Emotional Awareness Predicts Specific Cognitive-Behavioral Therapy Outcomes for Anxious Youth

Evaluating clinical outcomes for anxiety and depression: A real-world comparison of the digital clinic and primary care

BACKGROUND

Hybrid care models that blend synchronous and asynchronous tools have shown promise in increasing access to care. However, few studies have compared their effectiveness to an appropriate control group, and no RCT has been conducted to tease apart the role of the clinician, app and Digital Navigator components.

OBJECTIVE

We aim to evaluate the effectiveness of a blended hybrid care model, the Digital Clinic, in reducing anxiety and depression, compared to a large primary care control group.

METHODS

Effectiveness was assessed by comparing GAD-7 and PHQ-9 scores from intake to end of follow-up. Independent t-tests were used to evaluate mean percentage score changes for each subgroup, with Cohen's d calculated to estimate effect sizes. We constructed univariate logistic regression models to identify predictors of improvement for depression and anxiety.

RESULTS

Patients in the hybrid model (n = 208) experienced greater reductions in PHQ-9 and GAD-7 scores compared to patients in primary care with 0-3 months follow-up (n = 1077), yielding effect sizes of 0.50 and 0.37, respectively. Improvements in self-efficacy predicted better outcomes for both depression and anxiety, while increases in emotional self-awareness were predictive of anxiety improvement. Total app time and therapist alliance were significant predictors of depression improvement.

CONCLUSION

Eight-week blended hybrid care models can offer effective treatment outcomes for depression and anxiety, even when compared to the real-world setting of primary care. These findings can inform future research aimed at elucidating the mechanisms that drive individual clinical effects.

Differential Associations of Intrapersonal and Interpersonal Emotion Regulation with Generalized Anxiety and Social Withdrawal Among Children

Anxiety and social withdrawal are common internalizing problems among children linked to poor emotion regulation (ER). We investigated how specific components of ER (emotion awareness, emotion regulation strategy) are associated with generalized anxiety and social withdrawal in the two ER domains (intrapersonal and interpersonal). Study participants were 398 fourth- and fifth-grade students (49% girls) and 22 teachers from a Midwestern state in the United States. Study constructs were measured with student self-report, peer nominations, and teacher reports. We found anxiety was linked to poorer intrapersonal emotion awareness and greater use of adaptive and maladaptive intrapersonal regulation strategies. Social withdrawal was associated with poorer interpersonal emotion awareness and lower use of supportive and unsupportive interpersonal regulation strategies. Social withdrawal was also negatively associated with intrapersonal, adaptive strategy. The findings highlight the relevance of intrapersonal and interpersonal domains of ER in helping anxious and socially withdrawn children regarding their unique emotion regulation difficulties.

Validation of the Capacity for the Psychotherapy Process Scale for Use in Adolescent Patients

Although pre-treatment assessments of the capacity for the psychotherapy process can aid in identifying patients experiencing great difficulties in therapy and in tailoring therapies for individual patients, limited information exists for adolescents. To address this gap, this study followed the World Health Organization's age standards for adolescents (younger adolescents aged 10-14 years; older adolescents aged 15-19 years), examined the psychometric properties of the Capacity for Psychotherapy Process Scale (CFPPS; mainly used for adult patients) in these two groups of adolescents, and compared their capacities for the psychotherapy process. The participants were 434 younger adolescent (mean age = 13.00 ± 1.08 years; 70.0% female) and 883 older adolescent outpatients (mean age = 16.68 ± 1.29 years; 62.3% female) at the department of psychiatry of the hospital in Guangzhou, China. The results of exploratory and confirmatory factor analyses validated the 5-factor model (motivation, belief, self-revelation, persistence, and insight) in both groups. The scale also demonstrated good internal consistency. Furthermore, the CFPPS exhibited small or no associations with pre-treatment sleep problems, depression symptoms, or anxiety symptoms but was a significant predictor of working alliance and psychological benefit in therapy. The capacity for the psychotherapy process among younger adolescents was lower than that among older adolescents. The CFPPS appears to be a reliable and validated instrument for measuring the capacity for the psychotherapy process among adolescent outpatients in China. Therapists should provide therapy tailored to the Chinese adolescents' capacity. Future studies are needed to examine the predictive utility of the CFPPS for the whole sessions of the psychotherapy.

School-aged children with higher anxiety symptoms show greater correspondence between subjective negative emotions and autonomic arousal

Individuals exhibit variability in the degree of correspondence between autonomic and subjective indicators of emotional experience. The current study examined whether convergence between autonomic arousal and negative emotions during emotion-inducing story vignettes is associated with internalizing symptoms in school-aged children. A diverse sample of 97 children aged 8 to 12 years participated in this study in which they reported on their anxiety and depression. Children's electrodermal activity was assessed while they read vignettes depicting children experiencing sadness and fear. Participants also reported on their emotional reaction to the vignettes. Children's anxiety and electrodermal activity to fear vignettes were associated only at high levels, but not mean or low levels, of self-reported negative emotions to fear vignettes. These findings suggest that hyperawareness, in which self-reported negative emotionality is high when physiological reactivity is also high, is associated with greater risk for anxiety, but not depression, during middle childhood.

Meta-mood knowledge moderates the relationship between neuroticism and depression but not between neuroticism and anxiety in a sample of nonclinical adolescents

Research shows a strong link between neuroticism and internalizing psychopathology, such as depression and anxiety. However, it is unclear to what extent meta-mood knowledge (i.e., attention to emotion and emotional clarity) plays a role as a moderator in this relationship. To investigate this, we collected data on meta-mood knowledge, personality traits, depression, and anxiety in a sample of adolescents (N = 244; 53.7% girls) aged 12 to 18 years (M = 14.6, SD = 1.7) from Catalonia, Spain. Regarding the relationship between neuroticism and depression, results showed that emotional clarity buffered this relationship. Although attention to emotion did not, the joint moderating effect of attention to emotion and emotional clarity was significant. The results on the four different combinations of attention to emotion and emotional clarity showed that the relationship between neuroticism and depression was strongest for high attention and low clarity, less strong for low attention and low clarity, and even lower for high attention and high clarity. And importantly, these similar patterns of association disappeared at low attention and high clarity. In contrast to the relationship between neuroticism and depression, we found no statistically significant moderating effects for the relationship between neuroticism and anxiety. Based on these results, we argue the importance of examining individual differences in emotion-based cognition and understanding when the benefits of emotional clarity are associated with fewer disadvantages of excessive attention. These results provide preliminary evidence that the combination of low attention and high clarity may be an adaptive version of emotional self-awareness in relation to neuroticism and depression.

Self and Other Mentalizing Polarities and Dimensions of Mental Health: Association With Types of Symptoms, Functioning and Well-Being

Research suggests that the ability to understand one's own and others' minds, or mentalizing, is a key factor for mental health. Most studies have focused the attention on the association between global measures of mentalizing and specific disorders. In contrast, very few studies have analyzed the association between specific mentalizing polarities and global measures of mental health. This study aimed to evaluate whether self and other polarities of mentalizing are associated with a multidimensional notion of mental health, which considers symptoms, functioning, and well-being. Additionally, the level or depth of mentalizing within each polarity was also analyzed. A sample of 214 adolescents (12-18 years old, M = 14.7, and SD = 1.7; 53.3% female) was evaluated on measures of self- (Trait Meta-Mood Scale or TMMS-24) and other- mentalizing (Adolescent Mentalizing Interview or AMI), multi-informed measures of psychopathology and functioning based on Achenbach's system, and measures of psychological well-being (self-esteem, happiness, and motivation to life goals). Results revealed no association between mentalizing polarities and higher-order symptom factors (internalizing, externalizing, and global symptoms or "p" factor). Self-mentalizing was associated with self-esteem (B = 0.076, p < 0.0005) and motivation to life goals (B = 0.209, p = 0.002), and other-mentalizing was associated to general, social and role functioning (B = 0.475, p < 0.0005; B = 0.380, p = 0.005; and B = 0.364, p = 0.004). This association between aspects of self-other mentalizing and self-other function has important implications for treatment and prevention. Deeper mentalizing within each polarity (i.e., comprehension beyond simple attention to one's own mental states, and mentalizing referred to attachment figures vs. mentalizing referred to the characters of a story) revealed stronger associations with functioning and well-being. Because mentalizing polarities are associated with functioning and well-being but not with symptoms, a new hypothesis is developed: mentalizing does not contribute to resiliency by preventing symptoms, but by helping to deal with them, thus improving functioning and well-being independently of psychopathology. These findings support that promoting mentalizing across development may improve mental health, even in non-clinical population.