence in psychological treatments remains understudied compared to questions of benefit or efficacy, especially in youth populations. Further study is critical for upholding the ethical mandate to both maximize salutary outcomes and minimize harm/non-beneficence. In the present special issue, authors of target articles incisively delineate parameters of harm and associated clinical strategies for measuring and addressing it, along with recommendations for research advancing understanding of harm in youth mental health treatment. In this commentary, we synthesize key points across the articles and offer future directions for advancing knowledge on treatment harm. First, we provide historical context that includes the origins of the concept of Primum non nocere, its initial linkages with clinical psychology, and controversies relating to the scientific study of psychotherapy. Second, we leverage lessons learned from the evidence-based treatment movement to advance the study of harm. We suggest that research aimed at advancing understanding harm in youth treatment ought to transpire concurrently with research examining putative benefits of such interventions, including a deliberate focus on mechanisms and moderators of both benefit and harm. Third, we identify several contemporary societal trends relevant to our understanding of harm, including current skepticism of science and proliferation of pseudoscientific interventions. We conclude by discussing implications for furthering knowledge of potential harms in youth mental health treatment across the domains of theory, research, and dissemination. We hope this special issue and commentary stimulate further thought and research in this heretofore understudied area.

Interest-Curiosity, Depression, and Peer Relationships Among Chinese Adolescents: A Cross-Lagged, Semi-Longitudinal Study

Background

Based on cognitive-behavioral therapy and the positive emotion expansion and construction theory, this study investigated how interest-curiosity influences adolescent peer relationships through depressive symptoms.

Methods

A cross-lagged, semi-longitudinal study was conducted with Chinese adolescents (N = 224; Mage = 13.23, SD = 0.95). Data were collected in December 2023 (T1) and March 2024 (T2). Semi-longitudinal analyses were employed to examine the relationships among interest-curiosity, depressive symptoms, and peer relationships.

Results

The findings revealed that (1) adolescents with higher levels of interest-curiosity tended to experience lower levels of depressive symptoms over time; (2) adolescents who reported higher levels of depressive symptoms were more likely to experience difficulties in peer relationships; and (3) the positive influence of interest-curiosity on peer relationships was explained by its role in reducing depressive symptoms.

Conclusion

This study highlights the crucial role of interest-curiosity in adolescent development. The findings suggest that fostering adolescents' interest-curiosity may help reduce depressive symptoms and consequently enhance peer relationships.

Systematic review and meta-analysis: do best-evidenced trauma-focused interventions for children and young people with PTSD lead to changes in social and interpersonal domains?

Objective: Young people with post-traumatic stress disorder experience difficulties in social and interpersonal domains. We examined whether the best-evidenced treatments of PTSD for children and young people (Trauma-focussed Cognitive Behavioural Therapy or Eye Movement Desensitisation and Reprocessing; aged 5-25) improve social or interpersonal factors in randomised controlled trials, compared to a comparator condition.Method: The review was preregistered on PROSPERO (CRD42023455615; 18th August 2023). Web of Science Core Collection, EMBASE, CINAHL, Pubmed, PsycINFO, Cochrane Central Register of Controlled Trials and PTSDPubs were searched, and data were extracted for social and interpersonal outcomes post treatment. A random effect meta-analysis was conducted to obtain between-group pooled effect size estimates.Results: The search resulted in 792 studies, of which 17 met our inclusion criteria (N = 2498). Our meta-analysis included 13 studies which investigated social skills and functioning, revealing a small but non-significant effect favouring the evidence-based treatment versus comparison (g = .20, 95% CI [-0.03, 0.44], p = .09). We narratively synthesised six studies which reported other social-related outcomes (e.g. perceptions of social support), and four out of six reported improved social domain outcomes for the evidence-based PTSD treatment condition. There was a large amount of heterogeneity, with no evidence that this could be explained by moderators.Conclusion: Few trials report on social and interpersonal outcomes, and where they are reported the evidence is mixed. It may be that trauma-focused therapies for PTSD need to be adapted in some circumstances, so that they address social and interpersonal deficits often seen in children and young people with PTSD.

A Systematic Review and Meta-Analysis of Impairment and Quality of Life in Children and Adolescents with Anxiety Disorders

Anxiety disorders are common, emerge during childhood, and pose a significant burden to society and individuals. Research evaluating the impact of anxiety on functional impairment and quality of life (QoL) is increasing; however, there is yet to be a systematic review and meta-analysis of these relationships in pediatric samples. This systematic review and meta-analysis were conducted to determine the extent of impairments in functioning and QoL that young people with anxiety disorders experience relative to their healthy peers, as well as sociodemographic and clinical moderators of these relationships. Studies were included when they compared young people (mean age range within studies 7-17 years) with a primary clinical anxiety disorder to a healthy comparison group and measured impairment and/or QoL via a validated instrument. A total of 12 studies met criteria for this review (N = 3,129 participants). A majority of studies (K = 9) assessed impairment as an outcome measure, and three assessed QoL outcomes. Meta-analysis of nine studies (N = 1,457 children) showed large relationships between clinical anxiety and life impairment (g = 3.23) with the strongest effects seen for clinician report (g = 5.00), followed by caregiver (g = 2.15) and child (g = 1.58) report. The small number of studies and diversity in methodology prevented quantitative investigation of moderating factors. In the systematic review of QoL outcomes, all three studies reported significantly poorer QoL for youth with anxiety disorders relative to unaffected peers. Findings support the importance of measuring functioning and QoL as outcomes in clinical research and practice among anxious young people.This study is registered with PROSPERO under the identification number CRD42023439040.

Autism Spectrum Disorder: Brain Areas Involved, Neurobiological Mechanisms, Diagnoses and Therapies

Autism spectrum disorder (ASD), affecting over 2% of the pre-school children population, includes an important fraction of the conditions accounting for the heterogeneity of autism. The disease was discovered 75 years ago, and the present review, based on critical evaluations of the recognized ASD studies from the beginning of 1990, has been further developed by the comparative analyses of the research and clinical reports, which have grown progressively in recent years up to late 2023. The tools necessary for the identification of the ASD disease and its related clinical pathologies are genetic and epigenetic mutations affected by the specific interaction with transcription factors and chromatin remodeling processes occurring within specific complexes of brain neurons. Most often, the ensuing effects induce the inhibition/excitation of synaptic structures sustained primarily, at dendritic fibers, by alterations of flat and spine response sites. These effects are relevant because synapses, established by specific interactions of neurons with glial cells, operate as early and key targets of ASD. The pathology of children is often suspected by parents and communities and then confirmed by ensuing experiences. The final diagnoses of children and mature patients are then completed by the combination of neuropsychological (cognitive) tests and electro-/magneto-encephalography studies developed in specialized centers. ASD comorbidities, induced by processes such as anxieties, depressions, hyperactivities, and sleep defects, interact with and reinforce other brain diseases, especially schizophrenia. Advanced therapies, prescribed to children and adult patients for the control of ASD symptoms and disease, are based on the combination of well-known brain drugs with classical tools of neurologic and psychiatric practice. Overall, this review reports and discusses the advanced knowledge about the biological and medical properties of ASD.