1
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Dawson RL, Nixon RDV, Calear AL, Sivanathan D, O'Kearney R. Efficacy of two brief trauma-focussed writing interventions in comparison to positive experiences writing: A randomized controlled trial. J Affect Disord 2024; 358:449-457. [PMID: 38734242 DOI: 10.1016/j.jad.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 04/13/2024] [Accepted: 05/01/2024] [Indexed: 05/13/2024]
Abstract
BACKGROUND There is emerging literature regarding the efficacy of trauma-focussed writing therapies (TF-WTs) for posttraumatic stress. Such therapies have the potential to reduce posttraumatic stress symptoms (PTSS) in a brief time frame and can be delivered remotely. There remains a need for further research assessing the efficacy of different types of TF-WTs, as well comparing them to alternative control conditions not previously assessed. The present study assessed two TF-WTs that had differing writing instructions in comparison to an intervention that involved writing about positive experiences. METHODS Adult community participants (n = 83) with subthreshold or clinical PTSD symptoms were randomized to one of three conditions (two of which involved trauma-focussed writing, and the other involved writing about positive experiences). All conditions involved three weekly telehealth-delivered writing appointments. Outcomes were measured using the PTSD Checklist (PCL-5) and the Depression, Anxiety and Stress Scales (DASS-21), and were evaluated at baseline, one-week post-intervention, and five-weeks post-intervention. This trial was registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR Protocol 12620001065987). RESULTS There was no evidence that the two TF-WTs were more efficacious in reducing PTSS or producing clinically meaningful change in comparison to positive experiences writing. Instead, a significant reduction from baseline to follow-up in PTSS, depression, anxiety and stress was observed in all three conditions. LIMITATIONS The results should be interpreted with consideration of the modest sample size and absence of longer-term follow-up. CONCLUSIONS Three-session trauma-focussed writing delivered via telehealth may not be superior to writing about positive experiences.
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Affiliation(s)
- R L Dawson
- School of Medicine and Psychology, Australian National University, Australia.
| | - R D V Nixon
- College of Education, Psychology and Social Work, Flinders University, Australia
| | - A L Calear
- Centre for Mental Health Research, Australian National University, Australia
| | - D Sivanathan
- School of Medicine and Psychology, Australian National University, Australia; Faculty of Health, Charles Darwin University, Australia
| | - R O'Kearney
- School of Medicine and Psychology, Australian National University, Australia
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2
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Pham T, Pasalich D, Tran P, O'Kearney R. A randomized controlled trial of therapist-facilitated brief online behavioral parent training for reducing child disruptive behavior. Int J Clin Health Psychol 2024; 24:100448. [PMID: 38371397 PMCID: PMC10869913 DOI: 10.1016/j.ijchp.2024.100448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 02/01/2024] [Indexed: 02/20/2024] Open
Abstract
Background Addressing child disruptive behavior in low and middle-income countries (LMICs) is challenging. Therapist-facilitated, multisession, brief, online group parent training offers hope for mitigating this issue. However, trials, particularly in Asia, are limited. Objective This study primarily assessed the effectiveness of Brief Behavior Parent Training Vietnam (BBPTV) in reducing child disruptive behavior. Method This study was a randomized controlled trial involving 109 Vietnamese parents (mean age = 34.1, 96 % were mothers) of preschool children displaying ongoing disruptive behaviors. Interventions included the BBPTV group (n = 56) receiving a therapist-facilitated, four-session program conducted through online group meetings and the care-as-usual (CAU) group (n = 53) having a 15 min individual online consultation. Primary outcomes, assessed online at two and six months postintervention, encompassed the intensity and frequency of children's disruptive problems. Secondary outcomes involved parenting practices, coercive interactions, marital conflicts, parenting self-efficacy, and parental mental health. Results In contrast to CAU, the BBPTV group showed lower child disruptive intensity, reduced parent-child coercive interactions, and diminished marital conflicts, with a higher score in involving parenting two months post-intervention. Six months postintervention, BBPTV also exhibited significantly lower scores in child disruptive intensity and problems, harsh parenting, and coercive processes compared to CAU. Conclusions The therapist-facilitated, four-session, internet-delivered group parent intervention resulted in superior and sustained improvements in child disruptive behavior, parenting practices, and parent-child coercive interaction compared to usual care, highlighting the potential for online BBPT to extend mental health care in Vietnam and other LMICs.
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Affiliation(s)
- Triet Pham
- School of Medicine and Psychology, ANU College Health and Medicine, The Australian National University, Building 39, Science Road, Canberra, ACT 2601, Australia
- Children's Hospital 1 (Benh vien Nhi dong 1), 341 Su Van Hanh street, District 10, Ho Chi Minh City, Viet Nam
| | - Dave Pasalich
- School of Medicine and Psychology, ANU College Health and Medicine, The Australian National University, Building 39, Science Road, Canberra, ACT 2601, Australia
| | - Phu Tran
- Children's Hospital 1 (Benh vien Nhi dong 1), 341 Su Van Hanh street, District 10, Ho Chi Minh City, Viet Nam
| | - Richard O'Kearney
- School of Medicine and Psychology, ANU College Health and Medicine, The Australian National University, Building 39, Science Road, Canberra, ACT 2601, Australia
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3
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Jugovac S, O'Kearney R, Hawes DJ, Pasalich DS. Correction to: Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis. Clin Child Fam Psychol Rev 2022; 25:774-778. [PMID: 35771303 PMCID: PMC9622531 DOI: 10.1007/s10567-022-00403-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Samantha Jugovac
- Research School of Psychology, Australian National University, Canberra, Australia.
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, Australia
| | - David J Hawes
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Dave S Pasalich
- Research School of Psychology, Australian National University, Canberra, Australia
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4
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Jugovac S, O'Kearney R, Hawes DJ, Pasalich DS. Attachment- and Emotion-Focused Parenting Interventions for Child and Adolescent Externalizing and Internalizing Behaviors: A Meta-Analysis. Clin Child Fam Psychol Rev 2022; 25:754-773. [PMID: 35680711 PMCID: PMC9622525 DOI: 10.1007/s10567-022-00401-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2022] [Indexed: 11/24/2022]
Abstract
Attachment- and emotion-focused parenting interventions (AE) have grown in popularity as an alternative to behavioral parent training (BPT) for children and adolescents. AE go beneath behavior by helping parents understand and respond to their child’s underlying attachment and emotional needs. Past reviews have examined their effects on attachment security and caregiver sensitivity, though less is known regarding their effects on child mental health symptoms. Reported here is the first systematic review and meta-analysis of individual and group AE on externalizing behavior (EXT) and internalizing behavior (INT) for children aged 0–18 years. A search of four databases prior to July 2021 elicited 43 studies that met eligibility criteria. Meta-analysis revealed that AE were superior to waitlist controls for EXT (SMD = − 0.17) and INT (SMD = − 0.34). Effects were sustained at follow-up periods of 6 months and greater, and AE considered to target child mental health were significantly more effective than those that did not in reducing EXT and INT. Two studies retrieved directly compared AE to BPT, which showed no evidence of a difference for follow-up measures of EXT. No studies compared AE to BPT on INT. AE demonstrated no evidence of superiority compared to controls for parent mental health. Findings support the potential for AE to reduce EXT and INT in children and adolescents; however, future research should consider the relative effectiveness of AE.
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Affiliation(s)
- Samantha Jugovac
- Research School of Psychology, Australian National University, Canberra, Australia.
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, Australia
| | - David J Hawes
- School of Psychology, The University of Sydney, Sydney, Australia
| | - Dave S Pasalich
- Research School of Psychology, Australian National University, Canberra, Australia
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5
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Aguilar-Mediavilla E, O'Kearney R, Adrover-Roig D, Simon-Cereijido G, Buil-Legaz L. Editorial: Socio-Emotional and Educational Variables in Developmental Language Disorder (DLD). Front Psychol 2022; 13:882397. [PMID: 35401314 PMCID: PMC8990923 DOI: 10.3389/fpsyg.2022.882397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/02/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Eva Aguilar-Mediavilla
- Investigation in Development, Education and Language Laboratory, Institute of Educational Research and Innovation, University of the Balearic Islands, Palma, Spain
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
| | - Daniel Adrover-Roig
- Investigation in Development, Education and Language Laboratory, Institute of Educational Research and Innovation, University of the Balearic Islands, Palma, Spain
| | - Gabriela Simon-Cereijido
- Department of Communication Disorders, California State University, Los Angeles, CA, United States
| | - Lucía Buil-Legaz
- Investigation in Development, Education and Language Laboratory, Institute of Educational Research and Innovation, University of the Balearic Islands, Palma, Spain
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O'Kearney R, Chng RY, Salmon K. Callous-Unemotional Features are Associated with Emotion Recognition Impairments in Young ODD Children with Low but not High Affective Arousal. Child Psychiatry Hum Dev 2021; 52:869-879. [PMID: 32996006 DOI: 10.1007/s10578-020-01070-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/29/2022]
Abstract
Despite increasing support for the distinction between primary and secondary variants of callous-unemotional features in children with disruptive behavioural disorders, evidence about whether emotion recognition deficits are only characteristic of primary CU is inconclusive. We tested whether, in young children with Oppositional Defiant Disorder (ODD; N = 74), level of affective arousal moderated the association between CU and performance on behavioural measures of emotional abilities. The association between CU and emotion recognition abilities was dependent on the child's level of affective arousal with higher CU associated with poorer emotion recognition abilities for ODD children with lower affective arousal (r = - 0.49; p = .007) but not for those with higher levels (r = 0.03; p = .838). Our results replicate recent findings and give support to the notion that the primary CU variant is characterised emotionally by under arousal of affect, low affect dysregulation and impaired emotion recognition abilities.
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Affiliation(s)
- Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, 2601, Australia.
| | - Ren Ying Chng
- Research School of Psychology, Australian National University, Canberra, 2601, Australia
| | - Karen Salmon
- School of Psychology, Victoria University, Wellington, New Zealand
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7
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Dawson RL, Calear AL, McCallum SM, McKenna S, Nixon RDV, O'Kearney R. Exposure-Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Systematic Review and Meta-Analysis. J Trauma Stress 2021; 34:81-91. [PMID: 33043507 DOI: 10.1002/jts.22596] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 06/23/2020] [Accepted: 07/27/2020] [Indexed: 12/30/2022]
Abstract
We undertook a systematic review to assess the efficacy of exposure-based writing therapies (WTs) for trauma-exposed adults with subthreshold or clinical levels of posttraumatic stress disorder. Four databases (PsycINFO, Medline, Wiley Online, PILOTS) were searched for randomized controlled trials (RCTs) of exposure-based WTs. A total of 13 RCTs that reported on results from 17 WT versus control comparisons were included. The primary outcomes were posttraumatic stress symptom severity at posttreatment and/or clinical response. An overall unclear or high risk of bias was identified in 84.6% of studies. In comparison to both waitlist k = 3, Hedges' g = -0.97, 95% CI [-1.20, -0.73], and placebo writing conditions, k = 9, Hedges' g = -0.48, 95% CI [-0.87, -0.08], WTs were more beneficial to participants. There was no evidence of a difference between WTs that were longer in duration compared to other psychotherapy, k = 2; pooled OR = 1.42; 95% CI [0.83, 2.43]. These findings indicate that exposure-based WTs are effective when compared to waitlist and placebo writing control conditions. The evidence needs to be considered in the context of the modest number of studies conducted to date, the high methodological heterogeneity between the studies, and the high or unclear risk of bias across many studies. Further research is needed to increase the evidence base regarding the efficacy of WTs for posttraumatic stress. Future research should also measure the mediators and predictors of outcomes to further develop protocols and understand which variants of WTs work for different populations or individuals.
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Affiliation(s)
- Rachelle L Dawson
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Sonia M McCallum
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Sarah McKenna
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Reginald D V Nixon
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, Australia
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8
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Dawson RL, Calear AL, McCallum SM, McKenna S, Nixon RDV, O'Kearney R. The Emerging Literature on Exposure-Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Response to Thompson-Hollands et al.'s (2020) Commentary on Dawson et al. (2020). J Trauma Stress 2021; 34:269-270. [PMID: 33434342 DOI: 10.1002/jts.22643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/11/2022]
Abstract
Thompson-Hollands et al.'s (2020) commentary on our systematic review of exposure-based writing therapies for subthreshold and clinical posttraumatic stress symptoms (Dawson et al., 2020) emphasizes important questions about the impact of heterogeneity in drawing inferences from evidence reviews. In this reply, we discuss (a) our rationale for undertaking a systematic review that was broad rather than narrow in scope and (b) provide clarifications on how heterogeneity was considered in the meta-analyses that were conducted. We also strongly agree with Thompson-Hollands et al.'s recommendation that future research should focus on better understanding the mechanisms by which exposure-based writing therapies help reduce posttraumatic stress symptoms.
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Affiliation(s)
- Rachelle L Dawson
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Alison L Calear
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Sonia M McCallum
- Centre for Mental Health Research, Australian National University, Canberra, Australia
| | - Sarah McKenna
- Research School of Psychology, Australian National University, Canberra, Australia
| | - Reginald D V Nixon
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, Australia
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9
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McKenna S, Hassall A, O'Kearney R, Pasalich D. Gaining a new perspective on the quality of parent-adolescent relationships from adolescent speech samples. J Fam Psychol 2020; 34:938-948. [PMID: 32700928 DOI: 10.1037/fam0000787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Although the quality of the parent-teen relationship is key to understanding both psychopathology and well-being in adolescence, there are limited assessments of adolescents' underlying attitudes regarding their parents. This study aimed to evaluate a novel and brief method of coding adolescents' 3-min speech samples regarding their affective attitudes (e.g., thoughts and feelings) toward their parent. A community sample of 72 adolescents (M age = 16 years) completed a 3-min speech sample and several questionnaire measures of the quality of the parent-teen relationship and adolescents' psychosocial outcomes. Speech samples were coded for critical and warm affective attitudes toward the parent using the Family Affective Attitude Rating Scale (FAARS). Results showed that FAARS negative relational schemas (NRS) and positive relational schemas (PRS) scales were reliable and converged with questionnaire assessments of attachment and relationship quality, antisocial outcomes, and pro-social behavior. When included in the same model, adolescents' NRS, but not the questionnaire measures, was uniquely associated with externalizing behavior and prosocial behavior. Furthermore, adolescents' PRS, but not the questionnaires, was uniquely associated with callous-unemotional traits. Results suggest that the FAARS coding scheme can reliably assess adolescents' affective attitudes toward their parents and that this information is relevant to understanding adolescents' psychosocial outcomes. The implications of these findings for multimethod clinical assessments, large cohort research, and adolescents' therapeutic outcomes are discussed. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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10
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Pate A, Salmon K, Fortune CA, O'Kearney R. Maternal Elaborative Language in Shared Emotion Talk with ODD Children: Relationship to Child Emotion Competencies. Child Psychiatry Hum Dev 2020; 51:254-267. [PMID: 31485860 DOI: 10.1007/s10578-019-00927-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
While maternal elaborative reminiscing has been found to be positively connected to children's emotion competencies, little is known about how the quality of maternal talk during mother-child talk about shared emotion events relates to emotional competencies in children with disruptive behavioural disorders. In this study of 68 four to eight year-olds with oppositional defiant disorder and 34 children without a diagnosis there was no evidence of differences between mothers of oppositional defiant disorder (ODD) children and mothers of non-ODD children in their use of emotion descriptors and open-ended questions when discussing emotion events with their child. After controlling for child age, gender, expressive verbal abilities and number of conversational turns, the more the mothers used these devices the poorer child's ability to generate causes for emotions and the lower the child's emotion regulation ability. The association for child emotion regulation was moderated by child's diagnostic status with a notable relationship for ODD mother-child dyads but not for the other group. The implications of the findings for the conceptualisation of mother-child talk and its relationship to the development of emotion competencies in children with disruptive behavioural problems are discussed.
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Affiliation(s)
- Annie Pate
- Research School of Psychology, Australian National University, Canberra, ACT 2601, Australia
| | - Karen Salmon
- School of Psychology, Victoria University, Wellington, New Zealand
| | | | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, ACT 2601, Australia.
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11
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O'Kearney R, Kim S, Dawson RL, Calear AL. Are claims of non-inferiority of Internet and computer-based cognitive-behavioural therapy compared with in-person cognitive-behavioural therapy for adults with anxiety disorders supported by the evidence from head-to-head randomised controlled trials? A systematic review. Aust N Z J Psychiatry 2019; 53:851-865. [PMID: 31339342 DOI: 10.1177/0004867419864433] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This review examines the evidence from head-to-head randomised controlled trials addressing whether the efficacy of cognitive-behavioural therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorders in adults delivered by computer or online (computer- and Internet-delivered cognitive-behavioural therapy) is not inferior to in-person cognitive-behavioural therapy for reducing levels of symptoms and producing clinically significant gains at post-treatment and at follow-up. A supplementary aim is to examine the evidence for severity as a moderator of the relative efficacy of computer- and Internet-delivered cognitive-behavioural therapy and in-person cognitive-behavioural therapy. METHOD PubMed, PsycINFO, Embase and Cochrane database of randomised trials were searched for randomised controlled trials of cognitive-behavioural therapy for these disorders with at least an in-person cognitive-behavioural therapy and Internet or computer cognitive-behavioural therapy arm. RESULTS A total of 14 randomised controlled trials (9 Internet, 5 computer) of cognitive-behavioural therapy for social anxiety disorder, panic disorder and specific phobia and 3 reports of effect moderators were included. One study showed a low risk of bias when assessed against risk of bias criteria for non-inferiority trials. The remaining studies were assessed as high or unclear risk of bias. One study found that Internet-delivered cognitive-behavioural therapy was superior and non-inferior at post-treatment and follow-up to group in-person cognitive-behavioural therapy for social anxiety disorder. One study of Internet-delivered cognitive-behavioural therapy for panic disorder showed non-inferiority to individual in-person cognitive-behavioural therapy for responder status at post-treatment and one of Internet cognitive-behavioural therapy for panic disorder for symptom severity at follow-up. Other comparisons (22 Internet, 13 computer) and for estimates pooled for Internet cognitive-behavioural therapy for social anxiety disorder, Internet cognitive-behavioural therapy for panic disorder and computer-delivered cognitive-behavioural therapy studies did not support non-inferiority. Evidence of effect moderation by severity and co-morbidity was mixed. CONCLUSION There is limited evidence from randomised controlled trials which supports claims that computer- or Internet-delivered cognitive-behavioural therapy for anxiety disorders is not inferior to in-person delivery. Randomised controlled trials properly designed to test non-inferiority are needed before conclusions about the relative benefits of in-person and Internet- and computer-delivered cognitive-behavioural therapy can be made. PROSPERO CRD420180961655-6.
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Affiliation(s)
- Richard O'Kearney
- 1 Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Sheri Kim
- 1 Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Rachelle L Dawson
- 1 Research School of Psychology, The Australian National University, Canberra, ACT, Australia
| | - Alison L Calear
- 2 Research School of Population Health, The Australian National University, Canberra, ACT, Australia
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Dawel A, Dumbleton R, O'Kearney R, Wright L, McKone E. Reduced willingness to approach genuine smilers in social anxiety explained by potential for social evaluation, not misperception of smile authenticity. Cogn Emot 2018; 33:1342-1355. [PMID: 30585120 DOI: 10.1080/02699931.2018.1561421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We investigate perception of, and responses to, facial expression authenticity for the first time in social anxiety, testing genuine and polite smiles. Experiment 1 (N = 141) found perception of smile authenticity was unaffected, but that approach ratings, which are known to be reduced in social anxiety for happy faces, are more strongly reduced for genuine than polite smiles. Moreover, we found an independent contribution of social anxiety to approach ratings, over and above general negative affect (state/trait anxiety, depression), only for genuine smiles, and not for polite ones. We argue this pattern of results can be explained by genuine smilers signalling greater potential for interaction - and thus greater potential for the scrutiny that is feared in social anxiety - than polite smiles. Experiment 2 established that, relative to polite smilers, genuine smilers are indeed perceived as friendlier and likely to want to talk for longer if approached. Critically, the degree to which individual face items were perceived as wanting to interact correlated strongly with the amount that social anxiety reduced willingness to approach in Experiment 1. We conclude it is the potential for social evaluation and scrutiny signalled by happy expressions, rather than their positive valence, that is important in social anxiety.
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Affiliation(s)
- Amy Dawel
- a Research School of Psychology, and ARC Centre of Excellence in Cognition and its Disorders, The Australian National University , Canberra , Australia
| | - Rachael Dumbleton
- a Research School of Psychology, and ARC Centre of Excellence in Cognition and its Disorders, The Australian National University , Canberra , Australia
| | - Richard O'Kearney
- a Research School of Psychology, and ARC Centre of Excellence in Cognition and its Disorders, The Australian National University , Canberra , Australia
| | - Luke Wright
- a Research School of Psychology, and ARC Centre of Excellence in Cognition and its Disorders, The Australian National University , Canberra , Australia
| | - Elinor McKone
- a Research School of Psychology, and ARC Centre of Excellence in Cognition and its Disorders, The Australian National University , Canberra , Australia
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13
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Turner C, O'Gorman B, Nair A, O'Kearney R. Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: A systematic review. Psychiatry Res 2018; 261:50-60. [PMID: 29287236 DOI: 10.1016/j.psychres.2017.12.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 11/29/2017] [Accepted: 12/13/2017] [Indexed: 11/15/2022]
Abstract
We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations.
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Affiliation(s)
- Cynthia Turner
- School of Psychology, Australian Catholic University, Brisbane, QLD, Australia; Department of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Beth O'Gorman
- Department of Psychology, University of Queensland, Brisbane, QLD, Australia
| | - Archana Nair
- Research School of Psychology, Australian National University, Canberra, ACT 0020, Australia
| | - Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, ACT 0020, Australia.
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Salmon K, O'Kearney R, Reese E, Fortune CA. The Role of Language Skill in Child Psychopathology: Implications for Intervention in the Early Years. Clin Child Fam Psychol Rev 2018; 19:352-367. [PMID: 27678011 DOI: 10.1007/s10567-016-0214-1] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
In this narrative review, we suggest that children's language skill should be targeted in clinical interventions for children with emotional and behavioral difficulties in the preschool years. We propose that language skill predicts childhood emotional and behavioral problems and this relationship may be mediated by children's self-regulation and emotion understanding skills. In the first sections, we review recent high-quality longitudinal studies which together demonstrate that that children's early language skill predicts: (1) emotional and behavioral problems, and this relationship is stronger than the reverse pattern; (2) self-regulation skill; this pattern may be stronger than the reverse pattern but moderated by child age. Findings also suggest that self-regulation skill mediates the relation between early language skill and children's emotional and behavioral problems. There is insufficient evidence regarding the mediating role of emotion understanding. In subsequent sections, we review evidence demonstrating that: (1) particular kinds of developmentally targeted parent-child conversations play a vital role in the development of language skill, and (2) some current clinical interventions, directly or indirectly, have a beneficial impact on children's vocabulary and narrative skills, but most approaches are ad hoc. Targeting language via parent-child conversation has the potential to improve the outcomes of current clinical interventions in the preschool years.
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Affiliation(s)
- Karen Salmon
- School of Psychology, Victoria University of Wellington, Kelburn Parade, PO Box 600, Wellington, 6012, New Zealand.
| | - Richard O'Kearney
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Elaine Reese
- Department of Psychology, University of Otago, Dunedin, New Zealand
| | - Clare-Ann Fortune
- School of Psychology, Victoria University of Wellington, Kelburn Parade, PO Box 600, Wellington, 6012, New Zealand
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O'Kearney R, Salmon K, Liwag M, Fortune CA, Dawel A. Emotional Abilities in Children with Oppositional Defiant Disorder (ODD): Impairments in Perspective-Taking and Understanding Mixed Emotions are Associated with High Callous-Unemotional Traits. Child Psychiatry Hum Dev 2017; 48:346-357. [PMID: 27100725 DOI: 10.1007/s10578-016-0645-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Most studies of emotion abilities in disruptive children focus on emotion expression recognition. This study compared 74 children aged 4-8 years with ODD to 45 comparison children (33 healthy; 12 with an anxiety disorder) on behaviourally assessed measures of emotion perception, emotion perspective-taking, knowledge of emotions causes and understanding ambivalent emotions and on parent-reported cognitive and affective empathy. Adjusting for child's sex, age and expressive language ODD children showed a paucity in attributing causes to emotions but no other deficits relative to the comparison groups. ODD boys with high levels of callous-unemotional traits (CU) (n = 22) showed deficits relative to low CU ODD boys (n = 25) in emotion perspective-taking and in understanding ambivalent emotions. Low CU ODD boys did not differ from the healthy typically developing boys (n = 12). Impairments in emotion perceptive-taking and understanding mixed emotions in ODD boys are associated with the presence of a high level of CU.
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Affiliation(s)
- Richard O'Kearney
- Research School of Psychology, Australian National University, Canberra, ACT, 0200, Australia.
| | - Karen Salmon
- Victoria University of Wellington, Wellington, New Zealand
| | - Maria Liwag
- Research School of Psychology, Australian National University, Canberra, ACT, 0200, Australia
| | | | - Amy Dawel
- Research School of Psychology, Australian National University, Canberra, ACT, 0200, Australia.,ARC Centre of Excellence in Cognition and its Disorders, University of Western of Australia, Perth, Australia
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Davis J, McKone E, Zirnsak M, Moore T, O'Kearney R, Apthorp D, Palermo R. Social and attention-to-detail subclusters of autistic traits differentially predict looking at eyes and face identity recognition ability. Br J Psychol 2017; 108:191-219. [PMID: 26988108 DOI: 10.1111/bjop.12188] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 12/20/2015] [Indexed: 01/27/2023]
Abstract
This study distinguished between different subclusters of autistic traits in the general population and examined the relationships between these subclusters, looking at the eyes of faces, and the ability to recognize facial identity. Using the Autism Spectrum Quotient (AQ) measure in a university-recruited sample, we separate the social aspects of autistic traits (i.e., those related to communication and social interaction; AQ-Social) from the non-social aspects, particularly attention-to-detail (AQ-Attention). We provide the first evidence that these social and non-social aspects are associated differentially with looking at eyes: While AQ-Social showed the commonly assumed tendency towards reduced looking at eyes, AQ-Attention was associated with increased looking at eyes. We also report that higher attention-to-detail (AQ-Attention) was then indirectly related to improved face recognition, mediated by increased number of fixations to the eyes during face learning. Higher levels of socially relevant autistic traits (AQ-Social) trended in the opposite direction towards being related to poorer face recognition (significantly so in females on the Cambridge Face Memory Test). There was no evidence of any mediated relationship between AQ-Social and face recognition via reduced looking at the eyes. These different effects of AQ-Attention and AQ-Social suggest face-processing studies in Autism Spectrum Disorder might similarly benefit from considering symptom subclusters. Additionally, concerning mechanisms of face recognition, our results support the view that more looking at eyes predicts better face memory.
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Affiliation(s)
- Joshua Davis
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Elinor McKone
- Research School of Psychology, and ARC Centre of Excellence in Cognition and its Disorders, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Marc Zirnsak
- Department of Neurobiology, Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford University, California, USA
| | - Tirin Moore
- Department of Neurobiology, Howard Hughes Medical Institute, Stanford University School of Medicine, Stanford University, California, USA
| | - Richard O'Kearney
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Deborah Apthorp
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
| | - Romina Palermo
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia.,ARC Centre of Excellence in Cognition and its Disorders, and School of Psychology, University of Western Australia, Perth, Western Australia, Australia
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Menchón JM, van Ameringen M, Dell'Osso B, Denys D, Figee M, Grant JE, Hollander E, Marazziti D, Nicolini H, Pallanti S, Ruck C, Shavitt R, Stein DJ, Andersson E, Bipeta R, Cath DC, Drummond L, Feusner J, Geller DA, Hranov G, Lochner C, Matsunaga H, McCabe RE, Mpavaenda D, Nakamae T, O'Kearney R, Pasquini M, Pérez Rivera R, Poyurovsky M, Real E, do Rosário MC, Soreni N, Swinson RP, Vulink N, Zohar J, Fineberg N. Standards of care for obsessive-compulsive disorder centres. Int J Psychiatry Clin Pract 2016; 20:204-8. [PMID: 27359333 PMCID: PMC4950405 DOI: 10.1080/13651501.2016.1197275] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
In recent years, many assessment and care units for obsessive-compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a standards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries.
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Affiliation(s)
- José M Menchón
- a Psychiatry Department , Bellvitge University Hospital_IDIBELL , Barcelona , Spain ;,b Carlos III Health Institute_CIBERSAM , Spain ;,c Department of Clinical Sciences, School of Medicine , University of Barcelona , Barcelona , Spain
| | - Michael van Ameringen
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Bernardo Dell'Osso
- e Department of Psychiatry , University of Milan , Milan , Italy ;,f Fondazione IRCCS Ca' Granda Policlinico , Milan , Italy
| | - Damiaan Denys
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands ;,h Brain and Cognition , Amsterdam , The Netherlands ;,i Netherlands Institute for Neuroscience , Amsterdam , The Netherlands ;,j Royal Netherlands Academy of Arts and Sciences , Amsterdam , The Netherlands
| | - Martijn Figee
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands
| | - Jon E Grant
- k Department of Psychiatry and Behavioral Neuroscience , University of Chicago , Chicago , IL , USA
| | - Eric Hollander
- l Department of Psychiatry and Behavioral Sciences , Albert Einstein College of Medicine , NY , USA ;,m Montefiore Medical Center , NY , USA
| | - Donatella Marazziti
- n Dipartimento di Medicina Clinica e Sperimentale, Sezione di Psichiatria , University of Pisa , Pisa , Italy
| | - Humberto Nicolini
- o National Institute of Genomic Medicine , Mexico City , Mexico ;,p Carracci Medical Group , Mexico City , Mexico
| | - Stefano Pallanti
- q Psychiatry and Behavioral Sciences , UC Davis Health System , Sacramento , CA , USA ;,r Istituto di Neuroscienze , Florence , Italy
| | - Christian Ruck
- s Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | - Roseli Shavitt
- t Department and Institute of Psychiatry , University of São Paulo School of Medicine , São Paulo , Brazil
| | - Dan J Stein
- u Psychiatry and Mental Health Department , University of Cape Town , Cape Town , South Africa ;,v Groote Schuur Hospital , Cape Town , South Africa ;,w MRC Unit on Anxiety and Stress Disorders , South Africa
| | - Erik Andersson
- s Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden
| | | | - Danielle C Cath
- y Department of Clinical Psychology , Utrecht University , Utrecht , The Netherlands
| | - Lynne Drummond
- z South West London and St George's Mental Health NHS Trust , London , United Kingdom ;,aa St George's, University of London , London , United Kingdom
| | - Jamie Feusner
- ab Semel Institute for Neuroscience and Human Behavior , Los Angeles , CA , USA ;,ac David Geffen School of Medicine at UCLA University of California , Los Angeles , CA , USA
| | - Daniel A Geller
- ad Department of Psychiatry , Massachusetts General Hospital , Boston , MA , USA ;,ae Harvard Medical School , Boston , MA , USA
| | | | - Christine Lochner
- w MRC Unit on Anxiety and Stress Disorders , South Africa ;,ag Department of Psychiatry , Stellenbosch University , South Africa
| | - Hisato Matsunaga
- ah Department of Neuropsychiatry , Hyogo College of Medicine , Nishinomiya , Hyogo , Japan
| | - Randy E McCabe
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada ;,ai Anxiety Treatment and Research Center , St. Joseph's Healthcare Hamilton , Hamilton , Canada
| | - Davis Mpavaenda
- aj Hertfordshire Partnership University NHS Foundation Trust , Hertfordshire , United Kingdom
| | - Takashi Nakamae
- ak Department of Psychiatry, Graduate School of Medical Science , Kyoto Prefectural University of Medicine , Kyoto , Japan
| | - Richard O'Kearney
- al The Australian National University , Research School of Psychology , Canberra , Australia
| | - Massimo Pasquini
- am Department of Neurology and Psychiatry , Sapienza University of Rome , Rome , Italy
| | | | | | - Eva Real
- a Psychiatry Department , Bellvitge University Hospital_IDIBELL , Barcelona , Spain ;,b Carlos III Health Institute_CIBERSAM , Spain
| | - Maria Conceição do Rosário
- ap Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry , Federal University of São Paulo (UNIFESP) , São Paulo , Brazil
| | - Noam Soreni
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada ;,aq Pediatric OCD Consultation Service, Anxiety Treatment and Research Center , St. Joseph's HealthCare , Hamilton , Ontario , Canada
| | - Richard P Swinson
- d Department of Psychiatry and Behavioural Neurosciences , McMaster University , Hamilton , Ontario , Canada
| | - Nienke Vulink
- g Academic Medical Center , Department of Psychiatry , University of Amsterdam , Amsterdam , The Netherlands
| | - Joseph Zohar
- ar Tel Aviv University , Sackler School of Medicine , NY , USA
| | - Naomi Fineberg
- aj Hertfordshire Partnership University NHS Foundation Trust , Hertfordshire , United Kingdom
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Dawel A, McKone E, O'Kearney R, Sellbom M, Irons J, Palermo R. Elevated levels of callous unemotional traits are associated with reduced attentional cueing, with no specificity for fear or eyes. ACTA ACUST UNITED AC 2015; 6:216-228. [DOI: 10.1037/per0000108] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dawel A, Palermo R, O'Kearney R, McKone E. Children can discriminate the authenticity of happy but not sad or fearful facial expressions, and use an immature intensity-only strategy. Front Psychol 2015; 6:462. [PMID: 25999868 PMCID: PMC4419677 DOI: 10.3389/fpsyg.2015.00462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 03/31/2015] [Indexed: 11/30/2022] Open
Abstract
Much is known about development of the ability to label facial expressions of emotion (e.g., as happy or sad), but rather less is known about the emergence of more complex emotional face processing skills. The present study investigates one such advanced skill: the ability to tell if someone is genuinely feeling an emotion or just pretending (i.e., authenticity discrimination). Previous studies have shown that children can discriminate authenticity of happy faces, using expression intensity as an important cue, but have not tested the negative emotions of sadness or fear. Here, children aged 8–12 years (n = 85) and adults (n = 57) viewed pairs of faces in which one face showed a genuinely-felt emotional expression (happy, sad, or scared) and the other face showed a pretend version. For happy faces, children discriminated authenticity above chance, although they performed more poorly than adults. For sad faces, for which our pretend and genuine images were equal in intensity, adults could discriminate authenticity, but children could not. Neither age group could discriminate authenticity of the fear faces. Results also showed that children judged authenticity based on intensity information alone for all three expressions tested, while adults used a combination of intensity and other factor/s. In addition, novel results show that individual differences in empathy (both cognitive and affective) correlated with authenticity discrimination for happy faces in adults, but not children. Overall, our results indicate late maturity of skills needed to accurately determine the authenticity of emotions from facial information alone, and raise questions about how this might affect social interactions in late childhood and the teenage years.
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Affiliation(s)
- Amy Dawel
- Research School of Psychology and ARC Centre of Excellence in Cognition and its Disorders, The Australian National University , Canberra, ACT, Australia
| | - Romina Palermo
- Research School of Psychology, The Australian National University , Canberra, ACT, Australia ; ARC Centre of Excellence in Cognition and its Disorders, and School of Psychology, University of Western Australia , Perth, WA, Australia
| | - Richard O'Kearney
- Research School of Psychology, The Australian National University , Canberra, ACT, Australia
| | - Elinor McKone
- Research School of Psychology and ARC Centre of Excellence in Cognition and its Disorders, The Australian National University , Canberra, ACT, Australia
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Yew SGK, O'Kearney R. Early language impairments and developmental pathways of emotional problems across childhood. Int J Lang Commun Disord 2015; 50:358-373. [PMID: 25556640 DOI: 10.1111/1460-6984.12142] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Accepted: 09/21/2014] [Indexed: 06/04/2023]
Abstract
BACKGROUND Language impairments are associated with an increased likelihood of emotional difficulties later in childhood or adolescence, but little is known about the impact of LI on the growth of emotional problems. AIMS To examine the link between early language status (language impaired (LI), typical language (TL)) and the pattern and predictors of growth in emotional difficulties from school entry to the start of high school in a large cohort of Australian children. METHODS & PROCEDURES Unconditional latent growth curves of emotional difficulties were modelled across four waves (ages 4-5, 6-7, 8-9 and 10-11) using data from 1627 boys (280 LI, 1347 TL) and 1609 girls (159 LI, 1450 TL). Conditional latent growth curves estimated the main effects of LI on the severity and slope of growth in emotional problems. Simultaneous multiple regression tested the interaction between language status and the other predictors of the development of emotional symptoms. OUTCOMES & RESULTS LI predicted a significant persistent elevation in severity of emotional difficulties across childhood among boys (d = 0.33-0.57) and girls (d = 0.25-0.39) but was not associated with their growth. LI moderated the association between hostile parenting and the severity of emotional symptoms for boys and the effect of socioeconomic status (SES) and temperamental sociability on the linear and quadratic growth of emotional problems for girls but had no impact on the influence of other predictors. CONCLUSIONS & IMPLICATIONS There is no effect of LI on the characteristic rate and shape of growth in emotional symptoms across childhood although LI children maintain elevated severities of emotional difficulties. The associations between child reactivity, peer problems, prosocial behaviours, maternal distress and parental warmth and the development of emotional difficulties were the same for LI and TL children. LI enhanced the influence of hostile parenting on a higher severity of emotional symptoms for boys and of lower SES on a faster rate of development of emotional symptoms for girls. LI offset the usual protective effect of higher sociability and the usual vulnerability of higher social avoidance to a faster increase in emotional symptoms with age.
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Affiliation(s)
- Shaun Goh Kok Yew
- Research School of Psychology, Australian National University, Canberra, ACT, Australia
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Dawel A, Palermo R, O'Kearney R, Irons J, McKone E. Fearful faces drive gaze-cueing and threat bias effects in children on the lookout for danger. Dev Sci 2014; 18:219-31. [DOI: 10.1111/desc.12203] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/09/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Amy Dawel
- Research School of Psychology; The Australian National University; Australia
- ARC Centre of Excellence in Cognition and its Disorders; Australia
| | - Romina Palermo
- Research School of Psychology; The Australian National University; Australia
- ARC Centre of Excellence in Cognition and its Disorders; Australia
- School of Psychology; University of Western Australia; Australia
| | - Richard O'Kearney
- Research School of Psychology; The Australian National University; Australia
| | - Jessica Irons
- Research School of Psychology; The Australian National University; Australia
| | - Elinor McKone
- Research School of Psychology; The Australian National University; Australia
- ARC Centre of Excellence in Cognition and its Disorders; Australia
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O'Kearney R, Parry L. Comparative physiological reactivity during script-driven recall in depression and posttraumatic stress disorder. J Abnorm Psychol 2014; 123:523-32. [PMID: 25000153 DOI: 10.1037/a0037326] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Increased physiological responsiveness to trauma memories is common in posttraumatic stress disorder (PTSD) and is related to higher felt memory intrusiveness. Physiological reactivity to remembering of distressing personal events in depression and its association with memory quality have not been examined. Heart rate (HR) and skin conductance (SC) reactivity during script-driven recall were assessed in participants with a depressive episode without PTSD (n = 24), participants with PTSD (n = 24), and nondisordered controls (n = 24). Participants reported on event impact and memory quality. PTSD participants showed higher HR and SC reactivity during trauma recall compared with recall of other events and compared with depressed participants for HR and SC reactivity and compared with nondisordered participants for HR reactivity. Although reactivity between depressed and nondisordered participants was not significantly different, the findings indicated a consistent trend toward an attenuation of reactivity to memories of events subjectively associated with symptom onset for those with depression. There was no evidence that the presence of depression impacted the increased physiological responsiveness observed in PTSD. Higher avoidance was associated with lower HR reactivity to the event memory for depressed participants, whereas higher avoidance was associated with higher HR reactivity to the trauma memory for PTSD participants. Trauma remembering in PTSD is distinctive from comparable remembering in depression in triggering high physiological reactivity. Avoidance of remembering the event predicts attenuated physiological reactivity to critical event recall in depression.
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Affiliation(s)
- Richard O'Kearney
- Research School of Psychology; The Australian National University; Canberra Australian Capital Territory Australia
| | - Melissa Pech
- Research School of Psychology; The Australian National University; Canberra Australian Capital Territory Australia
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Dawel A, McKone E, Irons J, O'Kearney R, Palermo R. Look out! Gaze-cueing is greater from fearful faces in a dangerous context for children and adults. J Vis 2013. [DOI: 10.1167/13.9.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
As in post-traumatic stress disorder (PTSD), intrusive memories (IMs) also play an important role in depression. Evidence about the comparative quality of IMs in PTSD and depression is limited and inconsistent. A total of 28 adults with PTSD, 29 with depression, and 30 controls identified intrusive and voluntary segments of narrative memories of key events. Self-report and language measures of memory quality were obtained. Depressed and PTSD participants reported higher frequency of IMs and higher IM-related interference than controls. IMs in PTSD participants were distinguished from depressed and control participants by higher self-rated distress, higher self-rated sensory quality, and a higher proportion of sensory words in the narrative. The depressed and control groups did not differ on IM quality. PTSD IM segments had more sensory content than voluntary segments and fewer temporal markers. The IM segments of the depressed and control groups had fewer temporal markers than the voluntary segments. Depression severity predicted fewer sensory words in the IM after considering peri-event dissociation and arousal but did not add to the prediction of other IM qualities. A strong sensory quality is a distinctive feature of IMs in PTSD but not in depression. Basic sensory processes contribute to the intrusiveness of remembering in PTSD but not in depression.
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Affiliation(s)
- Lian Parry
- a Research School of Psychology , The Australian National University , Canberra , ACT , Australia
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Yew SGK, O'Kearney R. Emotional and behavioural outcomes later in childhood and adolescence for children with specific language impairments: meta-analyses of controlled prospective studies. J Child Psychol Psychiatry 2013; 54:516-24. [PMID: 23082773 DOI: 10.1111/jcpp.12009] [Citation(s) in RCA: 191] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Prospective evidence on psychological outcomes for children with specific language impairments (SLI) is accumulating. To date, there has been no attempt to summarise what this evidence says about the strength of link between SLI and later child and adolescent emotional and behavioural (EB) outcomes. METHODS We undertook a systematic review and meta-analysis (following PRISMA guidelines and involving a literature search to June 2012 of seven databases, including MEDLINE and PsychAPA) of prospective, cohort studies of children with SLI and typical language development (TLD) reporting on the incidence and severity of EB problems later in childhood or adolescence. RESULTS Nineteen follow-up reports of eight cohorts with 553 SLI children and 1533 TLD controls were identified. Initial assessment was at 3-8.8 years of age and follow-up duration from 2 to 12 years. Pooled across comparable studies, SLI children were about two times more likely to show disorder levels of overall internalising problems, overall externalising and ADHD problems than TLD children. Compared with the average TLD child (50 percentile), at follow-up, the symptom severity of the average SLI child was at the 72 percentile (95% CI 65-79 percentile) on internalising symptoms, the 69 percentile (95% CI 63-74 percentile) on externalising symptoms and the 60 percentile (95% CI 52-68 percentile) on AHDH severity. The findings about risk to specific mental disorders and the severity of specific problems were inconclusive. CONCLUSIONS Relative to typical children, SLI children experience clinically important increases in the severity of diverse emotional, behavioural and ADHD symptoms and more frequently show a clinical level of these problems. The small number of studies included in pooled analysis and methodological heterogeneity reduce the precision and generalisability of the findings. Most studies do not account for initial levels of EB problems.
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Affiliation(s)
- Shaun Goh Kok Yew
- Department of Psychology, Australian National University, Canberra, ACT, Australia
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Pech M, O'Kearney R. A randomized controlled trial of problem-solving therapy compared to cognitive therapy for the treatment of insomnia in adults. Sleep 2013; 36:739-49. [PMID: 23633757 DOI: 10.5665/sleep.2640] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES To compare the efficacy of problem-solving therapy (PST) combined with behavioral sleep strategies to standard cognitive therapy (CT) combined with behavioral sleep strategies in the treatment of insomnia. DESIGN A six-week randomized controlled trial with one month follow-up. SETTING The Australian National University Psychology Clinic, Canberra, Australia. PARTICIPANTS Forty-seven adults aged 18-60 years recruited from the community meeting the Research Diagnostic Criteria for insomnia. INTERVENTIONS Participants received 6 weeks of treatment including one group session (sleep education and hygiene, stimulus control instructions and progressive muscle relaxation) followed by 5 weeks of individual treatment of PST or CT. MEASUREMENTS AND RESULTS Primary outcomes included sleep efficiency (SE) from sleep diaries, the Insomnia Severity Index (ISI), and the Pittsburgh Sleep Quality Index (PSQI). Secondary measures assessed dysfunctional sleep beliefs, problem-solving skills and orientations, and worry. Both treatments produced significant post therapy improvements in sleep which were maintained at 1 month follow-up (on SE Cohen d = 1.42, 95% CI 1.02-1.87 for PST; d = 1.26, 95% CI 0.81-1.65 for CT; on ISI d = 1.46, 95% CI 1.03-1.88 for PST; d = 1.95, 95% CI 0.52-2.38 for CT; for PSQI d = 0.97, 95% CI 0.55-1.40 for PST and d = 1.34, 95% CI 0.90-1.79 for the CT). There were no differences in PST and CT in the size or rate of improvement in sleep although CT produced a significant faster rate of decline in negative beliefs about sleep than PST and there was a trend (P = 0.08) for PST to produce a faster rate of improvement in negative problem orientation than CT. CONCLUSIONS The results provide preliminary support for problem solving treatment as an equally efficacious alternative component to cognitive therapy in psychological interventions for insomnia.
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Affiliation(s)
- Melissa Pech
- Research School of Psychology, The Australian National University, Canberra, Australian Capital Territory, Australia
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Dawel A, O'Kearney R, McKone E, Palermo R. Not just fear and sadness: meta-analytic evidence of pervasive emotion recognition deficits for facial and vocal expressions in psychopathy. Neurosci Biobehav Rev 2012. [PMID: 22944264 DOI: 10.1016/j.neurobiorev.2016.10.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
The present meta-analysis aimed to clarify whether deficits in emotion recognition in psychopathy are restricted to certain emotions and modalities or whether they are more pervasive. We also attempted to assess the influence of other important variables: age, and the affective factor of psychopathy. A systematic search of electronic databases and a subsequent manual search identified 26 studies that included 29 experiments (N = 1376) involving six emotion categories (anger, disgust, fear, happiness, sadness, surprise) across three modalities (facial, vocal, postural). Meta-analyses found evidence of pervasive impairments across modalities (facial and vocal) with significant deficits evident for several emotions (i.e., not only fear and sadness) in both adults and children/adolescents. These results are consistent with recent theorizing that the amygdala, which is believed to be dysfunctional in psychopathy, has a broad role in emotion processing. We discuss limitations of the available data that restrict the ability of meta-analysis to consider the influence of age and separate the sub-factors of psychopathy, highlighting important directions for future research.
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Affiliation(s)
- Amy Dawel
- Department of Psychology (buiding 39), The Australian National University, Canberra, ACT 0200, Australia.
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Logan S, O'Kearney R. Individual differences in emotionality and peri-traumatic processing. J Behav Ther Exp Psychiatry 2012; 43:815-22. [PMID: 22197753 DOI: 10.1016/j.jbtep.2011.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/24/2011] [Accepted: 12/02/2011] [Indexed: 10/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent cognitive models propose that intrusive trauma memories arise and persist because high levels of emotional arousal triggered by the trauma disrupt conceptual processing of elements of the event, while enhancing sensory/perceptual processing. A trauma film analogue design was used to investigate if the predicted facilitating effects on intrusions from inhibiting conceptual processing and predicted attenuating effects on intrusions from inhibiting sensory processing are moderated by individual differences in emotionality. METHODS One hundred and five non-clinical participants viewed a traumatic film while undertaking a conceptual interference task, a sensory interference task, or no interference task. Participants recorded the frequency and intensity of intrusions over the following week. RESULTS There was no facilitating effect for the conceptual interference task compared to no interference task. A significant attenuation of the frequency of intrusions was evident for those undertaking sensory interference (ŋ(2) = .04). This effect, however, was only present for those with high trait anxiety (d = .82) and not for those with low trait anxiety (d = .08). Relative to high trait anxious controls, high anxious participants who undertook sensory interference also reported lower intensity of intrusions (d = .66). CONCLUSIONS This is the first trauma film analogue study to show that the attenuating effect of concurrent sensory/perceptual processing on the frequency and intensity of subsequent intrusions is evident only for people with high trait anxiety. The results have implications for conceptual models of intrusion development and for their application to the prevention of post traumatic distress.
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Affiliation(s)
- Shanna Logan
- Department of Psychology, Australian National University, Canberra, ACT 0200, Australia
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Abstract
AbstractThis study investigated whether individual differences in obsessive-compulsive symptoms and in thought–action fusion are related to theory of mind abilities. One hundred and ninety-two adult participants completed self-reports of obsessive–compulsive symptoms (OCI-R), thought–action fusion (TAF), private self-consciousness (PSC) and self-reflectiveness (SR) as mentalising abilities, and anxiety and depression. A nonintrospective method examining participants' implicit structure of their lexicon for ‘knowing’ was used to assess theory of mind. Private self-conciousness and SR added to the prediction of OCD symptoms independently of TAF and depression but did not mediate the relationship between TAF and OCD symptoms. Participants high in thought–action fusion gave a greater emphasis to the certainty dimension of the mental lexicon and placed lesser importance on the source of information dimension than those low in TAF. Our results provide preliminary evidence of a relationship between theory of mind and thought–action fusion. People disposed to thought–action fusion are more likely to make a significance judgment about ‘knowing’ based on the degree of certainty than on reference to the source of knowledge. Identifying disruptions to theory of mind abilities in OCD provides links to solid theory and evidence about metacognitive development and may help integrate cognitive processing and cognitive appraisal models of OCD.
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Davis JM, McKone E, Dennett H, O'Connor KB, O'Kearney R, Palermo R. Individual differences in the ability to recognise facial identity are associated with social anxiety. PLoS One 2011; 6:e28800. [PMID: 22194916 PMCID: PMC3237502 DOI: 10.1371/journal.pone.0028800] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Accepted: 11/15/2011] [Indexed: 01/08/2023] Open
Abstract
Previous research has been concerned with the relationship between social anxiety and the recognition of face expression but the question of whether there is a relationship between social anxiety and the recognition of face identity has been neglected. Here, we report the first evidence that social anxiety is associated with recognition of face identity, across the population range of individual differences in recognition abilities. Results showed poorer face identity recognition (on the Cambridge Face Memory Test) was correlated with a small but significant increase in social anxiety (Social Interaction Anxiety Scale) but not general anxiety (State-Trait Anxiety Inventory). The correlation was also independent of general visual memory (Cambridge Car Memory Test) and IQ. Theoretically, the correlation could arise because correct identification of people, typically achieved via faces, is important for successful social interactions, extending evidence that individuals with clinical-level deficits in face identity recognition (prosopagnosia) often report social stress due to their inability to recognise others. Equally, the relationship could arise if social anxiety causes reduced exposure or attention to people's faces, and thus to poor development of face recognition mechanisms.
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Affiliation(s)
- Joshua M Davis
- The Department of Psychology, Australian National University, Canberra, Australian Capital Territory, Australia.
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Abstract
To examine the connection between trauma memory integration in personal memory, memory organization, and posttraumatic symptom severity, 47 trauma-exposed adults undertook an event-cuing task for their trauma memory and for a memorable nontraumatic negative event. Measures of integration provided by self-endorsement, rated by naïve judges, or calculated from the language of the memories, did not significantly predict posttraumatic stress disorder symptom severity after adjusting for age, time since the event, anxiety when disclosing, familiarity of the memory, and integration of nontrauma memory. Less use of casual connectives in the trauma memory narrative was associated with higher trauma-related avoidance (r = .33; p = .03), whereas self-rating of the trauma memory as disorganized was associated with higher overall symptom severity (r = .42; p = .006).
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Affiliation(s)
- Richard O'Kearney
- Department of Psychology, Australian National University, Canberra, ACT 0200, Australia.
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Abstract
OBJECTIVE Despite high demand for anticipatory planning tools in mental health there is little Australian research about their implementation. This study examines the processes and outcomes of the introduction of structured mental health advanced agreements in the Australian Capital Territory. METHOD Thirty-three patients with serious mental illness collaborated with a key clinician to develop an advanced agreement. Patients and clinicians were provided with appropriate education, workbooks and materials. The process and outcomes associated with developing and completing an agreement were evaluated with patient and clinician interviews and self-report measures. RESULTS The process was strongly accepted by the patients with only 16% discontinuing for reasons related to the advanced agreement. Participants strongly endorsed benefits both to themselves and to the management of patients' illnesses. Service level impediments, particularly clinician acceptance, limited treatment options, and the lack of legal force of the agreement were identified. CONCLUSIONS When supported, mental health patients can work collaboratively with clinicians to produce anticipatory treatment requests which are beneficial, feasible and consistent with good care. Implementation of anticipatory planning in mental health will require service-level changes to promote clinician acceptance and to embed practices which facilitate these tools as part of routine care.
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Affiliation(s)
- Bronwyn Wauchope
- Junction Community Mental Health Service, The Alfred, Prahran, Victoria 3181, Australia.
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Abstract
OBJECTIVES This study investigated cultural differences in goals, self-defining memories, and self-cognitions in those with and without post-traumatic stress disorder (PTSD). METHOD Trauma survivors with and without PTSD, from independent and interdependent cultures (N=106) provided major personal goals, self-defining memories, and self-cognitions. RESULTS Trauma survivors with PTSD from independent cultures reported more goals, self-defining memories, and self-cognitions that were trauma-related than non-PTSD trauma survivors from independent cultures. In contrast, for those from interdependent cultures, there was no difference between trauma survivors with and without PTSD in terms of trauma-centred goals, self-defining memories, and self-cognitions. CONCLUSIONS The results suggest cultural variability in the impact of trauma on memory and identity, and highlight the need for contemporary models of PTSD to more explicitly consider culture in their accounts of PTSD. Clinical implications of these findings, such as cultural considerations in assessment and treating trauma relevant self-schema in cognitive therapy for PTSD, are discussed.
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Affiliation(s)
- Laura Jobson
- School of Psychology, Australian National University, Canberra, Australia.
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Affiliation(s)
| | - Mark Dadds
- b University of New South Wales, Sydney, Australia
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Affiliation(s)
- Richard O'Kearney
- Department of Psychology, Australian National University , Canberra, Australian Capital Territory
| | - Deborah Wilmoth
- Registered Clinical Psychologist , Perth, Western Australia, Australia
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Calear AL, Christensen H, Mackinnon A, Griffiths KM, O'Kearney R. The YouthMood Project: A cluster randomized controlled trial of an online cognitive behavioral program with adolescents. J Consult Clin Psychol 2009; 77:1021-32. [PMID: 19968379 DOI: 10.1037/a0017391] [Citation(s) in RCA: 200] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Alison L Calear
- Centre for Mental Health Research, The Australian National University, ACT 0200, Australia.
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O'Kearney R, Kang K, Christensen H, Griffiths K. A controlled trial of a school-based Internet program for reducing depressive symptoms in adolescent girls. Depress Anxiety 2009; 26:65-72. [PMID: 18828141 DOI: 10.1002/da.20507] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND This study evaluates the benefits of a self-directed Internet intervention for depression (MoodGYM) delivered as a part of the high school curriculum. METHOD One hundred and fifty-seven girls, aged 15 and 16 years, were allocated to undertake either MoodGYM or their usual curriculum. MoodGYM's impact on depressive symptoms, risk of depression, attributional style, depression literacy and attitudes toward depression was examined using random effect regression. RESULTS MoodGYM produced a significantly faster rate of decline in depressive symptoms over the trial period than the control condition. The effect size for MoodGYM was not significant immediately after the intervention (Cohen's d=.19, 95% CI -.18-.56) but was moderate and significant 20 weeks after the intervention (d=.46, 95% CI .10-.82). Girls with high depression scores before intervention showed the strongest benefits on self-reported depression at follow-up (d=.92, 95% CI .10-1.38). There were no significant intervention effects on depression status, attributional style, depression literacy, and attitudes. Approximately 70% of girls in the MoodGYM group completed less than three of its modules and completion of fewer modules was related to high depression score before intervention. CONCLUSIONS The findings suggest that there are benefits from MoodGYM on self-reported depressive symptoms but has low rates of completion highlight problems in ensuring adherence to Internet programs for depression.
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Affiliation(s)
- Richard O'Kearney
- School of Psychology, The Australian National University, Canberra, Australia.
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Affiliation(s)
- Tegan Cruwys
- Department of Psychology, Australian National University , Canberra, Australian Capital Territory, Australia
| | - Richard O'Kearney
- Department of Psychology, Australian National University , Canberra, Australian Capital Territory, Australia
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Abstract
Australians and Asians were asked to provide autobiographical memories of events they believe shaped who they are as individuals (self-defining memories). The authors found the anticipated cultural differences for the memories' themes. Contrary to previous suggestions, however, elaboration of personal memories occurred equally for both groups and was dependent on the content of the memory. Australians provided more elaborate autonomous memories and Asians more elaborate relatedness memories. The findings indicate that elaborating personal memories may function to enhance the dominant self-focus.
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Affiliation(s)
- Laura Jobson
- The Australian National University, Canberra, Australia
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Affiliation(s)
- Richard O'Kearney
- University of New South Wales
- School of Psychology, University of New South Wales, Sydney, NSW, 2052, Australia,
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Anstey KJ, von Sanden C, Salim A, O'Kearney R. Smoking as a risk factor for dementia and cognitive decline: a meta-analysis of prospective studies. Am J Epidemiol 2007; 166:367-78. [PMID: 17573335 DOI: 10.1093/aje/kwm116] [Citation(s) in RCA: 537] [Impact Index Per Article: 31.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The authors assessed the association of smoking with dementia and cognitive decline in a meta-analysis of 19 prospective studies with at least 12 months of follow-up. Studies included a total of 26,374 participants followed for dementia for 2-30 years and 17,023 participants followed up for 2-7 years to assess cognitive decline. Mean study age was 74 years. Current smokers at baseline, relative to never smokers, had risks of 1.79 (95% confidence interval (CI): 1.43, 2.23) for incident Alzheimer's disease, 1.78 (95% CI: 1.28, 2.47) for incident vascular dementia, and 1.27 (95% CI: 1.02, 1.60) for any dementia. Compared with those who never smoked, current smokers at baseline also showed greater yearly declines in Mini-Mental State Examination scores over the follow-up period (effect size (beta)=-0.13, 95% CI: -0.18, -0.08). Compared with former smokers, current smokers at baseline showed an increased risk of Alzheimer's disease (relative risk=1.70, 95% CI: 1.25, 2.31) and an increased decline in cognitive abilities (effect size (beta)=-0.07, 95% CI: -0.11, -0.03), but the groups were not different regarding risk of vascular dementia or any dementia. The authors concluded that elderly smokers have increased risks of dementia and cognitive decline.
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Affiliation(s)
- Kaarin J Anstey
- Centre for Mental Health Research, School of Psychology, The Australian National University, Canberra, Australia.
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Abstract
The aim of the present paper was to critically examine evidence about the benefits of cognitive-behavioural therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) from controlled and single group studies, including its benefits relative to medication are critically reviewed. Selected studies were categorized by study type and by risk of bias classification. Standardized mean differences (Hedges' g or Cohen d) and, where appropriate, weighted mean difference (WMD) were calculated. All five comparison and 14 one-group studies showed a significant benefit for CBT within a wide range (ES = .78 to 4.38). Low risk of bias studies produced the lower adjusted effect sizes. The best available estimate of CBT efficacy relative to no treatment is about 1 standardized mean difference, equivalent to a treatment effect of 8 points on the Children's Yale-Brown Obsessive-Compulsive Scale. This represents a reduction in the risk of continuing to have OCD post-treatment of about 37% (95% CI 14% to 54%). Evidence from 3 studies indicates that the efficacy of CBT and medication do not differ significantly. CBT combined with medication is significantly more efficacious than non-active controls or medication alone but not relative to CBT alone. CBT should be regarded as a first line equivalent to anti-OCD medication with the potential to lead to better outcomes when combined with medication than medication alone can provide. Additional studies are needed to further clarify CBT's benefits and to investigate how it can be made more available as a treatment option for children and youth who suffer from OCD.
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Affiliation(s)
- Richard O'Kearney
- School of Psychology, The Australian National University, Canberra, ACT 0200, Australia.
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Affiliation(s)
- Laura Jobson
- School of Psychology, Australian National University , Canberra, Australian Capital Territory, Australia
| | - Richard O'Kearney
- School of Psychology, Australian National University , Canberra, Australian Capital Territory, Australia
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Abstract
This study compared the structure and quality of emotion language in adolescents with externalizing disorders (N = 21), internalizing disorders (N = 18), and without a behavioral or emotional disorder (N = 16). Emotion language was elicited in response to vignette material prototypical for anger/sadness and fear, to autobiographical experiences, and to an actual emotional challenge. The findings reveal different emphases in the emotion language of internalizing and externalizing youth rather than a relative weakness for externalizing adolescents. Overall, clinical adolescents used fewer emotion terms that were semantically specific for anger, sad, or fear than typical adolescents. The results also show that emotion language is affected differentially for externalizing and internalizing adolescents depending on the emotion domain. Internalizing youth's emotion language to anger/sad events used inner-directed terms, situational references, and reduced intensity while their representation of emotions in response to salient threatening material was dominated by terms with a cognitive focus. Externalizing adolescents' emotion language responses to anger/sad events were more outer directed and intense, and their emotion language in a salient threat situation more orientated to direct affective terms. The results suggest that examining emotion language for specific emotion domains in adolescents with specific disorders will better clarify the role of emotion language in the regulation of emotions than approaches that globalize emotion language competencies or deficits.
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O'Kearney R, Gibson M, Christensen H, Griffiths KM. Effects of a cognitive-behavioural internet program on depression, vulnerability to depression and stigma in adolescent males: a school-based controlled trial. Cogn Behav Ther 2006; 35:43-54. [PMID: 16500776 DOI: 10.1080/16506070500303456] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study evaluated the effectiveness of a cognitive behaviour therapy Internet program (MoodGYM) for depressive symptoms, attributional style, self-esteem and beliefs about depression, and on depression and depression-vulnerable status in male youth. A total of 78 boys age 15 and 16 years were allocated to either undertake MoodGYM or to standard personal development activities. Outcomes were measured before commencement, post-program and 16 weeks post-program. There were no significant between-group differences in change scores pre- to post- or pre- to follow-up using the intention to treat sample or for participants with post- and/or follow-up data. For boys completing 3 or more modules there were small relative benefits of MoodGYM for depressive symptoms (Effect Size, ES = 0.34), attributional style (ES = 0.17) and self-esteem (ES = 0.16) at post-program, although only the effect for self-esteem was sustained at follow-up. Both groups showed improvement in their beliefs about depression at follow-up, with the control group showing a moderate relative benefit (ES = 0.40). While the numbers are small, there was a reduction in the risk of being depressed in the MoodGYM group of 9% at post-treatment compared with a slightly increased risk for the control group. The risk of being classified as vulnerable to depression reduced by 17% in the MoodGYM group at post-treatment compared with no change in risk for the control group. These reductions in risk for the MoodGYM group were not sustained at follow-up. The limitations of the study highlight several important challenges for MoodGYM and other self-directed Internet cognitive behaviour therapy programs. These include how to ensure enough of the program is received and that people who could potentially benefit access the program and continue to remain engaged with it, and how to enhance the sustainability of any benefits.
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Affiliation(s)
- Richard O'Kearney
- School of Psychology, The Australian National University, Canberra, ACT, Australia.
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Abstract
Nineteen empirical studies providing evidence about the nature of trauma narratives in posttraumatic stress disorder (PTSD) were reviewed. Selected studies had participants with a diagnosis of PTSD or with PTSD symptoms. The studies used either linguistic indices or participants' rating of narrative quality. There was evidence of a relationship between PTSD specific pathology and the occurrence of sensory/perceptual references and disturbed temporal aspects. Evidence for PTSD-related narrative fragmentation was inconclusive, and there were little data about specific self-referential content. Poor validity and confusion of content and syntactic aspects of narrative organization limited the data on the organization of PTSD narratives. Approaches that address some of these limitations and allow narrative-based evaluation of memory for trauma in PTSD are outlined.
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Jorm AF, Kitchener BA, O'Kearney R, Dear KBG. Mental health first aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541]. BMC Psychiatry 2004; 4:33. [PMID: 15500695 PMCID: PMC526774 DOI: 10.1186/1471-244x-4-33] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2004] [Accepted: 10/23/2004] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A Mental Health First Aid course has been developed which trains members of the public in how to give initial help in mental health crisis situations and to support people developing mental health problems. This course has previously been evaluated in a randomized controlled trial in a workplace setting and found to produce a number of positive effects. However, this was an efficacy trial under relatively ideal conditions. Here we report the results of an effectiveness trial in which the course is given under more typical conditions. METHODS The course was taught to members of the public in a large rural area in Australia by staff of an area health service. The 16 Local Government Areas that made up the area were grouped into pairs matched for size, geography and socio-economic level. One of each Local Government Area pair was randomised to receive immediate training while one served as a wait-list control. There were 753 participants in the trial: 416 in the 8 trained areas and 337 in the 8 control areas. Outcomes measured before the course started and 4 months after it ended were knowledge of mental disorders, confidence in providing help, actual help provided, and social distance towards people with mental disorders. The data were analysed taking account of the clustered design and using an intention-to-treat approach. RESULTS Training was found to produce significantly greater recognition of the disorders, increased agreement with health professionals about which interventions are likely to be helpful, decreased social distance, increased confidence in providing help to others, and an increase in help actually provided. There was no change in the number of people with mental health problems that trainees had contact with nor in the percentage advising someone to seek professional help. CONCLUSIONS Mental Health First Aid training produces positive changes in knowledge, attitudes and behaviour when the course is given to members of the public by instructors from the local health service.
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Affiliation(s)
- Anthony F Jorm
- Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia
| | - Betty A Kitchener
- Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia
| | - Richard O'Kearney
- School of Psychology, Australian National University, Canberra, ACT 0200, Australia
| | - Keith BG Dear
- Centre for Mental Health Research, Australian National University, Canberra, ACT 0200, Australia
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O'Kearney R. Cognitive behavioural therapy reduced distress and doctor visits in patients with medically unexplained symptoms. Evidence-Based Mental Health 2001. [DOI: 10.1136/ebmh.4.1.22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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