1
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Halldorsson B, Waite P, Harvey K, Pearcey S, Creswell C. In the moment social experiences and perceptions of children with social anxiety disorder: A qualitative study. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:53-69. [PMID: 36214425 PMCID: PMC10091697 DOI: 10.1111/bjc.12393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 08/26/2022] [Accepted: 09/07/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Childhood social anxiety disorder (SAD) is a common and disabling condition. General forms of cognitive behavioural treatments have demonstrated poorer efficacy for childhood SAD when compared to other childhood anxiety disorders and further understanding of the psychological factors that contribute to the maintenance of childhood SAD is warranted. Examining the social experiences of children with SAD may help to identify relevant psychological factors and increase our understanding of what keeps childhood SAD going. METHODS The current study used reflexive thematic analysis to analyse the transcripts of interviews with 12 children aged 8-12 years with SAD who had been interviewed about their 'in the moment' social experiences during a social stress induction task. The interview topic guide included factors hypothesized to maintain SAD in adult cognitive models of the disorder. RESULTS The interviews revealed both variety and commonalities in the experiences and interpretations of social events in children with SAD, captured in three related main themes: (i) Discomfort being the centre of attention, (ii) (Lack of) awareness of cognitions and (iii) Managing social fears. Findings indicated likely developmental influences on which maintenance mechanisms apply at which point in time. CONCLUSIONS There is variation in the psychological mechanisms that children with SAD endorse and developmental factors are likely to influence when specific mechanisms are relevant. We now need further studies that take a developmentally informed approach to understand the nature of the association between the factors identified in this study and social anxiety in childhood to inform the development of more effective interventions for childhood SAD.
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Affiliation(s)
- Brynjar Halldorsson
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,Oxford Health NHS Foundation Trust, Oxford, UK.,Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Polly Waite
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Kate Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Samantha Pearcey
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
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2
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Gittins Stone DI, Elkins RM, Gardner M, Boger K, Sperling J. Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01500-5. [PMID: 36749490 PMCID: PMC9902833 DOI: 10.1007/s10578-023-01500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.
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Affiliation(s)
| | - R Meredith Elkins
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - Kathryn Boger
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Jacqueline Sperling
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
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3
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Savaglio M, Yap MB, O'Donnell R, Skouteris H. Targeted community-based programmes for children's mental health: A systematic review and meta-analysis of the Australian literature. Aust N Z J Psychiatry 2023; 57:197-212. [PMID: 36113092 DOI: 10.1177/00048674221124506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE No synthesis of the Australian evidence regarding targeted prevention and early intervention for mental health concerns among young children exists. This review aimed to (1) describe the types of targeted community-based mental health programmes evaluated in Australia to support children aged 1-9 years exhibiting internalising and/or externalising symptoms and (2) examine their impact on children's internalising and externalising symptoms and disorder diagnosis. METHOD A systematic review and meta-analysis was conducted (PROSPERO: CRD42021255257). Four databases (PsycINFO, PsycArticles, MEDLINE and CINAHL) were searched for Australian studies published in the past 10 years that quantitatively evaluated the impact of a targeted programme on children's mental health. The National Institute of Health Quality Assessment Tools were used to evaluate the study quality. RESULTS Forty-two studies were included; the majority (67%) were medium quality. The mean sample size was 142 (SD = 170), children's average age was 5.78 years (SD = 2.44) and 58% were male. Aboriginal and Torres Strait Islander children were underrepresented. Studies evaluated 16 programmes that targeted (1) externalising symptoms (n = 20 studies, n = 6 programmes), (2) internalising symptoms (n = 14 studies, n = 7 programmes) or (3) both, termed transdiagnostic programmes (n = 8 studies, n = 3 programmes). Externalising programmes achieved a significant moderate mean reduction in externalising behaviours (standardised mean differences = -0.56), internalising programmes yielded a small mean improvement in anxiety symptoms (standardised mean differences = -0.25) and 57% reduced odds of anxiety disorder diagnosis. Evidence supporting transdiagnostic programmes was inconclusive. CONCLUSION Parenting-focused programmes targeting young children's internalising or externalising behaviours have the largest local evidence base supporting their effectiveness. Limitations include a lack of engagement with fathers, triangulation of outcomes, homogeneity and implementation reporting. Greater implementation and evaluation of community-driven integrated and systemic approaches that identify, engage and support Australia's most disadvantaged cohorts of young children and their families are needed.
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Affiliation(s)
- Melissa Savaglio
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Marie Bh Yap
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Renee O'Donnell
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Helen Skouteris
- Health and Social Care Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.,Warwick Business School, University of Warwick, Coventry, UK
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4
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O'Shannessy DM, Waters AM, Donovan CL. Feasibility of an Intensive, Disorder-Specific, Group-Based Cognitive Behavioural Therapy Intervention for Adolescents with Social Anxiety Disorder. Child Psychiatry Hum Dev 2023; 54:546-557. [PMID: 34669067 PMCID: PMC8526989 DOI: 10.1007/s10578-021-01265-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
This study examined the preliminary acceptability and efficacy of an intensive, group-based, disorder-specific cognitive behavioural therapy (CBT) intervention for adolescents with social anxiety disorder (SAD). Fourteen Australian adolescents with SAD (78.6% female, M age = 13.93 years) and their parents completed the program plus measures of treatment satisfaction, and provided feedback. Clinical interviews and surveys were administered pre-treatment, post-treatment, and at 6-month follow-up to determine diagnostic status and assess related variables. Post-treatment satisfaction scores were very high for adolescents and parents. Post-treatment, 32.3% of participants no longer met criteria for SAD diagnosis, increasing to 42.9% at follow-up. Participants showed sizeable reductions in comorbid diagnoses, significant improvements in global functioning, social anxiety symptoms, and internalising symptoms from pre- to post-treatment (maintained at follow-up), and significant improvements in social skills and social competence from pre-treatment to follow-up. This study supports the use of an intensive CBT program for adolescents with SAD.
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Affiliation(s)
- Dustin M O'Shannessy
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia.
| | - Allison M Waters
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia
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5
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A Pilot Feasibility Study of an Intensive Summer Day Camp Intervention for Children with Selective Mutism. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111732. [PMID: 36421181 PMCID: PMC9689151 DOI: 10.3390/children9111732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Cost, scheduling, and implementation competency are barriers to accessing traditional evidence-based behavioral interventions for childhood selective mutism (SM). Brief, or intensive, interventions are a disruptive innovation to traditional therapy given the use of fewer sessions during a short-term time period. This study explored the acceptability, integrity, and effectiveness (i.e., single-case replicated AB design) of an intensive summer camp consisting of a 5-day behavioral therapy for 25 children with SM. Caregiver-rated treatment acceptability ratings and family interviews support intensive summer day camp as an acceptable intervention approach for SM. Additionally, results revealed that counselors and parents implemented SM behavioral therapy during camp with impressive integrity (>90%) after receiving training about SM behavioral therapy from an SM expert clinician. Effect size calculations of counselor-rated daily behavior ratings revealed reductions in anxiety during camp for 18 of the 25 campers. Significant caregiver-rated improvements in speaking behaviors were reported for 9 out of 14 campers with data available for analysis at the 3-month follow-up. This pilot feasibility study is the first to investigate intensive summer day camp as a treatment approach for SM and implications for future research are discussed.
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6
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Diagnosis-Specific Group CBT Treating Social Anxiety in Adolescents: A Feasibility Study. Scand J Child Adolesc Psychiatr Psychol 2022; 10:89-101. [PMID: 36133734 PMCID: PMC9454321 DOI: 10.2478/sjcapp-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Social anxiety disorder (SAD) is one of the most common anxiety disorders among adolescents. It is associated with extensive distress and negative long-term consequences. Generic cognitive behavioral therapy (CBT) is one of the preferred treatments for anxiety disorders, but it has shown poorer outcome for adolescents with SAD than for other anxiety disorders. Aim As preparation for a randomized controlled trial the aim of the present study was to examine the feasibility of an adjusted diagnosis-specific CBT group intervention for adolescents with SAD, and provide preliminary information on adolescent and family outcomes. Method Thirteen adolescents (age 12-17 years) diagnosed with SAD received a group therapy version of the Cool Kids Anxiety Program, Social Enhanced (CK-E), a program developed at Macquarie University, Sydney, Australia. The treatment is a diagnosis-specific manualized CBT treatment for adolescents with SAD. Semi-diagnostic interviews and questionnaires were completed at baseline, post, 3-month follow-up and 1-year follow-up. Results Thirteen adolescents participated with no drop-outs. Most families attended all 10 intervention sessions. The families were generally satisfied with the treatment and would recommend it to others in need. Preliminary outcomes showed that participants had marked improvements in their anxiety symptoms and life interference, with significant medium to large baseline-post effect sizes durable at 1-year follow-up. Two of the adolescents were free of their SAD diagnosis at 3-month follow-up. Conclusion Results from this feasibility study indicate that the Danish-translated and revised version of Cool Kids Anxiety Program - Social Enhanced could be a feasible intervention for Danish adolescents with SAD. The intervention will be investigated further in a randomized controlled trial.
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7
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Hudson K, Fenley AR, Pincus DB, Leyfer O. Intensive Cognitive-Behavioral Therapy for Anxiety Disorders in Adolescents: A Case Study. Clin Case Stud 2022. [DOI: 10.1177/15346501221113523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anxiety disorders are one of the most common psychiatric conditions in youth and can contribute to impairment in social, academic, and family functioning. Cognitive-behavioral therapy (CBT) has been shown to be efficacious in treating youth anxiety disorders; however, for a multitude of reasons, fewer than 20% of adolescents with anxiety disorders receive services for anxiety-related problems. Intensive treatments, which rely on the same traditional components of CBT but are delivered over a shorter period of time or in a fewer number of sessions, may be particularly helpful for anxiety disorders and can offer a number of advantages over standard CBT. Despite emerging evidence supporting the advantages of the intensive approach, there are few established intensive treatment programs for youth with anxiety disorders. Further, no treatment to date has comprehensively targeted the entire spectrum of comorbid adolescent anxiety disorders in a combined intensive and transdiagnostic format, even though non-intensive (i.e., weekly delivered) CBT has been tested using a transdiagnostic approach. We developed an intensive, six-session intervention based on Angelosante and colleagues’ 2009 The Adolescent Panic Control Treatment with In-Vivo Exposures (Angelosante et al., 2009) and other empirically-supported treatments for youth to target all anxiety disorders in adolescents. We present a case study on an adolescent with multiple comorbid anxiety and related disorders who received intensive CBT treatment as a way to illustrate the clinical benefit and utility of an intensive, transdiagnostic approach. Findings support the acceptability and feasibility of transdiagnostic treatment of youth anxiety.
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Affiliation(s)
- Kelsey Hudson
- Climate Psychology Alliance of North America, New York, NY, USA
| | - Alicia R. Fenley
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - Donna B. Pincus
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - Ovsanna Leyfer
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
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8
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Waters AM, Sluis RA, Farrell LJ, Donovan CL, Elvin OM, Rossow N, van den Muyzenberg J, Dowell TL, Ryan KM, Finch J, Usher W, Modecki KL, Zimmer-Gembeck MJ, Spence SH. Examining the Process of Implementing a Three-Step Mental Health and Wellbeing System of Care for Children and Adolescents Across Multiple Community Settings. Child Psychiatry Hum Dev 2022; 53:822-839. [PMID: 33966149 DOI: 10.1007/s10578-021-01184-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2021] [Indexed: 02/05/2023]
Abstract
Mental health problems affect large numbers of young people. Integrated systems are required that can be applied in diverse settings to reach youth 'where they are'. We evaluated the process of implementing a three-step youth mental health and wellbeing system in diverse community settings according to three implementation outcomes: feasibility, penetration and acceptability. The study describes 49 applications of the 'Life-Fit-Learning system' designed to assess the mental health and wellbeing of youth (Assess step), provide feedback on assessment results (Reflect step), and connect them to resources and services proportionate to their needs (Connect step). Within a participatory research approach, 3798 administrations were conducted with youth between 9 and 18 years and 90 administrations were conducted with adults. Implementation was based on the four phases of the Quality Implementation Framework and was staged to integrate stakeholder and consumer feedback and experience gained from focus groups and two pilot phases before full implementation. Feasibility ratings of successful implementation ranged from 86.7 to 96.4% across applications and settings. High penetration rates were achieved. The Life-Fit-Learning system successfully reached 91.9% to 96% of youth with the Assess and Reflect steps and low intensity Connect step resources. Of those, 14.7% to 23% were identified at-risk for mental health problems and 93% to 97% of those at-risk youth additionally received Connect step co-delivered group-based programs (moderate intensity care) and/or individual treatment (high intensity care). Youth and parents reported high satisfaction across all steps and delivery modes. With strong collaboration, an integrated model of care can be delivered feasibly, effectively and satisfactorily to reach large numbers of young people across settings.
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Affiliation(s)
- Allison M Waters
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia.
| | - Rachel A Sluis
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Lara J Farrell
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Olivia M Elvin
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Nicolas Rossow
- e-Research Services, Griffith University, Mt Gravatt, Australia
| | | | - Tiah L Dowell
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Katherine M Ryan
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Jules Finch
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Wayne Usher
- School of Education and Professional Studies, Griffith University, Mt Gravatt, Australia
| | - Kathryn L Modecki
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Melanie J Zimmer-Gembeck
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
| | - Susan H Spence
- School of Applied Psychology, Griffith University, 176 Messines Ridge Road, Mt Gravatt, QLD, 4122, Australia
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9
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Dowell TL, Waters AM, Usher W, Farrell LJ, Donovan CL, Modecki KL, Zimmer-Gembeck MJ, Castle M, Hinchey J. Tackling Mental Health in Youth Sporting Programs: A Pilot Study of a Holistic Program. Child Psychiatry Hum Dev 2021; 52:15-29. [PMID: 32246362 DOI: 10.1007/s10578-020-00984-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Linking mental health services to organised sport offers an avenue to identify and improve mental health among adolescents. In this study, we investigated the efficacy, acceptability and feasibility of an integrated mental health system embedded within a junior sports development program. A three-step integrated mental health program for 12- to 15-year-old rugby league players (N = 74) was delivered in urban (n = 44) and rural (n = 33) areas. Specifically, this system (a) assessed participant mental health on primary outcome measures of anxiety, depression, and anger/conduct problems (and secondary outcome measures of personal attributes and relationships), (b) provided feedback to participants, parents and program coordinators, and (c) connected participants and parents to a multi-component intervention including online resources, a group-based workshop program (4 × 30-min sessions), and tailored individual-level follow-up and referral to further care for participants at high risk of mental health problems. From pre- to post-program, boys' anxiety symptoms declined significantly (with only a trend-level reduction in depression), and there were significant improvements in grit (for urban boys only), efficacy to manage negative emotions, and prosocial behaviour. In addition, when boys reported symptoms associated with high risk for mental health problems, providing parents with feedback enhanced boys' access to care and was associated with significant declines in anxiety symptoms. The program was generally acceptable and feasible, with very high retention in the youth sports development program. Overall, early findings support further deployment and evaluation of integrated mental health systems embedded within sporting contexts to address mental health problems among adolescent boys.
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Affiliation(s)
- Tiah L Dowell
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia.
| | - Wayne Usher
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Lara J Farrell
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
| | - Kathryn L Modecki
- School of Applied Psychology, Griffith University, Mount Gravatt, Australia
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10
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Waters AM, Groth TA, Purkis H, Alston‐knox C. Predicting outcomes for anxious children receiving group cognitive‐behavioural therapy: Does the type of anxiety diagnosis make a difference? CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12128] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Allison M. Waters
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia,
| | - Trisha A. Groth
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia,
| | - Helena Purkis
- School of Applied Psychology, Griffith University, Brisbane, Queensland, Australia,
| | - Clair Alston‐knox
- College of Griffith Social and Behavioural Research College, Griffith University, Brisbane, Queensland, Australia,
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11
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Wootton BM, Macgregor A. Accelerated outpatient individual cognitive‐behaviour therapy for panic disorder: A case study. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Bethany M. Wootton
- Department of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia,
- School of Behavioural, Cognitive and Social Sciences, University of New England, Armidale, New South Wales, Australia,
| | - Amy Macgregor
- Department of Medicine (Psychology), University of Tasmania, Hobart, Tasmania, Australia,
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12
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Held P, Bagley JM, Klassen BJ, Pollack MH. Intensively Delivered Cognitive-Behavioral Therapies: An Overview of a Promising Treatment Delivery Format for PTSD and Other Mental Health Disorders. Psychiatr Ann 2019. [DOI: 10.3928/00485713-20190711-01] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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13
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Halldorsson B, Castelijn S, Creswell C. Are children with social anxiety disorder more likely than children with other anxiety disorders to anticipate poor social performance and reflect negatively on their performance? J Affect Disord 2019; 245:561-568. [PMID: 30445381 DOI: 10.1016/j.jad.2018.11.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 08/14/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The cognitive theory of social anxiety disorder (SAD) suggests that adults with SAD have a tendency to anticipate poor social performance and reflect negatively on their performance following a social event. While a number of studies with socially anxious adults have supported the role of poor performance anticipation and post-event rumination in SAD, to date, only a few studies have addressed whether this also applies to children with SAD. METHODS Children (7-12 years) diagnosed with SAD (n = 40), other anxious children (n = 40) and non-anxious children (n = 34) were exposed to a social stressor speech task and their pre- and post-performance appraisals assessed, taking into account objective performance ratings. RESULTS Although observers rated some aspects of performance as significantly worse among children with SAD than children with other anxiety disorders, children with SAD were not more likely than their anxious or non-anxious peers to show a general bias in pre- or post-performance appraisals. Furthermore, children with SAD were just as likely as their anxious and non-anxious peers to recognize good performance but were more critical of themselves when their performance was poor. LIMITATIONS The speech task did not involve a same-age peer. Participants were relatively affluent group of predominantly non-minority status. Specificity for SAD in relation to other anxiety disorders remains unclear. CONCLUSIONS Focusing on counteracting pre- and post-event social performance appraisals may potentially be inappropriate for childhood SAD. Children with SAD might benefit from interventions that focus on helping them to become less critical of themselves after social interactions have not gone well.
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Affiliation(s)
- Brynjar Halldorsson
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK.
| | - Saskia Castelijn
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK
| | - Cathy Creswell
- School of Psychology & Clinical Language Sciences, University of Reading, Reading RG6 6AL, UK
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14
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Spence SH. Assessing anxiety disorders in children and adolescents. Child Adolesc Ment Health 2018; 23:266-282. [PMID: 32677290 DOI: 10.1111/camh.12251] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Given the relatively high prevalence of anxiety problems among young people and their adverse consequences if left untreated, it is important that clinicians and researchers have access to reliable and valid assessment tools to facilitate early detection, case formulation, treatment design and evaluation of outcomes. METHOD This paper presents the findings of a pragmatic review of the literature regarding the assessment of anxiety in young people in multiple contexts, including mental health services, school-based screening and research trials. RESULTS Commonly used diagnostic interviews, questionnaire measures and alternative assessment methods are described, along with psychometric properties and practical issues. The review indicates the complexities of assessing anxiety problems given the high level of comorbidity between anxiety disorders and with depression. It also highlights the different approaches required for assessment across different age groups, the need for multiple informants and issues relating to the lack of agreement between reporters. There is a strong evidence-base for several diagnostic instruments and anxiety scales, although the accuracy of youth and parent report scales in forming clinical diagnoses is not sufficiently strong to justify their use in isolation for diagnostic purposes. CONCLUSIONS The assessment of youth anxiety should ideally include a multiinformant, multimethod approach, with measures tailored to the age of the child, and the purpose of the evaluation. There is now a sufficiently strong research base to enable clinicians and researchers to ensure that they select evidence-based instruments.
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Affiliation(s)
- Susan H Spence
- Australian Institute for Suicide Research and Prevention and School of Applied Psychology, Griffith University, Mt Gravatt, Australia
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15
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Comparison of the Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR): Reducing Anxiety Symptoms. WOMEN’S HEALTH BULLETIN 2018. [DOI: 10.5812/whb.60585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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16
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Comparison of the Effectiveness of Cognitive Behavioral Therapy and Neurofeedback: Reducing Anxiety Symptoms. ARCHIVES OF NEUROSCIENCE 2018. [DOI: 10.5812/archneurosci.62341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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17
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Halldorsson B, Draisey J, Cooper P, Creswell C. Symptoms of social anxiety, depression, and stress in parents of children with social anxiety disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 57:148-162. [DOI: 10.1111/bjc.12170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/02/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Brynjar Halldorsson
- School of Psychology and Clinical Language Sciences; University of Reading; UK
| | - Jenny Draisey
- School of Psychology and Clinical Language Sciences; University of Reading; UK
| | - Peter Cooper
- School of Psychology and Clinical Language Sciences; University of Reading; UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences; University of Reading; UK
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Dowell T, Donovan CL, Farrell LJ, Waters AM. Treatment of Anxiety in Children and Adolescents. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/s40501-018-0136-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Halldorsson B, Creswell C. Social anxiety in pre-adolescent children: What do we know about maintenance? Behav Res Ther 2017; 99:19-36. [PMID: 28881221 DOI: 10.1016/j.brat.2017.08.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 08/18/2017] [Accepted: 08/28/2017] [Indexed: 10/18/2022]
Abstract
The cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, yet it remains unknown if, or to what extent, the same cognitive and behavioral maintenance mechanisms that occur in adult SAD also apply to SAD among pre-adolescent children. In contrast to the adult literature, current models of SAD in children mostly account for etiology and maintenance processes are given limited attention. Consequently, their clinical utility for the treatment of SAD in children may be limited. This narrative review, first, critically examines the different theoretical conceptualizations of the maintenance of social anxiety in the child and adult literature and illustrates how these have resulted in different treatment approaches and clinical understanding. Second, it reviews the available evidence relating to hypotheses about the maintenance of SAD in children as derived from adult cognitive and etiological models. Third, it highlights the need to attend directly to child specific maintenance mechanisms in SAD, to draw on cognitive theory, and to account for the influence of childhood-specific contextual (e.g. family and school-based interactions) and developmental factors on children's social experiences.
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Affiliation(s)
- Brynjar Halldorsson
- School of Psychology and Clinical Language Sciences, University of Reading, UK.
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, UK
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Working with parents to treat anxiety-disordered children: A proof of concept RCT evaluating Fear-less Triple P. Behav Res Ther 2017. [DOI: 10.1016/j.brat.2017.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Spence SH, Donovan CL, March S, Kenardy JA, Hearn CS. Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: A randomized controlled trial using internet delivery. Behav Res Ther 2016; 90:41-57. [PMID: 27988427 DOI: 10.1016/j.brat.2016.12.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/14/2016] [Accepted: 12/05/2016] [Indexed: 12/01/2022]
Abstract
The study examined whether the efficacy of cognitive behavioral treatment for Social Anxiety Disorder for children and adolescents is increased if intervention addresses specific cognitive and behavioral factors linked to the development and maintenance of SAD in young people, over and above the traditional generic CBT approach. Participants were 125 youth, aged 8-17 years, with a primary diagnosis of SAD, who were randomly assigned to generic CBT (CBT-GEN), social anxiety specific CBT (CBT-SAD) or a wait list control (WLC). Intervention was delivered using a therapist-supported online program. After 12-weeks, participants who received treatment (CBT-SAD or CBT-GEN) showed significantly greater reduction in social anxiety and post-event processing, and greater improvement in global functioning than the WLC but there was no significant difference between CBT-SAD and CBT-GEN on any outcome variable at 12-weeks or 6-month follow-up. Despite significant reductions in anxiety, the majority in both treatment conditions continued to meet diagnostic criteria for SAD at 6-month follow-up. Decreases in social anxiety were associated with decreases in post-event processing. Future research should continue to investigate disorder-specific interventions for SAD in young people, drawing on evidence regarding causal or maintaining factors, in order to enhance treatment outcomes for this debilitating condition.
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Affiliation(s)
- Susan H Spence
- Australian Institute of Suicide Research and Prevention (AISRAP) and School of Applied Psychology, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, QLD, 4122, Australia
| | - Sonja March
- School of Psychology and Counselling & Institute for Resilient Regions, University of Southern Queensland, Springfield, QLD, Australia, 4300
| | - Justin A Kenardy
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Cate S Hearn
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, QLD, 4122, Australia
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Kendall PC, Makover H, Swan A, Carper MM, Mercado R, Kagan E, Crawford E. What steps to take? How to approach concerning anxiety in youth. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2016. [DOI: 10.1111/cpsp.12156] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Farrell LJ, Oar EL, Waters AM, McConnell H, Tiralongo E, Garbharran V, Ollendick T. Brief intensive CBT for pediatric OCD with E-therapy maintenance. J Anxiety Disord 2016; 42:85-94. [PMID: 27395805 DOI: 10.1016/j.janxdis.2016.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 06/04/2016] [Accepted: 06/15/2016] [Indexed: 12/21/2022]
Abstract
Cognitive behaviour therapy (CBT), incorporating exposure and response prevention (ERP), has received strong empirical support for the treatment of paediatric OCD, and moreover, is considered the first line treatment of choice (Geller & March, 2012). However, despite the availability of effective treatments for this chronic and debilitating disorder, only a small proportion of youth receive these evidence-based approaches. The present study aimed to examine the effectiveness of an intensive ERP-based treatment for youth OCD, using a multiple baseline controlled design. Children and youth (N=10; aged 11-16 years) with a primary diagnosis of OCD were randomly assigned to a 1- or 2-week baseline monitoring condition followed by the intervention. The efficacy of the intensive treatment, involving 1 session psychoeducation, 2-sessions ERP plus e-therapy maintenance was examined across parent- child- and clinician-rated measures at post-treatment and 6-month follow-up. Overall, there were significant reductions across time on almost all measures (except self-report anxiety), and moreover, the majority of the sample (80%) were considered reliably improved, and meeting clinically significant change. At post-treatment, 60% were in remission of symptoms, and at 6-month follow-up this increased to 70%. These findings provide strong support for intensive, time-limited approaches to ERP-based CBT for children and youth with OCD.
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Affiliation(s)
- Lara J Farrell
- School of Applied Psychology and Menzies Health Institute QLD, Griffith University, Australia.
| | - Ella L Oar
- School of Applied Psychology and Menzies Health Institute QLD, Griffith University, Australia
| | - Allison M Waters
- School of Applied Psychology and Menzies Health Institute QLD, Griffith University, Australia
| | - Harry McConnell
- School of Medicine and Menzies Health Institute QLD, Griffith University, Australia
| | - Evelin Tiralongo
- School of Pharmacy and Menzies Health Institute QLD, Griffith University, Australia
| | | | - Thomas Ollendick
- Child Study Centre, Department of Psychology, Virginia Polytechnic Institute and State University, USA
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Abstract
Anxiety disorders occur frequently, and can have a negative impact on the quality of people's lives. They often begin at an early age and can have some serious consequences. This article is an overview of the recent studies concerning group cognitive-behavioral interventions for anxiety disorders. In the last few years, anxiety disorder prevention for children and adolescents has become an important focus of research work. Group prevention programs are based on standard cognitive behavioral therapy (CBT) strategies and are aimed at preventing anxiety disorders as early as possible. Numerous cognitive behavioral group therapies for children as well as adults have been well studied. There are many CBT protocols that have been developed for treating specific anxiety disorders. Now, specialized CBT programs are available for individuals who suffer from different anxiety disorders, enabling them to be treated together in groups.
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Affiliation(s)
- Laure Wolgensinger
- Pôle de Psychiatrie de I'Enfant et de I'Adolescent, Centre Hospitalier de Rouffach, France
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