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Bertie LA, Arendt K, Coleman JRI, Cooper P, Creswell C, Eley TC, Hartman C, Heiervang ER, In-Albon T, Krause K, Lester KJ, Marin CE, Nauta M, Rapee RM, Schneider S, Schniering C, Silverman WK, Thastum M, Thirlwall K, Waite P, Wergeland GJ, Hudson JL. Patterns of sub-optimal change following CBT for childhood anxiety. J Child Psychol Psychiatry 2024. [PMID: 38817012 DOI: 10.1111/jcpp.14009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/02/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Children and adolescents demonstrate diverse patterns of symptom change and disorder remission following cognitive behavioural therapy (CBT) for anxiety disorders. To better understand children who respond sub-optimally to CBT, this study investigated youths (N = 1,483) who continued to meet criteria for one or more clinical anxiety diagnosis immediately following treatment or at any point during the 12 months following treatment. METHODS Data were collected from 10 clinical sites with assessments at pre-and post-treatment and at least once more at 3, 6 or 12-month follow-up. Participants were assigned to one of three groups based on diagnostic status for youths who: (a) retained an anxiety diagnosis from post to end point (minimal responders); (b) remitted anxiety diagnoses at post but relapsed by end point (relapsed responders); and (c) retained a diagnosis at post but remitted to be diagnosis free at end point (delayed responders). Growth curve models assessed patterns of change over time for the three groups and examined predictors associated with these patterns including demographic, clinical and parental factors, as well as treatment factors. RESULTS Higher primary disorder severity, being older, having a greater number of anxiety disorders, having social anxiety disorder, as well as higher maternal psychopathology differentiated the minimal responders from the delayed and relapsed responders at the baseline. Results from the growth curve models showed that severity of the primary disorder and treatment modality differentiated patterns of linear change only. Higher severity was associated with significantly less improvement over time for the minimal and relapsed response groups, as was receiving group CBT, when compared to the delayed response group. CONCLUSIONS Sub-optimal response patterns can be partially differentiated using variables assessed at pre-treatment. Increased understanding of different patterns of change following treatment may provide direction for clinical decision-making and for tailoring treatments to specific groups of clinically anxious youth. Future research may benefit from assessing progress during treatment to detect emerging response patterns earlier.
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Affiliation(s)
- Lizel-Antoinette Bertie
- School of Psychology, UNSW, Sydney, NSW, Australia
- Department of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Kristian Arendt
- Department of Psychology, University of Aarhus, Aarhus, Denmark
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, & King's College London, London, UK
| | - Peter Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, & King's College London, London, UK
| | - Catharina Hartman
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Einar R Heiervang
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Tina In-Albon
- Clinical Child and Adolescent Psychology and Psychotherapy, Department of Psychology, University of Koblenz-Landau, Landau, Germany
| | - Karen Krause
- Mental Health Research and Treatment Center, Ruhr-Universtät Bochum, Bochum, Germany
| | | | - Carla E Marin
- Yale University, Child Study Center, New Haven, CT, USA
| | - Maaike Nauta
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald M Rapee
- Department of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universtät Bochum, Bochum, Germany
| | - Carolyn Schniering
- Department of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | | | - Mikael Thastum
- Department of Psychology, University of Aarhus, Aarhus, Denmark
| | - Kerstin Thirlwall
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Gro Janne Wergeland
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Jennifer L Hudson
- School of Psychology, UNSW, Sydney, NSW, Australia
- Department of Psychological Sciences, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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2
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Wake S, Hedger N, van Reekum CM, Dodd H. The effect of social anxiety on threat acquisition and extinction: a systematic review and meta-analysis. PeerJ 2024; 12:e17262. [PMID: 38737738 PMCID: PMC11088819 DOI: 10.7717/peerj.17262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 03/28/2024] [Indexed: 05/14/2024] Open
Abstract
Although exposure-based therapy has been found to be effective at alleviating symptoms of social anxiety disorder, it often does not lead to full remission, and relapse after treatment is common. Exposure therapy is based on theoretical principles of extinction of conditioned fear responses. However, there are inconsistencies in findings across experiments that have investigated the effect of social anxiety on threat conditioning and extinction processes. This systematic review and meta-analysis aimed to examine whether elevated levels of social anxiety are associated with abnormalities in threat conditioning and extinction processes. A second aim was to examine the sensitivity of various study designs and characteristics to detect social anxiety-related differences in threat conditioning and extinction. A systematic search was conducted, which identified twenty-three experiments for inclusion in the review. The findings did not demonstrate compelling evidence that high levels of social anxiety are associated with atypical threat conditioning or extinction. Further, when systematically examining the data, there was no convincing support that the use of a particular psychophysiological measure, subjective rating, or experimental parameter yields more consistent associations between social anxiety and conditioning processes during threat acquisition or extinction. Meta-analyses demonstrated that during threat extinction, the use of anxiety ratings as a dependent variable, socially relevant unconditioned stimuli, and a higher reinforcement schedule produced more detectable effects of social anxiety on compromised extinction processes compared to any other dependent variable (subjective or physiological) or experimental parameter. Overall, the results of this study suggest that social anxiety is not reliably related to deficits in conditioning and extinction processes in the context of laboratory-based Pavlovian conditioning paradigms.
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Affiliation(s)
- Shannon Wake
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Nicholas Hedger
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Carien M. van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, United Kingdom
| | - Helen Dodd
- University of Exeter, Exeter, United Kingdom
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Chen RJ, Nabila A, Gal Toth J, Stuhlmann H, Toth M. The chemokine XCL1 functions as a pregnancy hormone to program offspring innate anxiety. Brain Behav Immun 2024; 118:178-189. [PMID: 38428650 DOI: 10.1016/j.bbi.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 02/21/2024] [Accepted: 02/27/2024] [Indexed: 03/03/2024] Open
Abstract
Elevated levels of cytokines in maternal circulation increase the offspring's risk for neuropsychiatric disease. Because of their low homeostatic levels, circulating maternal cytokines during normal pregnancies have not been considered to play a role in fetal brain development and offspring behavior. Here we report that the T/NK cell chemotactic cytokine XCL1, a local paracrine immune signal, can function as a pregnancy hormone and is required for the proper development of placenta and male offspring approach-avoidance behavior. We found that circulating XCL1 levels were at a low pregestational level throughout pregnancy except for a midgestational rise and fall. Blunted elevation in maternal plasma XCL1 in dams with a genetic 5HT1A receptor deficit or following neutralization by anti-XCL1 antibodies increased the expression of tissue damage associated factors in WT fetal placenta and led to increased innate anxiety and stress reactivity in the WT male offspring. Therefore, chemokines like XCL1 may act as pregnancy hormones to regulate placenta development and offspring emotional behavior.
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Affiliation(s)
- Rosa J Chen
- Department of Pharmacology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Anika Nabila
- Department of Pharmacology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Judit Gal Toth
- Department of Pharmacology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Heidi Stuhlmann
- Cell and Developmental Biology, Weill Cornell Medicine, New York, NY 10065, USA
| | - Miklos Toth
- Department of Pharmacology, Weill Cornell Medicine, New York, NY 10065, USA.
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4
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Lisøy C, Neumer SP, Adolfsen F, Ingul JM, Potulski Rasmussen LM, Wentzel-Larsen T, Patras J, Sund AM, Ytreland K, Waaktaar T, Holen S, Askeland AL, Haug IM, Bania EV, Martinsen K. Optimizing indicated cognitive behavioral therapy to prevent child anxiety and depression: A cluster-randomized factorial trial. Behav Res Ther 2024; 176:104520. [PMID: 38522127 DOI: 10.1016/j.brat.2024.104520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 12/12/2023] [Accepted: 03/13/2024] [Indexed: 03/26/2024]
Abstract
Identifying effective components can lead to interventions that are less resource-intensive and better suited for real-world needs. In this 2×2×2 cluster-randomized factorial trial (clinicaltrials.gov NCT04263558), we investigated the effects of three components of an indicated, transdiagnostic CBT intervention for children: 1) Intervention Delivery Format (child group format versus a blended format with group sessions and automated web-based sessions), 2) Parental Involvement in the intervention (group-based versus psychoeducational brochure), and 3) a Measurement Feedback System (MFS; on versus off). The intervention was delivered at schools in a group-based format. The participants (N = 701 children) were school children (age 8-12 years) with elevated symptoms of anxiety or depression, and their parents. The main outcomes were self-reported (N = 633) and parent-reported (N = 725) symptoms of child anxiety and depression post-intervention. The secondary outcome was children's user satisfaction with the intervention. We did not find significant main or interaction effects of Delivery Format, Parental Involvement, or MFS on children's symptom levels. There were no significant effects on children's user satisfaction. Results were compatible with retaining the least resource intensive combination (i.e., blended format, parental brochure, no MFS) in an optimized intervention.
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Affiliation(s)
- Carina Lisøy
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway; Department of Psychology, University of Oslo, Harald Schjelderups hus Forskningsveien 3A, 0373, Oslo, Norway.
| | - Simon-Peter Neumer
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Frode Adolfsen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, UiT - The Arctic University of Norway (UiT Norges Arktiske Universitet, Det helsevitenskapelige Fakultet, RKBU Nord, Varemottak-MH, Plan 6, Sykehusv. 44 9019 Tromsø, Norway.
| | - Jo Magne Ingul
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU, RKBU Midt-Norge, 7491, Trondheim, Norway.
| | - Lene-Mari Potulski Rasmussen
- Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, UiT - The Arctic University of Norway (UiT Norges Arktiske Universitet, Det helsevitenskapelige Fakultet, RKBU Nord, Varemottak-MH, Plan 6, Sykehusv. 44 9019 Tromsø, Norway.
| | - Tore Wentzel-Larsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Joshua Patras
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU, RKBU Midt-Norge, 7491, Trondheim, Norway.
| | - Kristin Ytreland
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU, RKBU Midt-Norge, 7491, Trondheim, Norway.
| | - Trine Waaktaar
- Department of Psychology, University of Oslo, Harald Schjelderups hus Forskningsveien 3A, 0373, Oslo, Norway.
| | - Solveig Holen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Anne Liv Askeland
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway.
| | - Ida Mari Haug
- Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, UiT - The Arctic University of Norway (UiT Norges Arktiske Universitet, Det helsevitenskapelige Fakultet, RKBU Nord, Varemottak-MH, Plan 6, Sykehusv. 44 9019 Tromsø, Norway.
| | - Elisabeth Valmyr Bania
- Regional Centre for Child and Youth Mental Health and Child Welfare - Central Norway, Department of Mental Health, Norwegian University of Science and Technology (NTNU, RKBU Midt-Norge, 7491, Trondheim, Norway.
| | - Kristin Martinsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP Øst og Sør, Postboks 4623 Nydalen, 0405, Oslo, Norway; Department of Psychology, University of Oslo, Harald Schjelderups hus Forskningsveien 3A, 0373, Oslo, Norway.
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5
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Smárason O, Guzick AG, Goodman WK, Salloum A, Storch EA. Predictors and Moderators of Treatment Outcomes for Anxious Children Randomized to Computer-Assisted Cognitive Behavioral Therapy or Standard Community Care. J Child Adolesc Psychopharmacol 2023; 33:316-324. [PMID: 37861988 PMCID: PMC10616955 DOI: 10.1089/cap.2023.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
Introduction: Computer-assisted cognitive behavioral therapy (CCBT) for childhood anxiety disorders may aid the dissemination of CBT, while maintaining treatment fidelity. Although CCBT is an effective intervention, not everyone benefits equally from treatment. Identifying patient characteristics that predict who will benefit from treatment and to what extent can help with matching patients to suitable interventions, and allow researchers and clinicians to modify, and individualize, their treatment formats more effectively. Such predictors and moderators have not yet been examined for CCBT outcomes in anxious children and studies of more traditional treatment formats have yielded inconsistent results. Methods: Using data from a randomized clinical trial evaluating CCBT for children with anxiety disorders, this study examined predictors and moderators of treatment outcomes in a sample of 100 children (age: mean [M] = 9.82, standard deviation [SD] = 1.82), randomized to either CCBT (n = 49) or standard community care (n = 51). Potential predictors and moderators were identified from the literature and examined in stepwise multiple linear regression models, using posttreatment anxiety severity and global impairment as outcomes. Results: Parent-rated internalizing symptoms predicted posttreatment anxiety severity for both treatment groups. High pretreatment levels of anxiety severity predicted higher global impairment at posttreatment for the group receiving community care, but not for the CCBT group. Conclusion: Further research is needed to clarify which patient characteristics are associated with CCBT outcomes in a consistent way. ClinicalTrials.gov identifier: NCT01416805.
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Affiliation(s)
- Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, Florida, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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6
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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7
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Mobach L, Rapee RM, Klein AM. The Role of Distorted Cognitions in Mediating Treatment Outcome in Children with Social Anxiety Disorder: A Preliminary Study. Child Psychiatry Hum Dev 2023; 54:558-569. [PMID: 34674074 PMCID: PMC9977708 DOI: 10.1007/s10578-021-01268-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 11/30/2022]
Abstract
This study examined whether distorted cognition changes during cognitive behavioural therapy (CBT) in children (N = 61; aged 7-12) with social anxiety disorder (SAD) and whether changes in distorted cognition from pre- to post-treatment predict SAD at 6-month follow-up. Baseline distorted cognition was also examined as a predictor of post-treatment outcome. Multiple informant SAD-measures were obtained pre-treatment, post-treatment and at 6-month follow-up. Children reported on interpretation bias and dysfunctional beliefs. A decrease in interpretation bias and dysfunctional beliefs was prospectively related to greater SAD change between post-treatment and 6-month follow-up. Child-reported SAD-change at post-treatment predicted greater change in dysfunctional beliefs at 6-month follow-up. Higher baseline interpretation bias predicted greater change in SAD-severity at post-treatment. Children with greater distorted cognition reductions during treatment, showed greater treatment gains at 6-month follow-up. Children who do not show this reduction may require additional efforts focused on distorted cognition to maximally benefit from treatment.
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Affiliation(s)
- Lynn Mobach
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia.
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands.
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia
| | - Anke M Klein
- Department of Clinical Psychology, Behavioural Science Institute, Radboud University, Montessorilaan 3, 6525 HR, Nijmegen, the Netherlands
- Unit Developmental and Educational Psychology, Institute of Psychology, Leiden University, Leiden, the Netherlands
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8
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Goetz AR, Kennedy SM, Kook M, Guzick AG, Nwankwo GNA, Hana LM, Schneider SC, Cepeda SL, Weinzimmer SA, Shah AA, Goodman WK, Salloum A, Ehrenreich-May J, Storch EA. Examining the Effectiveness of the Transdiagnostic Unified Protocol for Emotional Disorders Delivered to Youth Following Hurricane Harvey. CHILD & YOUTH CARE FORUM 2023. [DOI: 10.1007/s10566-023-09740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
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9
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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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10
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Bailey AP, Castellano G, Aleman A. Exercise for the treatment of anxiety in children and adolescents. Hippokratia 2022. [DOI: 10.1002/14651858.cd014426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alan P Bailey
- Orygen; Melbourne Australia
- Centre for Youth Mental Health; University of Melbourne; Melbourne Australia
| | | | - Alicia Aleman
- Preventive Medicine; School of Medicine - University of Uruguay; Montevideo Uruguay
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11
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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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Rapee RM, McLellan LF, Carl T, Trompeter N, Hudson JL, Jones MP, Wuthrich VM. Comparison of Transdiagnostic Treatment and Specialized Social Anxiety Treatment for Children and Adolescents With Social Anxiety Disorder: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2022; 62:646-655. [PMID: 35987298 DOI: 10.1016/j.jaac.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Pediatric social anxiety disorder consistently shows the poorest treatment response of all anxiety disorders. The current study compared a generic cognitive-behavioral therapy (CBT) treatment for pediatric anxiety against a modified (social anxiety) treatment that incorporated specific components to target theoretically important maintaining processes. METHOD A total of 200 children and adolescents (mean age = 9.5 years, SD = 2.2 years; 47% boys) diagnosed with social anxiety disorder as either their principal or additional disorder were randomly allocated to either the generic or the modified treatment. Both treatments were based on a manualized, empirically validated program (Cool Kids) and comprised 10 sessions over 12 weeks. Assessments comprised structured diagnostic interview and parent and youth reports, and covered diagnoses, symptoms, life impairment, and assessment of maintaining processes at post-treatment and 6-month follow-up. RESULTS The treatments did not differ significantly on the primary outcome (remission of social anxiety disorder) at either post-treatment (remission in generic = 41%; modified = 44%) or follow-up (remission in generic = 51%; modified = 69%), although the latter approached significance (p = .08). They also did not differ at either time point on most secondary measures of outcome. The only maintaining process that changed more under modified treatment was attention to the current task. CONCLUSION Despite some positive hints in the data, there was little evidence that the modified intervention significantly improved treatment of pediatric social anxiety disorder, despite incorporating strategies to address putative maintaining mechanisms. The similar improvement between treatments on most maintaining processes suggests that new and innovative strategies may be needed to better target these processes. CLINICAL TRIAL REGISTRATION INFORMATION Efficacy of Cognitive Behavioural Treatment for Socially Anxious Youth; https://www.anzctr.org.au/; 12616001065482.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Lauren F McLellan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Talia Carl
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia; Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Michael P Jones
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
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13
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Baartmans JMD, van Steensel FJA, Klein AM, Wiers RWHJ, Bögels SM. The role of parental anxiety symptoms in the treatment of childhood social anxiety disorder. Behav Res Ther 2022; 156:104157. [PMID: 35863242 DOI: 10.1016/j.brat.2022.104157] [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: 11/15/2020] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
The study investigated the role of parental anxiety symptoms in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. Participants were 152 children between 7 and 18 years and their parents (146 mothers, 123 fathers). Anxiety was assessed pretreatment, posttreatment, and at three months and one year follow ups. There were no baseline differences in parental anxiety symptoms between the two groups. In both groups parental anxiety symptoms decreased from pretreatment to posttreatment, and only mothers' anxiety symptoms decreased further from posttreatment to the one year follow up. Parental anxiety symptoms before the treatment were not related to the being free of all anxiety diagnoses in the children at posttreatment. However, some indications were found for greater improvements during treatment when parents had higher anxiety symptoms before treatment. Changes in parental anxiety symptoms were found to be related to changes in child anxiety symptoms. This was not found for the total clinical severity of all inclusion anxiety disorders. This relation was visible independently in fathers or mothers, or in groups of children with a primary social anxiety disorder or with another primary anxiety disorder. In conclusion, we did not find clear indications that parental anxiety symptoms explain the differences in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. More research with larger samples is needed to draw stronger conclusions.
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Affiliation(s)
- J M D Baartmans
- UvA Minds, Academic Treatment Centre, the Netherlands; Developmental Psychology, University of Amsterdam, the Netherlands.
| | - F J A van Steensel
- Child Development and Education, University of Amsterdam, the Netherlands
| | - A M Klein
- UvA Minds, Academic Treatment Centre, the Netherlands
| | - R W H J Wiers
- Developmental Psychology, University of Amsterdam, the Netherlands
| | - S M Bögels
- Child Development and Education, University of Amsterdam, the Netherlands
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14
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Bertelsen TB, Wergeland GJ, Nordgreen T, Himle JA, Håland ÅT. Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder. Psychiatry Res 2022; 313:114632. [PMID: 35597139 DOI: 10.1016/j.psychres.2022.114632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 04/05/2022] [Accepted: 05/11/2022] [Indexed: 10/18/2022]
Abstract
Although cognitive-behavioral therapy (CBT) is an effective treatment for adolescents with anxiety disorders, the majority remain impaired following treatment. We developed a group CBT program (RISK) with high degrees of exposure practice and family and school involvement delivered in a community-based setting and investigated its effectiveness. The treatment involved adolescents (N = 90), with a primary diagnosis of anxiety disorder (82%) or obsessive-compulsive disorder (18%), and their families who received 38 hours of group treatment over 10 weeks. Diagnostic status and symptom severity were assessed at pre- and post-treatment, and a 12-month follow-up and benchmarked against previous effectiveness studies. Our results showed that, at post-treatment, the RISK-treatment was comparably effective as benchmarks on measures of diagnostic status, parent-rated measures, adolescent-rated measures, and clinician-rated measures. At 12-month follow-up all outcomes were superior to benchmarks, including the proportion of participants in remission (79.5%, 95% Highest Posterior Density Interval [74.7, 84.2]), indicating that the RISK-treatment enhanced effectiveness over time. The combination of group format, a high degree of exposure practice, and school and family involvement is a promising format for real-world settings that may help sustain and increase treatment effectiveness. Trial registered at helseforskning.etikkom.no (reg. nr. 2017/1367).
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Affiliation(s)
- Thomas B Bertelsen
- Department of Child and Adolescence Mental Health, Sørlandet Sykehus, Kristiansand, Norway; Department of Clinical Child and Adolescent Psychology, Faculty of Psychology, University of Bergen, Norway.
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Global Health and primary care, Faculty of Medicine, University of Bergen, Norway
| | - Joseph A Himle
- School of Social Work and Department of Psychiatry, University of Michigan, Ann Arbor, Michigan USA
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15
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The Role of Comorbid Mood Disorders in Cognitive Behavioral Therapy for Childhood Social Anxiety. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10312-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Abstract
Background
Children with a social anxiety disorder have worse treatment outcomes after Cognitive Behavior Therapy (CBT) than children with other anxiety disorders. Anxiety disorders and mood disorders are strongly related and especially social anxiety is related to high comorbidity rates with mood disorders. The aim of the study was to investigate how comorbid mood disorders are related to treatment outcomes after CBT and whether this can explain the worse outcomes for childhood social anxiety.
Methods
Participants were 152 referred clinically children (7–18 years) with either a social anxiety disorder (n = 52) or another anxiety disorder (n = 100) of whom 24.3% (n = 37) had a comorbid mood disorder. Child anxiety, internalizing symptoms, and quality of life were measured pre-treatment, post-treatment, 3 months and 1 year after treatment, using child and both parents’ report.
Results
Children with a primary social anxiety disorder more often had a comorbid mood disorder than children with another primary anxiety disorder. Children with a mood disorder had more severe anxiety problems before treatment. Comorbid mood disorders were related to greater anxiety reductions after treatment. The worse outcomes for children with a primary social anxiety disorder remained after controlling for comorbid mood disorders.
Conclusions
Findings stress the importance of future studies examining why the presence of a comorbid mood disorder is associated with greater anxiety reductions, and other factors that explain the worse treatment outcomes found for childhood social anxiety disorder.
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16
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Schosser A, Fischer-Hansal D, Swoboda MM, Ludwig B, Carlberg L, Swoboda P, Kienesberger K, Bernegger A, Fuxjäger M, Zotter M, Schmelzle N, Inaner M, Koller R, Kapusta ND, Haslacher H, Aigner M, Kasper S, Senft B. BDNF gene polymorphisms predicting treatment response to CBT-based rehabilitation of depression: to be submitted to: European Neuropsychopharmacology. Eur Neuropsychopharmacol 2022; 58:103-108. [PMID: 35453068 DOI: 10.1016/j.euroneuro.2022.03.005] [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] [Received: 12/05/2021] [Revised: 03/10/2022] [Accepted: 03/13/2022] [Indexed: 11/26/2022]
Abstract
Genetic factors were shown to play a major role in both variation of treatment response and incidence of adverse effects to medication in affective disorders. Nevertheless, there is still a lack of therapygenetic studies, investigating the prediction of psychological therapy outcomes from genetic markers. Neuroplasticity and one of its mediators, brain-derived neurotrophic factor (BDNF), are potential research targets in this field. We aimed to investigate Tag SNP polymorphisms of the BDNF gene in depressed patients treated with cognitive behavioral therapy (CBT) in the context of a standardized 6-weeks outpatient rehabilitation program. Treatment response was assessed calculating the mean differences in BDI-II (Beck Depression Inventory) scores from admission to discharge. Six BDNF SNPs, including the Val66Met polymorphism (rs6265), were genotyped. Both genotypic data and BDI-II-scores at admission and discharge were available for 277 patients. Three SNPs, rs10501087 (p = 0.005, FDRp=0.015), rs11030104 (p = 0.006, FDRp=0.012), and the Val66Met polymorphism (rs6265, p<0.001, FDRp=0.006), were significantly associated with treatment response in depressed patients, even after multiple testing correction using the false discovery rate method (FDRp). We conclude that BDNF might serve as promising genetic marker for treatment response to psychological treatment in depression. However, due to our limited sample size, further studies are needed to disentangle the role of BDNF as potential therapygenetic marker.
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Affiliation(s)
- Alexandra Schosser
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Zentren für seelische Gesundheit, BBRZ-Med, Vienna, Austria; Faculty of Medicine, Sigmund Freud University, Freudplatz 3, Vienna 1020, Austria; Arbeitsgemeinschaft für Verhaltensmodifikation, Salzburg, Austria.
| | - Daniela Fischer-Hansal
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Zentren für seelische Gesundheit, BBRZ-Med, Vienna, Austria
| | - Marleen M Swoboda
- Department of Psychiatry and Psychotherapy, Karl Landsteiner University for Health and Science, Tulln, Austria
| | - Birgit Ludwig
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Department of Neurology, Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Laura Carlberg
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Patrick Swoboda
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Klemens Kienesberger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Alexandra Bernegger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; St. John of God Hospital, Vienna, Austria
| | - Monika Fuxjäger
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Melanie Zotter
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Zentren für seelische Gesundheit, BBRZ-Med, Vienna, Austria
| | - Nicolas Schmelzle
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Michelle Inaner
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Romina Koller
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Nestor D Kapusta
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Martin Aigner
- Department of Psychiatry and Psychotherapy, Karl Landsteiner University for Health and Science, Tulln, Austria
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria; Center for Brain Research, Medical University of Vienna, Vienna, Austria
| | - Birgit Senft
- Zentren für seelische Gesundheit, BBRZ-Med, Vienna, Austria
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17
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Implementing Cognitive-Behavioral Therapy in Children and Adolescents with Anxiety Disorders. KLINICHESKAIA I SPETSIAL'NAIA PSIKHOLOGIIA = CLINICAL PSYCHOLOGY AND SPECIAL EDUCATION 2022; 11:108-122. [PMID: 36474931 PMCID: PMC9720550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This article provides an introduction and overview of the cognitive-behavioral treatment approach to anxiety disorders in children and adolescents. We first provide an introduction to the cognitive-behavioral conceptualization of anxiety, emphasizing the tripartite model of emotions: cognitions, physiological arousal, and avoidance behaviors. We then provide an overview of the basic principles of cognitive behavioral treatment for anxiety disorders in children and adolescents, including generalized, social, and separation anxiety, and specific phobia. We follow this introduction and overview with a discussion of the structure and goals of treatment, including the three phases of treatment (psychoeducation, application, and relapse prevention). In the context of discussing application, we focus primarily on implementation strategies relating to behavioral exposures and cognitive restructuring. We conclude with a summary of different formats wherein cognitive-behavioral treatment can be implemented, including child-only, peer-group, parent-involved, and telehealth.
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18
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Bertie LA, Hudson JL. CBT for Childhood Anxiety: Reviewing the State of Personalised Intervention Research. Front Psychol 2021; 12:722546. [PMID: 34899467 PMCID: PMC8663921 DOI: 10.3389/fpsyg.2021.722546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/02/2021] [Indexed: 11/13/2022] Open
Abstract
This article presents a mini-review of the state of personalised intervention research in the field of child and adolescent anxiety. We evaluated narrative, systematic and meta-analytic reviews of key research methodologies and how they relate to current approaches for personalising CBT, specifically. Preliminary evidence of predictors (severity of primary disorder, social anxiety disorder (SoAD), comorbid depression, parental psychopathology, parental involvement and duration of treatment), moderators (type of primary disorder) and mediators (self-talk, coping, problem-solving and comorbid symptoms) of CBT outcomes provides content for several personalised approaches to treatment. Finally, we present a novel conceptual model depicting the state of personalised intervention research in childhood anxiety and propose a research agenda for continued progress.
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Affiliation(s)
- Lizél-Antoinette Bertie
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
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19
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Frank HE, Titone MK, Kagan ER, Alloy LB, Kendall PC. The Role of Comorbid Depression in Youth Anxiety Treatment Outcomes. Child Psychiatry Hum Dev 2021; 52:1024-1031. [PMID: 33068210 PMCID: PMC8052378 DOI: 10.1007/s10578-020-01081-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2020] [Indexed: 12/22/2022]
Abstract
Findings have been mixed regarding the relationship between comorbid depression and anxiety and treatment outcomes for anxious youth. The current study compared a sample of anxious youth with a comorbid depressive disorder (n = 20) and those without comorbid depression (n = 137). All participants received 16 weekly sessions of Coping Cat and completed measures assessing anxiety/depression severity, impairment, and functioning at pretreatment and posttreatment. Results indicated that anxiety-focused CBT is efficacious for anxious youth with and without comorbid depressive disorders, with a higher rate of symptom improvement for youth with comorbid depression during treatment. However, comorbid depression was associated with higher severity at baseline and after treatment. Thus, despite the higher rate of symptom improvement, anxious youth with comorbid depression may benefit from additional treatment to address remaining symptoms.
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Affiliation(s)
- Hannah E Frank
- Department of Psychology, Temple University, Philadelphia, PA, USA.
- Alpert Medical School of Brown University and Bradley Hospital, 1011 Veterans Memorial Parkway, Riverside, RI, 02915, USA.
| | - Madison K Titone
- Department of Psychology, Temple University, Philadelphia, PA, USA
- VASDHD/UCSD, 3350 La Jolla Village Drive, San Diego, CA, 92161, USA
| | - Elana R Kagan
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Kennedy Krieger Institute, 720 Aliceanna St, Baltimore, MD, 21202, USA
| | - Lauren B Alloy
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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20
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Baker HJ, Lawrence PJ, Karalus J, Creswell C, Waite P. The Effectiveness of Psychological Therapies for Anxiety Disorders in Adolescents: A Meta-Analysis. Clin Child Fam Psychol Rev 2021; 24:765-782. [PMID: 34471966 PMCID: PMC8541960 DOI: 10.1007/s10567-021-00364-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2021] [Indexed: 12/23/2022]
Abstract
Anxiety disorders are common in adolescence but outcomes for adolescents are unclear and we do not know what factors moderate treatment outcome for this age group. We conducted meta-analyses to establish the effectiveness of psychological therapies for adolescent anxiety disorders in (i) reducing anxiety disorder symptoms, and (ii) remission from the primary anxiety disorder, compared with controls, and examine potential moderators of treatment effects. The protocol was registered with PROSPERO (CRD42018091744). Electronic databases (Web of Science, MEDLINE, Psycinfo, EMBASE) were searched from January 1990 to December 2019. 2511 articles were reviewed, those meeting strict criteria were included. Random effects meta-analyses were conducted. Analyses of symptom severity outcomes comprised sixteen studies (CBT k = 15, non-CBT k = 1; n = 766 adolescents), and analyses of diagnostic remission outcomes comprised nine (CBT k = 9; n = 563 adolescents). Post-treatment, those receiving treatment were significantly more likely to experience reduced symptom severity (SMD = 0.454, 95% CI 0.22–0.69) and remission from the primary anxiety disorder than controls (RR = 7.94, 95% CI 3.19–12.7) (36% treatment vs. 9% controls in remission). None of the moderators analysed were statistically significant. Psychological therapies targeting anxiety disorders in adolescents are more effective than controls. However, with only just over a third in remission post-treatment, there is a clear need to develop more effective treatments for adolescents, evaluated through high-quality randomised controlled trials incorporating active controls and follow-up data.
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Affiliation(s)
- Holly J. Baker
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL UK
| | - Peter J. Lawrence
- Centre for Innovation in Mental Health, School of Psychology, University of Southampton, Southampton, SO17 1BJ UK
| | - Jessica Karalus
- Central North West London NHS Foundation Trust, Grenfell Health and Wellbeing Service, St Charles Hospital, Exmoor Street, London, W10 6DZ UK
| | - Cathy Creswell
- Radcliffe Observatory, University of Oxford, Anna Watts Building, Woodstock Rd, Oxford, OX2 6GG UK
| | - Polly Waite
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 6AL UK
- Radcliffe Observatory, University of Oxford, Anna Watts Building, Woodstock Rd, Oxford, OX2 6GG UK
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21
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Evans R, Chiu K, Clark DM, Waite P, Leigh E. Safety behaviours in social anxiety: An examination across adolescence. Behav Res Ther 2021; 144:103931. [PMID: 34298437 PMCID: PMC7611485 DOI: 10.1016/j.brat.2021.103931] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/24/2021] [Accepted: 07/12/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Safety behaviours have been shown to be a key maintaining factor in Social Anxiety Disorder (SAD). In adults, a two-factor structure of safety behaviours reflecting 'avoidance' and 'impression-management' types has been identified. This has not yet been investigated in adolescents. AIMS We set out to investigate the factor structure of safety behaviours in relation to adolescent social anxiety symptoms and SAD, the extent to which this varies by age, and then to examine the association between the derived factor scores and other social anxiety related phenomena. METHOD Questionnaire measures of social anxiety symptoms, cognitions and safety behaviours, peer relationship outcomes, general anxiety and depression were collected from a community sample of 584 younger (11-14 years) and 208 older (16-18 years) adolescents, and a clinical sample of 80 adolescents (11-18 years) with a primary diagnosis of SAD. Four hypotheses were investigated using exploratory and confirmatory factor analyses, regressions, correlations and path analyses. RESULTS A two-factor structure reflecting 'avoidance' and 'impression-management' safety behaviours was supported in the community and clinical sample. Older adolescents were found to use 'impression-management' behaviours more than younger adolescents after controlling for overall safety behaviour score. Both types of safety behaviour were significantly positively associated with social anxiety symptoms and cognitions. Path analyses revealed an indirect effect of social anxiety symptoms on peer victimisation, social satisfaction and friendship quality via 'avoidance', but not 'impression-management' safety behaviours. CONCLUSIONS Both 'avoidance' and 'impression-management' safety behaviours are associated with social anxiety symptoms and cognitions in youth, with age-related differences in their frequency. 'Avoidance' behaviours are specifically associated with negative outcomes for quality of peer relationships.
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Affiliation(s)
- Rachel Evans
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kenny Chiu
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Polly Waite
- Department of Experimental Psychology, University of Oxford, Oxford, UK; School of Psychology and Clinical Language Sciences, University of Reading, UK; Department of Psychiatry, University of Oxford, Oxford, UK
| | - Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
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22
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Abstract
The purpose of the current article is to explore familial factors that influence the development of social anxiety disorder (SAD) in children and adolescents, including parenting, sibling relationships, and family environment. A multitude of interrelated genetic and familial factors have been found to cause and maintain SAD in children and adolescents. There are many challenges in diagnosing and treating the disorder. Knowledge and awareness of familial factors provide insight on targeted treatments that prevent or ameliorate SAD. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 23-34.].
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23
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Klein AM, Liber JM, van Lang NDJ, Reichart C, Nauta M, van Widenfelt BM, Utens EMWJ. The Role of Social Skills in Predicting Treatment-Recovery in Children with a Social Anxiety Disorder. Res Child Adolesc Psychopathol 2021; 49:1461-1472. [PMID: 34165687 PMCID: PMC8455491 DOI: 10.1007/s10802-021-00824-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
The current study investigated the role of social skills and its interaction with social anxiety as predictors of treatment outcome in children with an anxiety disorder either with or without a social anxiety disorder (SoAD). In total, 133 children (aged 8 to 13) with an anxiety disorder received a 10-session cognitive behavioral treatment (FRIENDS program). Pre- to post treatment Reliable Change (RC) and Treatment-Recovery (TR) were assessed from a multi-informant perspective, by including diagnostic information (ADIS C/P), child-reported anxiety symptoms (MASC) and parent-reported internalizing symptoms (CBCL-Int). Social skills were assessed with the parent-rated Social Skills Rating System (assertion, self-control, responsibility). Results showed that 1) parents of children with a SoAD reported significantly less favorable use of assertive and responsible social behavior in their children pre-treatment than parents of children without SoAD, 2) children with higher social skills had a better treatment recovery, and 3) children with anxiety and higher responsible behavior pre-treatment and without a SoAD had a better treatment recovery, but this effect did not show for children with SoAD. In conclusion, better use of social behavior increased the likelihood of treatment recovery but not of reliable change. Further studies on the role of social skills in the treatment of childhood (social) anxiety are needed to investigate the mechanisms by which social skills impact treatment outcome.
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Affiliation(s)
- Anke M Klein
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands. .,Clinical Child and Adolescent Psychology, Ruhr University, Bochum, Germany.
| | - Juliette M Liber
- Developmental Psychology, Utrecht University, Utrecht, The Netherlands.
| | | | - Catrien Reichart
- Curium, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike Nauta
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | | | - Elisabeth M W J Utens
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule/AMC, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus University, Rotterdam, The Netherlands
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24
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Storch EA, Wood JJ, Guzick AG, Small BJ, Kerns CM, Ordaz DL, Schneider SC, Kendall PC. Moderators of Response to Personalized and Standard Care Cognitive-Behavioral Therapy for Youth with Autism Spectrum Disorder and Comorbid Anxiety. J Autism Dev Disord 2021; 52:950-958. [PMID: 33826038 DOI: 10.1007/s10803-021-05000-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
Anxiety/obsessive-compulsive disorders are common among youth with autism spectrum disorder (ASD). Two versions of cognitive behavior therapy (CBT) are effective, with some advantage for a personalized, adapted version. This study evaluated predictors and moderators of standard CBT and adapted CBT. Youth (N = 167) ages 7-13 were randomized to standard or adapted CBT, or treatment-as-usual. Age, IQ, ASD severity, and emotional-behavioral symptom severity were examined. More severe internalizing and emotional-behavioral problems predicted poorer treatment outcomes especially in standard versus personalized CBT. Elevated repetitive behaviors and restricted interests predicted poorer treatment outcomes across treatments, though youth with "moderate" repetitive behaviors and restricted interested experienced poorer outcomes only in standard but not personalized CBT. Externalizing symptoms directly predicted treatment outcomes. Older age predicted improved outcomes in adapted but not standard CBT. Findings highlight the need for further treatment refinements and the value in adapting treatment for youth with more complex presentations. Trial Registration Clinicialtrials.gov: NCT02028247; https://clinicaltrials.gov/ct2/show/NCT02028247 .
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Affiliation(s)
- Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA.
| | - Jeffrey J Wood
- Department of Education, University of California, Los Angeles, CA, USA
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - D Luis Ordaz
- Jacob Center for Evidence-Based Therapy, Boca Raton, FL, USA
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400, Houston, TX, 77030, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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25
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Krause KR, Chung S, Adewuya AO, Albano AM, Babins-Wagner R, Birkinshaw L, Brann P, Creswell C, Delaney K, Falissard B, Forrest CB, Hudson JL, Ishikawa SI, Khatwani M, Kieling C, Krause J, Malik K, Martínez V, Mughal F, Ollendick TH, Ong SH, Patton GC, Ravens-Sieberer U, Szatmari P, Thomas E, Walters L, Young B, Zhao Y, Wolpert M. International consensus on a standard set of outcome measures for child and youth anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder. Lancet Psychiatry 2021; 8:76-86. [PMID: 33341172 DOI: 10.1016/s2215-0366(20)30356-4] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/27/2020] [Accepted: 08/03/2020] [Indexed: 12/20/2022]
Abstract
A major barrier to improving care effectiveness for mental health is a lack of consensus on outcomes measurement. The International Consortium for Health Outcomes Measurement (ICHOM) has already developed a consensus-based standard set of outcomes for anxiety and depression in adults (including the Patient Health Questionnaire-9, the Generalised Anxiety Disorder 7-item Scale, and the WHO Disability Schedule). This Position Paper reports on recommendations specifically for anxiety, depression, obsessive-compulsive disorder, and post-traumatic stress disorder in children and young people aged between 6 and 24 years. An international ICHOM working group of 27 clinical, research, and lived experience experts formed a consensus through teleconferences, an exercise using an adapted Delphi technique (a method for reaching group consensus), and iterative anonymous voting, supported by sequential research inputs. A systematic scoping review identified 70 possible outcomes and 107 relevant measurement instruments. Measures were appraised for their feasibility in routine practice (ie, brevity, free availability, validation in children and young people, and language translation) and psychometric performance (ie, validity, reliability, and sensitivity to change). The final standard set recommends tracking symptoms, suicidal thoughts and behaviour, and functioning as a minimum through seven primarily patient-reported outcome measures: the Revised Children's Anxiety and Depression Scale, the Obsessive Compulsive Inventory for Children, the Children's Revised Impact of Events Scale, the Columbia Suicide Severity Rating Scale, the KIDSCREEN-10, the Children's Global Assessment Scale, and the Child Anxiety Life Interference Scale. The set's recommendations were validated through a feedback survey involving 487 participants across 45 countries. The set should be used alongside the anxiety and depression standard set for adults with clinicians selecting age-appropriate measures.
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Affiliation(s)
- Karolin R Krause
- Evidence Based Practice Unit, Faculty of Brain Sciences, University College London, London, UK; Anna Freud National Centre for Children and Families, London, UK.
| | - Sophie Chung
- International Consortium for Health Outcomes Measurement (ICHOM), London, UK
| | - Abiodun O Adewuya
- Department of Behavioral Medicine, Lagos State University College of Medicine, Lagos, Nigeria
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA; Columbia University Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Rochelle Babins-Wagner
- Calgary Counselling Centre, Calgary, AB, Canada; Faculty of Social Work, University of Calgary, Calgary, AB, Canada
| | | | - Peter Brann
- Child and Youth Mental Health Service, Eastern Health, Melbourne, VIC, Australia; School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
| | | | - Bruno Falissard
- Université Paris-Saclay, Gif-sur-Yvette, France; Université de Versailles Saint-Quentin-en-Yvelines, Versailles, France; Institut national de la santé et de la recherche médicale (INSERM), Paris, France; Centre de recherche en Epidémiologie et Santé des Populations (CESP), Villejuif, Île-de-France, France
| | | | - Jennifer L Hudson
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | | | | | - Christian Kieling
- Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Judi Krause
- Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | | | - Vania Martínez
- Centro de Medicina Reproductiva y Desarrollo Integral del Adolescente (CEMERA), Facultad de Medicina, Universidad de Chile, Santiago, Chile; Agencia Nacional de Investigación y Desarrollo (ANID), Millennium Science Initiative Program, Millennium Nucleus to Improve the Mental Health of Adolescents and Youths (IMHAY), and Millennium Institute for Research in Depression and Personality (MIDAP), Santiago, Chile
| | - Faraz Mughal
- School of Primary, Community and Social Care, Keele University, Staffordshire, UK
| | - Thomas H Ollendick
- Department of Psychology, Child Study Center, Virginia Tech, Blacksburg, VA, USA
| | - Say How Ong
- Department of Child and Adolescent Psychiatry, Institute of Mental Health, Singapore, Singapore
| | - George C Patton
- Murdoch Children's Research Institute, Melbourne, VIC, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Szatmari
- The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Cundill Centre for Child and Youth Depression, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Evie Thomas
- Child and Youth Mental Health Service, Eastern Health, Melbourne, VIC, Australia
| | | | | | - Yue Zhao
- Teaching and Learning Evaluation and Measurement Unit, The University of Hong Kong, Hong Kong
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Moussavi Y, Breivik K, Wergeland GJ, Haugland BSM, Larsen M, Lehmann S. Internalizing Symptom Profiles Among Youth in Foster Care: A Comparison Study. Front Psychiatry 2021; 12:711626. [PMID: 34489762 PMCID: PMC8418133 DOI: 10.3389/fpsyt.2021.711626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/09/2021] [Indexed: 11/23/2022] Open
Abstract
Background: A high prevalence of anxiety and depression is found among youth in foster care. There is limited knowledge on the anxiety and depression symptom profiles of youth in foster care. We examined latent profiles of anxiety and depression symptoms across three unique youth samples and whether youth in foster care were more or less likely to belong to specific symptom profiles than their peers recruited from clinical or general youth populations. We also investigated if these profiles were predicted by sex and age. Methods: Self-reported anxiety and depression symptoms were assessed by Spence Children's Anxiety Scale and Short Mood and Feelings Questionnaire. Data were pooled from three youth samples (N = 2,005; mean age = 13.9 years, range = 11-18 years) comprising youth in foster care (n = 245), a clinical youth sample (n = 107), and a general population youth sample (n = 1,653). Symptom profiles were identified using latent profile analyses. Multinominal logistic regression was used to predict the latent profile membership. Results: Three profiles that differed both in symptom level and shape were identified and labeled as low, medium, and high symptom profile. Compared to the general population youth sample, youth in foster care had a higher likelihood of belonging to the high symptom profile, but not the medium symptom profile. Youth from the clinical sample had an increased risk of belonging to the medium and high symptom profiles compared to the youth in foster care and general population youth samples. Across samples, girls yielded a higher likelihood of having a medium or high symptom profile. Increasing age was associated with a higher likelihood of being in the high symptom profile. Conclusion: Compared to their counterparts in the general population, youth in foster care are at risk of belonging to a class of youth with high symptom levels across subtypes of internalizing symptoms, indicating the importance of systematic and broad assessment of internalizing symptoms among these youth. Knowledge on the symptom profiles of anxiety subtypes and depression increases our understanding of the treatment needs of youth in foster care.
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Affiliation(s)
- Yasmin Moussavi
- Regional Centre for Child and Youth Mental Health and Child Welfare-West, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Kyrre Breivik
- Regional Centre for Child and Youth Mental Health and Child Welfare-West, NORCE Norwegian Research Centre, Bergen, Norway
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | | | - Marit Larsen
- Regional Centre for Child and Youth Mental Health and Child Welfare-West, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Stine Lehmann
- Regional Centre for Child and Youth Mental Health and Child Welfare-West, NORCE Norwegian Research Centre, Bergen, Norway.,Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, Bergen, Norway
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Waszczuk MA, Zavos HMS, Eley TC. Why do depression, conduct, and hyperactivity symptoms co-occur across adolescence? The role of stable and dynamic genetic and environmental influences. Eur Child Adolesc Psychiatry 2021; 30:1013-1025. [PMID: 32253524 PMCID: PMC8295149 DOI: 10.1007/s00787-020-01515-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 03/16/2020] [Indexed: 12/17/2022]
Abstract
Depression, conduct, and hyperactivity symptoms are chronic and frequently co-occur in adolescence. Common genetic and environmental vulnerability to these conditions have previously been demonstrated, however, the manner in which common versus disorder-specific etiological influences operate across development and maintain symptom co-occurrence is unclear. Thus, the current study investigated the role of common genetic and environmental influences in the comorbidity of depression, conduct, and hyperactivity across adolescence. Over 10,000 twins and their parents reported adolescents' symptoms at mean ages 11 and 16 years. Biometric independent pathway models were fitted to estimate genetic and environmental contributions to the continuity of symptom co-occurrence over time, as well as time- and symptom-specific influences. Results found that a common stable genetic factor accounted for the concurrent and longitudinal co-occurrence of depression, conduct, and hyperactivity symptoms. New genetic influences common to these three symptom scales emerged at 16 years, and further contributed to symptom co-occurrence. Conversely, environmental influences largely contributed to the time-specific associations. The findings were generally consistent for self- and parent-reported symptoms. Overall, the results suggest that stable, overlapping genetic influences contribute to the co-occurrence of depression, conduct, and hyperactivity symptoms across adolescence. The results are in line with hierarchical causal models of psychopathology, which posit that much of the developmental co-occurrence between different symptoms is due to common liability. Specifically, current findings indicate that only genetic influences constitute common liability over time. Future studies should identify genetically influenced transdiagnostic risk and maintenance factors to inform prevention and treatment of comorbid internalizing and externalizing symptoms in adolescence.
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Affiliation(s)
| | - Helena M. S. Zavos
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Thalia C. Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Box PO80, De Crespigny Park, London, SE5 8AF UK
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Are young people with primary social anxiety disorder less likely to recover following generic CBT compared to young people with other primary anxiety disorders? A systematic review and meta-analysis. Behav Cogn Psychother 2020; 49:352-369. [PMID: 33298222 PMCID: PMC8293629 DOI: 10.1017/s135246582000079x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Social anxiety disorder (SoAD) in youth is often treated with a generic form of cognitive behavioural therapy (CBT). Some studies have suggested that primary SoAD is associated with lower recovery rates following generic CBT compared with other anxiety disorders. Aims: This systematic review and meta-analysis investigated recovery rates following generic CBT for youth with primary SoAD versus other primary anxiety disorders. Method: Five databases (PsycINFO, Web of Science, PubMed, Embase, Medline) were searched for randomised controlled trials of generic CBT for child and/or adolescent anxiety. Results: Ten trials met criteria for inclusion in the systematic review, six of which presented sufficient data for inclusion in the meta-analysis. Sixty-seven did not report data on recovery rates relative to primary diagnosis. While most individual studies included in the systematic review were not sufficiently powered to detect a difference in recovery rates between diagnoses, there was a pattern of lower recovery rates for youth with primary SoAD. Across the trials included in the meta-analysis, the post-CBT recovery rate from primary SoAD (35%) was significantly lower than the recovery rate from other primary anxiety disorders (54%). Conclusions: Recovery from primary SoAD is significantly less likely than recovery from any other primary anxiety disorder following generic CBT in youth. This suggests a need for research to enhance the efficacy of CBT for youth SoAD.
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Nikolić M, Majdandžić M, Colonnesi C, de Vente W, Möller E, Bögels S. The unique contribution of blushing to the development of social anxiety disorder symptoms: results from a longitudinal study. J Child Psychol Psychiatry 2020; 61:1339-1348. [PMID: 32080848 PMCID: PMC7754350 DOI: 10.1111/jcpp.13221] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/20/2019] [Accepted: 01/24/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Self-conscious emotional reactivity and its physiological marker - blushing has been proposed to be an etiological mechanism of social anxiety disorder (SAD), but so far, untested in longitudinal designs. This study tested, for the first time, whether self-conscious emotional reactivity (indexed as physiological blushing) contributes to the development of SAD symptoms over and above social behavioral inhibition (BI), which has been identified as the strongest predictor of SAD development in early childhood. METHODS One hundred fifteen children (45% boys) and their mothers and fathers participated at ages 2.5, 4.5, and 7.5 years. Social BI was observed at all time points in a stranger approach task, and physiological blushing (blood volume, blood pulse amplitude, and temperature increases) was measured during a public performance (singing) and watching back the performance at ages 4.5 and 7.5. Child early social anxiety was reported by both parents at 4.5 years, and SAD symptoms were diagnosed by clinicians and reported by both parents at 7.5 years. RESULTS Higher social BI at 2.5 and 4.5 years predicted greater social anxiety at 4.5 years, which, in turn, predicted SAD symptoms at 7.5 years. Blushing (temperature increase) at 4.5 years predicted SAD symptoms at 7.5 years over and above the influence of social BI and early social anxiety. CONCLUSIONS That blushing uniquely contributes to the development of SAD symptoms over and above social BI suggests two pathways to childhood SAD: one that entails early high social BI and an early onset of social anxiety symptoms, and the other that consists of heightened self-conscious emotional reactivity (i.e. blushing) in early childhood.
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Affiliation(s)
- Milica Nikolić
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Mirjana Majdandžić
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Cristina Colonnesi
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Wieke de Vente
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Eline Möller
- Research Institute of Child Development and EducationUniversity of AmsterdamAmsterdamThe Netherlands
| | - Susan Bögels
- Developmental PsychologyUniversity of AmsterdamAmsterdamThe Netherlands
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30
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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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31
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Norris LA, Kendall PC. Moderators of Outcome for Youth Anxiety Treatments: Current Findings and Future Directions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:450-463. [PMID: 33140992 DOI: 10.1080/15374416.2020.1833337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To improve outcomes and create more personalized interventions, the field has sought to identify moderators of treatment response (variables that specify which treatments work for whom and under what conditions).Method: The current review examines moderators of youth anxiety treatments.Results: The majority of studies to date have examined variables of convenience, including demographics (age, sex, race, ethnicity, socioeconomic status), pretreatment youth clinical characteristics (anxiety severity, principal diagnosis, comorbidity) and pretreatment parent variables (parent psychopathology, parenting). Findings indicate few consistent moderators.Conclusions: Future directions are discussed, including (a) group to individual generalizability, (b) power considerations, and (c) updates to study design and measure selection.
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Ramirez AC, Grebe SC, McNeel MM, Limon DL, Schneider SC, Berry LN, Goin-Kochel RP, Cepeda SL, Voigt RG, Salloum A, Storch EA. Parent-led, stepped-care cognitive-behavioral therapy for youth with autism and co-occurring anxiety: study rationale and method. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:638-645. [PMID: 32520166 PMCID: PMC7678910 DOI: 10.1590/1516-4446-2020-0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 03/01/2020] [Indexed: 11/21/2022]
Abstract
Anxiety disorders affect up to 50% of individuals with autism spectrum disorder (ASD) and are significantly impairing to the person affected, as well as to their loved ones. Cognitive-behavioral therapy (CBT) has been established as the gold-standard treatment for anxiety disorders among typically developing youth and adults, and demonstrates similar efficacy among youth with high-functioning autism (HFA). Many CBT interventions utilize a "full-package" treatment approach to treat co-occurring anxiety in youth with ASD. However, these service delivery systems are often therapist-intensive, costly, and impractical, thereby compromising full engagement and treatment adherence. This paper describes the design, rationale, and methodology of a study examining stepped-care CBT for youth with HFA and co-occurring anxiety - a clinical trial examining the efficacy of low-intensity, parent-led CBT as the first line of treatment and utilizing a more intensive, therapist-led intervention for nonresponders. The study will evaluate the potential benefits of stepped-care and parent-led therapist-assisted interventions, predictors of treatment response, and the economic value of using a stepped-care model. Implications for practice will be discussed.
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Affiliation(s)
- Ana C. Ramirez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
| | - Stacey C. Grebe
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Morgan M. McNeel
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Danica L. Limon
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
| | - Sophie C. Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Leandra N. Berry
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Robin P. Goin-Kochel
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Sandra L. Cepeda
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Robert G. Voigt
- Autism Center, Texas Children’s Hospital, Houston, TX, USA
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
- Meyer Center for Developmental Pediatrics, Texas Children’s Hospital, Houston, TX, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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33
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Nikolić M. Disturbed Social Information Processing as a Mechanism in the Development of Social Anxiety Disorder. CHILD DEVELOPMENT PERSPECTIVES 2020. [DOI: 10.1111/cdep.12390] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Spence SH, Prosser SJ, March S, Donovan CL. Internet-delivered cognitive behavior therapy with minimal therapist support for anxious children and adolescents: predictors of response. J Child Psychol Psychiatry 2020; 61:914-927. [PMID: 32424896 DOI: 10.1111/jcpp.13257] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/09/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In general, Internet-delivered cognitive behavior therapy (iCBT) produces significant reductions in child and adolescent anxiety, but a proportion of participants continue to show clinical levels of anxiety after treatment. It is important to identify demographic, clinical, and family factors that predict who is most likely to benefit from iCBT in order to better tailor treatment to individual needs. METHODS Participants were 175 young people (7-18 years) with an anxiety disorder, and at least one of their parents, who completed an iCBT intervention with minimal therapist support. Multilevel modeling (MLM) examined predictors of response to iCBT as measured by the slope for changes in the primary outcome measures of child- and parent-reported anxiety scores, from pretreatment, to 12-weeks, 6-month, and 12-month follow-ups, controlling for pretreatment total clinician severity ratings of all anxiety diagnoses. RESULTS Child age, gender, father age, parental education, parental mental health, parenting style, and family adaptability and cohesion did not significantly predict changes in anxiety in the multivariate analyses. For child-reported anxiety, greater reductions were predicted by a separation anxiety disorder diagnosis (SEP) and elevated depression, with lower reductions predicted by poor couple relationship quality. For parent-reported child anxiety, greater reductions were predicted by higher pretreatment total CSRs, SEP, and lower family income, with lower reductions for children of older mothers. Irrespective of these predictors of change, children in general showed reductions in anxiety to within the normal range. CONCLUSIONS Overall, children responded well to iCBT irrespective of the demographic, clinical, and family factors examined here. Poor couple relationship quality and older mother age were risk factors for less positive response to iCBT in terms of reductions in anxiety symptoms although still to within the normal range.
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Affiliation(s)
| | | | - Sonja March
- The University of Southern Queensland, Springfield, QLD, Australia
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McBride NM, Weinzimmer SA, La Buissonnière-Ariza V, Schneider SC, Ehrenreich May J, Lewin AB, McGuire JF, Goodman WK, Wood JJ, Storch EA. The Impact of Comorbidity on Cognitive-Behavioral Therapy Response in Youth with Anxiety and Autism Spectrum Disorder. Child Psychiatry Hum Dev 2020; 51:625-635. [PMID: 32026260 DOI: 10.1007/s10578-020-00961-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The impact of externalizing comorbidity on treatment outcome was examined in 104 youth ages 7-16 (M = 11.09 years) with autism spectrum disorder and primary anxiety/obsessive compulsive disorder who completed modular cognitive behavioral therapy (CBT) for anxiety/OCD. Three comorbidity profiles were utilized for group comparisons: participants with oppositional defiant or conduct disorder with attention-deficit hyperactivity disorder (ODD; CD; ADHD; group EXT, n = 25); those without ODD/CD and only ADHD (group ADHD, n = 46); and those without externalizing comorbidity (NO-EXT, n = 33). Post-treatment outcomes were measured continuously (Pediatric Anxiety Rating Scale, Clinical Global Impression-Severity) and categorically (treatment response, remission). The ADHD group was four times more likely of being a treatment responder compared to NO-EXT (OR 4.05). Comorbidity group did not impact remission. After controlling for pre-treatment scores, there was a significantly greater reduction of the CGI-S for ADHD versus NO-EXT and EXT versus NO-EXT, but results did not significantly differ for the PARS. Results suggest that a modular CBT approach yields positive impact for treatment outcomes in youth with comorbid externalizing problems, particularly among those with comorbid ADHD.
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Affiliation(s)
- Nicole M McBride
- Division of Child and Adolescent Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Saira A Weinzimmer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Joseph F McGuire
- Division of Child & Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey J Wood
- Department of Educational Psychology, University of California, Los Angeles, CA, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA.
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Bear HA, Edbrooke-Childs J, Norton S, Krause KR, Wolpert M. Systematic Review and Meta-analysis: Outcomes of Routine Specialist Mental Health Care for Young People With Depression and/or Anxiety. J Am Acad Child Adolesc Psychiatry 2020; 59:810-841. [PMID: 31881268 DOI: 10.1016/j.jaac.2019.12.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 11/30/2019] [Accepted: 12/19/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Depression and anxiety are the most prevalent mental health problems in youth, yet almost nothing is known about what outcomes are to be expected at the individual level following routine treatment. This paper sets out to address this gap by undertaking a systematic review of outcomes following treatment as usual (TAU) with a particular focus on individual-level outcomes. METHOD MEDLINE, Embase and PsycInfo were searched for articles published between 1980 and January 2019 that assessed TAU outcomes for youth depression and anxiety accessing specialist mental health care. Meta-analysis considered change at both group-level pre-post effect size (ES) and individual-level recovery, reliable change, and reliable recovery. Temporal analysis considered stability of primary and secondary outcomes over time. Subgroup analysis considered the moderating effect of informant; presenting problem; study design; study year; mean age of youth; use of medication; intervention dosage and type of treatment offered on outcomes. A protocol was preregistered on PROSPERO (CRD42017063914). RESULTS Initial screening of 6,350 publications resulted in 38 that met the inclusion criteria, and that were subsequently included in meta-analyses. This resulted in a final full pooled sample of 11,739 young people (61% of whom were female, mean age 13.8 years). The pre-post ES (Hedges' g) at first/final outcome (13/26 weeks) was -0.74/-0.87. The individual-level change on measures of self-report was 38% reliable improvement, 44% no reliable change, and 6% reliable deterioration. Outcomes varied according to moderators, informant, problem type and dosage. CONCLUSION Poor data quantity and quality are limitations, but this is the first study that indicates likely rates of reliable improvement for those accessing TAU. We propose the need for improved reporting of both individual-level metrics and details of TAU to enable greater understanding of likely current outcomes from routine care for youths with depression and anxiety in order to allow the potential for further improvement of impact.
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Affiliation(s)
- Holly Alice Bear
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK.
| | - Julian Edbrooke-Childs
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
| | - Sam Norton
- Health Psychology Section at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, Guy's Hospital Campus, London Bridge, London, UK
| | - Karolin Rose Krause
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK
| | - Miranda Wolpert
- University College London, UK; Anna Freud National Centre for Children and Families; The Kantor Centre of Excellence, London, UK; Child Outcomes Research Consortium, Brunswick Place London, UK
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37
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Gutzweiler R, Schwarz D, In-Albon T. Transdiagnostische Behandlung emotionaler Störungen bei Jugendlichen mit dem Unified Protocol: Eine Fallstudie. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000508454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Hintergrund:</i></b> Angst- und depressive Störungen sind die häufigsten psychischen Störungen im Jugendalter und weisen untereinander eine hohe Komorbiditätsrate auf. Während kognitive Verhaltenstherapie (KVT) in der Behandlung von Angststörungen bei Jugendlichen wirksam ist, weist die Behandlung von depressiven Störungen nur moderate Wirksamkeit auf. Es liegen jedoch kaum Studien vor, die die Wirksamkeit der KVT in der Behandlung komorbid vorliegender Angst- und depressiver Störungen bei Jugendlichen untersuchen. Der transdiagnostische Ansatz des Unified Protocols (UP) für emotionale Störungen konnte seine Wirksamkeit im englischsprachigen Raum bereits im Jugend- und Erwachsenenalter nachweisen. Eine deutsche Übersetzung und Überprüfung des UP für Jugendliche steht bislang noch aus. <b><i>Falldarstellung:</i></b> In dieser Kasuistik wird eine 17-jährige Patientin vorgestellt, die die Kriterien einer sozialen Angststörung nach ICD-10 und DSM-5 erfüllt und zudem eine depressive Symptomatik aufweist. Nach einer umfassenden Diagnostik mithilfe eines strukturierten klinischen Interviews und Selbstberichtverfahrens wurden 17 Sitzungen KVT basierend auf dem UP für Adoleszente (UP-A) durchgeführt. Ziel der vorliegenden Fallbeschreibung ist die Vorstellung des Therapierationals und der Umsetzung des Manuals. Nach der Therapie erfüllte die Jugendliche die Kriterien der sozialen Angststörung nicht mehr, es zeigte sich zudem eine Abnahme der depressiven Symptomatik. <b><i>Schlussfolgerungen:</i></b> Die Fallvorstellung verweist auf die Umsetzbarkeit der deutschen Übersetzung des UP-A für die transdiagnostische Behandlung von Angst- und depressiven Störungen bei Jugendlichen. Eine randomisiert kontrollierte Studie zur Wirksamkeitsprüfung steht noch aus.
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Creswell C, Waite P, Hudson J. Practitioner Review: Anxiety disorders in children and young people - assessment and treatment. J Child Psychol Psychiatry 2020; 61:628-643. [PMID: 31960440 DOI: 10.1111/jcpp.13186] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
Abstract
Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families.
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Affiliation(s)
- Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - 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
| | - Jennie Hudson
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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39
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Nikolić M. Social emotions and social cognition in the development of social anxiety disorder. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2020. [DOI: 10.1080/17405629.2020.1722633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Milica Nikolić
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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40
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Creswell C, Violato M, Cruddace S, Gerry S, Murray L, Shafran R, Stein A, Willetts L, McIntosh E, Cooper PJ. A randomised controlled trial of treatments of childhood anxiety disorder in the context of maternal anxiety disorder: clinical and cost-effectiveness outcomes. J Child Psychol Psychiatry 2020; 61:62-76. [PMID: 31364169 PMCID: PMC6916180 DOI: 10.1111/jcpp.13089] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND This study evaluated whether clinical and economic outcomes from CBT for child anxiety disorders in the context of maternal anxiety disorders are improved by adding treatment focused on (a) maternal anxiety disorders or (b) mother-child interactions. METHODS Two hundred and eleven children (7-12 years, 85% White British, 52% female) with a primary anxiety disorder, whose mothers also had a current anxiety disorder, were randomised to receive (a) child-focused CBT with nonspecific control interventions (CCBT+Con), (b) CCBT with CBT for the maternal anxiety disorder (CCBT+MCBT), or (c) CCBT with an intervention targeting the mother-child interaction (CCBT+MCI). A cost-utility analysis from a societal perspective was conducted using mother/child combined quality-adjusted life years (QALYs). [Trial registration: https://doi.org/10.1186/isrctn19762288]. RESULTS MCBT was associated with immediate reductions in maternal anxiety compared to the nonspecific control; however, after children had also received CCBT, maternal outcomes in the CCBT+MCI and CCBT+Con arms improved and CCBT+MCBT was no longer superior. Neither CCBT+MCBT nor CCBT+MCI conferred a benefit over CCBT+Con in terms of child anxiety disorder diagnoses post-treatment [primary outcome] (adj RR: 1.22 (95% CI: 0.88, 1.67), p = .23; adj RR: 1.21 (95% CI: 0.88, 1.65), p = .24, respectively) or global improvement ratings (adj RR: 1.25 (95% CI: 0.99, 1.57), p = .06; adj RR: 1.18 (95% CI: 0.93, 1.50), p = .17) or six and 12 months later. No significant differences between the groups were found on the main economic outcome measures (child/mother combined QALY mean difference: CCBT+MCBT vs. CCBT+Con: -0.04 (95% CI: -0.12, 0.04), p = .29; CCBT+MCI vs. CCBT+Con: 0.02 (95% CI: -0.05, -0.09), p = .54). CCBT+MCI was associated with nonsignificantly higher costs than CCBT (mean difference: £154 (95% CI: -£1,239, £1,547), p = .83) but, when taking into account sampling uncertainty, it may be cost-effective compared with CCBT alone. CONCLUSIONS Good outcomes were achieved for children and their mothers across treatment arms. There was no evidence of significant clinical benefit from supplementing CCBT with either CBT for the maternal anxiety disorder or treatment focussed on mother-child interactions, but the addition of MCI (and not MCBT) may be cost-effective.
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Affiliation(s)
- Cathy Creswell
- Department of PsychiatryUniversity of OxfordOxfordUK,Department of Experimental PsychologyUniversity of OxfordOxfordUK,School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Mara Violato
- Nuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Susan Cruddace
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Stephen Gerry
- Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal ScienceUniversity of OxfordOxfordUK
| | - Lynne Murray
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
| | - Roz Shafran
- Population, Policy and PracticeUCL Great Ormond Street Institute of Child HealthLondonUK
| | - Alan Stein
- Department of PsychiatryUniversity of OxfordOxfordUK,MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt)University of the WitwatersrandJohannesburgSouth Africa
| | - Lucy Willetts
- Berkshire Healthcare NHS Foundation TrustBerkshireUK
| | - Emma McIntosh
- Institute of Health and WellbeingUniversity of GlasgowGlasgowUK
| | - Peter J. Cooper
- School of Psychology and Clinical Language SciencesUniversity of ReadingReadingUK
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41
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Lassen NF, Hougaard E, Arendt KB, Thastum M. A disorder-specific group cognitive behavior therapy for social anxiety disorder in adolescents: study protocol for a randomized controlled study. Trials 2019; 20:757. [PMID: 31864383 PMCID: PMC6925436 DOI: 10.1186/s13063-019-3885-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/05/2019] [Indexed: 11/16/2022] Open
Abstract
Background Social anxiety disorder (SAD) is a common disorder in adolescence associated with extensive distress and long-term impairment. Generic cognitive behavior therapy (CBT) programs for anxiety disorders have shown poorer outcomes for adolescents with SAD than for other anxiety disorders. Aim The aim of the present study is to investigate the efficacy of a disorder-specific group cognitive behavior therapy (G-CBT) program for youth SAD, the Cool Kids Anxiety Program - Social Enhanced (CK-E), developed at Macquarie University, Sidney, Australia. Methods The study is a randomized controlled trial comparing CK-E to a generic G-CBT program for anxiety disorders. Approximately 96 adolescents aged 12 to 17 years are included with data points at pre- and post-treatment, and at 3 months and 1 year follow-ups. Discussion The current study will provide more information about the efficacy of diagnosis-specific G-CBT treatment for youth SAD. Trial registration ClinicalTrials.gov, NCT03986827. Registered on 14 June 2019.
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Affiliation(s)
- Nanna Fensman Lassen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Esben Hougaard
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Bech Arendt
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
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42
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Ryan JL, Fox JK, Lowe SR, Warner CM. Do Social Threat Cognitions Decrease With School-Based CBT and Predict Treatment Outcome in Adolescents With Social Anxiety Disorder? J Cogn Psychother 2019; 33:331-342. [PMID: 32746395 DOI: 10.1891/0889-8391.33.4.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence suggests that Social Anxiety Disorder (SAD) is less responsive to cognitive behavioral treatment (CBT) compared to other anxiety disorders. Therefore, exploring what might facilitate clinical benefit is essential. Social threat cognitions, characterized by exaggerated perceptions of negative evaluation by others, may be one important avenue to examine. The current study investigated whether youths' social threat cognitions decreased with Skills for Academic and Social Success (SASS), a group, school-based CBT designed for SAD, and whether decreases predicted SAD severity and treatment response. Participants included 138 high school students with SAD randomly assigned to SASS, or a nonspecific school counseling intervention. SASS participants showed significantly decreased social threat cognitions at 5-month follow-up. Treatment responders had significantly greater reductions in social threat cognitions compared to nonresponders at post-intervention and follow-up. These findings suggest that social threat cognitions may be important to assess and monitor when treating youth with SAD.
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Affiliation(s)
- Julie L Ryan
- William James College, Clinical Psychology Department
| | - Jeremy K Fox
- Montclair State University, Psychology Department
| | - Sarah R Lowe
- Montclair State University, Psychology Department
| | - Carrie Masia Warner
- Montclair State University, Psychology Department.,Nathan Kline Institute for Psychiatric Research.,NYU Langone Medical Center, Department of Child and Adolescent Psychiatry
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43
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Leigh E, Clark DM. Online Social anxiety Cognitive therapy for Adolescents (OSCA): protocol for a randomised controlled trial. Trials 2019; 20:574. [PMID: 31590681 PMCID: PMC6781376 DOI: 10.1186/s13063-019-3651-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/12/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Adolescent social anxiety disorder (SAD) is common, impairing and persistent. There is a need to intervene early to avert its long-term consequences. Cognitive Therapy for SAD is the leading treatment for adults and shows promise for adolescents. However, given the scale of the problem of adolescent SAD and the limited availability of psychological therapists in child and adolescent mental health services, there is a substantial gap in service provision. Delivering therapy via the Internet may provide part of the solution to this problem. An Internet version of adult Cognitive Therapy for SAD has been developed, with outcomes similar to face-to-face therapy. We have recently adapted this treatment for use with adolescents with SAD. Here, we describe a randomised controlled trial designed to test the efficacy of Internet Cognitive Therapy for adolescent SAD compared to waitlist. METHODS/DESIGN Forty adolescents aged 14-18 years with a diagnosis of SAD will be recruited via schools. Participants will be randomly allocated to Internet Cognitive Therapy or to waitlist. All participants will be assessed three times during the study-at baseline (pretreatment/wait), midtreatment/wait (week 8) and posttreatment/wait (week 15). Participants in the experimental arm will also complete weekly measures as part of the online program and they will be assessed at 3 and 6 months. Postwait, participants in the waitlist arm will be offered Internet Cognitive Therapy, and weekly and posttreatment data will also be collected for them. The trial aims to test whether Internet Cognitive Therapy is superior to waitlist in reducing social anxiety symptoms and in reducing the proportion of adolescents meeting criteria for SAD. Other outcomes of interest include depression and general anxiety symptoms. Acceptability of the online treatment will also be evaluated. DISCUSSION This randomised controlled trial will provide preliminary evidence on whether this intervention, requiring relatively low levels of therapist input, is safe and clinically effective. If this is shown to be the case, Internet Cognitive Therapy for adolescents has the potential to provide a service to the large population of adolescents with untreated SAD. TRIAL REGISTRATION ISRCTN Registry, ISRCTN15079139 . Version 1 registered on 06/02/2019.
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Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, OxCADAT, The Old Rectory, Paradise Square, Oxford, OX1 1TW UK
| | - David M. Clark
- Department of Experimental Psychology, University of Oxford, OxCADAT, The Old Rectory, Paradise Square, Oxford, OX1 1TW UK
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44
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Mobach L, Rinck M, Becker ES, Hudson JL, Klein AM. Content-Specific Interpretation Bias in Children with Varying Levels of Anxiety: The Role of Gender and Age. Child Psychiatry Hum Dev 2019; 50:803-814. [PMID: 30879167 PMCID: PMC6737177 DOI: 10.1007/s10578-019-00883-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The current study examined whether children varying in their levels of social anxiety, separation anxiety and spider fear exhibit a negative interpretation bias specific for their fears. Furthermore, age and gender were assessed as moderators of this relation. Children (N = 603) of the age of 7-12 years were asked to solve ambiguous scenarios reflecting social threat, separation threat or spider threat. Children's levels of anxiety were assessed with self-report questionnaires. Results indicated that children scoring higher on self-reported social anxiety, separation anxiety or spider fear, displayed a negative interpretation bias for the threat-scenarios pertaining to their specific anxiety or fear, even after controlling for comorbidity with other anxiety subtypes. Contrary to our hypotheses, we did not find moderating effects of age or gender. These results indicate that even in a community sample, content-specificity of negative interpretation biases is present.
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Affiliation(s)
- Lynn Mobach
- Department of Psychology, Behavioural Science Institute, Radboud University, Montessorilaan, 6525 HR, Nijmegen, The Netherlands.
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia.
| | - Mike Rinck
- Department of Psychology, Behavioural Science Institute, Radboud University, Montessorilaan, 6525 HR, Nijmegen, The Netherlands
| | - Eni S Becker
- Department of Psychology, Behavioural Science Institute, Radboud University, Montessorilaan, 6525 HR, Nijmegen, The Netherlands
| | - Jennifer L Hudson
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Anke M Klein
- Department of Psychology, Behavioural Science Institute, Radboud University, Montessorilaan, 6525 HR, Nijmegen, The Netherlands
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
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45
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Reardon T, Creswell C, Lester KJ, Arendt K, Blatter-Meunier J, Bögels SM, Coleman JRI, Cooper PJ, Heiervang ER, Herren C, Hogendoorn SM, Hudson JL, Keers R, Lyneham HJ, Marin CE, Nauta M, Rapee RM, Roberts S, Schneider S, Silverman WK, Thastum M, Thirlwall K, Wergeland GJ, Eley TC. The utility of the SCAS-C/P to detect specific anxiety disorders among clinically anxious children. Psychol Assess 2019; 31:1006-1018. [PMID: 31070449 PMCID: PMC6671872 DOI: 10.1037/pas0000700] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 10/17/2018] [Accepted: 12/31/2018] [Indexed: 12/14/2022]
Abstract
Questionnaire measures offer a time and cost-effective alternative to full diagnostic assessments for identifying and differentiating between potential anxiety disorders and are commonly used in clinical practice. Little is known, however, about the capacity of questionnaire measures to detect specific anxiety disorders in clinically anxious preadolescent children. This study aimed to establish the ability of the Spence Children's Anxiety Scale (SCAS) subscales to identify children with specific anxiety disorders in a large clinic-referred sample (N = 1,438) of children aged 7 to 12 years. We examined the capacity of the Separation Anxiety, Social Phobia, Generalized Anxiety, and Physical Injury Fears (phobias) subscales to discriminate between children with and without the target disorder. We also identified optimal cutoff scores on subscales for accurate identification of children with the corresponding disorder, and examined the contribution of child, mother, and father reports. The Separation Anxiety subscale was able to accurately identify children with separation anxiety disorder, and this was replicated across all 3 reporters. Mother- and father-reported Social Phobia subscales also accurately identified children with social anxiety disorder, although child report was only able to accurately detect social anxiety disorder in girls. Using 2 or more reporters improved the sensitivity of the Separation Anxiety and Social Phobia subscales but reduced specificity. The Generalized Anxiety and Physical Injury Fears subscales failed to accurately identify children with the corresponding disorders. These findings have implications for the potential use of mother-, father-, and child-report SCAS subscales to detect specific disorders in preadolescent children in clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Kristian Arendt
- Department of Psychology and Behavioural Sciences, Aarhus University
| | | | - Susan M Bögels
- Research Institute Child Development and Education, University of Amsterdam
| | - Jonathan R I Coleman
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry Centre, King's College London
| | - Peter J Cooper
- School of Psychology and Clinical Language Sciences, University of Reading
| | | | - Chantal Herren
- Department of Forensic Psychiatry, University of Basel Psychiatric Clinics
| | - Sanne M Hogendoorn
- Department of Child and Adolescent Psychiatry/De Bascule, Academic Medical Centre
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University
| | - Robert Keers
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry (SGDP) Centre, King's College London
| | - Heidi J Lyneham
- Centre for Emotional Health, Department of Psychology, Macquarie University
| | - Carla E Marin
- Child Study Center, Yale University School of Medicine
| | - Maaike Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University
| | - Susanna Roberts
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London
| | - Silvia Schneider
- Mental Health Research and Treatment Center (MHRTC), Ruhr University Bochum
| | | | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University
| | - Kerstin Thirlwall
- School of Psychology and Clinical Language Sciences, University of Reading
| | - Gro Janne Wergeland
- Anxiety Disorders Research Network and Division of Psychiatry, Department of Child and Adolescent Psychiatry, Haukeland University Hospital
| | - Thalia C Eley
- Institute of Psychiatry, Psychology and Neuroscience, Social, Genetic and Developmental Psychiatry (SGDP) Centre, King's College London
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46
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Walczak M, Breinholst S, Ollendick T, Esbjørn BH. Cognitive Behavior Therapy and Metacognitive Therapy: Moderators of Treatment Outcomes for Children with Generalized Anxiety Disorder. Child Psychiatry Hum Dev 2019; 50:449-458. [PMID: 30406900 DOI: 10.1007/s10578-018-0853-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although cognitive behavioral therapy (CBT) is effective for childhood anxiety disorders, approximately 40% of youth remain anxious after treatment. Metacognitive therapy (MCT-c) for children with generalized anxiety disorder (GAD) has shown promising effects. The present study aimed to examine if CBT and MCT-c show differential effects in children with primary GAD based on baseline characteristics, in a quasi-experimental design. To investigate which treatment is most beneficial for whom, three potential moderators: age, symptom severity, and comorbid social anxiety were examined. Sixty-three children aged 7-14 completed CBT or MCT-c. Participants were assessed before and after treatment. Both CBT and MCT-c were highly effective in treatment of childhood GAD. None of the selected variables significantly moderated treatment outcomes. Subgroups of children with high symptom severity and social anxiety comorbidity showed trends of responding better to CBT. Methodologically stronger studies are needed to facilitate a better adaptation of treatment for children with GAD.
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Affiliation(s)
- Monika Walczak
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark.
| | - Sonja Breinholst
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
| | | | - Barbara Hoff Esbjørn
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
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47
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Rayner C, Coleman JRI, Purves KL, Hodsoll J, Goldsmith K, Alpers GW, Andersson E, Arolt V, Boberg J, Bögels S, Creswell C, Cooper P, Curtis C, Deckert J, Domschke K, El Alaoui S, Fehm L, Fydrich T, Gerlach AL, Grocholewski A, Hahlweg K, Hamm A, Hedman E, Heiervang ER, Hudson JL, Jöhren P, Keers R, Kircher T, Lang T, Lavebratt C, Lee SH, Lester KJ, Lindefors N, Margraf J, Nauta M, Pané-Farré CA, Pauli P, Rapee RM, Reif A, Rief W, Roberts S, Schalling M, Schneider S, Silverman WK, Ströhle A, Teismann T, Thastum M, Wannemüller A, Weber H, Wittchen HU, Wolf C, Rück C, Breen G, Eley TC. A genome-wide association meta-analysis of prognostic outcomes following cognitive behavioural therapy in individuals with anxiety and depressive disorders. Transl Psychiatry 2019; 9:150. [PMID: 31123309 PMCID: PMC6533285 DOI: 10.1038/s41398-019-0481-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 03/01/2019] [Accepted: 03/23/2019] [Indexed: 01/04/2023] Open
Abstract
Major depressive disorder and the anxiety disorders are highly prevalent, disabling and moderately heritable. Depression and anxiety are also highly comorbid and have a strong genetic correlation (rg ≈ 1). Cognitive behavioural therapy is a leading evidence-based treatment but has variable outcomes. Currently, there are no strong predictors of outcome. Therapygenetics research aims to identify genetic predictors of prognosis following therapy. We performed genome-wide association meta-analyses of symptoms following cognitive behavioural therapy in adults with anxiety disorders (n = 972), adults with major depressive disorder (n = 832) and children with anxiety disorders (n = 920; meta-analysis n = 2724). We estimated the variance in therapy outcomes that could be explained by common genetic variants (h2SNP) and polygenic scoring was used to examine genetic associations between therapy outcomes and psychopathology, personality and learning. No single nucleotide polymorphisms were strongly associated with treatment outcomes. No significant estimate of h2SNP could be obtained, suggesting the heritability of therapy outcome is smaller than our analysis was powered to detect. Polygenic scoring failed to detect genetic overlap between therapy outcome and psychopathology, personality or learning. This study is the largest therapygenetics study to date. Results are consistent with previous, similarly powered genome-wide association studies of complex traits.
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Affiliation(s)
- Christopher Rayner
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jonathan R I Coleman
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK
| | - Kirstin L Purves
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - John Hodsoll
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kimberley Goldsmith
- Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Georg W Alpers
- Department of Psychology, School of Social Sciences, University of Mannheim, Mannheim, Germany
| | - Evelyn Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Volker Arolt
- Department of Psychiatry and Psychotherapy, University of Münster, Münster, Germany
| | - Julia Boberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Susan Bögels
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Peter Cooper
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Charles Curtis
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK
| | - Jürgen Deckert
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, 97078, Germany
| | - Katharina Domschke
- Faculty of Medicine, Department of Psychiatry and Psychotherapy, Medical Center, University of Freiburg, Freiburg, Germany
- Center for NeuroModulation, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Samir El Alaoui
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lydia Fehm
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Thomas Fydrich
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Alexander L Gerlach
- Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany
| | - Anja Grocholewski
- Department of Psychology, University of Braunschweig, Braunschweig, Germany
| | - Kurt Hahlweg
- Department of Psychology, University of Braunschweig, Braunschweig, Germany
| | - Alfons Hamm
- Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Erik Hedman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Einar R Heiervang
- Division of Mental Health and Addiction, Department of Child and Adolescent Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Peter Jöhren
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Robert Keers
- Department of Biological and Experimental Psychology, School of Biological and Chemical Sciences, Queen Mary University of London, London, UK
| | - Tilo Kircher
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Thomas Lang
- Christoph-Dornier-Stiftung für Klinische Psychologie, Institut für Klinische Psychologie und Psychotherapie, Bremen, Germany
| | - Catharina Lavebratt
- Neurogenetics Unit, Center for Molecular Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Sang-Hyuck Lee
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK
| | - Kathryn J Lester
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- School of Psychology, University of Sussex, Brighton, UK
| | - Nils Lindefors
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Maaike Nauta
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - Christiane A Pané-Farré
- Department of Biological and Clinical Psychology, University of Greifswald, Greifswald, Germany
| | - Paul Pauli
- Department of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital Frankfurt, Frankfurt am Main, Germany
| | - Winfried Rief
- Department of Psychiatry and Psychotherapy, University of Marburg, Marburg, Germany
| | - Susanna Roberts
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Martin Schalling
- Neurogenetics Unit, Center for Molecular Medicine, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Wendy K Silverman
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Andreas Ströhle
- Department of Psychiatry and Psychotherapy, Campus Charité Mitte, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Tobias Teismann
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Andre Wannemüller
- Mental Health Research and Treatment Center, Ruhr-Universität Bochum, Bochum, Germany
- Dental Clinic Bochum, Bochum, Germany
| | - Heike Weber
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, 97078, Germany
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Christiane Wolf
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University of Würzburg, Würzburg, 97078, Germany
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Gerome Breen
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK.
| | - Thalia C Eley
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Trust, NIHR Biomedical Research Centre for Mental Health, London, UK.
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Asher M, Hermesh H, Gur S, Marom S, Aderka I. Do men and women arrive, stay, and respond differently to cognitive behavior group therapy for social anxiety disorder? J Anxiety Disord 2019; 64:64-70. [PMID: 31048094 DOI: 10.1016/j.janxdis.2019.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 03/06/2019] [Accepted: 03/31/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Maya Asher
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Haggai Hermesh
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Shay Gur
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Sofi Marom
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel
| | - Idan Aderka
- University of Haifa, 172 Sderot Aba Hushi, Haifa 34988, Israel.
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Stjerneklar S, Hougaard E, Thastum M. Guided internet-based cognitive behavioral therapy for adolescent anxiety: Predictors of treatment response. Internet Interv 2019; 15:116-125. [PMID: 30792963 PMCID: PMC6371410 DOI: 10.1016/j.invent.2019.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Guided internet-based cognitive behavioral therapy (ICBT) has been found efficacious in reducing symptoms of anxiety in adolescents with anxiety disorders, but not all respond equally well. OBJECTIVE In this study, we explored candidate predictors of ICBT treatment response within the frame of a randomized controlled trial. METHODS Sixty-five adolescents (13-17 years) with anxiety disorders according to DSM-IV received 14 weeks of therapist-guided ICBT. Outcome was evaluated as improvement (continuous change score) from pre-treatment to 12-month follow-up according to self-reported anxiety symptoms and clinician-rated diagnostic severity. Clinical predictors included baseline self- and parent-reported anxiety symptom levels, baseline clinician-rated severity of primary diagnosis, summed baseline clinician-rated severity of all anxiety diagnoses, baseline self-rated depressive symptoms, age of onset, and primary diagnosis of social phobia. Demographic predictors included age, gender and computer comfortability. Therapy process-related predictors included number of completed modules and therapist phone calls, summed duration of therapist phone calls, degree of parent support, and therapeutic alliance. Multi-level models were used to test the prediction effects over time. RESULTS Higher levels of self- and clinician-rated baseline anxiety and self-rated depressive symptoms, female gender, and higher levels of computer comfortability were associated with increased treatment response. None of the proposed therapy process-related predictors significantly predicted treatment response. CONCLUSION The present findings indicate that ICBT may be an acceptable choice of treatment for youths, even those with relative high levels of anxiety and depressive symptoms.
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Affiliation(s)
- Silke Stjerneklar
- Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark
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Lavallee K, Schuck K, Blatter-Meunier J, Schneider S. Transgenerational improvements following child anxiety treatment: An exploratory examination. PLoS One 2019; 14:e0212667. [PMID: 30817752 PMCID: PMC6394948 DOI: 10.1371/journal.pone.0212667] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 02/02/2019] [Indexed: 11/18/2022] Open
Abstract
Background The present study conducted secondary analyses of a randomized controlled trial to examine the transgenerational relationship between cognitive-behavioral therapy for child Separation Anxiety Disorder (SepAD) and the mental health of parents. Symptoms of anxiety and depression were compared before and after child treatment between parents of children treated for SepAD and parents of healthy children, who did not receive any treatment. Methods One hundred and seven children aged 4–14 years with SepAD received one of two cognitive behavioral treatment programs for SepAD (TAFF; TrennungsAngstprogramm Für Familien; English: Separation Anxiety Family Therapy or CC; Coping Cat). Their parents (N = 189; 101 mothers and 88 fathers) were assessed at baseline and post-treatment for symptoms of separation anxiety, general anxiety, and depression. A comparison group of parents (N = 74; 42 mothers and 32 fathers) of 45 children without SepAD, who did not receive any treatment, were also assessed. Results Results indicated a significant interaction effect between group and time on mothers’ depression and separation anxiety, indicating that maternal symptoms of depression and separation anxiety improved in the child treatment condition in comparison to mothers of healthy children. There was no significant improvement in parental pathology levels among fathers of children treated for SepAD. Conclusions Treatment for child SepAD may have subsequent positive effects on mothers’ own levels of separation anxiety and depression, though the mechanisms are yet unknown. Future studies are needed that test the transgenerational effect of child SepAD treatment on parental mental health as the primary research question.
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