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Madhavan S, Stewart LC, Birk SL, Nielsen JD, Olino TM. Positive and Negative Life Events in Association with Psychopathology: An Examination of Sex Differences in Early Adolescence. Child Psychiatry Hum Dev 2024; 55:1431-1440. [PMID: 36809644 DOI: 10.1007/s10578-023-01509-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2023] [Indexed: 02/23/2023]
Abstract
Negative life events (NLEs) are associated with psychopathology in older adolescents and adults, particularly for women. However, less is known about the association between positive life events (PLEs) and psychopathology. This study examined associations between NLEs, PLEs, and their interaction, and sex differences in associations between PLEs and NLEs on internalizing and externalizing psychopathology. Youth completed interviews about NLEs and PLEs. Parents and youth reported on youth internalizing and externalizing symptoms. NLEs were positively associated with youth-reported depression and anxiety and parent-reported youth depression. Female youth had stronger positive associations between NLEs and youth-reported anxiety than male youth. Interactions between PLEs and NLEs were non-significant. Findings for NLEs and psychopathology are extended to earlier in development.
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Affiliation(s)
- Subhashini Madhavan
- Department of Psychology, Temple University, 1701 North 13th Street, Weiss Hall, Philadelphia, PA, United States
| | - Lindsey C Stewart
- Department of Psychology, Temple University, 1701 North 13th Street, Weiss Hall, Philadelphia, PA, United States
| | - Samantha L Birk
- Department of Psychology, Temple University, 1701 North 13th Street, Weiss Hall, Philadelphia, PA, United States
| | - Johanna D Nielsen
- Department of Psychology, Temple University, 1701 North 13th Street, Weiss Hall, Philadelphia, PA, United States
| | - Thomas M Olino
- Department of Psychology, Temple University, 1701 North 13th Street, Weiss Hall, Philadelphia, PA, United States.
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2
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Ustrup M, Christensen T, Curth NK, Heine K, Bojesen AB, Eplov LF. Predictors of Symptom Reduction and Remission Among People with Anxiety: Secondary Analyses from a Randomized Controlled Trial. Psychiatr Q 2024; 95:447-467. [PMID: 39023677 DOI: 10.1007/s11126-024-10081-y] [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] [Accepted: 06/02/2024] [Indexed: 07/20/2024]
Abstract
Despite the substantial disease burden of anxiety disorders, only limited or conflicting data on prognostic factors is available. Most studies include patients in the secondary healthcare sector thus, the generalizability of findings is limited. The present study examines predictors of symptom reduction and remission in patients with anxiety disorders in a primary care setting. 214 patients with anxiety disorders, recruited as part of the Collabri Flex trial, were included in secondary analyses. Data on potential predictors of anxiety symptoms at 6-month follow-up was collected at baseline, including patient characteristics related to demography, illness, comorbidity, functional level, life quality, and self-efficacy. The outcomes were symptom reduction and remission. Univariate and multivariate linear and logistic regression analyses were conducted to assess the associations between predictor variables and the outcome, and machine-learning methods were also applied. In multiple linear regression analysis, anxiety severity at baseline (β = -6.05, 95% CI = -7.54,-4.56, p < 0.001) and general psychological problems and symptoms of psychopathology (SCL-90-R score) (β = 2.19, 95% CI = 0.24,4.14, p = 0.028) were significantly associated with symptom change at 6 months. Moreover, self-efficacy was associated with the outcome, however no longer significant in the multiple regression model. In multiple logistic regression analysis, anxiety severity at baseline (OR = 0.54, 95% CI = -1.13,-0.12, p = 0.018) was significantly associated with remission at 6 months. There was no predictive performance of the machine-learning models. Our study contributes with information that could be valuable knowledge for managing anxiety disorders in primary care.
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Affiliation(s)
- Marte Ustrup
- Copenhagen Research Unit for Recovery, Mental Health Center Amager, Mental Health Services in the Capital Region of Denmark, Hans Bogbinders Allé 3, 2300, Copenhagen, Denmark.
| | - Thomas Christensen
- Copenhagen Research Unit for Recovery, Mental Health Center Amager, Mental Health Services in the Capital Region of Denmark, Hans Bogbinders Allé 3, 2300, Copenhagen, Denmark
| | - Nadja Kehler Curth
- Copenhagen Research Unit for Recovery, Mental Health Center Amager, Mental Health Services in the Capital Region of Denmark, Hans Bogbinders Allé 3, 2300, Copenhagen, Denmark
| | - Kimmie Heine
- Copenhagen Research Unit for Recovery, Mental Health Center Amager, Mental Health Services in the Capital Region of Denmark, Hans Bogbinders Allé 3, 2300, Copenhagen, Denmark
| | - Anders Bo Bojesen
- Copenhagen Research Unit for Recovery, Mental Health Center Amager, Mental Health Services in the Capital Region of Denmark, Hans Bogbinders Allé 3, 2300, Copenhagen, Denmark
| | - Lene Falgaard Eplov
- Copenhagen Research Unit for Recovery, Mental Health Center Amager, Mental Health Services in the Capital Region of Denmark, Hans Bogbinders Allé 3, 2300, Copenhagen, Denmark
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Skumsnes T, Fjermestad KW, Wergeland GJ, Aalberg M, Heiervang ER, Kodal A, Ingul JM. Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders. Res Child Adolesc Psychopathol 2024; 52:1427-1439. [PMID: 38869750 DOI: 10.1007/s10802-024-01215-8] [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] [Accepted: 05/17/2024] [Indexed: 06/14/2024]
Abstract
The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.
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Affiliation(s)
- Toril Skumsnes
- Tynset Child and Adolescents Mental Health Service, Innlandet Hospital Trust, Tynset, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, 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
| | - Marianne Aalberg
- Department for Research and Development, Division of Mental Health and Substance Use, Akershus University Hospital, Oslo, Norway
| | - Einar R Heiervang
- Tynset Child and Adolescents Mental Health Service, Innlandet Hospital Trust, Tynset, Norway
| | - Arne Kodal
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Jo Magne Ingul
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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Johnco CJ, Zagic D, Rapee RM, Kangas M, Wuthrich VM. Long-term remission and relapse of anxiety and depression in older adults after Cognitive Behavioural Therapy (CBT): A 10-year follow-up of a randomised controlled trial. J Affect Disord 2024; 358:440-448. [PMID: 38723682 DOI: 10.1016/j.jad.2024.05.033] [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: 11/06/2023] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND This study examined the long-term durability of cognitive behaviour therapy (CBT) for older adults with comorbid anxiety and depression 10 years after treatment, in comparison to an active control group. METHOD Participants from a randomised controlled trial for older adults with comorbid anxiety and depression (Wuthrich et al., 2016) were re-contacted. Participants had received either group CBT or an active control treatment (Discussion Group). The final sample (N = 54; Aged 70-84, Mage = 76.07, SD = 3.83; 59 % of the eligible original sample) completed a diagnostic interview, cognitive assessment and self-report measures of symptoms and quality of life. RESULTS CBT was associated with significantly improved long-term (10-year) efficacy for reducing anxiety and depression in older adults compared to the Discussion group. Effects included higher rates of remission (58 % remission of all diagnoses vs 27 %, 88 % of all depressive diagnoses vs 54 %, 63 % of all anxiety diagnoses vs 35 %, 67 % of primary diagnosis vs 42 %), lower rates of relapse (25-31 % vs 50-78 %) and lower rates of chronic treatment-resistance (8 % primary disorder vs 39 %, 21 % any disorder vs 58 %). Participants who showed an acute treatment response at post-treatment were 7-9 times more likely to be in remission after 10 years than those with residual symptoms. LIMITATIONS Results may not generalise to those who do not complete CBT, and the time trajectory of symptom change is unclear. CONCLUSIONS Long-term improvements in symptoms are specific to CBT. Results provide compelling evidence for CBT as an effective and durable treatment for late-life anxiety and depression.
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Affiliation(s)
- Carly J Johnco
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Dino Zagic
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Ronald M Rapee
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Maria Kangas
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia; School of Psychological Sciences, Macquarie University, Sydney, Australia
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Rabner J, Olino TM, Albano AM, Keeton CP, Sakolsky D, Birmaher B, Piacentini J, Peris TS, Compton SN, Gosch E, Ginsburg GS, Pinney EL, Kendall PC. Substance use outcomes from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). J Child Psychol Psychiatry 2024; 65:910-920. [PMID: 38217328 DOI: 10.1111/jcpp.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Substance use problems and anxiety disorders are both highly prevalent and frequently cooccur in youth. The present study examined the benefits of successful anxiety treatment at 3-12 years after treatment completion on substance use outcomes (i.e. diagnoses and lifetime expected use). METHODS The sample was from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), a naturalistic follow-up study to the Child/Adolescent Anxiety Multimodal Study (CAMS) which randomized youth to cognitive behavioral therapy (CBT; Coping cat), medication (sertraline), their combination, or pill placebo. The first CAMELS visit occurred an average of 6.5 years following CAMS randomization. Participants were 319 youth (65.4% of the CAMS sample), aged 7-17 years at CAMS baseline assessment with a mean age of 17.6 years (range: 11-26 years) at the time of the first CAMELS follow-up. Substance use outcomes included diagnoses as well as lifetime substance use (i.e. alcohol and tobacco use). RESULTS Eleven of 319 (3.4%) CAMELS participants were diagnosed with a substance use disorder at the initial follow-up visit. When compared to the population lifetime rate of 11.4%, the rate of diagnoses in the posttreated sample was significantly lower. Additionally, rates of lifetime alcohol use were lower than population rates at the initial and final follow-up visits. Rates of lifetime tobacco use were similarly lower than lifetime population rates at the initial visit (driven by significantly lower rates in the CBT treatment condition), but higher by the final visit. Furthermore, treatment remission (but not treatment response) was associated with a lower rate of substance use diagnoses at the initial follow-up visit, although rates of lifetime alcohol and tobacco use did not differ by treatment outcome. CONCLUSIONS Anxiety treatments confer a beneficial impact on problematic substance use (i.e. diagnoses) as well as on expected substance use (i.e. alcohol and tobacco use) for on average, a period of 6.5 years.
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Affiliation(s)
- Jonathan Rabner
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
| | - Thomas M Olino
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Courtney P Keeton
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Scott N Compton
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | | | - Philip C Kendall
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
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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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Yoder R, Michaud A, Feagans A, Hinton-Froese KE, Meyer A, Powers VA, Stalnaker L, Hord MK. Family-Based Treatment for Anxiety, Depression, and ADHD for a Parent and Child. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:504. [PMID: 38673415 PMCID: PMC11050397 DOI: 10.3390/ijerph21040504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/14/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024]
Abstract
Children with mental illness commonly live with caregivers who suffer from mental illness. Integrated mental-health-treatment approaches can provide more convenient and comprehensive care for families. This case report describes family-based treatment (FBT) for one parent/child dyad. The parent was a 37-year-old female with a history of anxiety and major depressive disorder and concern for symptoms of attention-deficit/hyperactivity disorder (ADHD). The child was an 8-year-old female with generalized anxiety disorder and concern for ADHD and behavioral problems. The parent received individual cognitive behavioral therapy (CBT) and parent management training. The child received CBT. Both also received medication management. The FBT team met regularly for coordinated treatment planning. Self-reported assessments via the Child Behavior Checklist showed meaningful improvement; anxiety decreased to nonclinical range week 12 and depression decreased to nonclinical range week 8. Clinician assessments showed improvement for both patients. Though more time intensive, FBT can yield significant improvement, particularly for children. Pragmatic approaches to treatment planning are important to minimize barriers to FBT.
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Affiliation(s)
- Rachel Yoder
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN 46202, USA (A.F.); (K.E.H.-F.)
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Krause K, Zhang XC, Schneider S. Long-Term Effectiveness of Cognitive Behavioral Therapy in Routine Outpatient Care for Youth with Anxiety Disorders. PSYCHOTHERAPY AND PSYCHOSOMATICS 2024; 93:181-190. [PMID: 38615662 PMCID: PMC11151973 DOI: 10.1159/000537932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 02/14/2024] [Indexed: 04/16/2024]
Abstract
INTRODUCTION This study examined the long-term effectiveness of cognitive behavioral therapy (CBT) (≥ 2 years after the end of therapy) in the routine care of youth (mean 11.95 years; SD = 3.04 years) with primary anxiety disorder (AD). METHODS Two hundred and ten children with any AD as a primary diagnosis and with any comorbidity were included in the "Kids Beating Anxiety (KibA)" clinical trial and received evidence-based CBT. Diagnoses, severity of diagnoses, and further dimensional outcome variables of symptoms and functioning were assessed before (baseline), after the last treatment session (POST), and at two follow-up (FU) assessments in the child and caregiver report: 6 months (6MONTHS-FU) and >2 years (mean 4.31; SD = 1.07 years) after the last treatment session (long-term FU). RESULTS At POST, 61.38% showed total remission of all and any ADs. At long-term FU, the remission rate was 63.64%. Compared to baseline, ratings of severity, anxiety, impairment/burden, and life quality improved significantly after CBT in child and caregiver report. All pre-post/FU improvements and global success ratings were stable in child (Pre-Post: Hedges' g = 3.57; Pre-6MONTHS-FU: Hedges' g = 3.43; Pre-LT-FU: Hedges' g = 2.34) and caregiver report (Pre-Post: Hedges' g = 2.00; Pre-6MONTHS-FU: Hedges' g = 2.31; Pre-LT-FU: Hedges' g = 2.31) across all POST- and FU-assessment points. Some outcomes showed further significant improvement, and no deterioration was found over the course of time. Effect sizes calculated in the present study correspond to, or even exceed, effect sizes reported in previous meta-analysis. CONCLUSIONS Stable long-term effects of "KibA" CBT for youth with ADs, comparable to those results from efficacy studies, were achieved in a routine practice setting by applying treatment manuals tested in randomized controlled trials. These findings are remarkable, as the patient group studied here consisted of an age group within the main risk phase of developing further mental disorders, and therefore an increase in new-onset anxiety and further mental disorders would be expected over the long time span studied here.
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Affiliation(s)
- Karen Krause
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Xiao Chi Zhang
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
| | - Silvia Schneider
- Mental Health Research and Treatment Center, Ruhr University Bochum, Bochum, Germany
- Deutsches Zentrum für Psychische Gesundheit (DZPG), Bochum, Germany
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Lin Z, Zheng J, Wang Y, Su Z, Zhu R, Liu R, Wei Y, Zhang X, Wang F. Prediction of the efficacy of group cognitive behavioral therapy using heart rate variability based smart wearable devices: a randomized controlled study. BMC Psychiatry 2024; 24:187. [PMID: 38448895 PMCID: PMC10916138 DOI: 10.1186/s12888-024-05638-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 02/26/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Depression and anxiety are common and disabling mental health problems in children and young adults. Group cognitive behavioral therapy (GCBT) is considered that an efficient and effective treatment for these significant public health concerns, but not all participants respond equally well. The aim of this study was to examine the predictive ability of heart rate variability (HRV), based on sensor data from consumer-grade wearable devices to detect GCBT effectiveness in early intervention. METHODS In a study of 33 college students with depression and anxiety, participants were randomly assigned to either GCBT group or a wait-list control (WLC) group. They wore smart wearable devices to measure their physiological activities and signals in daily life. The HRV parameters were calculated and compared between the groups. The study also assessed correlations between participants' symptoms, HRV, and GCBT outcomes. RESULTS The study showed that participants in GCBT had significant improvement in depression and anxiety symptoms after four weeks. Higher HRV was associated with greater improvement in depressive and anxious symptoms following GCBT. Additionally, HRV played a noteworthy role in determining how effective GCBT was in improve anxiety(P = 0.002) and depression(P = 0.020), and its predictive power remained significant even when considering other factors. CONCLUSION HRV may be a useful predictor of GCBT treatment efficacy. Identifying predictors of treatment response can help personalize treatment and improve outcomes for individuals with depression and anxiety. TRIAL REGISTRATION The trial has been retrospectively registered on [22/06/2023] with the registration number [NCT05913349] in the ClinicalTrials.gov. Variations in heart rate variability (HRV) have been associated with depression and anxiety, but the relationship of baseline HRV to treatment outcome in depression and anxiety is unclear. This study predicted GCBT effectiveness using HRV measured by wearable devices. 33 students with depression and anxiety participated in a trial comparing GCBT and wait-list control. HRV parameters from wearables correlated with symptoms (PHQ, PSS) and GCBT effectiveness. Baseline HRV levels are strongly associated with GCBT treatment outcomes. HRV may serve as a useful predictor of efficacy of GCBT treatment,facilitating personalized treatment approaches for individuals with depression and anxiety.
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Affiliation(s)
- Zexin Lin
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
| | - Junjie Zheng
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
| | - Yang Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
| | - Zhao Su
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Rongxin Zhu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
| | - Rongxun Liu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
- Henan Key Laboratory of Immunology and Targeted Drugs, School of Laboratory Medicine, Xinxiang Medical University, Xinxiang, P.R. China
| | - Yange Wei
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China
- Department of Psychiatry, The Second Affiliated Hospital of Xinxiang Medical University, Henan Mental Hospital, Xinxiang, Henan, China
| | - Xizhe Zhang
- School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, Jiangsu, China.
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, P.R. China.
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, P.R. China.
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Ladouceur CD. Can Cognitive-Behavioral Therapy Normalize Neural Function in Youths With Pediatric Anxiety Disorders? A Developmental Neuroscience Perspective. Am J Psychiatry 2024; 181:175-177. [PMID: 38425260 DOI: 10.1176/appi.ajp.20240024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
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Rothenberg WA, Lansford JE, Godwin JW, Dodge KA, Copeland WE, Odgers CL, McMahon RJ, Rybinska A. Intergenerational Effects of the Fast Track Intervention on Next-Generation Child Outcomes: A Preregistered Randomized Clinical Trial. Am J Psychiatry 2024; 181:213-222. [PMID: 38321914 PMCID: PMC11137839 DOI: 10.1176/appi.ajp.20220927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVE The authors sought to determine whether the Fast Track mental health intervention delivered to individuals in childhood decreased mental health problems and the need for health services among the children of these individuals. METHODS The authors examined whether Fast Track assignment in one generation of children (generation 2; G2) from grades 1 through 10 reduced parent-reported mental health problems and health services use in these children's children (generation 3; G3) 18 years later relative to a control group. The Fast Track intervention blended parent behavior-management training, child social-cognitive skills tutoring, home visits, and classroom social-ecology changes across grades 1-10 to ameliorate emerging conduct problems among the G2 children. For this study, 1,057 G3 children of Fast Track participants (N=581 intervention group, N=476 control group) were evaluated. RESULTS G3 children of G2 parents who were randomized to the Fast Track intervention group used fewer general inpatient services and fewer inpatient or outpatient mental health services compared with G3 children of G2 parents randomized to the control group. Some of these effects were mediated: randomization to Fast Track predicted fewer internalizing problems and less use of corporal punishment among G2 adults at age 25, which subsequently predicted less general inpatient service use and outpatient mental health service use among the G3 children by the time the G2 parents were 34 years old. There were no significant differences between G3 children from these two groups on the use of other health services or on mental health measures. CONCLUSIONS Fast Track was associated with lower use of general inpatient services and inpatient and outpatient mental health services intergenerationally, but effects on parent-reported mental health of the children were not apparent across generations. Investing in interventions for the mental health of children could reduce service use burdens across generations.
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Affiliation(s)
- W. Andrew Rothenberg
- Duke University Center for Child and Family Policy
- University of Miami Miller School of Medicine’s Mailman Center for Child Development
| | | | | | | | - William E. Copeland
- Duke University Center for Child and Family Policy
- University of Vermont Department of Psychiatry
| | - Candice L. Odgers
- Duke University Center for Child and Family Policy
- University of California Irvine
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Zugman A, Winkler AM, Qamar P, Pine DS. Current and Future Approaches to Pediatric Anxiety Disorder Treatment. Am J Psychiatry 2024; 181:189-200. [PMID: 38425255 PMCID: PMC11256210 DOI: 10.1176/appi.ajp.20231037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
This overview critically appraises the literature on the treatment of pediatric anxiety disorders. The two established treatments for these conditions comprise cognitive-behavioral therapy (CBT) and antidepressant medications. Many youths receiving these treatments fail to achieve remission, which creates a need for new treatments. After summarizing the literature on CBT and currently available medications, the authors describe research that lays a foundation for improvements in the treatment of pediatric anxiety disorders. This foundation leverages neuroscientific investigations, also described in the overview, which provide insights on mechanisms of successful treatment.
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Affiliation(s)
- Andre Zugman
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Anderson M. Winkler
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
- Division of Human Genetics, School of Medicine, The University of Texas Rio Grande Valley, Brownsville, Texas, United States
| | - Purnima Qamar
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
| | - Daniel S. Pine
- Section on Development and Affective Neuroscience (SDAN), Emotion and Development Branch (EDB), National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States
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Haller SP, Linke JO, Grassie HL, Jones EL, Pagliaccio D, Harrewijn A, White LK, Naim R, Abend R, Mallidi A, Berman E, Lewis KM, Kircanski K, Fox NA, Silverman WK, Kalin NH, Bar-Haim Y, Brotman MA. Normalization of Fronto-Parietal Activation by Cognitive-Behavioral Therapy in Unmedicated Pediatric Patients With Anxiety Disorders. Am J Psychiatry 2024; 181:201-212. [PMID: 38263879 DOI: 10.1176/appi.ajp.20220449] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
OBJECTIVE Anxiety disorders are prevalent among youths and are often highly impairing. Cognitive-behavioral therapy (CBT) is an effective first-line treatment. The authors investigated the brain mechanisms associated with symptom change following CBT. METHODS Unmedicated youths diagnosed with an anxiety disorder underwent 12 weeks of CBT as part of two randomized clinical trials testing the efficacy of adjunctive computerized cognitive training. Across both trials, participants completed a threat-processing task during functional MRI before and after treatment. Age-matched healthy comparison youths completed two scans over the same time span. The mean age of the samples was 13.20 years (SD=2.68); 41% were male (youths with anxiety disorders, N=69; healthy comparison youths, N=62). An additional sample including youths at temperamental risk for anxiety (N=87; mean age, 10.51 years [SD=0.43]; 41% male) was utilized to test the stability of anxiety-related neural differences in the absence of treatment. Whole-brain regional activation changes (thresholded at p<0.001) were examined using task-based blood-oxygen-level-dependent response. RESULTS Before treatment, patients with an anxiety disorder exhibited altered activation in fronto-parietal attention networks and limbic regions relative to healthy comparison children across all task conditions. Fronto-parietal hyperactivation normalized over the course of treatment, whereas limbic responses remained elevated after treatment. In the at-risk sample, overlapping clusters emerged between regions showing stable associations with anxiety over time and regions showing treatment-related changes. CONCLUSIONS Activation in fronto-parietal networks may normalize after CBT in unmedicated pediatric anxiety patients. Limbic regions may be less amenable to acute CBT effects. Findings from the at-risk sample suggest that treatment-related changes may not be attributed solely to the passage of time.
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Affiliation(s)
- Simone P Haller
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Julia O Linke
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Hannah L Grassie
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Emily L Jones
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - David Pagliaccio
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Anita Harrewijn
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Lauren K White
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Reut Naim
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Rany Abend
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Ajitha Mallidi
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Erin Berman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Krystal M Lewis
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Katharina Kircanski
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Nathan A Fox
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Wendy K Silverman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Ned H Kalin
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Yair Bar-Haim
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
| | - Melissa A Brotman
- Emotion and Development Branch, NIMH, Bethesda, Md. (Haller, Grassie, Jones, Mallidi, Berman, Lewis, Kircanski, Brotman); Department of Psychology, University of Freiburg, Freiburg, Germany (Linke); Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute, New York (Pagliaccio); Department of Psychology, Education and Child Studies, Erasmus University Rotterdam, Rotterdam, the Netherlands (Harrewijn); Department of Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia (White); Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel (Abend); Department of Human Development and Quantitative Methodology, University of Maryland, College Park (Fox); Yale Child Study Center, Yale School of Medicine, New Haven, Conn. (Silverman); Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison (Kalin); School of Psychological Sciences (Bar-Heim, Naim) and Sagol School of Neuroscience (Bar-Haim), Tel Aviv University, Tel Aviv, Israel
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McAusland L, Burton CL, Bagnell A, Boylan K, Hatchard T, Lingley-Pottie P, Al Maruf A, McGrath P, Newton AS, Rowa K, Schachar RJ, Shaheen SM, Stewart S, Arnold PD, Crosbie J, Mattheisen M, Soreni N, Stewart SE, Meier S. The genetic architecture of youth anxiety: a study protocol. BMC Psychiatry 2024; 24:159. [PMID: 38395805 PMCID: PMC10885620 DOI: 10.1186/s12888-024-05583-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric problems among Canadian youth and typically have an onset in childhood or adolescence. They are characterized by high rates of relapse and chronicity, often resulting in substantial impairment across the lifespan. Genetic factors play an important role in the vulnerability toward anxiety disorders. However, genetic contribution to anxiety in youth is not well understood and can change across developmental stages. Large-scale genetic studies of youth are needed with detailed assessments of symptoms of anxiety disorders and their major comorbidities to inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. METHODS The Genetic Architecture of Youth Anxiety (GAYA) study is a Pan-Canadian effort of clinical and genetic experts with specific recruitment sites in Calgary, Halifax, Hamilton, Toronto, and Vancouver. Youth aged 10-19 (n = 13,000) will be recruited from both clinical and community settings and will provide saliva samples, complete online questionnaires on demographics, symptoms of mental health concerns, and behavioural inhibition, and complete neurocognitive tasks. A subset of youth will be offered access to a self-managed Internet-based cognitive behavioral therapy resource. Analyses will focus on the identification of novel genetic risk loci for anxiety disorders in youth and assess how much of the genetic risk for anxiety disorders is unique or shared across the life span. DISCUSSION Results will substantially inform early intervention or preventative strategies and suggest novel targets for therapeutics and personalization of care. Given that the GAYA study will be the biggest genomic study of anxiety disorders in youth in Canada, this project will further foster collaborations nationally and across the world.
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Affiliation(s)
- Laina McAusland
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada.
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada.
| | - Christie L Burton
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
| | - Alexa Bagnell
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Khrista Boylan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Center for Child Studies, Hamilton, ON, Canada
- Child and Youth Mental Health Program, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Taylor Hatchard
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Youth Wellness Center, St. Joseph's Healthcare, Hamilton, ON, Canada
| | - Patricia Lingley-Pottie
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Psychiatry, IWK Health Centre, Halifax, NS, Canada
| | - Abdullah Al Maruf
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- College of Pharmacy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Patrick McGrath
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Amanda S Newton
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Karen Rowa
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, Hamilton, ON, Canada
| | - Russell J Schachar
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - S-M Shaheen
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Sam Stewart
- Department of Epidemiology and Community Health, Dalhousie University, Halifax, NS, Canada
| | - Paul D Arnold
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
- Department of Medical Genetics, University of Calgary, Calgary, AB, Canada
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada
| | - Jennifer Crosbie
- Neurosciences & Mental Health, Hospital for Sick Children, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Manuel Mattheisen
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Epidemiology and Community Health, Dalhousie University, Halifax, NS, Canada
- Department of Computer Science, Dalhousie University, Halifax, NS, Canada
| | - Noam Soreni
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Offord Center for Child Studies, Hamilton, ON, Canada
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Pediatric OCD Consultation Service, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - S Evelyn Stewart
- British Columbia Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sandra Meier
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Department of Epidemiology and Community Health, Dalhousie University, Halifax, NS, Canada
- Department of Computer Science, Dalhousie University, Halifax, NS, Canada
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15
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Roesmann K, Asbrand J. Developmental pathways in youth anxiety disorders: potential mechanisms for (mal)adapting to crises and improving treatment - a commentary on Klein et al. (2023). J Child Psychol Psychiatry 2024; 65:229-232. [PMID: 37815123 DOI: 10.1111/jcpp.13905] [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] [Accepted: 08/14/2023] [Indexed: 10/11/2023]
Abstract
The ability to cope with threats is crucial in today's troubling times, especially for young people who are still developing coping mechanisms. Psychopathology and the development of anxiety disorders can be viewed as a failure to adapt to changing demands. We draw on a study by Klein et al. (Journal of Child Psychology and Psychiatry, 2023), which showed that anxious youths exhibited stronger conditioned fear responses and, during delayed extinction learning, greater electrocortical differences between threat and safety stimuli. Interestingly, these signatures of learning processes were also associated with treatment outcomes. We argue for developmentally sensitive research: Individual learning and associated cognitive-affective changes are strongly age-dependent and represent the key mechanism for both anxiety development and treatment. They also interact with social and environmental factors. Based on the call for age- and context-sensitive research, future research should focus on establishing reliable risk profiles that consider a variety of factors to enable evidence-based, individualized treatment decisions.
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Affiliation(s)
- Kati Roesmann
- Institute of Psychology, Unit of Clinical Psychology and Psychotherapy in Childhood and Adolescence, University of Osnabrueck, Osnabruck, Germany
- Department of Psychology, Unit of Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany
| | - Julia Asbrand
- Institute of Psychology, Department of Clinical Psychology in Childhood and Adolescence, University of Jena, Jena, Germany
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16
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Storch EA, Guzick AG, Ayton DM, Palo AD, Kook M, Candelari AE, Maye CE, McNeel M, Trent ES, Garcia JL, Onyeka OC, Rast CE, Shimshoni Y, Lebowitz ER, Goodman WK. Randomized trial comparing standard versus light intensity parent training for anxious youth. Behav Res Ther 2024; 173:104451. [PMID: 38154287 DOI: 10.1016/j.brat.2023.104451] [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: 08/28/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 12/30/2023]
Abstract
OBJECTIVE To examine the efficacy of the parent-led intervention Supportive Parenting for Anxious Childhood Emotions (SPACE) relative to a low-dose version of the protocol among children and adolescents with clinically significant anxiety and/or obsessive-compulsive disorder (OCD). METHOD 68 youth (7-17) with anxiety/OCD and their parents were randomized to receive 12 weekly telehealth SPACE sessions (SPACE-Standard) or bibliotherapy plus 4 telehealth sessions over 12 weeks (SPACE-light). After screening, assessments were conducted via videoconferencing at baseline, post-treatment, and one-month follow-up. Independent evaluators were blind to treatment condition. RESULTS Treatment condition did not predict whether a participant responded to the intervention (SPACE-Standard = 70%; SPACE-Light = 68%), nor was treatment condition a predictor of anxiety severity, parent-reported anxiety, or parent-/child-reported functional impairment at post-treatment or one-month follow-up. Youth in SPACE-Light self-reported higher post-treatment anxiety than youth in SPACE-standard, though this was no longer significant at one-month follow-up. Parent-reported family accommodation total change scores were associated with anxiety severity at post-treatment across both arms. CONCLUSION This is the second randomized controlled trial (RCT) evaluating SPACE and provides further support for the efficacy of this intervention both in standard and low-dose formats. This study provides support for parent-led anxiety treatment targeting family accommodation as a primary mechanism of change and extends evidence of efficacy to a more clinically diverse sample. TRIAL REGISTRATION ClinicalTrials.gov Registry: NCT04922502.https://classic. CLINICALTRIALS gov/ct2/show/NCT04922502.
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Affiliation(s)
- Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Daphne M Ayton
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Amanda D Palo
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Abigail E Candelari
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Caitlyn E Maye
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychological & Brain Sciences, Texas A&M University, College Station, TX, USA
| | - Morgan McNeel
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Erika S Trent
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychology, University of Houston, Houston, TX, USA
| | - Jessica L Garcia
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA; Department of Psychology, University of Houston, Houston, TX, USA
| | - Ogechi C Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Catherine E Rast
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Yaara Shimshoni
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Eli R Lebowitz
- Department of Psychiatry, Yale University, New Haven, CT, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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17
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Kajastus K, Haravuori H, Kiviruusu O, Marttunen M, Ranta K. Associations of generalized anxiety and social anxiety with perceived difficulties in school in the adolescent general population. J Adolesc 2024; 96:291-304. [PMID: 37985185 DOI: 10.1002/jad.12275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION Generalized anxiety disorder (GAD), marked by excessive worry, and social anxiety disorder (SAD) are among the clinically most important anxiety disorders in the adolescent population. This study aimed to explore the associations between perceived difficulties in school and heightened levels of self-reported noncomorbid and comorbid GAD and SAD symptoms. METHODS Survey data of 37,905 Finnish upper secondary school students with a mean age of 17.33 years (SD = 0.63) were obtained from the School Health Promotion study, implemented in April and May 2015 in Finland. Exploratory factor analysis was used to determine indicators of academic and social difficulties in school. Logistic regression analysis was conducted to examine multivariate associations between anxiety symptoms and difficulties in the school. The anxiety symptom thresholds were based on the seven-item Generalized Anxiety Disorder Scale (≥10 points) for GAD-related symptoms and the Mini-SPIN (≥6 points) for SAD-related symptoms. RESULTS Self-reported generalized anxiety and social anxiety were both significantly associated with various perceived difficulties in school among this adolescent general population sample. Noncomorbid and comorbid GAD and SAD symptoms were both associated with an increased risk of academic and social difficulties, even when controlling for school performance. Comorbid symptoms were associated with significantly higher rates of social difficulties than noncomorbid symptoms of GAD or SAD. Furthermore, GAD symptoms were associated with a high risk for academic difficulties, irrespective of comorbidity. CONCLUSIONS Excessive worry, a defining feature of GAD, is central to school-related impairments among adolescents. The present study highlights the importance of school-based interventions for anxious adolescents. Interventions to improve adolescents'; school functioning should account for the interference of pathological worry related to GAD.
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Affiliation(s)
- Kati Kajastus
- Department of Psychology, Tampere University, Tampere, Finland
| | - Henna Haravuori
- HUS Helsinki University Hospital, Helsinki, Finland
- Mental Health Team, Finnish Institute for Health and Welfare, Helsinki, Finland
- Adolescent Psychiatry, University of Helsinki, Helsinki, Finland
| | - Olli Kiviruusu
- Mental Health Team, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mauri Marttunen
- HUS Helsinki University Hospital, Helsinki, Finland
- Adolescent Psychiatry, University of Helsinki, Helsinki, Finland
| | - Klaus Ranta
- Department of Psychology, Tampere University, Tampere, Finland
- Adolescent Psychiatry, University of Helsinki, Helsinki, Finland
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18
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Klein Z, Shner-Livne G, Danon-Kraun S, Ginat-Frolich R, Pine DS, Shechner T. Enhanced late positive potential to conditioned threat cue during delayed extinction in anxious youth. J Child Psychol Psychiatry 2024; 65:215-228. [PMID: 37157184 DOI: 10.1111/jcpp.13814] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Deficits in threat learning relate to anxiety symptoms. Since several anxiety disorders arise in adolescence, impaired adolescent threat learning could contribute to adolescent changes in risk for anxiety. This study compared threat learning among anxious and non-anxious youth using self-reports, peripheral psychophysiology measures, and event-related potentials. Because exposure therapy, the first-line treatment for anxiety disorders, is largely based on principles of extinction learning, the study also examined the link between extinction learning and treatment outcomes among anxious youth. METHODS Clinically anxious (n = 28) and non-anxious (n = 33) youth completed differential threat acquisition and immediate extinction. They returned to the lab a week later to complete a threat generalization test and a delayed extinction task. Following these two experimental visits, anxious youth received exposure therapy for 12 weeks. RESULTS Anxious as compared to non-anxious youth demonstrated elevated cognitive and physiological responses across acquisition and immediate extinction learning, as well as greater threat generalization. In addition, anxious youth showed enhanced late positive potential response to the conditioned threat cue compared to the safety cue during delayed extinction. Finally, aberrant neural response during delayed extinction was associated with poorer treatment outcomes. CONCLUSIONS The study emphasizes differences between anxious and non-anxious youth in threat learning processes and provides preliminary support for a link between neural processing during delayed extinction and exposure-based treatment outcome in pediatric anxiety.
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Affiliation(s)
- Zohar Klein
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Gil Shner-Livne
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Shani Danon-Kraun
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Rivkah Ginat-Frolich
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
| | - Daniel S Pine
- National Institute of Mental Health (NIMH), National Institutes of Health (NIH), Bethesda, MD, USA
| | - Tomer Shechner
- School of Psychological Sciences and the Integrated Brain and Behavior Research Center, University of Haifa, Haifa, Israel
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19
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Cobham VE, Radtke SR, Hawkins I, Jordan M, Ali NR, Ollendick TH, Sanders MR. Piloting a one-day parent-only intervention in the treatment of youth with anxiety disorders: child and family-level outcomes. Child Adolesc Psychiatry Ment Health 2024; 18:8. [PMID: 38218829 PMCID: PMC10787495 DOI: 10.1186/s13034-023-00702-y] [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: 10/27/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE Parent-only cognitive-behavioural therapy (CBT) interventions have promise for youth with anxiety disorders. Fear-Less Triple P (FLTP) is one such intervention that has been found comparable to child-focused CBT. Although traditionally administered in six sessions, a one-day workshop format of FLTP was developed to improve accessibility. The current study compared the effectiveness of the six-session and one-day workshop formats. METHOD Seventy-three youth (mean age, 8.4 years; 74% male) were randomized to traditional FLTP (6-week group) or the one-day workshop format. Anxiety diagnostic status, self- and parent-reported anxiety symptoms scores, independent evaluator-rated improvement, treatment satisfaction, and measures of family functioning were included to assess treatment outcome. Data were collected prior to treatment, and 1-week, 6-months, and 12-months following treatment. RESULTS Both conditions resulted in significant improvement in child anxiety symptom scores per parent report (on both questionnaire and diagnostic interview measures). Furthermore, significant decreases in sibling anxiety were observed in both treatment conditions. There were no statistically significant differences between conditions on any outcome measure. CONCLUSIONS Results of this study add to the growing evidence that brief, low-intensity, parent-only interventions can effectively target child psychopathology. These brief interventions are ideal for families for whom the resources and time required to commit to a standard multi-week intervention are prohibitive. REGISTRATION OF CLINICAL TRIALS This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12615001284550).
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Affiliation(s)
- Vanessa E Cobham
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia.
| | - Sarah R Radtke
- Virginia Tech: Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Ingrid Hawkins
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Michele Jordan
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Nasriah Rizman Ali
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Thomas H Ollendick
- Virginia Tech: Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Matthew R Sanders
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
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20
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Aggarwal N, Oler JA, Tromp DPM, Roseboom PH, Riedel MK, Elam VR, Brotman MA, Kalin NH. A preliminary study of the effects of an antimuscarinic agent on anxious behaviors and white matter microarchitecture in nonhuman primates. Neuropsychopharmacology 2024; 49:405-413. [PMID: 37516801 PMCID: PMC10724160 DOI: 10.1038/s41386-023-01686-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 07/17/2023] [Accepted: 07/21/2023] [Indexed: 07/31/2023]
Abstract
Myelination subserves efficient neuronal communication, and alterations in white matter (WM) microstructure have been implicated in numerous psychiatric disorders, including pathological anxiety. Recent work in rodents suggests that muscarinic antagonists may enhance myelination with behavioral benefits; however, the neural and behavioral effects of muscarinic antagonists have yet to be explored in non-human primates (NHP). Here, as a potentially translatable therapeutic strategy for human pathological anxiety, we present data from a first-in-primate study exploring the effects of the muscarinic receptor antagonist solifenacin on anxious behaviors and WM microstructure. 12 preadolescent rhesus macaques (6 vehicle control, 6 experimental; 8F, 4M) were included in a pre-test/post-test between-group study design. The experimental group received solifenacin succinate for ~60 days. Subjects underwent pre- and post-assessments of: 1) anxious temperament (AT)-related behaviors in the potentially threatening no-eye-contact (NEC) paradigm (30-min); and 2) WM and regional brain metabolism imaging metrics, including diffusion tensor imaging (DTI), quantitative relaxometry (QR), and FDG-PET. In relation to anxiety-related behaviors expressed during the NEC, significant Group (vehicle control vs. solifenacin) by Session (pre vs. post) interactions were found for freezing, cooing, and locomotion. Compared to vehicle controls, solifenacin-treated subjects exhibited effects consistent with reduced anxiety, specifically decreased freezing duration, increased locomotion duration, and increased cooing frequency. Furthermore, the Group-by-Session-by-Sex interaction indicated that these effects occurred predominantly in the males. Exploratory whole-brain voxelwise analyses of post-minus-pre differences in DTI, QR, and FDG-PET metrics revealed some solifenacin-related changes in WM microstructure and brain metabolism. These findings in NHPs support the further investigation of the utility of antimuscarinic agents in targeting WM microstructure as a means to treat pathological anxiety.
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Affiliation(s)
- Nakul Aggarwal
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA.
| | - Jonathan A Oler
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
| | - Do P M Tromp
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
| | - Patrick H Roseboom
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
| | - Marissa K Riedel
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
| | - Victoria R Elam
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
| | - Melissa A Brotman
- Neuroscience and Novel Therapeutics Unit, National Institute of Mental Health, Bethesda, MD, 20892, USA
| | - Ned H Kalin
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, 53719, USA
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21
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Langenecker SA, Westlund Schreiner M, Bessette KL, Roberts H, Thomas L, Dillahunt A, Pocius SL, Feldman DA, Jago D, Farstead B, Pazdera M, Kaufman E, Galloway JA, Kerig PK, Bakian A, Welsh RC, Jacobs RH, Crowell SE, Watkins ER. Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:1-10. [PMID: 38021251 PMCID: PMC10654545 DOI: 10.1016/j.bpsgos.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Rumination-focused cognitive behavioral therapy (RF-CBT) is designed to reduce depressive rumination or the habitual tendency to dwell on experiences in a repetitive, negative, passive, and global manner. RF-CBT uses functional analysis, experiential exercises, and repeated practice to identify and change the ruminative habit. This preregistered randomized clinical trial (NCT03859297, R61) is a preregistered replication of initial work. We hypothesized a concurrent reduction of both self-reported rumination and cross-network connectivity between the left posterior cingulate cortex and right inferior frontal and inferior temporal gyri. Methods Seventy-six youths with a history of depression and elevated rumination were randomized to 10 to 14 sessions of RF-CBT (n = 39; 34 completers) or treatment as usual (n = 37; 28 completers). Intent-to-treat analyses assessed pre-post change in rumination response scale and in functional connectivity assessed using two 5 minute, 12 second runs of resting-state functional magnetic resonance imaging. Results We replicated previous findings: a significant reduction in rumination response scale and a reduction in left posterior cingulate cortex to right inferior frontal gyrus/inferior temporal gyrus connectivity in participants who received RF-CBT compared with those who received treatment as usual. Reductions were large (z change = 0.84; 0.73, respectively [ps < .05]). Conclusions This adolescent clinical trial further demonstrates that depressive rumination is a brain-based mechanism that is modifiable via RF-CBT. Here, we replicated that RF-CBT reduces cross-network connectivity, a possible mechanism by which rumination becomes less frequent, intense, and automatic. This National Institute of Mental Health-funded fast-fail study continues to the R33 phase during which treatment-specific effects of RF-CBT will be compared with relaxation therapy.
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Affiliation(s)
- Scott A. Langenecker
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Katie L. Bessette
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Henrietta Roberts
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Leah Thomas
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Alina Dillahunt
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Stephanie L. Pocius
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Daniel A. Feldman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Dave Jago
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Brian Farstead
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Myah Pazdera
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Erin Kaufman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Jennica A. Galloway
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Patricia K. Kerig
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Amanda Bakian
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Robert C. Welsh
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheila E. Crowell
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Edward R. Watkins
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
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22
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Theiss MR, Clement ML, Delaney B. Routine assessment of anxiety among adolescents in a primary care clinic. Nurse Pract 2023; 48:31-35. [PMID: 37991518 DOI: 10.1097/01.npr.0000000000000120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
BACKGROUND Approximately 20% to 25% of all adolescents experience significant symptoms of anxiety, but only half of those adolescents are diagnosed and treated. Recent clinical guidelines recommend routine assessment of adolescent anxiety symptoms in the primary care setting to improve the rates of identification and treatment of anxiety in this population. The objective of this project was to increase early identification and referral for treatment of adolescent anxiety during primary care visits. METHODS This project used the Generalized Anxiety Disorder-7 screening tool to assess anxiety symptoms in adolescents in a school-based primary care clinic. Upon arrival to the clinic, adolescent patients completed the brief self-assessment. The provider then used the assessment score to determine the need for further assessment and referral for treatment. RESULTS Of the 51 participants, 21.6% were referred to a mental health provider following assessment, compared with 1.2% of adolescent patients seen in the 6-month period immediately preceding the project. CONCLUSION The results indicate that screening for symptoms of anxiety in adolescents using a brief self-assessment survey is an effective method for achieving the desired outcome of increased identification and referral for treatment of anxiety symptoms in this population.
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23
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Creswell C, Chessell C, Halliday G. Parent-led cognitive behaviour therapy for child anxiety problems: overcoming challenges to increase access to effective treatment. Behav Cogn Psychother 2023; 51:512-532. [PMID: 36458498 DOI: 10.1017/s1352465822000546] [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] [Indexed: 12/03/2022]
Abstract
BACKGROUND Anxiety problems have a particularly early age of onset and are common among children. As we celebrate the anniversary of the BABCP, it is important to recognise the huge contribution that cognitive behavioural therapy (CBT) has made to the treatment of anxiety problems in children. CBT remains the only psychological intervention for child anxiety problems with a robust evidence base, but despite this, very few children with anxiety problems access CBT. Creative solutions are urgently needed to ensure that effective treatments can be delivered at scale. Here we focus on parent-led CBT as this offers a potential solution that is brief and can be delivered by clinicians without highly specialised training. Over the last decade there has been a substantial increase in randomised controlled trials evaluating this approach with consistent evidence of effectiveness. Nonetheless clinicians, and parents, often have concerns about trying the approach and can face challenges in its delivery. METHOD We draw on empirical evidence and our clinical experience to address some of these common concerns and challenges, with particular emphasis on the key principles of empowering parents and working with them to provide opportunities for new learning for their children. CONCLUSIONS We conclude by highlighting some important directions for future research and practice, including further evaluation of who does and does not currently benefit from the approach, determining how it should be adapted to optimise outcomes among groups that may not currently get maximum benefits and across cultures, and capitalising on recent technological developments to increase engagement and widen access.
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Affiliation(s)
- Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Chloe Chessell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Gemma Halliday
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK
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Meyer HC, Lee FS. Intermixed safety cues facilitate extinction retention in adult and adolescent mice. Physiol Behav 2023; 271:114336. [PMID: 37619817 PMCID: PMC10592038 DOI: 10.1016/j.physbeh.2023.114336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/01/2023] [Accepted: 08/21/2023] [Indexed: 08/26/2023]
Abstract
Extinction learning is tremendously adaptive as it allows an animal to adjust their behavior in a changing environment. Yet, extinction is not without limitations and fear often reemerges over time (i.e. spontaneous recovery). Relative to adults, adolescent rodents and humans are particularly prone to spontaneous recovery following extinction. In this study, we aimed to address whether combining methods of fear regulation (extinction and conditioned inhibition) can facilitate extinction retention. Early adolescent (29 days old, n = 81) and adult (70 days old, n = 80) mice underwent extinction with or without a safety cue present. Safety cue presentations were systematically varied to overlap with or alternate with fear cue presentations. We found that initial safety learning was faster in adolescent mice. In addition, intermixing safety cues into extinction reduced spontaneous recovery during a test two weeks later. The decrease in spontaneous recovery relative to a standard extinction protocol was greater in adolescents than adults. Together, our findings provide initial evidence that safety learning may be inherently stronger during adolescence. These results inform the parameters by which conditioned safety and extinction learning may be merged to augment the inhibition of fear. While methods to enhance fear regulation are valuable for any age, the potential to do so during adolescence is particularly striking.
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Affiliation(s)
- Heidi C Meyer
- Department of Psychological and Brain Sciences, Boston University, 610 Commonwealth Avenue, Boston, MA 02215, USA; Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA.
| | - Francis S Lee
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
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25
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Shackman AJ, Gee DG. Maternal Perinatal Stress Associated With Offspring Negative Emotionality, But the Underlying Mechanisms Remain Elusive. Am J Psychiatry 2023; 180:708-711. [PMID: 37777854 PMCID: PMC10558087 DOI: 10.1176/appi.ajp.20230630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Affiliation(s)
- Alexander J. Shackman
- Department of Psychology, University of Maryland, College Park, MD 20742 USA
- Department of Neuroscience and Cognitive Science Program, University of Maryland, College Park, MD 20742 USA
- Department of Maryland Neuroimaging Center, University of Maryland, College Park, MD 20742 USA
| | - Dylan G. Gee
- Department of Psychology, Yale University, New Haven, CT 06520 USA
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26
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Baumel WT, Mills JA, Schroeder HK, Neptune Z, Levine A, Strawn JR. Gastrointestinal Symptoms in Pediatric Patients with Anxiety Disorders and Their Relationship to Selective Serotonin Reuptake Inhibitor Treatment or Placebo. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01586-x. [PMID: 37659029 DOI: 10.1007/s10578-023-01586-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2023] [Indexed: 09/05/2023]
Abstract
Gastrointestinal symptoms are commonly reported as adverse effects of selective serotonin reuptake inhibitors (SSRIs), the first-line pharmacologic treatment for pediatric anxiety disorders; however, the temporal course of these symptoms during treatment, although believed to be transient, has never been prospectively evaluated. Additionally, rates of gastrointestinal symptoms and functional gastrointestinal syndromes in anxious youth are poorly understood. We examined gastrointestinal symptoms in youth with anxiety disorders during a double-blind, placebo-controlled trial of escitalopram (n = 51). Then, in a separate sample of prospectively treated children and adolescents with generalized, social and/or separation anxiety disorders (n = 56), we examined the frequency of gastrointestinal symptoms based on the Questionnaire on Pediatric Gastrointestinal Symptoms (QPGS) and ROME III criteria and the association of these symptoms with clinical and demographic characteristics using logistic regression. The frequency/severity of abdominal pain, diarrhea, bloating constipation or total gastrointestinal symptoms did not differ between patients receiving placebo (n = 25) or escitalopram (n = 26). However, escitalopram-treated youth had transient changes in nausea/vomiting and total upper gastrointestinal symptoms during the first two weeks of treatment. ROME III criteria for functional gastrointestinal syndromes were present in 12/56 patients (21.4%). QPGS-related functional gastrointestinal syndromes and symptoms were unrelated to treatment, treatment type, or clinical or demographic variables. Gastrointestinal symptoms are common in youth with anxiety and SSRIs produce transient-rather than sustained-gastrointestinal symptoms. Assessing gastrointestinal symptoms prior to pharmacotherapy and discussing factors that increase (or decrease) the likelihood of transient SSRI-related symptoms in youth may decrease patient uncertainty related to side effects and decrease medication-related anxiety.
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Affiliation(s)
- W Thomas Baumel
- Department of Psychiatry, University of North Carolina, 77 Vilcom Center Dr, Chapel Hill, NC, 27514, USA.
| | - Jeffrey A Mills
- Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, OH, USA
| | - Heidi K Schroeder
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Zoe Neptune
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Amir Levine
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
- Department of Pediatrics, Division of Child & Adolescent Psychiatry, Divisions of Clinical Pharmacology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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27
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Pollard J, Reardon T, Williams C, Creswell C, Ford T, Gray A, Roberts N, Stallard P, Ukoumunne OC, Violato M. The multifaceted consequences and economic costs of child anxiety problems: A systematic review and meta-analysis. JCPP ADVANCES 2023; 3:e12149. [PMID: 37720587 PMCID: PMC10501703 DOI: 10.1002/jcv2.12149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 01/26/2023] [Indexed: 09/19/2023] Open
Abstract
Background Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs. Methods A systematic review of Medline, PsycINFO, EconLit and the National Health Service Economic Evaluation Database was conducted for longitudinal and economic studies reporting on the association between childhood anxiety problems and at least one individual-, family- or societal-level outcome or cost. All studies were synthesised narratively. For longitudinal studies, 'effect direction' was used as a common metric, with random effects meta-analysis undertaken where possible. Results Eighty-three studies met inclusion criteria and were synthesised narratively. We identified 788 separate analyses from the longitudinal studies, which we grouped into 15 overarching outcome domains. Thirteen of the studies were incorporated into 13 meta-analyses, which indicated that childhood anxiety disorders were associated with future anxiety, mood, behaviour and substance disorders. Narrative synthesis also suggested associations between anxiety problems and worse physical health, behaviour, self-harm, eating, relationship, educational, health care, employment, and financial outcomes. 'Effect direction' was conflicting in some domains due to a sparse evidence base. Higher economic costs were identified for the child, their families, healthcare providers and wider society, although evidence was limited and only covered short follow-up periods, up to a maximum of 2 years. Total annual societal costs per anxious child were up to £4040 (2021 GBP). Conclusions Childhood anxiety problems are associated with impaired outcomes in numerous domains, and considerable economic costs, which highlight the need for cost-effective interventions and policies to tackle them. More economic evidence is needed to inform models of the long-term, economic-related, consequences of childhood anxiety problems.
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Affiliation(s)
- Jack Pollard
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Tessa Reardon
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Chloe Williams
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Cathy Creswell
- Departments of Experimental Psychology and PsychiatryUniversity of OxfordOxfordUK
| | - Tamsin Ford
- University of Cambridge and Cambridge and Peterborough Foundation TrustCambridgeUK
| | - Alastair Gray
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
| | - Nia Roberts
- Bodleian Health Care LibrariesUniversity of OxfordOxfordUK
| | | | - Obioha C. Ukoumunne
- NIHR Applied Research Collaboration South West Peninsula (PenARC)University of ExeterExeterUK
| | - Mara Violato
- Health Economics Research CentreNuffield Department of Population HealthUniversity of OxfordOxfordUK
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28
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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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29
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Trent ES, Viana AG, Raines EM, Busch HEC, Silva K, Storch EA, Zvolensky MJ. Childhood exposure to parental threatening behaviors and anxiety in emerging adulthood: Indirect effects of perceived stress. J Clin Psychol 2023; 79:1984-2008. [PMID: 36971223 PMCID: PMC10440255 DOI: 10.1002/jclp.23516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND Although childhood exposure to parental threatening behaviors is associated with elevated anxiety in emerging adulthood, the underlying mechanisms remain unexplored. Perceived stress-a subjective experience comprised of feelings of helplessness (being unable to cope or exert control) and poor self-efficacy (confidence in one's ability to manage stressors)-is one candidate mechanism. The present investigation examined the underlying role of perceived stress in the association between childhood exposure to parental threatening behaviors and anxiety symptom severity in a sample of emerging adults. METHODS Participants (N = 855; Mage = 18.75 years, SD = 1.05, range 18-24; 70.8% female) were recruited from a large state university and administered a battery of self-report questionnaires assessing constructs of interest. RESULTS Structural equation modeling (SEM) analyses indicated that only greater childhood exposure to maternal threatening behaviors was directly associated with greater feelings of helplessness and lower self-efficacy. Furthermore, only childhood exposure to maternal threatening behaviors was indirectly associated with anxiety severity through greater feelings of helplessness and lower self-efficacy. In contrast, childhood exposure to paternal threatening behaviors was neither directly nor indirectly associated with anxiety severity. LIMITATIONS Limitations include a cross-sectional design, use of self-report measures, and a nonclinical sample. Replicating these findings in a clinical sample and testing the hypothesized model in a longitudinal design is necessary. CONCLUSIONS Findings underscore the need for intervention efforts that screen for and target perceived stress in emerging adults exposed to negative maternal parenting behaviors.
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Affiliation(s)
- Erika S. Trent
- Department of Psychology, University of Houston, Houston, TX
| | - Andres G. Viana
- Department of Psychology, University of Houston, Houston, TX
- Texas Institute of Measurement, Evaluation, & Statistics, University of Houston, Houston, TX
| | | | | | - Karina Silva
- Department of Psychology, University of Houston, Houston, TX
| | - Eric A. Storch
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX
| | - Michael J. Zvolensky
- Department of Psychology, University of Houston, Houston, TX
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
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30
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Harasymiw LA, Grosse SD, Cullen KR, Bitsko RH, Perou R, Sarafoglou K. Depressive and anxiety disorders and antidepressant prescriptions among insured children and young adults with congenital adrenal hyperplasia in the United States. Front Endocrinol (Lausanne) 2023; 14:1129584. [PMID: 37664854 PMCID: PMC10470620 DOI: 10.3389/fendo.2023.1129584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/25/2023] [Indexed: 09/05/2023] Open
Abstract
Background Dysfunction in the hypothalamic-pituitary-adrenal axis has been associated with depressive and anxiety disorders. Little is known about the risk for these disorders among individuals with congenital adrenal hyperplasia (CAH), a form of primary adrenal insufficiency. Objective We investigated the prevalence of depressive and anxiety disorders and antidepressant prescriptions in two large healthcare databases of insured children, adolescents, and young adults with CAH in the United States. Methods We conducted a retrospective cohort study using administrative data from October 2015 through December 2019 for individuals aged 4-25 years enrolled in employer-sponsored or Medicaid health plans. Results Adjusting for age, the prevalence of depressive disorders [adjusted prevalence ratio (aPR) = 1.7, 95% confidence interval (CI): 1.4-2.0, p<0.001], anxiety disorders [aPR = 1.7, 95% CI: 1.4-1.9, p<0.001], and filled antidepressant prescriptions [aPR = 1.7, 95% CI: 1.4-2.0, p<0.001] was higher among privately insured youth with CAH as compared to their non-CAH peers. Prevalence estimates were also higher among publicly insured youth with CAH for depressive disorders [aPR = 2.3, 95% CI: 1.9-2.9, p<0.001], anxiety disorders [aPR = 2.0, 95% CI: 1.6-2.5, p<0.001], and filled antidepressant prescriptions [aPR = 2.5, 95% CI: 1.9-3.1, p<0.001] as compared to their non-CAH peers. Conclusions The elevated prevalence of depressive and anxiety disorders and antidepressant prescriptions among youth with CAH suggests that screening for symptoms of depression and anxiety among this population might be warranted.
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Affiliation(s)
- Lauren A. Harasymiw
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kathryn R. Cullen
- Department of Psychiatry and Behavioral Science, University of Minnesota Medical School, Minneapolis, MN, United States
| | - Rebecca H. Bitsko
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ruth Perou
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kyriakie Sarafoglou
- Department of Pediatrics, Division of Pediatric Endocrinology, University of Minnesota Medical School, Minneapolis, MN, United States
- Department of Experimental and Clinical Pharmacology, University of Minnesota College of Pharmacy, Minneapolis, MN, United States
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31
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Uhlhaas PJ, Davey CG, Mehta UM, Shah J, Torous J, Allen NB, Avenevoli S, Bella-Awusah T, Chanen A, Chen EYH, Correll CU, Do KQ, Fisher HL, Frangou S, Hickie IB, Keshavan MS, Konrad K, Lee FS, Liu CH, Luna B, McGorry PD, Meyer-Lindenberg A, Nordentoft M, Öngür D, Patton GC, Paus T, Reininghaus U, Sawa A, Schoenbaum M, Schumann G, Srihari VH, Susser E, Verma SK, Woo TW, Yang LH, Yung AR, Wood SJ. Towards a youth mental health paradigm: a perspective and roadmap. Mol Psychiatry 2023; 28:3171-3181. [PMID: 37580524 PMCID: PMC10618105 DOI: 10.1038/s41380-023-02202-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 07/04/2023] [Accepted: 07/21/2023] [Indexed: 08/16/2023]
Abstract
Most mental disorders have a typical onset between 12 and 25 years of age, highlighting the importance of this period for the pathogenesis, diagnosis, and treatment of mental ill-health. This perspective addresses interactions between risk and protective factors and brain development as key pillars accounting for the emergence of psychopathology in youth. Moreover, we propose that novel approaches towards early diagnosis and interventions are required that reflect the evolution of emerging psychopathology, the importance of novel service models, and knowledge exchange between science and practitioners. Taken together, we propose a transformative early intervention paradigm for research and clinical care that could significantly enhance mental health in young people and initiate a shift towards the prevention of severe mental disorders.
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Affiliation(s)
- Peter J Uhlhaas
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK.
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Christopher G Davey
- Department of Psychiatry, The University of Melbourne, Carlton, VIC, Australia
| | - Urvakhsh Meherwan Mehta
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - John Torous
- Division of Digital Psychiatry and Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | | | - Shelli Avenevoli
- Office of the Director, National Institute of Mental Health, Bethesda, MD, USA
| | - Tolulope Bella-Awusah
- Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Andrew Chanen
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Eric Y H Chen
- Department of Psychiatry, University of Hong Kong, Hong Kong, China
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Departments of Psychiatry and Molecular Medicine, Donald and Barbara Zucker School of Medicine at Hostra/Northwell, Hempstead, NY, USA
- Department of Psychiatry, The Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
| | - Kim Q Do
- Centre for Psychiatric Neuroscience, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
| | - Helen L Fisher
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- ESRC Centre for Society and Mental Health, King's College London, London, UK
| | - Sophia Frangou
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Ian B Hickie
- Brain and Mind Centre, University of Sydney, Camperdown, NSW, Australia
| | - Matcheri S Keshavan
- Department of Psychiatry, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Kerstin Konrad
- Child Neuropsychology Section, Department of Child and Adolescent Psychiatry, RWTH, Aachen, Germany
- JARA-Brain Institute II, Molecular Neuroscience and Neuroimaging, Research Center Jülich, Jülich, Germany
| | - Francis S Lee
- Department of Psychiatry, Weill Cornell Cornell Medicall College, New York, NY, USA
| | - Cindy H Liu
- Departments of Pediatrics and Psychiatry, Brigham and Women's Hospital/Harvard Medical School, Boston, MA, USA
| | - Beatriz Luna
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | - Patrick D McGorry
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
| | - Andreas Meyer-Lindenberg
- Department of Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany
| | - Merete Nordentoft
- CORE-Copenhagen Research Centre for Mental Health, Mental Health Center Copenhagen, University of Copenhagen, Faculty of Health and Medical Sciences, Department of Clinical Medicine, Hellerup, Denmark
| | - Dost Öngür
- McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, University of Melbourne, Parkville, VIC, Australia
| | - Tomáš Paus
- Departments of Psychiatry and Neuroscience, Faculty of Medicine and Centre Hospitalier Universitaire Sainte Justine, University of Montreal, Montreal, QC, Canada
- Department of Psychology and Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Ulrich Reininghaus
- Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Mannheim, Germany
- Centre for Epidemiology and Public Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Akira Sawa
- The John Hopkins Schizophrenia Center, Johns Hopkins University, Baltimore, MD, USA
| | - Michael Schoenbaum
- Division of Service and Intervention Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Gunter Schumann
- Centre for Population Neuroscience and Stratified Medicine, ISTBI, Fudan University, Shanghai, China
- Department of Psychiatry and Neuroscience, Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Vinod H Srihari
- Department of Psychiatry, Yale University, New Haven, CT, USA
- Program for Specialized Treatment Early in Psychosis (STEP), New Haven, VIC, USA
| | - Ezra Susser
- Departments of Epidemiology and Psychiatry, Columbia University, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Swapna K Verma
- Department of Psychosis, Institute of Mental Health, Buangkok, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - T Wilson Woo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Laboratory for Cellular Neuropathology, McLean Hospital, Belmont, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Lawrence H Yang
- Department of Social and Behavioral Sciences, New York University, New York, NY, USA
- Department of Epidemiology, Columbia University, New York, NY, USA
| | - Alison R Yung
- School of Medicine, Faculty of Health, Deakin University, Melbourne, VIC, Australia
- Department of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Stephen J Wood
- Orygen: National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
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32
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Warner EN, Ammerman RT, Glauser TA, Pestian JP, Agasthya G, Strawn JR. Developmental Epidemiology of Pediatric Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:511-530. [PMID: 37201964 DOI: 10.1016/j.chc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
This review summarizes the developmental epidemiology of childhood and adolescent anxiety disorders. It discusses the coronavirus disease of 2019 (COVID-19) pandemic, sex differences, longitudinal course, and stability of anxiety disorders in addition to recurrence and remission. The trajectory of anxiety disorders-whether homotypic (ie, the same anxiety disorder persists over time) or heterotypic (ie, an anxiety disorder shifts to a different diagnosis over time) is discussed with regard to social, generalized, and separation anxiety disorders as well as specific phobia, and panic disorder. Finally, strategies for early recognition, prevention, and treatment of disorders are discussed.
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Affiliation(s)
- Emily N Warner
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Department of Environmental and Public Health Sciences, University of Cincinnati.
| | - Robert T Ammerman
- Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy A Glauser
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John P Pestian
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Greeshma Agasthya
- Oak Ridge National Laboratory, Computational Sciences and Engineering Division, Advanced Computing for Health Sciences Section
| | - Jeffrey R Strawn
- University of Cincinnati College of Medicine, Cincinnati, OH, USA; Division of Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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33
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Nicotra CM, Strawn JR. Advances in Pharmacotherapy for Pediatric Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:573-587. [PMID: 37201968 DOI: 10.1016/j.chc.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
The evidence base for psychopharmacologic interventions in children and adolescents with anxiety disorders has significantly increased, and our understanding of the relative efficacy and tolerability of interventions has expanded contemporaneously. Selective serotonin reuptake inhibitors (SSRIs) are the first-line pharmacologic treatment for pediatric anxiety due to their robust efficacy although other agents may have efficacy. This review summarizes the data concerning the use of SSRIs, serotonin and norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants, atypical anxiolytics (eg, 5HT1A agonists, alpha agonists), and benzodiazepines in pediatric anxiety disorder cases (ie, generalized anxiety disorder, separation anxiety disorder, social anxiety disorder, and panic disorder). The extant data suggest that SSRIs and SNRIs are effective and well tolerated. SSRIs as monotherapy and SSRIs + cognitive behavioral therapy reduce symptoms in youth with anxiety disorders. However, randomized controlled trials do not suggest efficacy for benzodiazepines or the 5HT1A agonist, buspirone, in pediatric anxiety disorder cases.
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Affiliation(s)
- Cassandra M Nicotra
- Department of Pediatrics, Division of Child & Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267, USA
| | - Jeffrey R Strawn
- Department of Pediatrics, Division of Child & Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45267, USA; Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati, College of Medicine, Cincinnati, OH 45219, USA.
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34
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Skarphedinsson G, Karlsson GK. The Feasibility and Efficacy of a Group-Based, Brief Transdiagnostic Cognitive-Behavioral Treatment for Adolescents with Internalizing Problems. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01552-7. [PMID: 37294420 DOI: 10.1007/s10578-023-01552-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
The present study aimed to assess the efficacy of a group-based, brief transdiagnostic cognitive-behavioral therapy (CBT) program for adolescents with internalizing problems, such as anxiety and depressive disorders, seeking help in a primary health care clinic in Iceland. The group-based CBT program consisted of eight weekly 110-min sessions covering psychoeducation, cognitive restructuring, behavioral activation, exposure, problem-solving, social skills, and mindfulness. The study recruited 53 participants, who were randomly assigned to either receive the group treatment or be placed on a wait-list for monitoring purposes. Measures were taken at baseline, during treatment (week 4), at posttreatment (week 8), and at 2-, 4-month, and 1-year follow-ups. The primary outcome measures were the self-reported total scores of total anxiety and depression using the Revised Children's Anxiety and Depression Scale (RCADS). The study found a significant effect of time and time * treatment interaction on the depression and anxiety total scores. The secondary outcome measures, RCADS parent-rated depression and anxiety total scores, did not show significant effects of time * treatment interaction. However, during naturalistic follow-up, a significant reduction in parent-reported depression and anxiety total scores was observed. The study also observed good treatment adherence, as well as high satisfaction among parents and youth. The results suggest that this group-based, brief transdiagnostic CBT group treatment is feasible and effective in reducing depressive and anxiety symptoms in adolescents with internalizing problems and highlights the importance of addressing comorbidity in treatment.
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35
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Bilek EL, Meyer AE, Tomlinson R, Chen C. Pilot Study of Self-Distancing Augmentation to Exposure Therapy for Youth Anxiety. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01540-x. [PMID: 37231323 DOI: 10.1007/s10578-023-01540-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/27/2023]
Abstract
This pilot examines a self-distancing augmentation to exposure. Nine youth with anxiety (ages 11-17; 67% female) completed treatment. The study employed a brief (eight session) crossover ABA/BAB design. Exposure difficulty, engagement with exposure, and treatment acceptability were examined as primary outcome variables. Visual inspection of plots indicated that youth completed more difficult exposures during augmented exposure sessions [EXSD] than classic exposure sessions [EX] by therapist- and youth-report and that therapists reported higher youth engagement during EXSD than EX sessions. There were no significant differences between EXSD and EX on exposure difficulty or engagement by therapist- or youth-report. Treatment acceptability was high, although some youth reported that self-distancing was "awkward". Self-distancing may be associated with increased exposure engagement and willingness to complete more difficult exposures, which has been linked to treatment outcomes. Future research is needed to further demonstrate this link, and link self-distancing to outcomes directly.
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Affiliation(s)
- Emily L Bilek
- Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Rd., SPC 5765, Ann Arbor, MI, 48109, USA.
| | - Allison E Meyer
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Rachel Tomlinson
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Carol Chen
- Department of Psychiatry, Michigan Medicine, University of Michigan, 4250 Plymouth Rd., SPC 5765, Ann Arbor, MI, 48109, USA
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Castagna PJ, Farahdel E, Potenza MN, Crowley MJ. The current state-of-the-art in pharmacotherapy for pediatric generalized anxiety disorder. Expert Opin Pharmacother 2023; 24:835-847. [PMID: 37074259 PMCID: PMC10197951 DOI: 10.1080/14656566.2023.2199921] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 04/03/2023] [Indexed: 04/20/2023]
Abstract
INTRODUCTION Anxiety disorders are the most prevalent psychiatric disorders among youth. Among the various anxiety disorders, generalized anxiety disorder is particularly prevalent. Youth with GAD appear at elevated risk of developing other anxiety disorders, mood disorder, and substance use disorders. Functional outcomes of youth with GAD can be improved through early recognition and treatment, thus promoting better longer-term outcomes. AREAS COVERED The current article summarizes evidence-based state-of-the-art pharmacotherapy for pediatric GAD based on open-label, randomized, and controlled trials. Two electronic databases (PubMed and Scopus) were systematically searched in April 2022 for relevant publications. EXPERT OPINION The literature supports a combination of psychotherapy and pharmacotherapy as being associated with better outcomes when compared to mono-therapies. While longer-term follow-ups are limited, one such study does challenge this notion. Both selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors (SNRIs) have been found across studies to have moderate effect sizes in the treatment of pediatric anxiety disorders. SSRIs continue to be a first-line intervention, whereas SNRIs may be considered a second-line treatment. While more evidence is needed, there are emerging data indicating that SSRIs are associated with a more rapid and greater reduction in anxiety symptoms when compared to SNRIs.
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Affiliation(s)
- Peter J. Castagna
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, 06511, USA
| | | | - Marc N. Potenza
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, 06511, USA
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA
- Connecticut Council on Problem Gambling, Wethersfield, CT, 06109, USA
- Connecticut Mental Health Center, New Haven, CT, 06519, USA
- Wu Tsai Institute, Yale University, New Haven CT, 06510, USA
- Department of Neuroscience, Yale University School of Medicine, New Haven, CT, 06511, US
| | - Michael J. Crowley
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, 06511, USA
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Harrison TJ, Ginsburg GS, Smith IC, Orlando CM. Youth stress generation: an examination of the role of anxiety, anxiety symptoms and cognitive distortions. ANXIETY, STRESS, AND COPING 2023; 36:304-319. [PMID: 35576123 PMCID: PMC9666622 DOI: 10.1080/10615806.2022.2076083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Stress generation suggests a reciprocal relationship between depression and prospective stressful life events. However, the applicability of stress generation to anxiety disorders has been understudied, particularly among youth. We address this gap by examining stress generation in youth at high-risk of developing anxiety disorders. METHODS Participants were one-hundred thirty-six at-risk youth (M age = 8.69, 84.6% Caucasian; 55.9% female), each of whom had a parent with an anxiety disorder. We examined the role of an anxiety disorder diagnosis, anxiety symptoms, and cognitive distortions in youth's prospective one and six-year stressful life events (i.e., stress generation). RESULTS Anxiety symptoms and cognitive distortions were significant predictors of one-year total dependent stress. Anxiety diagnosis and anxiety symptoms were significant predictors of one-year dependent interpersonal stress. Anxiety diagnosis and anxiety symptoms were significant predictors of six-year independent stress. CONCLUSION Support for the stress generation model was found in high-risk youth, but only over a one-year period. This suggests important effects of anxiety and cognitive distortions on stress generation, though their implications might be time-capped.
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Affiliation(s)
| | | | - Isaac C. Smith
- University of Connecticut Health Center, Department of Psychiatry
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Meyer HC, Fields A, Vannucci A, Gerhard DM, Bloom PA, Heleniak C, Opendak M, Sullivan R, Tottenham N, Callaghan BL, Lee FS. The Added Value of Crosstalk Between Developmental Circuit Neuroscience and Clinical Practice to Inform the Treatment of Adolescent Anxiety. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2023; 3:169-178. [PMID: 37124361 PMCID: PMC10140450 DOI: 10.1016/j.bpsgos.2022.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 02/01/2022] [Accepted: 02/07/2022] [Indexed: 01/04/2023] Open
Abstract
Significant advances have been made in recent years regarding the developmental trajectories of brain circuits and networks, revealing links between brain structure and function. Emerging evidence highlights the importance of developmental trajectories in determining early psychiatric outcomes. However, efforts to encourage crosstalk between basic developmental neuroscience and clinical practice are limited. Here, we focus on the potential advantage of considering features of neural circuit development when optimizing treatments for adolescent patient populations. Drawing on characteristics of adolescent neurodevelopment, we highlight two examples, safety cues and incentives, that leverage insights from neural circuit development and may have great promise for augmenting existing behavioral treatments for anxiety disorders during adolescence. This commentary seeks to serve as a framework to maximize the translational potential of basic research in developmental populations for strengthening psychiatric treatments. In turn, input from clinical practice including the identification of age-specific clinically relevant phenotypes will continue to guide future basic research in the same neural circuits to better reflect clinical practices. Encouraging reciprocal communication to bridge the gap between basic developmental neuroscience research and clinical implementation is an important step toward advancing both research and practice in this domain.
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Affiliation(s)
- Heidi C. Meyer
- Department of Psychiatry, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts
| | - Andrea Fields
- Department of Psychology, Columbia University, New York, New York
| | - Anna Vannucci
- Department of Psychology, Columbia University, New York, New York
| | - Danielle M. Gerhard
- Department of Psychiatry, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
| | - Paul A. Bloom
- Department of Psychology, Columbia University, New York, New York
| | | | - Maya Opendak
- Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, New York
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
- Department of Neuroscience, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Regina Sullivan
- Emotional Brain Institute, Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Nim Tottenham
- Department of Psychology, Columbia University, New York, New York
| | - Bridget L. Callaghan
- Department of Psychology, University of California, Los Angeles, Los Angeles, California
| | - Francis S. Lee
- Department of Psychiatry, Joan & Sanford I. Weill Medical College of Cornell University, New York, New York
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Singewald N, Sartori SB, Reif A, Holmes A. Alleviating anxiety and taming trauma: Novel pharmacotherapeutics for anxiety disorders and posttraumatic stress disorder. Neuropharmacology 2023; 226:109418. [PMID: 36623804 PMCID: PMC10372846 DOI: 10.1016/j.neuropharm.2023.109418] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/30/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023]
Abstract
Psychiatric disorders associated with psychological trauma, stress and anxiety are a highly prevalent and increasing cause of morbidity worldwide. Current therapeutic approaches, including medication, are effective in alleviating symptoms of anxiety disorders and posttraumatic stress disorder (PTSD), at least in some individuals, but have unwanted side-effects and do not resolve underlying pathophysiology. After a period of stagnation, there is renewed enthusiasm from public, academic and commercial parties in designing and developing drug treatments for these disorders. Here, we aim to provide a snapshot of the current state of this field that is written for neuropharmacologists, but also practicing clinicians and the interested lay-reader. After introducing currently available drug treatments, we summarize recent/ongoing clinical assessment of novel medicines for anxiety and PTSD, grouped according to primary neurochemical targets and their potential to produce acute and/or enduring therapeutic effects. The evaluation of putative treatments targeting monoamine (including psychedelics), GABA, glutamate, cannabinoid, cholinergic and neuropeptide systems, amongst others, are discussed. We emphasize the importance of designing and clinically assessing new medications based on a firm understanding of the underlying neurobiology stemming from the rapid advances being made in neuroscience. This includes harnessing neuroplasticity to bring about lasting beneficial changes in the brain rather than - as many current medications do - produce a transient attenuation of symptoms, as exemplified by combining psychotropic/cognitive enhancing drugs with psychotherapeutic approaches. We conclude by noting some of the other emerging trends in this promising new phase of drug development.
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Affiliation(s)
- Nicolas Singewald
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria.
| | - Simone B Sartori
- Institute of Pharmacy, Department of Pharmacology and Toxicology, Center for Molecular Biosciences Innsbruck (CMBI), Leopold Franzens University Innsbruck, Innsbruck, Austria
| | - Andreas Reif
- Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Andrew Holmes
- Laboratory of Behavioral and Genomic Neuroscience, National Institute on Alcohol Abuse and Alcoholism, NIH, Bethesda, MD, USA
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Gaudreau H, Radziszewski S, Houle J, Beaudin A, Boisvert LP, Brouri S, Charrette M, Côté L, Coulombe S, Labelle R, Louka E, Mousseau B, Phaneuf N, Rickwood D, Tremblay PH. Self-Management Strategies in Youth With Difficulties Related to Anxiety or Depression: What Helps Them Feel Better. JOURNAL OF ADOLESCENT RESEARCH 2023. [DOI: 10.1177/07435584231154840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Anxiety and depressive disorders are the most prevalent mental health problems in adolescents, however, little is known about the strategies they use to deal with their difficulties and regain power over their symptoms. This exploratory study documented the self-management strategies used by adolescents to recover from difficulties related to anxiety and/or depression. Individual interviews were conducted in Montreal, Canada with 49 participants aged 11 to 18 years (28 girls, 20 boys, and 1 non-binary person from various cultural origins) after approval by the Institutional Review Board. Young people were questioned about the self-management strategies they put in place when they felt stressed, sad, or anxious. The data were coded according to the thematic analysis method using an inductive approach. Participants reported 73 self-management strategies, regrouped in four broad themes: (a) I think through; (b) I surround myself with people/animals; (c) I feel and manage my emotions; (d) I continue my daily activities. Their strategies emphasize the role played by their social network and the place of social media as a support in their recovery. Self-management is an empowering process that allows adolescents to take responsibility and to make decisions that foster their recovery.
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Affiliation(s)
| | | | | | - Annie Beaudin
- Peer Researcher, Laboratoire Vitalité, Université du Québec à Montréal, Montréal, QC, Canada
- Relief, Montréal, QC, Canada
| | - Louis-Philippe Boisvert
- Direction des services en santé mentale volet jeunes, Ministère de la Santé et des Services sociaux, Montreal, QC, Canada
| | - Syphax Brouri
- Peer Researcher, Laboratoire Vitalité, Université du Québec à Montréal, Montréal, QC, Canada
| | - Mathieu Charrette
- Peer Researcher, Laboratoire Vitalité, Université du Québec à Montréal, Montréal, QC, Canada
| | - Laurent Côté
- Peer Researcher, Laboratoire Vitalité, Université du Québec à Montréal, Montréal, QC, Canada
| | | | | | - Elissa Louka
- Peer Researcher, Laboratoire Vitalité, Université du Québec à Montréal, Montréal, QC, Canada
| | - Benjamin Mousseau
- Peer Researcher, Laboratoire Vitalité, Université du Québec à Montréal, Montréal, QC, Canada
| | - Noémie Phaneuf
- Peer Researcher, Laboratoire Vitalité, Université du Québec à Montréal, Montréal, QC, Canada
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Jamison J, Baker N, Lopez M, Bearman SK. An Analysis of Six Month Follow-Up Data from a Peer Parent Support Study. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2023; 50:225-236. [PMID: 36355256 DOI: 10.1007/s10488-022-01234-x] [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] [Accepted: 10/22/2022] [Indexed: 11/11/2022]
Abstract
The current study examines trajectories of treatment outcomes 6 months after completion of a peer parent program, NAMI Basics. Fifty-two caregivers who were part of a larger trial completed questionnaires prior to, immediately after, and 6 months after completing NAMI Basics. Growth curve models were used to examine trajectories of caregiver ratings of parent activation and engagement, parent help-seeking intentions, child symptoms, outpatient service use, and parent stress at 6 months after completion of the program. Prior improvements to the outcomes of parent activation and engagement (β = 2.31, p < .001, d = 1.35), parent help-seeking intentions (β = 1.94, p = .017, d = 0.69), and child intrapersonal distress (β = - 3.93, p = 0.046, d = 0.58) were maintained at 6 months, while help-seeking intentions was not (β = 1.31, p = .222, d = 0.47). Though no changes were observed immediately post-class, caregivers reported significant increases in outpatient services use (β = - 1.51, p = .030, d = 0.68) and reductions in parenting stress (β = - 4.99, p = 0.009, d = 0.75) and overall child symptoms (β = - 19.67, p = 0.001, d = 0.90) at 6 month follow-up. These results suggest that many of the positive impacts of the NAMI Basics program are sustained 6 months after the intervention. Additionally, these results suggest that some positive outcomes of the program may not emerge until several months after taking the class. Implications and future directions are discussed.
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Affiliation(s)
- Jesslyn Jamison
- Department of Educational Psychology, The University of Texas at Austin, Austin, TX, USA.
| | - Nichole Baker
- Department of Educational Psychology, The University of Texas at Austin, Austin, TX, USA
| | - Molly Lopez
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, TX, USA
| | - Sarah Kate Bearman
- Department of Educational Psychology, The University of Texas at Austin, Austin, TX, USA
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Arnardóttir A, Skarphedinsson G. Comparative effectiveness of cognitive behavioral treatment, serotonin, and serotonin noradrenaline reuptake inhibitors for anxiety in children and adolescents: a network meta-analysis. Nord J Psychiatry 2023; 77:118-126. [PMID: 35507829 DOI: 10.1080/08039488.2022.2069858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM Cognitive behavioral treatment (CBT) and selective serotonin reuptake inhibitors (SSRIs) are considered first-line treatments for childhood anxiety disorders (ADs). The objective of this current analysis was to conduct a network meta-analysis to evaluate the comparative effectiveness of CBT, pharmacotherapy, and the combination of the two in treating pediatric ADs. METHODS The studies included consisted of randomized controlled trials evaluating non-selective serotonin reuptake inhibitors (e.g. clomipramine), SSRIs, selective noradrenaline reuptake inhibitors, CBT, or a combination of CBT and pharmacotherapy. Studies were eligible for inclusion if participants were 18 years or younger. RESULTS A total of 86 studies were included, with a total of 7594 participants, of which 41.51% were females. For remission, all three treatments were significantly more effective than both placebo (ORs ranging from 0.07 and 0.18) and wait-list (ORs ranging from 0.06 and 0.16). In terms of the severity of anxiety symptoms, all treatment forms were significantly more effective for reducing anxiety than wait-list (standardized mean differences (SMDs) ranging from 0.98 and 2.91). Only pharmacotherapy was significantly more effective in reducing anxiety symptoms than placebo (SMD = 2.01, 95% confidence interval, 1.02 to 3.01). Overall, the results demonstrate that CBT, pharmacotherapy, and their combination are effective treatments for childhood ADs. There was no significant difference between the three treatment forms. However, CBT was associated with lower attrition rates. CONCLUSION CBT, pharmacotherapy, and the combination of the two should all be considered to treat youths with ADs. However, potential risks and benefits should be considered before devising a treatment plan.
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Adherence, Competence, and Alliance as Predictors of Long-term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders. Res Child Adolesc Psychopathol 2023; 51:761-773. [PMID: 36692616 DOI: 10.1007/s10802-023-01028-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/25/2023]
Abstract
The present study investigated therapist adherence, therapist competence, and patient-therapist alliance as predictors of long-term outcomes of cognitive behavioral therapy (CBT) for anxiety disorders in youth. Potential differential effects for group versus individual CBT, for therapists with or without formal CBT training, and based on youth symptom severity were examined. Videotapes (n = 181) from treatment sessions in a randomized controlled effectiveness trial comprising youth (N = 170, M age = 11.6 years, SD = 2.1) with anxiety disorders were assessed for therapist adherence and competence. Alliance was rated by therapists and youth. Participants completed a diagnostic interview and an anxiety symptom measure at pre-treatment, post-treatment, one-year follow-up, and long-term follow-up (M = 3.9 years post-treatment, SD = 0.8, range = 2.2-5.9 years). The change in anxiety symptoms or diagnostic status from pre-treatment to long-term follow-up was not significantly related to any predictor variables. However, several interaction effects were found. For loss of principal diagnosis, therapist competence predicted positive outcome when therapist adherence also was high. Adherence was found to predict positive outcome if CBT was provided individually. Therapist-rated alliance was related to both loss of principal diagnosis and loss of all diagnoses when CBT was provided in groups. Interaction effects suggested that therapists displaying both high adherence and high competence produced better long-term outcomes. Further, the alliance may be particularly important for outcomes in group CBT, whereas adherence may be particularly important for outcomes in individual CBT.
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Strawn JR, Mills JA, Poweleit EA, Ramsey LB, Croarkin PE. Adverse Effects of Antidepressant Medications and their Management in Children and Adolescents. Pharmacotherapy 2023. [PMID: 36651686 PMCID: PMC10378577 DOI: 10.1002/phar.2767] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Selective serotonin reuptake inhibitors (SSRIs) and, to a lesser extent, serotonin-norepinephrine reuptake inhibitors (SNRIs) are the cornerstone of pharmacotherapy for children and adolescents with anxiety and depressive disorders. These medications alleviate symptoms and restore function for many youths; however, they are associated with a distinct adverse effect profile, and their tolerability may complicate treatment or lead to discontinuation. Yet, SSRI/SNRI tolerability has received limited attention in the pediatric literature. METHODS This review examines the early- (e.g., activation, gastrointestinal symptoms, sedation) and late-emerging (e.g., weight gain) adverse effects of SSRIs and some SNRIs in pediatric patients. RESULTS We provide a framework for discussing SSRI/SNRI tolerability with patients and their families and describe the pharmacologic basis, course, and predictors of adverse events in youth. Strategies to address specific tolerability concerns are presented. For selected adverse events, using posterior simulation of mean differences over time, we describe their course based on Physical Symptom Checklist measures in a prospective, randomized trial of anxious youth aged 7-17 years who were treated with sertraline (n = 139) or placebo (n = 76) for 12 weeks in the Child/Adolescent Anxiety Multimodal Study (CAMS). MAIN RESULTS In CAMS, the relative severity/burden of total physical symptoms (p < 0.001), insomnia (p = 0.001), restlessness (p < 0.001), nausea (p = 0.002), abdominal pain (p < 0.001), and dry mouth (p = 0.024) decreased from baseline over 12 weeks of sertraline treatment, raising the possibility that these symptoms are transient. No significant changes were observed for sweating (p = 0.103), constipation (p = 0.241), or diarrhea (p = 0.489). Finally, we review the antidepressant withdrawal syndrome in children and adolescents and provide guidance for SSRI discontinuation, using pediatric pharmacokinetic models of escitalopram and sertraline-two of the most used SSRIs in youth. CONCLUSION SSRI/SNRIs are associated with both early-emerging (often transient) and late-emerging adverse effects in youth. Pharmacokinetically-informed appraoches may address some adverse effects and inform SSRI/SNRI discontinuation strategies.
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Affiliation(s)
- Jeffrey R Strawn
- Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, University of Cincinnati, Cincinnati, Ohio, USA.,Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Child and Adolescent Psychiatry, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jeffrey A Mills
- Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ethan A Poweleit
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Biomedical Informatics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Department of Biomedical Informatics, University of Cincinnati, Cincinnati, Ohio, USA
| | - Laura B Ramsey
- Division of Clinical Pharmacology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.,Division of Research in Patient Services, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
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Casline EP, Ogle RR, Peris TS, Kendall PC, Piacentini J, Compton S, Keeton C, Ginsburg GS. Client-rated facilitators and barriers to long-term youth anxiety disorder recovery. J Clin Psychol 2022; 78:2164-2179. [PMID: 35687807 PMCID: PMC9561069 DOI: 10.1002/jclp.23400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/10/2022] [Accepted: 05/28/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study examined client ratings of 26 facilitators and barriers to anxiety improvement approximately 6 years after randomization to treatment for anxiety. METHOD 319 youth (average 17.12 years old; 82.1% Caucasian; 58.6% female) participated in the longitudinal follow-up study to child and adolescent anxiety multimodal study (CAMS), a randomized controlled trial of medication, cognitive-behavioral therapy (CBT), combination, and placebo. RESULTS Correcting for multiple comparisons, CBT components (i.e., problem solving, changing unhelpful thoughts, relaxation skills) were rated significantly more helpful among youth without, versus with, an anxiety disorder at follow-up. Barriers that differentiated youth with and without an anxiety disorder included being bullied and difficulty applying therapy content to new situations. Comparisons between youth with different anxiety disorder trajectories (e.g., stable remission, relapsed, or chronically ill) also revealed several differences. CONCLUSION Findings suggest that client-rated facilitators and barriers covary with anxiety disorder recovery and may serve as useful tools when evaluating long-term treatment efficacy.
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Affiliation(s)
| | - Robert R. Ogle
- Counseling Center, Yeshiva University, New York, NY, USA
| | - Tara S. Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | | | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Golda S. Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
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Cougle JR, Grubaugh AL. Do psychosocial treatment outcomes vary by race or ethnicity? A review of meta-analyses. Clin Psychol Rev 2022; 96:102192. [DOI: 10.1016/j.cpr.2022.102192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 06/15/2022] [Accepted: 08/04/2022] [Indexed: 11/30/2022]
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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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Levy HC, Stevens KT, Tolin DF. Research Review: A meta-analysis of relapse rates in cognitive behavioral therapy for anxiety and related disorders in youth. J Child Psychol Psychiatry 2022; 63:252-260. [PMID: 34296755 DOI: 10.1111/jcpp.13486] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 05/28/2021] [Accepted: 06/04/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is an effective treatment for youth with anxiety and related disorders, with a 59% remission rate at post-treatment. Results of reviews and meta-analyses indicate that treatment gains are maintained across long-term follow-up, at least in terms of symptom improvement. Less is known about relapse, defined as patients who initially achieve remission status but then experience a return of symptoms after a follow-up period. METHOD The current study used meta-analysis to determine the overall rate of relapse in CBT for children and adolescents (age 18 years or younger) with anxiety and related disorders. Potential moderating factors of relapse rates, including demographic, methodological, and clinical/intervention characteristics, were also examined. Out of a pool of 78 abstracts, 13 full-text articles were retained for meta-analysis. An additional two articles were identified from other sources (total N = 535 patients). RESULTS Results showed an overall relapse rate of 10.5% (including comorbid autism spectrum disorder) and 8% (excluding comorbid autism spectrum disorder) across studies. Moderator analyses demonstrated that relapse rates were higher among younger and more racially diverse samples, as well as among patients with comorbid externalizing disorders and those taking psychiatric medications. There were no differences in relapse rates as a function of primary diagnosis. CONCLUSIONS Taken together, the findings indicate that relapse rates in CBT for anxious youth are relatively low, suggesting that treatment development and refinement efforts should focus on improving treatment response and remission rates for this population.
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Affiliation(s)
- Hannah C Levy
- Anxiety Disorders Center, Institute of Living, Hartford, CT, USA
| | | | - David F Tolin
- Anxiety Disorders Center, Institute of Living, Hartford, CT, USA.,Yale University School of Medicine, New Haven, CT, USA
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Cervin M, Lundgren T. Technology-delivered cognitive-behavioral therapy for pediatric anxiety disorders: a meta-analysis of remission, posttreatment anxiety, and functioning. J Child Psychol Psychiatry 2022; 63:7-18. [PMID: 34235730 DOI: 10.1111/jcpp.13485] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/17/2021] [Accepted: 05/28/2021] [Indexed: 12/25/2022]
Abstract
BACKGROUND The efficacy of technology-delivered cognitive-behavioral therapy (tCBT) for pediatric anxiety disorders (ADs) is uncertain as no meta-analysis has examined outcomes in trials that used structured diagnostic assessments at pre- and posttreatment. METHODS We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) of tCBT for pediatric ADs that included participants <18 years of age with a confirmed primary AD according to a structured diagnostic interview. Nine studies with 711 participants were included. RESULTS tCBT outperformed control conditions for remission for primary AD (37.9% vs. 10.2%; k = 9; OR = 4.73; p < .0001; I2 = 0%; moderate certainty), remission for all ADs (19.5% vs. 5.3%; k = 8; OR = 3.32; p < .0001; I2 = 0%; moderate certainty), clinician-rated functioning (k = 7; MD = -4.38; p < .001; I2 = 56.9%; low certainty), and caregiver-reported anxiety (k = 7; SMD = 0.27; p = .02; I2 = 41.4%; low certainty), but not for youth-reported anxiety (k = 9; SMD = 0.13; p = .12; I2 = 0%; low certainty). More severe pretreatment anxiety, a lower proportion of completed sessions, no face-to-face sessions, media recruitment, and a larger proportion of females were associated with lower remission rates for primary AD. CONCLUSIONS tCBT has a moderate effect on remission for pediatric ADs and clinician-rated functioning, a small effect on caregiver-reported anxiety, and no statistically significant effect on youth-reported anxiety. The certainty of these estimates is low to moderate. Remission rates vary substantially across trials and several factors that may influence remission were identified. Future research should examine for whom tCBT is most appropriate and what care to offer the large proportion that does not remit. Future RCTs should consider contrasting tCBT with partial tCBT (e.g., including therapist-led exposure) and/or face-to-face CBT.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Novins DK, Althoff RR, Cortese S, Drury SS, Frazier JA, Henderson SW, McCauley E, Njoroge WFM, White T. Editors' Best of 2021. J Am Acad Child Adolesc Psychiatry 2022; 61:4-9. [PMID: 34949338 DOI: 10.1016/j.jaac.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 10/19/2022]
Abstract
There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2021 articles that we think deserve your attention or at least a second read.
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