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Redburn J, Hayes B. Facilitators and barriers to "Positive Outcomes" from cognitive-behavioral therapy, according to young people: A thematic synthesis. J Clin Psychol 2024; 80:968-1002. [PMID: 38328892 DOI: 10.1002/jclp.23653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 07/18/2023] [Accepted: 01/20/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE This qualitative review sought to explore how young people (YP) conceptualize positive outcomes from cognitive-behavioral therapy (CBT) and what YP perceive to be the facilitators and barriers to positive outcomes. METHODS A systematic literature search was conducted in June 2021 using six online databases. Studies were included if qualitative data were collected from participants who were aged up to 25, had internalizing mental health difficulties, and had received in-person CBT from trained practitioners. RESULTS Nineteen studies were included. The Gough Weight of Evidence framework was used to assess methodological and topical quality and relevance. A thematic synthesis identified 34 conceptualizations of positive outcomes, 57 facilitators, and 49 barriers. Descriptive and analytical themes were identified. In line with the review's pragmatic perspective, the latter were worded as practice recommendations: acknowledge YP's perspectives on outcomes, teach tangible CBT techniques, balance autonomy and support, frame CBT as "upskilling," explore nuanced barriers to engagement, and consider the power of group dynamics. CONCLUSIONS This review established the range of YP's views about positive outcomes from CBT, as well as facilitators and barriers to achieving these. Findings should prompt CBT practitioners to reflect and consider how their practice might be shaped through reports from YP as experts by experience.
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Affiliation(s)
- James Redburn
- Clinical Educational and Health Psychology, University College London, London, UK
| | - Ben Hayes
- Clinical Educational and Health Psychology, University College London, London, UK
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2
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Dülsen P, Baumeister H. Internet- and mobile-based anxiety and depression interventions for children and adolescents: efficacy and negative effects - a systematic review and meta-analysis. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02404-y. [PMID: 38430237 DOI: 10.1007/s00787-024-02404-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 02/19/2024] [Indexed: 03/03/2024]
Abstract
Mental disorders, most commonly anxiety disorders and fourth most common depression, are prevalent in children and adolescents. Internet- and mobile-based interventions might represent a scalable approach to improve mental health care, however, evidence so far is inconclusive and systematic reports on negative effects are missing. Four data-bases were searched for randomized controlled trials evaluating internet- and mobile-based interventions (IMIs) targeting anxiety disorders or depression in children and adolescents up to 18 years exhibiting clinically relevant symptoms. Meta-analytic evaluations were conducted in comparison to active and passive control groups, furthermore, pre-defined sub-groups were explored and reported negative effects examined. Pooled estimates showed a moderate positive effect for IMIs targeting anxiety disorders compared to passive control groups (g = -0.69; CI -0.94 to -0.45; k = 8; n = 559; p ≤ 0,001), but not for depression. Pooled estimates compared to active control groups remained non-significant. Subgroup analyses were largely omitted due to an insufficient number of trials or were non-significant. Negative effects were mainly reported as drop-out rates and (non)-response rates, while additional negative effects, such as deterioration rates or the development of additional symptoms, were reported by only one third of included studies. The focus on children and adolescents with clinically relevant symptoms allowed the present findings to complement previous work, however, the limited amount of trials hindered many planned comparisons. The overview of reported negative effects highlighted that negative effects are being neglected in the majority of RCTs. Hence, in the future RCTs should include more information about potential negative effects, at best a combination of quantitative and qualitative information. Open Science Framework (osf.io/ch5nj).
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Affiliation(s)
- Patrick Dülsen
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, 89081, Ulm, Germany.
| | - Harald Baumeister
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology and Education, Ulm University, Lise-Meitner-Straße 16, 89081, Ulm, Germany
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3
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Henderson RR, Nielsen AM, Fernandez AMP, Downing ST, McCarty RJ, Strekalova YA, Cobite-Njoh J, Mirhosseini T, Guzick AG, McNamara JPH, Mathews CA. Expectations and perspectives of cognitive behavioural therapy for childhood anxiety and related disorders. Behav Cogn Psychother 2024; 52:65-77. [PMID: 37699703 DOI: 10.1017/s1352465823000346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
BACKGROUND Anxiety disorders are the most frequently diagnosed psychiatric conditions in children and adolescents. Cognitive behavioural therapy (CBT) is a well-established and effective treatment for anxiety and related disorders across the lifespan. Expectations of psychotherapy have been demonstrated to affect outcomes, yet there is sparse existing literature on adolescent patient and parent perspectives of CBT prior to engagement with treatment. AIMS This study aimed to qualitatively explore the expectations and perceptions of CBT for anxiety and related disorders among adolescent patients and parents. METHOD Fourteen adolescent patients and 16 parents participated in semi-structured individual interviews or focus groups consisting of 2-3 participants. Interview transcripts were analysed using inductive analysis. RESULTS Three themes were identified: worries about CBT, expectations and knowledge of the CBT process, and the role of parents and families. Overall, we found that adolescents and parents had generally positive views of CBT. The outset of CBT saw adolescents and parents express concern about stigma as well as the ambiguity of CBT. Parents continued to express a lack of understanding of what CBT entailed during their child's treatment course. CONCLUSION These results suggest that both adolescents and parents would benefit from early discussion and reinforcement of expectations for CBT treatment. Further research efforts are warranted and should be directed towards determining appropriate expectations for parental involvement in a child's CBT course and effective communication of treatment expectations to both adolescents and parents.
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Affiliation(s)
| | - Alyssa M Nielsen
- College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Seth T Downing
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Ryan J McCarty
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Yulia A Strekalova
- College of Journalism and Communications, University of Florida, Gainesville, FL, USA
| | - Journa Cobite-Njoh
- Psychological, Health, and Learning Sciences, University of Houston, Houston, TX, USA
| | | | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
- Center for OCD, Anxiety, and Related Disorders, University of Florida, Gainesville, FL, USA
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4
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Grasser LR, Erjo T, Goodwin MS, Naim R, German RE, White J, Cullins L, Tseng WL, Stoddard J, Brotman MA. Can peripheral psychophysiological markers predict response to exposure-based cognitive behavioral therapy in youth with severely impairing irritability? A study protocol. BMC Psychiatry 2023; 23:926. [PMID: 38082431 PMCID: PMC10712194 DOI: 10.1186/s12888-023-05421-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/29/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Irritability, an increased proneness to anger, is a primary reason youth present for psychiatric care. While initial evidence supports the efficacy of exposure-based cognitive behavioral therapy (CBT) for youth with clinically impairing irritability, treatment mechanisms remain unclear. Here, we propose to measure peripheral psychophysiological indicators of arousal-heart rate (HR)/electrodermal activity (EDA)-and regulation-heart rate variability (HRV)-during exposures to anger-inducing stimuli as potential predictors of treatment efficacy. The objective of this study is to evaluate whether in-situ biosensing data provides peripheral physiological indicators of in-session response to exposures. METHODS Blood volume pulse (BVP; from which HR and HRV canl be derived) and EDA will be collected ambulatorily using the Empatica EmbracePlus from 40 youth (all genders; ages 8-17) undergoing six in-person exposure treatment sessions, as part of a multiple-baseline trial of exposure-based CBT for clinically impairing irritability. Clinical ratings of irritability will be conducted at baseline, weekly throughout treatment, and at 3-month and 6-month follow-ups via the Clinical Global Impressions Scale (CGI) and the Affective Reactivity Index (ARI; clinician-, parent-, and child-report). Multilevel modeling will be used to assess within- and between-person changes in physiological arousal and regulation throughout exposure-based CBT and to determine whether individual differences are predictive of treatment response. DISCUSSION This study protocol leverages a wearable biosensor (Empatica) to continuously record HR/HRV (derived from BVP) and EDA during in-person exposure sessions for youth with clinically impairing irritability. Here, the goal is to identify changes in physiological arousal (EDA, HR) and regulation (HRV) over the course of treatment in tandem with changes in clinical symptoms. TRIAL REGISTRATION The participants in this study come from an overarching clinical trial (trial registration numbers: NCT02531893 first registered on 8/25/2015; last updated on 8/25/2023). The research project and all related materials were submitted and approved by the appropriate Institutional Review Board of the National Institute of Mental Health (NIMH).
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Affiliation(s)
- Lana Ruvolo Grasser
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA.
| | - Trinity Erjo
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Matthew S Goodwin
- Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Reut Naim
- School of Psychological Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Ramaris E German
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Jamell White
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Lisa Cullins
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Wan-Ling Tseng
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Joel Stoddard
- Department of Psychiatry and Biomedical Informatics, University of Colorado, School of Medicine, Aurora, CO, USA
| | - Melissa A Brotman
- Neuroscience and Novel Therapeutics Unit, Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
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5
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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6
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Biagianti B, Conelea C, Dabit S, Ross D, Beard KL, Harris E, Shen E, Jordan J, Bernstein GA. A Mobile Application Adjunct to Augment Cognitive-Behavioral Group Therapy for Adolescents with Social Anxiety: Feasibility and Acceptability Results from the Wiring Adolescents with Social Anxiety via Behavioral Interventions Pilot Trial. J Child Adolesc Psychopharmacol 2023; 33:212-224. [PMID: 37471177 PMCID: PMC10458379 DOI: 10.1089/cap.2023.0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
Objective: Cognitive-Behavioral Group Therapy (CBGT) is an established treatment for Social Anxiety (SA). However, diagnostic recovery rate is only 20.5% in CBGT, and up to 50% of patients remain symptomatic posttreatment. Using videocalls to deliver digital CBGT (dCBGT) is feasible, cost-effective, and efficacious. Yet, the impact of dCBGT on social functioning remains limited, as dCBGT does not offer opportunities for monitoring cognition and behavior in social situations. Wiring Adolescents with Social Anxiety via Behavioral Interventions (WASABI), a clinician-assisted application that uses ecological momentary assessments (EMAs), cognitive bias tests, and clinical self-reports, was investigated as an adjunct to dCBGT. Methods: A prospective, parallel arm, double-blind randomized controlled trial was employed in 24 SA adolescents randomly assigned to dCBGT versus dCBGT plus WASABI. Results: Study completion rates (83%) and exit survey data indicated that WASABI is feasible and acceptable. Engagement with EMAs varied from four to 244 EMAs completed per person. Cognitive bias tests and clinical self-reports were completed at least weekly by 53% and 69% of participants, respectively. While standard tests did not reveal statistically significant differences between dCBGT plus WASABI and dCBGT alone, effect sizes were greater for dCBGT plus WASABI on symptom severity, social skills, and functioning. Conclusions: Despite the small sample, preliminary results suggest that WASABI is feasible, acceptable, and may be an effective augmentation tool for treating SA in teenagers.
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Affiliation(s)
- Bruno Biagianti
- Department of Psychology, University of Milano-Bicocca, Milan, Italy
| | - Christine Conelea
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Sawsan Dabit
- Department of R&D, Posit Science Corporation, San Francisco, California, USA
| | - Daniel Ross
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Katie L. Beard
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Elizabeth Harris
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Erin Shen
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
| | - Josh Jordan
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Gail A. Bernstein
- Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School, Masonic Institute for the Developing Brain, Minneapolis, Minnesota, USA
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7
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Notice M, Robertson J, Smith K, Kim S, LaRiviere M, Byno L, Binette N, Anaeche C, Tadros E. A Phenomenological Exploration of Families' Experiences of the Mental Health System of Care in the Monadnock Region. Community Ment Health J 2023; 59:1217-1226. [PMID: 36905553 DOI: 10.1007/s10597-023-01104-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023]
Abstract
Accessing mental health treatment in rural locations is a unique challenge for families with youth experiencing adverse mental health conditions. Families often experience a variety of difficulties accessing and negotiating changes within the system of care. This study aimed to understand the experiences of families and their youth in navigating the mental health system in a rural community. Interpretative phenomenological analysis was used to examine how participants interpret their experiences within the local system of care. Qualitative interviews were conducted with eight families. Results included five main themes: youth experience, family experience, access to a system of care, relationships between stakeholders, and larger societal beliefs. Families highlighted their experiences accessing the local care system and their hope for strengthening community access and partnerships. Findings indicate that prioritizing family voices should be encouraged by local systems.
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Affiliation(s)
- Maxine Notice
- Department of Applied Psychology, Antioch University New England, 40 Avon Street, Keene, NH, 03431, USA.
- School of Health and Human Services, Abilene Christian University, 16633 Dallas Parkway, Suite 800, Addison, TX, 75001, USA.
| | - Janet Robertson
- Department of Applied Psychology, Antioch University New England, 40 Avon Street, Keene, NH, 03431, USA
| | - Karmen Smith
- Department of Applied Psychology, Antioch University New England, 40 Avon Street, Keene, NH, 03431, USA
| | - Seon Kim
- Department of Applied Psychology, Antioch University New England, 40 Avon Street, Keene, NH, 03431, USA
| | - Martha LaRiviere
- Department of Applied Psychology, Antioch University New England, 40 Avon Street, Keene, NH, 03431, USA
| | - Lucille Byno
- Department of Applied Psychology, Antioch University New England, 40 Avon Street, Keene, NH, 03431, USA
| | - Neil Binette
- Department of Applied Psychology, Antioch University New England, 40 Avon Street, Keene, NH, 03431, USA
| | - Collins Anaeche
- Department of Applied Psychology, Antioch University New England, 40 Avon Street, Keene, NH, 03431, USA
- Department of Marriage and Family Therapy, Eastern University, 1300 Eagle Road, St. Davids, PA, 19087, USA
| | - Eman Tadros
- Division of Psychology and Counseling, Governors State University, 1 University Pkwy, University Park, IL, 60484, USA
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8
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de Soet R, Vermeiren RRJM, Bansema CH, van Ewijk H, Nijland L, Nooteboom LA. Drop-out and ineffective treatment in youth with severe and enduring mental health problems: a systematic review. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02182-z. [PMID: 36882638 DOI: 10.1007/s00787-023-02182-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 02/27/2023] [Indexed: 03/09/2023]
Abstract
Youth with severe and enduring mental health problems (SEMHP) tend to drop out of treatment or insufficiently profit from treatment in child and adolescent psychiatry (CAP). Knowledge about factors related to treatment failure in this group is scarce. Therefore, the aim of this systematic review was to thematically explore factors associated with dropout and ineffective treatment among youth with SEMHP. After including 36 studies, a descriptive thematic analysis was conducted. Themes were divided into three main categories: client, treatment, and organizational factors. The strongest evidence was found for the association between treatment failure and the following subthemes: type of treatment, engagement, transparency and communication, goodness of fit and, perspective of practitioner. However, most other themes showed limited evidence and little research has been done on organizational factors. To prevent treatment failure, attention should be paid to a good match between youth and both the treatment and the practitioner. Practitioners need to be aware of their own perceptions of youth's perspectives, and transparent communication with youth contributes to regaining their trust.
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Affiliation(s)
- R de Soet
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands.
| | - R R J M Vermeiren
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
- Youz, Parnassia Group, The Hague, The Netherlands
| | - C H Bansema
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - H van Ewijk
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - L Nijland
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
| | - L A Nooteboom
- LUMC Curium-Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Post Box 15, 2300 AA, Leiden, The Netherlands
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9
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O'Shannessy DM, Waters AM, Donovan CL. Feasibility of an Intensive, Disorder-Specific, Group-Based Cognitive Behavioural Therapy Intervention for Adolescents with Social Anxiety Disorder. Child Psychiatry Hum Dev 2023; 54:546-557. [PMID: 34669067 PMCID: PMC8526989 DOI: 10.1007/s10578-021-01265-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2021] [Indexed: 11/26/2022]
Abstract
This study examined the preliminary acceptability and efficacy of an intensive, group-based, disorder-specific cognitive behavioural therapy (CBT) intervention for adolescents with social anxiety disorder (SAD). Fourteen Australian adolescents with SAD (78.6% female, M age = 13.93 years) and their parents completed the program plus measures of treatment satisfaction, and provided feedback. Clinical interviews and surveys were administered pre-treatment, post-treatment, and at 6-month follow-up to determine diagnostic status and assess related variables. Post-treatment satisfaction scores were very high for adolescents and parents. Post-treatment, 32.3% of participants no longer met criteria for SAD diagnosis, increasing to 42.9% at follow-up. Participants showed sizeable reductions in comorbid diagnoses, significant improvements in global functioning, social anxiety symptoms, and internalising symptoms from pre- to post-treatment (maintained at follow-up), and significant improvements in social skills and social competence from pre-treatment to follow-up. This study supports the use of an intensive CBT program for adolescents with SAD.
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Affiliation(s)
- Dustin M O'Shannessy
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia.
| | - Allison M Waters
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia
| | - Caroline L Donovan
- School of Applied Psychology, Griffith University, 176 Messines Ridge Rd, Mount Gravatt, Brisbane, QLD, 4122, Australia
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10
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Diagnosis-Specific Group CBT Treating Social Anxiety in Adolescents: A Feasibility Study. Scand J Child Adolesc Psychiatr Psychol 2022; 10:89-101. [PMID: 36133734 PMCID: PMC9454321 DOI: 10.2478/sjcapp-2022-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Social anxiety disorder (SAD) is one of the most common anxiety disorders among adolescents. It is associated with extensive distress and negative long-term consequences. Generic cognitive behavioral therapy (CBT) is one of the preferred treatments for anxiety disorders, but it has shown poorer outcome for adolescents with SAD than for other anxiety disorders. Aim As preparation for a randomized controlled trial the aim of the present study was to examine the feasibility of an adjusted diagnosis-specific CBT group intervention for adolescents with SAD, and provide preliminary information on adolescent and family outcomes. Method Thirteen adolescents (age 12-17 years) diagnosed with SAD received a group therapy version of the Cool Kids Anxiety Program, Social Enhanced (CK-E), a program developed at Macquarie University, Sydney, Australia. The treatment is a diagnosis-specific manualized CBT treatment for adolescents with SAD. Semi-diagnostic interviews and questionnaires were completed at baseline, post, 3-month follow-up and 1-year follow-up. Results Thirteen adolescents participated with no drop-outs. Most families attended all 10 intervention sessions. The families were generally satisfied with the treatment and would recommend it to others in need. Preliminary outcomes showed that participants had marked improvements in their anxiety symptoms and life interference, with significant medium to large baseline-post effect sizes durable at 1-year follow-up. Two of the adolescents were free of their SAD diagnosis at 3-month follow-up. Conclusion Results from this feasibility study indicate that the Danish-translated and revised version of Cool Kids Anxiety Program - Social Enhanced could be a feasible intervention for Danish adolescents with SAD. The intervention will be investigated further in a randomized controlled trial.
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11
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Temkin AB, Beaumont R, Wkya K, Hariton JR, Flye BL, Sheridan E, Miranda A, Vela J, Zendegui E, Schild J, Gasparro S, Loubriel D, Damiandies A, Weisman J, Silvestre A, Yadegar M, Catarozoli C, Bennett SM. Secret Agent Society: A Randomized Controlled Trial of a Transdiagnostic Youth Social Skills Group Treatment. Res Child Adolesc Psychopathol 2022; 50:1107-1119. [PMID: 35441908 DOI: 10.1007/s10802-022-00919-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2022] [Indexed: 11/29/2022]
Abstract
Group programs are key for targeting social skills (SS) for children with developmental disorders and/or mental illness. Despite promising evidence regarding efficacy of group treatments, there are several limitations to current research regarding generalizability and effectiveness across diagnoses. This randomized control trial assessed whether the Secret Agent Society (SAS) group program was superior to treatment as usual (TAU) in improving social-emotional functioning for children with Attention Deficit-Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and/or anxiety. Eighty-nine youth (8-12) with ADHD, ASD, and/or an anxiety disorder receiving treatment at hospital-based outpatient clinics were randomized to receive SAS (n = 47) or TAU (n = 42) over a three-month period, at which point TAU participants were offered the SAS intervention. Parent report showed significant improvement in Emotion Regulation (ER) and Social Skills (SS) for youth in SAS vs. TAU (Fs ≥ 6.79, ps ≤ 01). Gains for the SAS condition were maintained at 6-months. Intent-to-treat analysis of teacher report indicated youth in SAS had positive gains in SS (F = 0.41, p = 0.475) and ER (F = 0.99, p = 0.322), though not significantly better than youth in TAU. Clinically reliable improvement rates were significantly higher for SAS participants than TAU for parent and teacher reported SS and ER. Improvements were significant for youth with single and comorbid diagnoses. Results suggest that SAS was superior to TAU in improving SS and ER for youth aged 8-12 with ADHD, ASD, and/or anxiety. Gains maintained in the medium-term. Trial registration number NCT02574273, registered 10/12/2015.
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Affiliation(s)
- Andrea B Temkin
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.
| | - Renae Beaumont
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Katarzyna Wkya
- CUNY Graduate School of Public Health, New York, NY, USA
| | - Jo R Hariton
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Barabra L Flye
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Elisabeth Sheridan
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Drexel University (A.J. Drexel Autism Institute), Philadelphia, PA, USA
| | - Amy Miranda
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Jamie Vela
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Department of Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Elaina Zendegui
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Department of Psychiatry, Mount Sinai Hospital, New York, NY, USA
| | - Jennifer Schild
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Department of Clinical Psychology, Suffolk University, Boston, MA, USA
| | - Shannon Gasparro
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Daphne Loubriel
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Andreas Damiandies
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Touro College of Osteopathic Medicine, New York, NY, USA
| | - Julia Weisman
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Department of Clinical Psychology, Hofstra University, Long Island, NY, USA
| | - Alexandra Silvestre
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Columbia School of Social Work, New York, NY, USA
| | - Mina Yadegar
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA.,Rogers Behavioral Health, Los Angeles, CA, USA
| | - Corinne Catarozoli
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
| | - Shannon M Bennett
- Department of Psychiatry, Weill Cornell Medicine/New York Presbyterian, NY, New York, USA
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12
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Pegg S, Hill K, Argiros A, Olatunji BO, Kujawa A. Cognitive Behavioral Therapy for Anxiety Disorders in Youth: Efficacy, Moderators, and New Advances in Predicting Outcomes. Curr Psychiatry Rep 2022; 24:853-859. [PMID: 36370264 PMCID: PMC9660212 DOI: 10.1007/s11920-022-01384-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This review integrates recent systematic reviews and meta-analyses on the efficacy of cognitive behavioral therapy (CBT) for the treatment of anxiety disorders in children and adolescents. To inform personalized approaches to intervention, we also review recent research on moderators and predictors of outcomes. RECENT FINDINGS Meta-analyses provide strong support for the efficacy of CBT for youth anxiety disorders, including with preschool-aged children using appropriate modifications. Furthermore, there is evidence that CBT is an effective adjunct treatment to psychopharmacological interventions, and the combination of treatments may be most effective for some youth. There is limited evidence of consistent demographic and clinical moderators of outcomes. Recent work in neuroscience has highlighted novel predictors of treatment outcomes that, with replication, may aid in more personalized approaches to youth anxiety treatment. CBT is efficacious for treating anxiety disorders in youth and lowering recurrence rates. CBT can also be an efficacious adjunct treatment for psychopharmacological interventions. Neuroimaging and psychophysiological measures of threat and motivational processing have shown initial promise in predicting symptom change with CBT, with potential implications for precision medicine.
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Affiliation(s)
- Samantha Pegg
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN, 37203, USA
| | - Kaylin Hill
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN, 37203, USA
| | - Alexandra Argiros
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN, 37203, USA
| | - Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37203, USA.
| | - Autumn Kujawa
- Department of Psychology and Human Development, Vanderbilt University, Peabody College #552, 230 Appleton Place, Nashville, TN, 37203, USA
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13
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Abstract
The purpose of the current article is to explore familial factors that influence the development of social anxiety disorder (SAD) in children and adolescents, including parenting, sibling relationships, and family environment. A multitude of interrelated genetic and familial factors have been found to cause and maintain SAD in children and adolescents. There are many challenges in diagnosing and treating the disorder. Knowledge and awareness of familial factors provide insight on targeted treatments that prevent or ameliorate SAD. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 23-34.].
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14
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Klein AM, Liber JM, van Lang NDJ, Reichart C, Nauta M, van Widenfelt BM, Utens EMWJ. The Role of Social Skills in Predicting Treatment-Recovery in Children with a Social Anxiety Disorder. Res Child Adolesc Psychopathol 2021; 49:1461-1472. [PMID: 34165687 PMCID: PMC8455491 DOI: 10.1007/s10802-021-00824-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/30/2022]
Abstract
The current study investigated the role of social skills and its interaction with social anxiety as predictors of treatment outcome in children with an anxiety disorder either with or without a social anxiety disorder (SoAD). In total, 133 children (aged 8 to 13) with an anxiety disorder received a 10-session cognitive behavioral treatment (FRIENDS program). Pre- to post treatment Reliable Change (RC) and Treatment-Recovery (TR) were assessed from a multi-informant perspective, by including diagnostic information (ADIS C/P), child-reported anxiety symptoms (MASC) and parent-reported internalizing symptoms (CBCL-Int). Social skills were assessed with the parent-rated Social Skills Rating System (assertion, self-control, responsibility). Results showed that 1) parents of children with a SoAD reported significantly less favorable use of assertive and responsible social behavior in their children pre-treatment than parents of children without SoAD, 2) children with higher social skills had a better treatment recovery, and 3) children with anxiety and higher responsible behavior pre-treatment and without a SoAD had a better treatment recovery, but this effect did not show for children with SoAD. In conclusion, better use of social behavior increased the likelihood of treatment recovery but not of reliable change. Further studies on the role of social skills in the treatment of childhood (social) anxiety are needed to investigate the mechanisms by which social skills impact treatment outcome.
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Affiliation(s)
- Anke M Klein
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands. .,Clinical Child and Adolescent Psychology, Ruhr University, Bochum, Germany.
| | - Juliette M Liber
- Developmental Psychology, Utrecht University, Utrecht, The Netherlands.
| | | | - Catrien Reichart
- Curium, Leiden University Medical Center, Leiden, The Netherlands
| | - Maaike Nauta
- Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | | | - Elisabeth M W J Utens
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule/AMC, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry, Erasmus University, Rotterdam, The Netherlands
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15
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Taylor L, Creswell C, Pearcey S, Brooks E, Leigh E, Stallard P, Waite P, Clark DM, Stephens G, Larkin M. Delivering cognitive therapy for adolescent social anxiety disorder in NHS CAMHS: a qualitative analysis of the experiences of young people, their parents and clinicians-in-training. Behav Cogn Psychother 2021; 49:1-15. [PMID: 33645496 DOI: 10.1017/s1352465821000047] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for adolescents. AIMS The aim of this study was to conduct a qualitative exploration to contribute towards the evaluation of CT-SAD-A for adoption into Child and Adolescent Mental Health Services (CAMHS). METHOD We used interpretative phenomenological analysis (IPA) to analyse the transcripts of interviews with a sample of six young people, six parents and seven clinicians who were learning the treatment. RESULTS Three cross-cutting themes were identified: (i) endorsing the treatment; (ii) finding therapy to be collaborative and active; challenging but helpful; and (iii) navigating change in a complex setting. Young people and parents found the treatment to be useful and acceptable, although simultaneously challenging. This was echoed by the clinicians, with particular reference to integrating CT-SAD-A within community CAMHS settings. CONCLUSIONS The acceptability of the treatment with young people, their parents and clinicians suggests further work is warranted in order to support its development and implementation within CAMHS settings.
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Affiliation(s)
- Lucy Taylor
- Department of Psychiatry, University of Oxford, Warneford Hospital, OxfordOX3 7JX, UK
| | - Cathy Creswell
- Department of Experimental Psychology and Department of Psychiatry, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, OxfordOX2 6GG, UK
| | - Samantha Pearcey
- Department of Experimental Psychology and Department of Psychiatry, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, OxfordOX2 6GG, UK
| | - Emma Brooks
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights, ReadingRG6 6AL, UK
| | - Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford Centre for Anxiety Disorders and Trauma, The Old Rectory, Paradise Square, OxfordOX1 1TW, UK
| | - Paul Stallard
- Child and Adolescent Mental Health Service, Oxford Health NHS Trust, Temple House, Temple Street, Keynsham, Bristol, BS31 1HA, UK
| | - Polly Waite
- Department of Experimental Psychology and Department of Psychiatry, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, OxfordOX2 6GG, UK
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford Centre for Anxiety Disorders and Trauma, The Old Rectory, Paradise Square, OxfordOX1 1TW, UK
| | | | - Michael Larkin
- Department of Psychology, Aston Triangle, BirminghamB4 7ET, UK
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16
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Self-focused attention and safety behaviours maintain social anxiety in adolescents: An experimental study. PLoS One 2021; 16:e0247703. [PMID: 33635891 PMCID: PMC7909699 DOI: 10.1371/journal.pone.0247703] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Self-focused attention and safety behaviours are both associated with adolescent social anxiety. In adults, experimental studies have indicated that the processes are causally implicated in social anxiety, but this hypothesis has not yet been tested in a youth sample. METHODS This experiment explored this possibility by asking high and low socially anxious adolescents (N = 57) to undertake conversations under different conditions. During one conversation they were instructed to focus on themselves and use safety behaviours, and in the other they focused externally and did not use safety behaviours. Self-report, conversation partner report and independent assessor ratings were taken. RESULTS Self-focus and safety behaviours increased feelings and appearance of anxiety and undermined performance for all participants, but only high socially anxious participants reported habitually using self-focus and safety behaviours. CONCLUSIONS The findings provide support for the causal role of self-focus and safety behaviours in adolescent social anxiety and point to the potential clinical value of techniques reversing them to treat the disorder.
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17
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Grossman RA, Ehrenreich-May J. Using the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders With Youth Exhibiting Anger and Irritability. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2019.05.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Werneck AO, Vancampfort D, Oyeyemi AL, Stubbs B, Silva DR. Joint association of ultra-processed food and sedentary behavior with anxiety-induced sleep disturbance among Brazilian adolescents. J Affect Disord 2020; 266:135-142. [PMID: 32056867 DOI: 10.1016/j.jad.2020.01.104] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/26/2019] [Accepted: 01/20/2020] [Indexed: 11/15/2022]
Abstract
AIMS We analyzed the joint association of high ultra-processed food ingestion and sedentary behavior (SB) with anxiety-induced sleep disturbance among Brazilian adolescents. METHODS Data from the Brazilian Scholar Health Survey, a nationally representative survey of 9th grade adolescents [mean: 14.28 years (range: 11-18 years)] conducted in 2015 (n = 100,648) were used. Self-reported anxiety-induced sleep disturbance, SB (TV viewing and total sitting time), and frequency of ingestion of different ultra-processed foods were collected. Age, ethnicity, type of city (capital or interior), region of the country, and habitual physical activity (global scholar survey questionnaire) were covariates. Logistic regression analyses were conducted to assess the associations. RESULTS High ultra-processed food ingestion plus low SB [boys:OR:1.44(99%CI:1.16-1.79), girls:OR:1.41(99%CI:1.22-1.63)] were risk factors for anxiety-induced sleep disturbance. The highest risk of anxiety-induced sleep disturbance was observed among those who joint high ultra-processed food ingestion with high SB [boys:OR:1.85(99%CI:1.46-2.35), girls:OR:1.62(99%CI:1.39-1.89)]. In addition, the interaction of high ultra-processed food ingestion with TV-viewing substantially increased the odds of anxiety-induced sleep disturbance [boys:OR:2.03(99%CI:1.61-2.56), girls:OR:2.04(99%CI:1.76-2.36)]. CONCLUSIONS Both the high consumption of ultra-processed foods and SB (especially TV-viewing) appear to be independently associated with anxiety-induced sleep disturbance in both sexes. However, the co-occurrence of both negative lifestyle behaviors is associated with a substantial increase in the risk of anxiety-induced sleep disturbance. Future longitudinal research is required to confirm/refute our findings and explore potential mechanisms.
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Affiliation(s)
- André O Werneck
- Department of Physical Education, Universidade Estadual Paulista "Júlio de Mesquita Filho" (UNESP), Rua Roberto Símonsen, 305, 19060-900 Presidente Prudente, São Paulo,Brazil.
| | - Davy Vancampfort
- Department of Rehabilitation Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Adewale L Oyeyemi
- Department of Physiotherapy, College of Medical Sciences, University of Maiduguri, Maiduguri, Borno State, Nigeria
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London SE5 8AF, United Kingdom and South London and Maudsley NHS Foundation Trust, London, UK
| | - Danilo R Silva
- Department of Physical Education, Federal University of Sergipe - UFS, São Cristóvão, Brazil
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19
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Lassen NF, Hougaard E, Arendt KB, Thastum M. A disorder-specific group cognitive behavior therapy for social anxiety disorder in adolescents: study protocol for a randomized controlled study. Trials 2019; 20:757. [PMID: 31864383 PMCID: PMC6925436 DOI: 10.1186/s13063-019-3885-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 11/05/2019] [Indexed: 11/16/2022] Open
Abstract
Background Social anxiety disorder (SAD) is a common disorder in adolescence associated with extensive distress and long-term impairment. Generic cognitive behavior therapy (CBT) programs for anxiety disorders have shown poorer outcomes for adolescents with SAD than for other anxiety disorders. Aim The aim of the present study is to investigate the efficacy of a disorder-specific group cognitive behavior therapy (G-CBT) program for youth SAD, the Cool Kids Anxiety Program - Social Enhanced (CK-E), developed at Macquarie University, Sidney, Australia. Methods The study is a randomized controlled trial comparing CK-E to a generic G-CBT program for anxiety disorders. Approximately 96 adolescents aged 12 to 17 years are included with data points at pre- and post-treatment, and at 3 months and 1 year follow-ups. Discussion The current study will provide more information about the efficacy of diagnosis-specific G-CBT treatment for youth SAD. Trial registration ClinicalTrials.gov, NCT03986827. Registered on 14 June 2019.
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Affiliation(s)
- Nanna Fensman Lassen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Esben Hougaard
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Kristian Bech Arendt
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark.
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20
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Ryan JL, Fox JK, Lowe SR, Warner CM. Do Social Threat Cognitions Decrease With School-Based CBT and Predict Treatment Outcome in Adolescents With Social Anxiety Disorder? J Cogn Psychother 2019; 33:331-342. [PMID: 32746395 DOI: 10.1891/0889-8391.33.4.331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Evidence suggests that Social Anxiety Disorder (SAD) is less responsive to cognitive behavioral treatment (CBT) compared to other anxiety disorders. Therefore, exploring what might facilitate clinical benefit is essential. Social threat cognitions, characterized by exaggerated perceptions of negative evaluation by others, may be one important avenue to examine. The current study investigated whether youths' social threat cognitions decreased with Skills for Academic and Social Success (SASS), a group, school-based CBT designed for SAD, and whether decreases predicted SAD severity and treatment response. Participants included 138 high school students with SAD randomly assigned to SASS, or a nonspecific school counseling intervention. SASS participants showed significantly decreased social threat cognitions at 5-month follow-up. Treatment responders had significantly greater reductions in social threat cognitions compared to nonresponders at post-intervention and follow-up. These findings suggest that social threat cognitions may be important to assess and monitor when treating youth with SAD.
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Affiliation(s)
- Julie L Ryan
- William James College, Clinical Psychology Department
| | - Jeremy K Fox
- Montclair State University, Psychology Department
| | - Sarah R Lowe
- Montclair State University, Psychology Department
| | - Carrie Masia Warner
- Montclair State University, Psychology Department.,Nathan Kline Institute for Psychiatric Research.,NYU Langone Medical Center, Department of Child and Adolescent Psychiatry
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21
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Leigh E, Clark DM. Online Social anxiety Cognitive therapy for Adolescents (OSCA): protocol for a randomised controlled trial. Trials 2019; 20:574. [PMID: 31590681 PMCID: PMC6781376 DOI: 10.1186/s13063-019-3651-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 08/12/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Adolescent social anxiety disorder (SAD) is common, impairing and persistent. There is a need to intervene early to avert its long-term consequences. Cognitive Therapy for SAD is the leading treatment for adults and shows promise for adolescents. However, given the scale of the problem of adolescent SAD and the limited availability of psychological therapists in child and adolescent mental health services, there is a substantial gap in service provision. Delivering therapy via the Internet may provide part of the solution to this problem. An Internet version of adult Cognitive Therapy for SAD has been developed, with outcomes similar to face-to-face therapy. We have recently adapted this treatment for use with adolescents with SAD. Here, we describe a randomised controlled trial designed to test the efficacy of Internet Cognitive Therapy for adolescent SAD compared to waitlist. METHODS/DESIGN Forty adolescents aged 14-18 years with a diagnosis of SAD will be recruited via schools. Participants will be randomly allocated to Internet Cognitive Therapy or to waitlist. All participants will be assessed three times during the study-at baseline (pretreatment/wait), midtreatment/wait (week 8) and posttreatment/wait (week 15). Participants in the experimental arm will also complete weekly measures as part of the online program and they will be assessed at 3 and 6 months. Postwait, participants in the waitlist arm will be offered Internet Cognitive Therapy, and weekly and posttreatment data will also be collected for them. The trial aims to test whether Internet Cognitive Therapy is superior to waitlist in reducing social anxiety symptoms and in reducing the proportion of adolescents meeting criteria for SAD. Other outcomes of interest include depression and general anxiety symptoms. Acceptability of the online treatment will also be evaluated. DISCUSSION This randomised controlled trial will provide preliminary evidence on whether this intervention, requiring relatively low levels of therapist input, is safe and clinically effective. If this is shown to be the case, Internet Cognitive Therapy for adolescents has the potential to provide a service to the large population of adolescents with untreated SAD. TRIAL REGISTRATION ISRCTN Registry, ISRCTN15079139 . Version 1 registered on 06/02/2019.
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Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, OxCADAT, The Old Rectory, Paradise Square, Oxford, OX1 1TW UK
| | - David M. Clark
- Department of Experimental Psychology, University of Oxford, OxCADAT, The Old Rectory, Paradise Square, Oxford, OX1 1TW UK
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22
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Vancampfort D, Van Damme T, Stubbs B, Smith L, Firth J, Hallgren M, Mugisha J, Koyanagi A. Sedentary behavior and anxiety-induced sleep disturbance among 181,093 adolescents from 67 countries: a global perspective. Sleep Med 2019; 58:19-26. [PMID: 31048258 DOI: 10.1016/j.sleep.2019.01.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/26/2019] [Accepted: 01/31/2019] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Sleep problems are burdensome in adolescents. Understanding modifiable environmental risk factors is essential. There is evidence that physical activity is protective against sleep problems in adolescents. However, the association between sedentary behavior (SB) and anxiety-induced sleep disturbance has not been investigated. METHODS Using cross-sectional data from the Global school-based Student Health Survey, we explored the association between SB and anxiety-induced sleep disturbance in 181,093 adolescents [mean (standard deviation, SD) age 13.7 (1.0) years; 48.4% girls] from 67 countries, controlling for confounders (including physical activity). Adolescents reported anxiety-induced sleep disturbance during the past 12 months, and SB, which was a composite variable assessing time spent sitting and watching television, playing computer games, talking with friends during a typical day excluding the hours spent sitting at school and doing homework. Multivariable logistic regression analysis was conducted and a countrywide meta-analysis undertaken. RESULTS Overall, 7.8% of adolescents had anxiety-induced sleep disturbance. The prevalence of SB was: <1 h/day 39.9%; 1-2 h/day 33.8%; 3-4 h/day 15.4%; 5-8 h/day 7.4%; and >8 h/day 3.6%. Compared to <1 h/day of SB, >8 h/day was associated with a 2.27 [95% confidence interval (CI) = 1.98-2.62] times higher odds for anxiety-induced sleep disturbance. The association was similar among both sexes. The pooled odds ratio for anxiety-induced sleep disturbance when being sedentary ≥3 h/day was 1.42 (95% CI = 1.36-1.48) with only a small degree of between-country heterogeneity (I2 = 41.4%). CONCLUSIONS Future longitudinal data are required to confirm/refute the findings to inform public interventions which aim to reduce anxiety and sleep disturbance in adolescents.
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Affiliation(s)
- Davy Vancampfort
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; KU Leuven, University Psychiatric Center KU Leuven, Kortenberg, Belgium.
| | - Tine Van Damme
- KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, UK
| | - Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Joseph Firth
- NICM Health Research Institute, University of Western Sydney, Sydney, Australia; Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia; Division of Psychology and Mental Health, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Mats Hallgren
- Department of Public Health Sciences, Karolinska Institutet, Solna, Sweden
| | - James Mugisha
- Kyambogo University, Kampala, Uganda; Butabika National Referral and Mental Health Hospital, Kampala, Uganda
| | - Ai Koyanagi
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr. Antoni Pujadas, Barcelona, Spain
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23
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Predicting treatment outcome for anxiety disorders with or without comorbid depression using clinical, imaging and (epi)genetic data. Curr Opin Psychiatry 2019; 32:1-6. [PMID: 30480619 DOI: 10.1097/yco.0000000000000468] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE OF REVIEW The present review complements previous reviews on prediction research in anxiety disorders with a focus on clinical, imaging and genetic as well as epigenetic factors and aims to provide recommendations for the design of future integrative studies in adults as well as children. RECENT FINDINGS Clinical factors predicting worse outcome such as a diagnosis of social anxiety disorder, comorbid depression and certain cognitive, behavioral and personality traits as well as low socioeconomic status were confirmed in large clinical studies. Imaging factors focusing on the fear and anxiety network were repeatedly described as predicting therapy response in small exploratory studies. The plethora of candidate gene studies has now been complemented by large genome-wide association studies and small epigenetic investigations with the need for replication in larger samples. SUMMARY The present status of research on predictors for therapy response in anxiety disorders, in particular on imaging and genetic factors, is still fragmentary. Some clinical factors for poorer outcome, though, have been consistently replicated and should be considered in the revision of therapy guidelines. There is a definite need for large integrative studies at the national and international level integrating multiple levels of biomarkers at different stages of development.
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24
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Cheung AH, Cook S, Kozloff N, Chee JN, Mann RE, Boak A. Substance use and internalizing symptoms among high school students and access to health care services: results from a population-based study. Canadian Journal of Public Health 2018; 110:85-92. [PMID: 30406338 DOI: 10.17269/s41997-018-0144-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 10/03/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine co-occurring mental health problems among a population-based sample of high school students in Ontario, Canada, to understand their prevalence, associated risk factors, and relationship with mental health service access and utilization. METHODS The data were derived from the 2013 Ontario Student Drug Use and Health Survey, a biennial survey of students attending publicly funded Ontario schools, from a subsample of students who completed both the internalizing and substance use portions of the survey (n = 2945). Rates of co-occurring problems were calculated for the previous 12 months. Service use for students with co-occurring problems was also calculated for the past 12 months. Odds ratios were estimated using binary logistic regression models correcting for the survey design. RESULTS In an adjusted model, youth with internalizing symptoms were 2.40 times more likely and youth with substance use problems were 2.24 times more likely to have accessed mental health services during the past 12 months than youth without these problems. Youth with co-occurring internalizing and substance use problems were 6.74 times more likely (95% CI 4.66-9.76, p < 0.001) to have accessed mental health services during the past year compared with youth without co-occurring problems, but only 52.8% of youth with co-occurring problems (95% CI 45.6-59.9%) used mental health services. CONCLUSIONS The findings suggest that just over half of Ontario students in grades 9 through 12 who have co-occurring internalizing and substance use problems are utilizing mental health services. Further research should examine the factors related to service use in this population in order to better inform policy and program development.
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Affiliation(s)
- Amy H Cheung
- Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada. .,University of Toronto, Toronto, ON, Canada.
| | - Steven Cook
- School of Social Sciences, Cardiff University, Cardiff, Wales, UK
| | - Nicole Kozloff
- University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Justin N Chee
- Department of Psychiatry, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada.,University of Toronto, Toronto, ON, Canada
| | - Robert E Mann
- University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Angela Boak
- Centre for Addiction and Mental Health, Toronto, ON, Canada
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25
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Leigh E, Clark DM. Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Clin Child Fam Psychol Rev 2018; 21:388-414. [PMID: 29654442 PMCID: PMC6447508 DOI: 10.1007/s10567-018-0258-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. There are clear potential benefits to delivering effective interventions during adolescence. However, there is limited evidence on the specific efficacy of available therapies. This is in contrast to adults, for whom we have interventions with very specific treatment effects. One such treatment is individual cognitive therapy. Cognitive therapy is based on the cognitive model of social anxiety proposed by Clark and Wells (in: Heimberg, Leibowitz, Hope, Scheiber (eds) Social phobia: diagnosis, assessment and treatment, The Guilford Press, New York, 1995). The present review examines the potential application of this adult cognitive model to the understanding of adolescent social anxiety and considers additional adolescent-specific factors that need to be accommodated. It is suggested that a developmentally sensitive adoption of the cognitive model of social anxiety disorder (Clark and Wells 1995) for adolescents may lead to better treatment outcomes.
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Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Oxford Centre for Anxiety Disorders and Trauma, The Old Rectory, Paradise Square, Oxford, OX1 1TW, UK.
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Predictors of treatment outcome for the unified protocol for transdiagnostic treatment of emotional disorders in children (UP-C). J Anxiety Disord 2018; 57:66-75. [PMID: 29776708 DOI: 10.1016/j.janxdis.2018.05.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 04/28/2018] [Accepted: 05/07/2018] [Indexed: 11/21/2022]
Abstract
Various efficacious treatment packages exist for youth anxiety, and cognitive behavior therapy (CBT) is now considered to be a well-established treatment for child anxiety disorders (Higa-McMillan, Francis, Rith-Najarian, & Chorpita, 2016). Improving outcomes for the significant proportion of anxious youth who demonstrate inadequate response to CBT is imperative, but our understanding of who does and does not benefit is incomplete. Further, there are no known empirical studies of predictors of treatment response for youth who receive a transdiagnostic intervention for anxiety or depression, and it is therefore unclear whether predictors of response to a transdiagnostic treatment for children are similar to those found in previous studies of anxiety-specific treatments. This study investigated potential predictors of outcome following administration of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C; Ehrenreich-May et al., 2018). Participants were 60 children ages 6-13 (M = 9.47, SD = 1.68) with a primary anxiety diagnosis (with or without comorbid depression) who received a 15-week UP-C group treatment. Consistent with prior literature on CBT for anxiety, social anxiety emerged as a consistent predictor of poorer response to the UP-C. Inconsistent with prior literature, depression, symptom severity, parent psychopathology, and child age were not significant predictors of poor outcome. Results indicate some differences between predictors for transdiagnostic versus anxiety-focused treatments, but point to a need for both types of interventions to better target social anxiety in children.
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Walczak M, Ollendick T, Ryan S, Esbjørn BH. Does comorbidity predict poorer treatment outcome in pediatric anxiety disorders? An updated 10-year review. Clin Psychol Rev 2018; 60:45-61. [DOI: 10.1016/j.cpr.2017.12.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 12/18/2017] [Accepted: 12/20/2017] [Indexed: 11/25/2022]
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