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Kim YJ, Aslam MS, Deng R, Leghari QA, Naseem S, Ul Hassan MM, Nadeem E, Qian L, Lkhagvasuren D. Intolerance of uncertainty across stress, anxiety, and depression among university students in Pakistan: A descriptive cross-sectional study. Heliyon 2023; 9:e16636. [PMID: 37274650 PMCID: PMC10238721 DOI: 10.1016/j.heliyon.2023.e16636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 05/15/2023] [Accepted: 05/23/2023] [Indexed: 06/06/2023] Open
Abstract
Background The mental health issues due to COVID-19, such as intolerance of uncertainty (IOU), anxiety, stress, and depression, have attracted extensive attention from researchers. The challenges for Pakistani university students could be worse than developed countries due to the lack of online courses/programs and online mental health support provided by academic institutions. Therefore, the current study aims to assess the intolerance of uncertainty, depression, anxiety, and stress of Pakistani university students after the second wave of COVID-19 and the relationship among these constructs. Methods A convenience cross-sectional sampling method was used to collect data from university students in Pakistan between January 2021 and April 2022 via a structured online questionnaire. The Descriptive analysis focused on frequencies, percentages, mean, and standard deviation (SD) were calculated on IOU-12 and DASS-21. Covariance for the research model and confirmatory factor analyses fit indices for the IOU-12 and DASS-21 were analyzed by AMOS statistical packages. Results As expected, anxiety, depression, and stress persist among Pakistani university students. On average, they report mild to moderate mental health problems regarding anxiety, depression, stress, and intolerance of uncertainty. Our results indicate a strong positive relationship among the three emotional distress components - anxiety, depression, and stress. However, our results suggest no significant relationship between IOU and the three subcomponents of emotional distress (anxiety, depression, and stress). Limitations First, the cross-sectional survey design means we cannot conclude on the causal relations. Second, the self-report questionnaire embeds subjectivity issues. Last, the generalizability of the sample to the whole student population in Pakistan is limited, considering the sampling method. Conclusion This study expanded the current knowledge in the psychological health domain (intolerance of uncertainty, anxiety, depression, and stress) due to the COVID-19 pandemic. In practice, higher education institutions should further mitigate university students' mental health issues. For researchers, our findings inspire future studies to delve into the relationship between IOU and mental health issues due to COVID-19 since our findings display contrary evidence for various reasons.
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Affiliation(s)
- Yun Jin Kim
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Sepang, 43900, Malaysia
| | - Muhammad Shahzad Aslam
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Sepang, 43900, Malaysia
| | - Ruolan Deng
- Department of Communication, University of Vienna, Vienna, 1090, Austria
| | - Qurratul ain Leghari
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Hamdard University, Karachi, 74600, Pakistan
| | - Solomon Naseem
- Faculty of Pharmacy, Ziauddin University, Karachi, Sindh, 75600, Pakistan
| | | | - Ejaz Nadeem
- Independent Researcher, Bahawalpur, Punjab, 63100, Pakistan
| | - Linchao Qian
- School of Traditional Chinese Medicine, Xiamen University Malaysia, Sepang, 43900, Malaysia
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Kendall PC, Ney JS, Maxwell CA, Lehrbach KR, Jakubovic RJ, McKnight DS, Friedman AL. Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings. Front Psychiatry 2023; 14:1067047. [PMID: 36937729 PMCID: PMC10014836 DOI: 10.3389/fpsyt.2023.1067047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Anxiety disorders are common in youth, associated with impairments in daily functioning, and often persist into adulthood when untreated. Cognitive behavioral therapy (CBT) for youth anxiety is a well-established intervention and has been modified to fit several treatment settings. Despite decades of results supporting the efficacy of CBT, there is a large gap in access to this treatment and a need to consider how it can best be administered flexibly to increase uptake and personalization. We first discuss the core components of treatment for CBT through the lens of the Coping Cat treatment. Next, we review the empirical findings regarding adjustments made for CBT for youth anxiety delivered (a) in schools, (b) in community settings, (c) through telehealth, (d) through online computer programs, and (e) by caregivers at home. In each setting, we provide specific suggestions for how to implement CBT with flexibility while maintaining fidelity.
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Korte C, Friedberg RD, Wilgenbusch T, Paternostro JK, Brown K, Kakolu A, Tiller-Ormord J, Baweja R, Cassar M, Barnowski A, Movahedi Y, Kohl K, Martinez W, Trafalis S, Leykin Y. Intolerance of Uncertainty and Health-Related Anxiety in Youth amid the COVID-19 Pandemic: Understanding and Weathering the Continuing Storm. J Clin Psychol Med Settings 2022; 29:645-653. [PMID: 34478037 PMCID: PMC8414950 DOI: 10.1007/s10880-021-09816-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
The COVID-19 pandemic is a public health crisis that continues to impact individuals worldwide. While children may be less susceptible to severe medical complications, they are nonetheless vulnerable to stress and anxiety associated with the pandemic. However, current understanding of psychological functioning and potential strategies to mitigate distress amid a pandemic is naturally limited. Consequently, this article is an attempt to fill that gap. Existing literature on pandemics, health-related anxieties, intolerance of uncertainty, and psychopathological sequelae is summarized within the context of the COVID-19 outbreak. Conclusions from the empirical data and emerging theoretical models are reviewed and synthesized. Finally, several potentially engaging and effective examples of developmentally appropriate interventions targeting intolerance of uncertainty and health-related anxieties in pediatric patients during the peri- and post-pandemic periods are described.
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Affiliation(s)
- Ciera Korte
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
| | - Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA.
| | - Tammy Wilgenbusch
- Stead Family Children's Hospital, University of Iowa, Iowa City, IA, USA
| | | | - Kimberly Brown
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
| | - Anusha Kakolu
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
| | - Josh Tiller-Ormord
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
| | - Raman Baweja
- Penn State Milton Hershey Medical Center, Penn State University College of Medicine, Hershey, PA, USA
| | - Marissa Cassar
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
| | - Agatha Barnowski
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
| | - Yasaman Movahedi
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
| | - Krista Kohl
- Stead Family Children's Hospital, University of Iowa, Iowa City, IA, USA
| | - William Martinez
- Zuckerberg General Hospital, University of California-San Francisco, San Francisco, CA, USA
| | - Sandra Trafalis
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
| | - Yan Leykin
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, Los Altos, CA, USA
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Johnson DA, Stone A, Marsh S. Structural, Construct, and Concurrent Score Validity Evidence for the State-Interpersonal Reactivity Index in Telemental Health Care Sessions. MEASUREMENT AND EVALUATION IN COUNSELING AND DEVELOPMENT 2022. [DOI: 10.1080/07481756.2022.2066545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | | | - Sarah Marsh
- Wake Forest University, Winston Salem, NC, USA
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Hong N, Herrera A, Furr JM, Georgiadis C, Cristello J, Heymann P, Dale CF, Heflin B, Silva K, Conroy K, Cornacchio D, Comer JS. Remote Intensive Group Behavioral Treatment for Families of Children with Selective Mutism. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2022; 8:439-458. [PMID: 38155719 PMCID: PMC10752620 DOI: 10.1080/23794925.2022.2062688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Abstract
Selective mutism (SM) is a relatively rare, but highly interfering, child anxiety disorder characterized by a consistent failure to speak in certain situations, despite demonstrating fluent speech in other contexts. Exposure-based cognitive behavioral therapy and Parent-Child Interaction Therapy adapted for SM can be effective, but the broad availability and accessibility of such specialty care options remains limited. Stay-at-home guidelines to mitigate the spread of COVID-19 further limited the accessibility of office-based specialty care for SM. Building on separate lines of research supporting intensive treatments and telehealth service delivery models, this paper is the first to describe the development, preliminary feasibility, acceptability, and efficacy of a Remote Intensive Group Behavioral Treatment (IGBT) for families of young children with SM (N=9). Treatment leveraged videoconferencing technology to deliver caregiver training sessions, lead-in sessions, 5 consecutive daily IGBT sessions, and an individualized caregiver coaching session. Remote IGBT was found to be both feasible and acceptable. All families (100%) completed diagnostic assessments and caregiver-report questionnaires at four major study timepoints (i.e., intake, pre-treatment, post-treatment, 4-month follow-up) and participated in all treatment components. Caregivers reported high treatment satisfaction at post-treatment and 4-month follow-up and low levels of burden associated with treatment participation at post-treatment. Approximately half of participating children were classified as treatment responders by independent evaluators at post-treatment and 4-month follow-up. Although these pilot results should be interpreted with caution, the present work underscores the potential utility of using videoconferencing to remotely deliver IGBT to families in their natural environments.
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Friedberg RD. Pediatrician-friendly perspectives on cognitive behavioral therapy for anxious youth: Current status and clinical implications for the next normal. World J Clin Pediatr 2021; 10:112-123. [PMID: 34868888 PMCID: PMC8603637 DOI: 10.5409/wjcp.v10.i6.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
Pediatric anxiety disorders are common and often debilitating conditions. Cognitive is a psychosocial intervention that represents a potentially powerful antidote to these disorders. This article reviews data from treatment outcome studies, meta-analyses, and systematic reviews as well as from moderation/mediational investigations. The literature supports the efficacy, effectiveness, and durability of positive treatment outcomes for pediatric anxiety disorders. Recommendations for clinical applications are suggested.
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Affiliation(s)
- Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, San Jose, CA 95136, United States
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Fernandez E, Woldgabreal Y, Day A, Pham T, Gleich B, Aboujaoude E. Live psychotherapy by video versus in-person: A meta-analysis of efficacy and its relationship to types and targets of treatment. Clin Psychol Psychother 2021; 28:1535-1549. [PMID: 33826190 DOI: 10.1002/cpp.2594] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/26/2021] [Accepted: 03/27/2021] [Indexed: 12/14/2022]
Abstract
In-person psychotherapy (IPP) has a long and storied past, but technology advances have ushered in a new era of video-delivered psychotherapy (VDP). In this meta-analysis, pre-post changes within VDP were evaluated as were outcome differences between VDP versus IPP or other comparison groups. A literature search identified k = 56 within-group studies (N = 1681 participants) and 47 between-group studies (N = 3564). The pre-post effect size of VDP was large and highly significant, g = +0.99 95% CI [0.67-0.31]. VDP was significantly better in outcome than wait list controls (g = 0.77) but negligible in difference from IPP. Within-groups heterogeneity of effect sizes was reduced after subgrouping studies by treatment target, of which anxiety, depression, and posttraumatic stress disorder (PTSD) (each with k > 5) had effect sizes nearing 1.00. Disaggregating within-groups studies by therapy type, the effect size was 1.34 for CBT and 0.66 for non-CBT. Adjusted for possible publication bias, the overall effect size of VDP within groups was g = 0.54. In conclusion, substantial and significant improvement occurs from pre- to post-phases of VDP, this in turn differing negligibly from IPP treatment outcome. The VDP improvement is most pronounced when CBT is used, and when anxiety, depression, or PTSD are targeted, and it remains strong though attenuated by publication bias. Clinically, therapy is no less efficacious when delivered via videoconferencing than in-person, with efficacy being most pronounced in CBT for affective disorders. Live psychotherapy by video emerges not only as a popular and convenient choice but also one that is now upheld by meta-analytic evidence.
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Affiliation(s)
- Ephrem Fernandez
- Department of Psychology, University of Texas at San Antonio, USA
| | | | - Andrew Day
- School of Social & Political Sciences, University of Melbourne, Melbourne, Australia
| | - Tuan Pham
- Department of Psychology, University of Texas at San Antonio, USA
| | - Bianca Gleich
- Department of Psychology, University of Texas at San Antonio, USA
| | - Elias Aboujaoude
- Department of Psychiatry & Behavioral Sciences, Stanford University, Stanford, California, USA
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