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Gladstone T, Buchholz KR, Fitzgibbon M, Schiffer L, Lee M, Voorhees BWV. Randomized Clinical Trial of an Internet-Based Adolescent Depression Prevention Intervention in Primary Care: Internalizing Symptom Outcomes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E7736. [PMID: 33105889 PMCID: PMC7660174 DOI: 10.3390/ijerph17217736] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 02/06/2023]
Abstract
Approximately 20% of people will experience a depressive episode by adulthood, making adolescence an important developmental target for prevention. CATCH-IT (Competent Adulthood Transition with Cognitive-behavioral, Humanistic, and Interpersonal Training), an online depression prevention intervention, has demonstrated efficacy in preventing depressive episodes among adolescents reporting elevated symptoms. Our study examines the effects of CATCH-IT compared to online health education (HE) on internalizing symptoms in adolescents at risk for depression. Participants, ages 13-18, were recruited across eight US health systems and were randomly assigned to CATCH-IT or HE. Assessments were completed at baseline, 2, 6, 12, 18, and 24 months. There were no significant differences between groups in change in depressive symptoms (b = -0.31 for CATCH-IT, b = -0.27 for HE, p = 0.80) or anxiety (b = -0.13 for CATCH-IT, b = -0.11 for HE, p = 0.79). Improvement in depressive symptoms was statistically significant (p < 0.05) for both groups (p = 0.004 for CATCH-IT, p = 0.009 for HE); improvement in anxiety was significant for CATCH-IT (p = 0.04) but not HE (p = 0.07). Parental depression and positive relationships with primary care physicians (PRPC) moderated the anxiety findings, and adolescents' externalizing symptoms and PRPC moderated the depression findings. This study demonstrates the long-term positive effects of both online programs on depressive symptoms and suggests that CATCH-IT demonstrates cross-over effects for anxiety as well.
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Affiliation(s)
- Tracy Gladstone
- The Robert S. and Grace W. Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College, Wellesley, MA 02481, USA;
| | - Katherine R. Buchholz
- The Robert S. and Grace W. Stone Primary Prevention Initiatives, Wellesley Centers for Women, Wellesley College, Wellesley, MA 02481, USA;
| | - Marian Fitzgibbon
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA; (M.F.); (M.L.); (B.W.V.V.)
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL 60608, USA;
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL 60612, USA
| | - Linda Schiffer
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, IL 60608, USA;
| | - Miae Lee
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA; (M.F.); (M.L.); (B.W.V.V.)
| | - Benjamin W. Van Voorhees
- Department of General Pediatrics, College of Medicine, University of Illinois at Chicago, Chicago, IL 60612, USA; (M.F.); (M.L.); (B.W.V.V.)
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Tsai N, Jaeggi SM, Eccles JS, Atherton OE, Robins RW. Predicting Late Adolescent Anxiety From Early Adolescent Environmental Stress Exposure: Cognitive Control as Mediator. Front Psychol 2020; 11:1838. [PMID: 32849080 PMCID: PMC7432129 DOI: 10.3389/fpsyg.2020.01838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 07/03/2020] [Indexed: 11/27/2022] Open
Abstract
Early exposure to stressful life events is associated with greater risk of chronic diseases and mental health problems, including anxiety. However, there is significant variation in how individuals respond to environmental adversity, perhaps due to individual differences in processing and regulating emotional information. Differences in cognitive control – processes necessary for implementing goal directed behavior – have been linked to both stress exposure and anxiety, but the directionality of these links is unclear. The present study investigated the longitudinal pathway of environmental stress exposure during early adolescence on later adolescent anxiety, and the possible mediating mechanism of cognitive control. Participants were 674 Mexican-origin adolescents (meanage = 10.8 years, 50% male) enrolled in the California Families Project, an ongoing longitudinal study of Mexican-origin families. In the current analysis, we examined self-reports of environmental stressors at age 14 (Time 1), cognitive control at age 16 (Time 2), and anxiety at age 18 (Time 3). Structural equation modeling revealed that environmental stressors (Time 1) had both direct and indirect effects on later anxiety (Time 3) through their effects on cognitive control (Time 2), even when accounting for prior levels of anxiety (Time 2). Cognitive control accounted for 18% of the association between environmental stressors and adolescent anxiety: an increase in stressors decreased cognitive control (β = −0.20, p < 0.001), however, cognitive control buffers against anxiety (β = −0.10, p = 0.004). These findings deepen our understanding of the mechanisms underlying the development of anxiety and highlight the importance of cognitive control as a potential protective factor.
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Affiliation(s)
- Nancy Tsai
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Susanne M Jaeggi
- School of Education, University of California, Irvine, Irvine, CA, United States
| | - Jacquelynne S Eccles
- School of Education, University of California, Irvine, Irvine, CA, United States
| | - Olivia E Atherton
- Department of Psychology, University of California, Davis, Davis, CA, United States
| | - Richard W Robins
- Department of Psychology, University of California, Davis, Davis, CA, United States
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The Association Between Parental Depression and Child Psychosocial Intervention Outcomes: Directions for Future Research. Harv Rev Psychiatry 2020; 27:241-253. [PMID: 31219883 DOI: 10.1097/hrp.0000000000000214] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Recent studies suggest that parental depressive symptoms may affect a child's ability to benefit from interventions for anxiety and depression. This article reviews the current literature, suggesting that, when parents experience current depressive symptoms, children are less likely to benefit from psychosocial interventions for anxiety and depression. Opportunities for future research are discussed, including moderators and mechanisms of the association between parental depressive symptoms and child intervention outcomes.
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Arman S, Soheilimehr A, Maracy MR. The Efficacy of Augment of D-Cycloserine and Cognitive-behavioral Therapy on Adolescent with one Type of Anxiety Disorders: A Double-blind Randomized Controlled Trial. Adv Biomed Res 2017; 6:11. [PMID: 28299303 PMCID: PMC5343611 DOI: 10.4103/2277-9175.200786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: This study was designed to investigating the effect of combining D-cycloserine (DCS) and cognitive-behavioral therapy (CBT) on adolescent with at least one type of anxiety disorders. Materials and Methods: The present study was conducted as a double-blind randomized controlled trial on 36 adolescent with anxiety disorders. Patients were assessed in two groups. In addition to 4 sessions of weekly CBT in both groups; case group, received a 50-mg DCS capsules, control group, received Placebo daily for a month. Patients received DCS capsules or placebo 1 h before sessions of CBT. Age, sex, kind of anxiety disorders “screen for child anxiety related disorders (SCARED)” and “cognitive abilities test (CATS)” scores were evaluated and compared between groups. Results: The mean age of the studied patients (29 females (80.6%) and 7 males (19.4%)) was 14.1 ± 1.8 years. The most frequent anxiety disorder among the study population was generalized social disorder (GAD) (77.7%). Age, sex and the frequency of anxiety disorders were not statistically significant between the study groups (P > 0.05). The mean score of “SCARED” and “CATS” at before starting the treatment, after treatment and three month after the treatment were not statistically significant between groups (P > 0.05). Also, decrease in values of “SCARED” and “CATS” during the evaluation time periods was not statistically significant between groups (P > 0.05). Conclusions: Findings of this study showed that there has been no difference in symptoms improvement in adolescent with anxiety disorder who received treatment protocol including 4 sessions of CBT, weekly, together with 50 mgs of DCS compared to the patients of the control group.
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Affiliation(s)
- Soroor Arman
- Department of Psychiatry, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Soheilimehr
- Department of Psychiatry, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Reza Maracy
- Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Pishva R. Becoming Therapeutic Agents: A Grounded Theory of Mothers' Process When Implementing Cognitive Behavioural Therapy at Home with an Anxious Child. Clin Psychol Psychother 2016; 24:766-784. [PMID: 27687013 DOI: 10.1002/cpp.2046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 08/30/2016] [Accepted: 09/14/2016] [Indexed: 11/09/2022]
Abstract
The premise of parent-centred programmes for parents of anxious children is to educate and train caregivers in the sustainable implementation of cognitive behaviour therapy (CBT) in the home. The existing operationalization of parent involvement, however, does not address the systemic, parent or child factors that could influence this process. The qualitative approach of grounded theory was employed to examine patterns of action and interaction involved in the complex process of carrying out CBT with one's child in one's home. A grounded theory goes beyond the description of a process, offering an explanatory theory that brings taken-for-granted meanings and processes to the surface. The theory that emerged from the analysis suggests that CBT implementation by mothers of anxious children is characterized by the evolution of mothers' perception of their child and mothers' perception of their role as well as a shift from reacting with emotion to responding pragmatically to the child. Changes occur as mothers recognize the crisis, make links between the treatment rationale, child's symptoms and their own parenting strategies, integrate tenets of CBT for anxiety and eventually focus on sustaining therapeutic gains through natural life transitions. The theory widens our understanding of mothers' role, therapeutic engagement, process, and decision-making. The theory also generates new hypotheses regarding parent involvement in the treatment of paediatric anxiety disorders and proposes novel research avenues that aim to maximize the benefits of parental involvement in the treatment of paediatric anxiety disorders. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE Mothers of anxious youth who take part in parent-centred programmes experience a shift in their perception of the child and of their role. Parental strategy after CBT implementation shifts from emotional empathy to cognitive empathy. Mothers experience significant challenges and require additional support in prevention of relapse and knowledge translation.
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Affiliation(s)
- Rana Pishva
- Department of Psychology, Queen's University, Kingston, Ontario, Canada
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Iniesta-Sepúlveda M, Storch EA. Clinical Considerations to Enhance the Efficacy of Cognitive Behavioral Treatments for OCD Including Parental Involvement. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:60-1. [DOI: 10.1111/jcap.12143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 05/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Eric A. Storch
- Departments of Pediatrics, Health Policy & Management, Psychiatry & Behavioral Neurosciences, and Psychology; University of South Florida; Tampa FL USA
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Oldham-Cooper R, Glasman D, Loades M. The Advantages of Parental Involvement in Cognitive-Behavioral Treatment of Childhood Obsessive-Compulsive Disorder: A Single-Case Example. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:44-53. [PMID: 27091103 DOI: 10.1111/jcap.12134] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/07/2016] [Accepted: 02/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interventions for the treatment of anxiety disorders in children have a growing evidence base. Cognitive-behavioral therapy for the treatment of specific anxiety disorders in children and adolescents, including obsessive-compulsive disorder, is now an established intervention. However, a question remains concerning the benefits of parental involvement in treatment. Some studies report limited or no benefit of including parents in treatment, whereas other studies have indicated additional advantages of parental involvement. INTERVENTION The present case report describes the treatment of an 11-year-old girl with obsessive-compulsive disorder using cognitive-behavioral therapy derived largely from the treatment approaches outlined in Carr (2006), March and Mulle (1998), and Derisley, Heyman, Robinson, and Turner (2008). The child's mother attended all sessions and also a one-off parent-only session toward the end of treatment. The report considers the benefits of involving the child's mother in treatment and possible factors that could suggest parental involvement is indicated in future cases. OUTCOMES Both child and mother, and the therapist, believed that parental involvement had been an important and useful element of treatment. Possible reasons for benefits of parental involvement were considered to be high parental anxiety at the outset of treatment, age of the client, and involvement of the parent in obsessions and compulsions.
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Affiliation(s)
| | - David Glasman
- Clinical Psychologist, North Bristol NHS Trust, South Gloucestershire, UK
| | - Maria Loades
- Clinical Psychologist and Clinical Tutor for the Doctorate in Clinical Psychology Program, University of Bath, Bath, UK
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8
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Prevention and Intervention for Anxiety Disorders in Children and Adolescents: A Whole School Approach. ACTA ACUST UNITED AC 2016. [DOI: 10.1017/s1037291100004738] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
This paper explores a whole school approach to the prevention and intervention for anxiety disorders in children and adolescents. Anxiety disorders are the most prevalent psychopathology in childhood and adolescence. In addition to having serious consequences for academic, social and family life, anxiety has also been shown to be a precursor to depression, substance abuse and eating disorders. School counsellors are well placed to identify students with anxiety disorders, instigate prevention programs and treat or refer anxious students. Prevention and early intervention for anxiety disorders needs to be coordinated and integrated into the regular curriculum as well as into the life of the classroom and the school. Barriers to schools working well in this area are identified and discussed.
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Changing problematic parent–child interaction in child anxiety disorders: The promise of Acceptance and Commitment Therapy (ACT). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2016. [DOI: 10.1016/j.jcbs.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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10
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Vidair HB, Fichter CN, Kunkle KL, Boccia AS. Targeting parental psychopathology in child anxiety. Child Adolesc Psychiatr Clin N Am 2012; 21:669-89. [PMID: 22801001 DOI: 10.1016/j.chc.2012.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The increased risk of anxiety in children of parents with psychopathology is a significant public health problem, as early-onset is associated with a variety of difficulties later in life. The aim of this article is to determine if treating parents is associated with improvements in child anxiety through the review of both top-down (parent identified for treatment) and family-focused child anxiety treatment studies. The authors present conclusions based on the state of the current literature, discuss implications for research and clinical practice, and propose utilizing a family-based model for treating parental psychopathology, parental behavior, and child anxiety.
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Affiliation(s)
- Hilary B Vidair
- Clinical Psychology Doctoral Program, Long Island University, Post Campus, 720 Northern Boulevard, Brookville, NY 11548, USA.
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11
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Hudson JL. Efficacy of Cognitive—Behavioural Therapy for Children and Adolescents With Anxiety Disorders. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.2005.22.2.55] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractSupport for the efficacy of cognitive—behavioural therapy (CBT) for anxious youth has accumulated. Significant treatment effects are observed and maintained over the long term for the majority of children receiving individual, family or group-based treatments. Nevertheless, all children do not improve. In fact, there is evidence to suggest that a significant percentage of children continue to experience anxiety following treatment and will seek additional treatment for their anxiety. This article will review the substantial evidence for CBT, the current information available on predictors of outcome and mechanisms of change. The article will also discuss the need for adequately powered randomised clinical trials that continue to refine and evaluate treatments for anxious children in an effort to improve outcomes for those children whose needs are not being met by our current treatments.
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Ben-Amitay G, Rosental B, Toren P. Brief parent-child group therapy for childhood anxiety disorders: a developmental perspective on cognitive-behavioral group treatment. Int J Group Psychother 2010; 60:389-406. [PMID: 20590435 DOI: 10.1521/ijgp.2010.60.3.389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The use of cognitive-behavioral group psychotherapy in treating childhood anxiety disorders has become widespread. This paper examines the dynamic processes underlying cognitive-behavioral group treatment for children with anxiety disorders and for their parents, with particular focus on the process of separation-individuation. Both children and their parents were empowered through processes of sub-grouping and thus helped to differentiate and separate. We consider this parallel dynamic process an important factor that can enhance cognitive-behavioral treatment.
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Monga S, Young A, Owens M. Evaluating a cognitive behavioral therapy group program for anxious five to seven year old children: a pilot study. Depress Anxiety 2009; 26:243-50. [PMID: 19212972 DOI: 10.1002/da.20551] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Cognitive Behavioral Therapy (CBT) has demonstrated benefits for anxious school-aged children and adolescents; however, treatment programs have not been developed to teach CBT strategies to children under the age of eight. This pilot study examined a novel treatment program for children aged 5-7 years with anxiety disorders. METHODS Thirty-two children (19 females) aged 5-7 years (mean age=6.51 years) with DSM-IV anxiety disorders and their families completed a 12-week, manualized CBT group program. Parent and child groups (5-8 children per group) were held separately but concurrently. Multiple measures of anxiety (Screen for Child Anxiety Related Emotional Disorders, Anxiety Disorders Interview Schedule for DSM-IV-Parent Version, and clinician Children's Global Assessment Scale ratings) were completed pre and post each treatment series. A subset of participants (n=11; 8 females; mean age=6.34 years) completed an initial assessment followed by a wait period of approximately 3.5 months (range 2.5-5 months) with a second assessment just before treatment start. No treatment was received during this wait time. RESULTS With treatment, 43.8% of children no longer met criteria for any Axis 1 anxiety disorders whereas 71.9% had at least one anxiety disorder resolve. A series of paired, two-tailed t-tests revealed significant reduction in anxiety symptoms on standardized measures. Children who waited for treatment showed no significant change in anxiety symptoms during nontreatment but demonstrated improvement after program attendance. CONCLUSIONS This pilot study suggests that CBT can be used effectively to treat anxious children as young as 5 years of age. Further research is warranted.
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Affiliation(s)
- Suneeta Monga
- Anxiety Disorders Program, Division of Child Psychiatry, University of Toronto, Toronto, Ontario, Canada
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14
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Liber JM, van Widenfelt BM, Goedhart AW, Utens EMWJ, van der Leeden AJM, Markus MT, Treffers PDA. Parenting and Parental Anxiety and Depression as Predictors of Treatment Outcome for Childhood Anxiety Disorders: Has the Role of Fathers Been Underestimated? JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2008; 37:747-58. [DOI: 10.1080/15374410802359692] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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15
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Legerstee JS, Huizink AC, van Gastel W, Liber JM, Treffers PDA, Verhulst FC, Utens EMWJ. Maternal anxiety predicts favourable treatment outcomes in anxiety-disordered adolescents. Acta Psychiatr Scand 2008; 117:289-98. [PMID: 18321354 DOI: 10.1111/j.1600-0447.2008.01161.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the differential impact of maternal and paternal internalizing psychopathology on cognitive-behavioural treatment (CBT) outcome of anxiety-disordered children and adolescents. METHOD Participants consisted of 127 children and 51 adolescents with a primary anxiety diagnosis. Children were randomly assigned to a standardized group CBT or individual CBT; adolescents received individual CBT. Parents received four training sessions. Participants were evaluated at pre- and post-treatment with a clinical interview and with self- and parent-reported questionnaires. Lifetime anxiety and mood disorders in parents were obtained with a clinical interview. RESULTS For children, no associations were found between maternal and paternal anxiety or mood disorders and treatment outcome. For adolescents, however, maternal lifetime anxiety disorders were positively associated with pre-post-treatment improvement in clinician severity ratings and with treatment success. CONCLUSION Lifetime maternal anxiety disorders were significantly associated with favourable treatment outcomes in adolescents. Paternal disorders were not associated with treatment response.
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Affiliation(s)
- J S Legerstee
- Department of Child and Adolescent Psychiatry, Erasmus Medical Centre Rotterdam/Sophia Children's Hospital, Rotterdam, The Netherlands
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Creswell C, Cartwright-Hatton S. Family Treatment of Child Anxiety: Outcomes, Limitations and Future Directions. Clin Child Fam Psychol Rev 2007; 10:232-52. [PMID: 17476594 DOI: 10.1007/s10567-007-0019-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Anxiety of childhood is a common and serious condition. The past decade has seen an increase in treatment-focussed research, with recent trials tending to give greater attention to parents in the treatment process. This review examines the efficacy of family-based cognitive behaviour therapy and attempts to delineate some of the factors that might have an impact on its efficacy. The choice and timing of outcome measure, age and gender of the child, level of parental anxiety, severity and type of child anxiety and treatment format and content are scrutinised. The main conclusions are necessarily tentative, but it seems likely that Family Cognitive Behaviour Therapy (FCBT) is superior to no treatment, and, for some outcome measures, also superior to Child Cognitive Behaviour Therapy (CCBT). Where FCBT is successful, the results are consistently maintained at follow-up. It appears that where a parent is anxious, and this is not addressed, outcomes are less good. However, for children of anxious parents, FCBT is probably more effective than CCBT. What is most clear is that large, well-designed studies, examining these factors alone and in combination, are now needed.
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Affiliation(s)
- Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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17
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In-Albon T, Schneider S. Psychotherapy of childhood anxiety disorders: A meta-analysis. PSYCHOTHERAPY AND PSYCHOSOMATICS 2007; 76:15-24. [PMID: 17170560 DOI: 10.1159/000096361] [Citation(s) in RCA: 243] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The present study compared the efficacy of psychotherapy for childhood anxiety disorders (excluding trials solely treating post-traumatic stress disorder or obsessive-compulsive disorder). METHODS The meta-analysis included studies that met the basic CONSORT (consolidated standards of reporting trials) criteria. Several outcome variables (e.g. effect sizes, percentage of recovery) were analyzed using completer and intent-to-treat analyses during post-treatment and follow-up assessment. Twenty-four studies published by March 2005 were included in this meta-analysis. RESULTS In all the included studies, the active treatment condition was cognitive-behavioral. The overall mean effect of treatment was 0.86. No differences in outcome were found between individual and group treatments or child- and family-focused treatments. Follow-up data demonstrated that treatment gains were maintained up to several years after treatment. CONCLUSIONS These findings provide evidence that anxiety disorders in children can be treated efficaciously. The gathered data support the clinical utility of cognitive-behavioral therapy in this regard. Randomized controlled trial studies investigating treatments other than cognitive-behavioral therapy are missing.
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Affiliation(s)
- Tina In-Albon
- Department of Clinical Child and Adolescent Psychology, University of Basel, Basel, Switzerland
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18
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Ben-Amitay G, Kosov I, Reiss A, Toren P, Yoran-Hegesh R, Kotler M, Mozes T. Is elective surgery traumatic for children and their parents? J Paediatr Child Health 2006; 42:618-24. [PMID: 16972969 DOI: 10.1111/j.1440-1754.2006.00938.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
AIM The emotional consequences of elective surgery to children and to their parents have not been sufficiently studied. The aim of the present study was to prospectively assess the prevalence and severity of post-traumatic, anxiety and depressive symptoms in this population. METHODS Forty children and adolescents consecutively admitted for elective surgery in a general hospital participated in the study. Their parents were also assessed. The assessments were made on the day of admission and surgery, and 1 and 6 months after the surgery. RESULTS Minor post-traumatic symptoms of the children were noted at the first and second assessments, decreasing significantly at the 6-month assessment. Further, the prevalence of children with elevated post-traumatic symptoms decreased significantly between the first and second assessments. Parents scored highest for anxiety and depression at the first assessment. Their symptoms, however, decreased significantly within 1 month. A significant decrease between the first and second assessments was also noted in the prevalence of parents with elevated anxiety symptoms. At the 1- and 6-month follow-up assessments, there was a significant correlation between the children's symptoms and their parents'. CONCLUSION Mild post-traumatic symptoms may accompany paediatric elective surgery and persist for at least 1 month. Parents may also manifest anxiety and depressive symptoms, which may diminish earlier, that is, immediately after the surgery or within 1 month.
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Affiliation(s)
- Galit Ben-Amitay
- Ness-Ziona Mental Health Center, Ness-Ziona, The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel.
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Abstract
Over the past decade, multiple controlled trials have demonstrated the efficacy of cognitive-behavior therapy (CBT) for the treatment of anxiety disorders in children and adolescents. Relying heavily on behavioral exposure, cognitive restructuring, and psychoeducation, CBT for child anxiety has been shown to be adaptable to a variety of implementation formats, including individual, family, and group treatment. This article describes the conceptual framework underlying CBT and the key elements of this treatment approach. Important developmental and family considerations in treatment are discussed, and the empirical literature is reviewed.
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Affiliation(s)
- Tami Roblek
- School of Medicine, University of California Los Angeles, Los Angeles, CA 90095, USA
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Lyneham HJ, Rapee RM. Evaluation and treatment of anxiety disorders in the general pediatric population: a clinician's guide. Child Adolesc Psychiatr Clin N Am 2005; 14:845-61, x. [PMID: 16171705 DOI: 10.1016/j.chc.2005.05.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This article provides an overview of research on the recognition, assessment, and treatment of children and adolescents who have anxiety disorders and emphasizes practical issues facing clinicians. Discussion includes an overview of the prevalence and consequences of anxiety and reviews assessment tools, maintenance factors, and evidence-based approaches to treatment. Topics also include developmental considerations, approaches to informant discrepancy, predictors of treatment outcome, and recent innovative approaches to treatment that may potentially improve dissemination to the general pediatric population.
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Affiliation(s)
- Heidi J Lyneham
- Department of Psychology, Macquarie University, Sydney, New South Wales 2109, Australia.
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Abstract
BACKGROUND This article presents a case for the development of cognitive therapy services for children, adolescents and their families. METHOD The theoretical basis of cognitive therapy is described, and illustrated with a case. The article continues by exploring the context for service development, with a specific emphasis on evaluating the evidence-base for using cognitive therapy with children and adolescents. Consideration is also given to adapting cognitive therapy to the child's developmental level, and the evidence for the efficacy of cognitive-behavioural family approaches. CONCLUSIONS The article concludes by arguing that there is a need to address mental health difficulties in young people by providing effective treatment approaches. The development of cognitive therapy services would support the further evaluation of this therapeutic approach.
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Affiliation(s)
- Jo Derisley
- Norfolk Mental Healthcare Trust, Bethel Child & Family Centre, Hotblack Road, Norwich NR2 4HN, UK
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22
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Garland EJ. New developments in pharmacotherapy of pediatric anxiety disorders. Expert Rev Neurother 2002; 2:203-11. [DOI: 10.1586/14737175.2.2.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Abstract
The following article reviews the literature on childhood anxiety disorders published during the past year. Publication trajectories suggest ever increasing empirical focus on the nature, developmental influences, assessment, and treatment of anxiety in children. The past year witnessed significant events on a national level with respect to public policy development. Despite such forward progress, research on childhood anxiety remains disproportionally behind that of the disruptive behavior disorders. With respect to treatment, cognitive-behavioral approaches have demonstrated strong empirical support. Although there is limited data yet available, selective serotonin reuptake inhibitors appear to be efficacious in treating anxiety in children.
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Affiliation(s)
- T L Morris
- Department of Psychology, West Virginia University, 114 Oglebay Hall, Morgantown, WV 26506-6040, USA.
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