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Fleischer NJ, Gosch E, Roberts MB, Albano AM, Ginsburg G, Piacentini J, Birmaher B, Compton SN, Walkup J, Kendall PC, Carper MM. Asthma and anxiety in children and adolescents: characteristics and treatment outcomes. J Asthma 2024; 61:396-404. [PMID: 37930754 DOI: 10.1080/02770903.2023.2280906] [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: 09/11/2023] [Accepted: 11/02/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE This study (a) examined anxious youth with and without asthma on measures of negative self-talk, parental psychopathology, worry content, physical symptoms, panic symptoms, generalized symptoms, and separation anxiety symptoms, and (b) tested if outpatient CBT or medication were differentially effective in reducing anxiety for youth with asthma and anxiety. METHODS This secondary analysis separated youth with an anxiety disorder into asthma and non-asthma groups. Youth were also compared on response to treatments (i.e. CBT, sertraline, combined, and placebo). RESULTS A total of 488 participants participated in the original study, with an average age of 10 years (SD 2.87). Youth with comorbid asthma and anxiety demonstrated higher rates of negative self-talk. Youth with comorbid asthma and anxiety did not differ from the non-asthma group on measures of physical symptoms, anxiety disorder specific symptoms, parental psychopathology, or worry content. Youth with asthma and anxiety responded similarly to the non-asthma group to treatment across treatment conditions. CONCLUSIONS Treatment was comparably effective for youth with comorbid asthma and anxiety and youth with anxiety. Future research could examine the effects of psychopharmaceuticals on asthma and anxiety comorbidity.
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Affiliation(s)
- Nicole J Fleischer
- Department of Pediatrics, St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Elizabeth Gosch
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Michael B Roberts
- School of Professional and Applied Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | | | - Golda Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, CT, USA
| | - John Piacentini
- Department of Psychiatry, UCLA School of Medicine, Los Angeles, CA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - John Walkup
- Department of Psychiatry, Lurie Children's Hospital, Chicago, IL, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
| | - Matthew M Carper
- Department of Clinical Psychology, William James College, Newton, MA, USA
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Soo CA, Tate RL, Catroppa C, Benson S, McDonald S, Rapee RM, Anderson V. A randomized controlled trial of cognitive behavioural therapy for managing anxiety in adolescents with acquired brain injury. Neuropsychol Rehabil 2024; 34:74-102. [PMID: 36534593 DOI: 10.1080/09602011.2022.2154811] [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: 05/10/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
The aim of this randomized controlled trial was to evaluate an adapted cognitive behavioural therapy (CBT) programme for treating anxiety in adolescents with acquired brain injury (ABI). Participants with ABI (12-19 years, N = 36) recruited from two sites were randomly allocated into either the intervention receiving 11 sessions of CBT (n = 19) or a wait-list control group (n = 17). The primary outcome was participants' anxiety and secondary outcomes were participants' depression, self-perception, and participation in daily activities, and parental stress, measured at (i) pre-intervention, (ii) immediately post-intervention, (iii) 2 months post-intervention and (iv) 6 months post-intervention. Repeated measures ANOVAs revealed significant treatment effects with the intervention group demonstrating greater improvements in self-reported anxiety, as well as self- and parent-reported depression from pre- to immediately post-treatment, compared to wait-list controls. Little evidence of treatment effects was found for the remaining outcomes (parent-reported anxiety, self-perception, daily participation, and parental stress). Significant improvement in self-reported anxiety found immediately post-treatment was maintained at two- and six-month follow-up. Findings provide support for adapted CBT as an effective means of reducing anxious and depressive symptomatology in adolescents with ABI compared to waitlist controls, and offer support for the use of these techniques to manage anxiety in this population.
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Affiliation(s)
- Cheryl A Soo
- Brain and Mind, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Robyn L Tate
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, St Leonards, Australia
| | - Cathy Catroppa
- Brain and Mind, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
| | - Suzanne Benson
- Rehabilitation Department, Children's Hospital at Westmead, Sydney, Australia
| | - Skye McDonald
- School of Psychology, University of NSW, Sydney, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Vicki Anderson
- Brain and Mind, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Australia
- Department of Psychology, Royal Children's Hospital, Melbourne, Australia
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Brief Behavioral Therapy for Anxiety and Depression in Pediatric Primary Care: Breadth of Intervention Impact. J Am Acad Child Adolesc Psychiatry 2023; 62:230-243. [PMID: 36030033 DOI: 10.1016/j.jaac.2022.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Revised: 06/01/2022] [Accepted: 08/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report on broad-based outcomes of the Brief Behavioral Therapy (BBT) trial for pediatric anxiety and depression. Secondary data analyses expand on previous reports by assessing diagnostic remission and independent functioning, impact on targeted psychopathology, and spillover effects on non-targeted outcomes. METHOD Youth (N = 185; 8-16.9 years; 58% female; 78% White; 21% Hispanic) with anxiety and/or depression were eligible for this multi-site trial. Enrolled youth were randomly assigned to receive 8 to 12 sessions of BBT in primary care or assisted referral to outpatient care (ARC). Assessments were conducted 16 and 32 weeks post randomization. RESULTS BBT was superior to ARC on remission of all targeted diagnoses (week 16: 56.8% vs 28.2%, p < .001; week 32: 62.5% vs 38.9%, p = .004), clinician-rated independent functioning (week 16: 75.0% vs 45.7%, p < .001; week 32: 81.2% vs 55.7%, p < .001), and on measures of anxiety, depression, suicide items, total comorbid behavioral and emotional problems, and hyperactivity (d = 0.21-0.49). Moderation analyses revealed superior outcomes for Hispanic youth in BBT vs ARC for diagnostic remission, anxiety, emotional problems, and parent-child conflict. Youth depression at baseline moderated effects on peer problems and parent-child conflict, with effects favoring BBT. Significant main and moderated effects of BBT on change in non-targeted outcomes were largely mediated by change in anxiety (24.2%-49.3% of total effects mediated). CONCLUSION BBT has positive effects on youth, mediated by the strong impact of the intervention on anxiety. Analyses continue to support positive outcomes for Hispanic youth, suggesting that BBT is a broadly effective transdiagnostic treatment option for diverse populations. CLINICAL TRIAL REGISTRATION INFORMATION Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; https://clinicaltrials.gov; NCT01147614.
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Farley R, de Diaz NAN, Emerson LM, Simcock G, Donovan C, Farrell LJ. Mindful Parenting Group Intervention for Parents of Children with Anxiety Disorders. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01492-2. [PMID: 36689038 PMCID: PMC9869845 DOI: 10.1007/s10578-023-01492-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
Parenting behaviour and rearing style contribute to the intergenerational relationship between parental and child anxiety. Current psychological interventions for child anxiety typically do not adequately address parental mental health, parenting behaviours or the parent-child relationship. The current pilot study examines the effectiveness of a mindful parenting intervention (MPI) for parents of young children with clinical anxiety. It was hypothesised that the intervention would be associated with improvements in parental stress, mental health, and mindfulness, and a reduction in child clinical anxiety symptoms. Twenty-one parents of children aged 3-7 years diagnosed with anxiety disorders participated in an 8-week group MPI program that aimed to increase their intentional moment to moment awareness of the parent-child relationship. Parental (anxiety, depression, hostility, stress, burden, mindfulness, mindful parenting) and child (anxiety diagnoses, anxiety severity, comorbidities) outcomes were assessed at pre- and post-intervention, and at 3-month follow-up. Parents reported a significant increase in mindful parenting and a significant reduction in parent-child dysfunctional interaction, but no change in mental health symptoms. There was a significant reduction in parent-rated child anxiety symptoms, severity of child anxiety diagnosis and number of comorbid diagnoses at post and 3-month follow-up. Limitations include a lack of waitlist control, small sample size, and participants were largely mothers, from intact families and highly educated. There was attrition of 43% and outcomes were predominantly self-report. MPIs offer a novel and potentially effective method of increasing mindful parenting, decreasing dysfunctional parent-child interactions, reducing parenting stress and might also be an effective early intervention for indirectly decreasing young children's clinical anxiety symptoms. Larger-scale controlled trials of MPIs are needed.
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Affiliation(s)
- Robyn Farley
- Griffith University, Gold Coast, Australia.
- School of Applied Psychology, Health Building (G40), Parklands Drive, Southport, QLD, 4222, Australia.
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Hunger-Schoppe C, Schweitzer J, Hilzinger R, Krempel L, Deußer L, Sander A, Bents H, Mander J, Lieb H. Integrative systemic and family therapy for social anxiety disorder: Manual and practice in a pilot randomized controlled trial (SOPHO-CBT/ST). Front Psychol 2022; 13:867246. [PMID: 36405178 PMCID: PMC9674087 DOI: 10.3389/fpsyg.2022.867246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/22/2022] [Indexed: 09/19/2023] Open
Abstract
Social anxiety disorders (SAD) are among the most prevalent mental disorders (lifetime prevalence: 7-12%), with high impact on the life of an affected social system and its individual social system members. We developed a manualized disorder-specific integrative systemic and family therapy (ISFT) for SAD, and evaluated its feasibility in a pilot randomized controlled trial (RCT). The ISFT is inspired by Helm Stierlin's concept of related individuation developed during the early 1980s, which has since continued to be refined. It integrates solution-focused language, social network diagnostics, and genogram work, as well as resource- and problem orientation for both case conceptualization and therapy planning. Post-Milan symptom prescription to fluidize the presented symptoms is one of the core interventions in the ISFT. Theoretically, the IFST is grounded in radical constructivism and "Cybern-Ethics," multi-directional partiality, and a both/and attitude toward a disorder-specific vs. non-disorder-specific therapy approach. SAD is understood from the viewpoint of social systems theory, especially in adaptation to a socio-psycho-biological explanatory model of social anxiety. In a prospective multicenter, assessor-blind pilot RCT, we included 38 clients with SAD (ICD F40.1; Liebowitz Social Anxiety Scale, LSAS-SR > 30): 18 patients participated in the ISFT, and 20 patients in Cognitive Behavioral Therapy (CBT; age: M = 36 years, SD = 14). Within-group, simple-effect intention-to-treat analyses showed significant reduction in social anxiety (LSAS-SR; ISFT: d = 1.67; CBT: d = 1.04), while intention-to-treat mixed-design ANOVA demonstrated the advantage of ISFT (d = 0.81). Per-protocol analyses supported these results. The remission rate based on blind diagnosticians' ratings was good to satisfactory (Structured Clinical Interview, SCID; 78% in ST, 45% in CBT, p = 0.083); this has yet to be verified in a subsequent confirmatory RCT. The article will present the ISFT rationale and manual, including a special focus on multi-person settings, and the central findings from our pilot RCT.
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Affiliation(s)
- Christina Hunger-Schoppe
- Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Jochen Schweitzer
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
- Helm Stierlin Institute, Heidelberg, Germany
| | - Rebecca Hilzinger
- Institute of Medical Psychology, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Laura Krempel
- Department of Clinical Psychology and Psychotherapy, Bergische University Wuppertal, Wuppertal, Germany
| | - Laura Deußer
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Anja Sander
- Institute of Medical Biometry, University Hospital Heidelberg, Heidelberg, Germany
| | - Hinrich Bents
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Johannes Mander
- Center for Psychological Psychotherapy, University of Heidelberg, Heidelberg, Germany
| | - Hans Lieb
- Private Practitioner, Edenkoben, Germany
- Institute of Systemic Training and Development, Weinheim, Germany
- Institute of Behaviour Therapy, Bad Dürkheim, Germany
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Dickson SJ, Kuhnert RL, Lavell CH, Rapee RM. Impact of Psychotherapy for Children and Adolescents with Anxiety Disorders on Global and Domain-Specific Functioning: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2022; 25:720-736. [PMID: 35794304 PMCID: PMC9622529 DOI: 10.1007/s10567-022-00402-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 12/01/2022]
Abstract
A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom or diagnostic reduction provides an incomplete picture of clinically meaningful efficacy given that anxiety disorders in this age group are integrally associated with problems in functioning. A systematic review and meta-analysis (N studies = 40, N participants = 3094) evaluating the impacts of psychotherapy for anxiety was conducted on the following outcomes: global functioning, social functioning, academic functioning, and school attendance. Randomised controlled trials with a passive control condition, a child and/or adolescent sample (7–17 years) with a primary anxiety diagnosis, and receiving anxiety-focused psychotherapy were eligible for inclusion if they reported suitable outcome data. Results from the meta-analysis indicated that from pre- to post-treatment, psychotherapy led to significant improvements in global functioning according to clinician (d = 1.55), parent (d = 0.67), and child (d = 0.31) reports and on social functioning according to parent (d = 0.51), but not child (d = 0.31) reports. The qualitative review provided preliminary support psychotherapy’s efficacy in increasing family functioning and school attendance, but not so much in enhancing academic performance. These results indicate that psychotherapy improves daily functioning in anxious children and adolescents. The study also highlighted the limited attention paid to measures of functioning in the empirical literature on treatment of childhood anxiety. Trial Registry: This study is registered with PROSPERO under the identification number CRD42021246565.
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Affiliation(s)
- Sophie J Dickson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Rebecca-Lee Kuhnert
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Cassie H Lavell
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
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7
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Calvano C, Warschburger P. Treatment for Pediatric Functional Abdominal Pain: An Initial Examination of Reciprocal Associations Between Pain, Functional Impairment, and Parental Distress. J Pediatr Psychol 2022; 47:483-496. [PMID: 35237811 DOI: 10.1093/jpepsy/jsac011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 02/06/2022] [Accepted: 02/06/2022] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE While cross-sectional studies underline that child and parent factors in pediatric chronic pain are reciprocally related, so far, little is known on their prospective relationship, especially in treatment contexts. This study aims to analyze directions of influence between child and parental outcomes using data from an intervention study. METHODS The sample covered 109 families with children aged 7-13 years diagnosed with functional abdominal pain (FAP). Child outcomes included pain and impairment, and parental outcomes covered caregiver-specific distress including both parental personal time burden (i.e., less time available for personal needs) and emotional burden due to child's pain (i.e., increased worries). Cross-lagged panel analyses examined the directions of the relations between child and parental outcomes across time (pretreatment T1, post-treatment T2, and 3-month follow-up and 12-month follow-up T3/T4). RESULTS First, a significant improvement over time in all measures was observed. Cross-lagged effects were found for less parental personal time burden at T2, predicting both less pain (β = -0.254, p = .004) and less impairment (β = -0.150, p = .039) at T3. Higher baseline pain was predictive for higher parental emotional burden after treatment (β = -0.130, p = .049) and, reversely, for less emotional burden at 12-month follow-up (β = 0.261, p = .004). CONCLUSIONS Addressing parental personal time burden in FAP treatment might possibly support the improvement on the child level. Replication of results in larger samples is warranted to gain more insight into the directions of influence and, in that way, to optimize treatment for pediatric FAP.
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Affiliation(s)
- Claudia Calvano
- University of Potsdam, Department Psychology, Counseling Psychology, Germany.,Freie Universität Berlin, Department of Education and Psychology, Clinical Child and Adolescent Psychology and Psychotherapy, Germany
| | - Petra Warschburger
- University of Potsdam, Department Psychology, Counseling Psychology, Germany
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8
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Goger P, Weersing VR. Family based treatment of anxiety disorders: A review of the literature (2010-2019). JOURNAL OF MARITAL AND FAMILY THERAPY 2022; 48:107-128. [PMID: 34424998 DOI: 10.1111/jmft.12548] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 08/05/2021] [Indexed: 06/13/2023]
Abstract
Anxiety disorders are the most common and impairing mental health problems across the lifespan. Familial factors are strongly implicated in the onset and maintenance of anxiety, but available evidence-based treatments are usually individual-focused. The aim of this review was to evaluate the current evidence base (2010-2019) of family based interventions addressing youth and adult anxiety and highlight findings comparing family based and individual-focused treatments. A systematic literature search was conducted. Articles were considered if they targeted primarily anxiety-related issues and utilized a randomized controlled trial design, resulting in 22 included youth studies. No adult studies met criteria for inclusion. Overall, family based treatments performed better than no-treatment controls and as well as individual-based interventions, with some evidence that family based interventions might outperform individual-based ones in certain populations (i.e., autism). Family based interventions may represent a good alternative for anxiety treatment in youth. Additional research on family based treatment for anxiety is adults is needed.
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Affiliation(s)
- Pauline Goger
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
| | - V Robin Weersing
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California, USA
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Sell M, Barkmann C, Adema B, Daubmann A, Kilian R, Stiawa M, Busmann M, Winter SM, Lambert M, Wegscheider K, Wiegand-Grefe S. Associations of Family Functioning and Social Support With Psychopathology in Children of Mentally Ill Parents: Multilevel Analyses From Different Rating Perspectives. Front Psychol 2021; 12:705400. [PMID: 34594270 PMCID: PMC8476746 DOI: 10.3389/fpsyg.2021.705400] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/16/2021] [Indexed: 11/13/2022] Open
Abstract
Offspring of mentally ill parents is at heightened risk for psychological symptoms. The identification of environmental factors that predict their mental health is crucial for the development of preventive and therapeutic measures. In the current study, we addressed the combined role of family functioning and social support by taking mentally ill patients’, their partners’, and children’s perspectives into account. The cross-sectional sample included n=195 families (195 patients, 127 partners, and 295 children). Family members completed questionnaires related to family functioning, social support as well as parental and child psychopathology. We conducted multilevel analyses to investigate the associations with internalizing and externalizing problems in children. Family functioning and social support were significantly associated with child internalizing and externalizing problems. However, results varied depending on the rating perspective. We found significant interaction effects of family functioning and social support on child psychopathology. The findings point to the importance of family functioning and social support as potential targets for interventions. Findings should be replicated in future longitudinal studies.
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Affiliation(s)
- Marlit Sell
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Claus Barkmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bonnie Adema
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Reinhold Kilian
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Maja Stiawa
- Department of Psychiatry and Psychotherapy II, Ulm University, Ulm, Germany
| | - Mareike Busmann
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sibylle M Winter
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health (BIH), Campus Virchow-Klinikum, Berlin, Germany
| | - Martin Lambert
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Karl Wegscheider
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Silke Wiegand-Grefe
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Kahn M, Livne-Karp E, Juda-Hanael M, Omer H, Tikotzky L, Anders TF, Sadeh A. Behavioral interventions for infant sleep problems: the role of parental cry tolerance and sleep-related cognitions. J Clin Sleep Med 2021; 16:1275-1283. [PMID: 32279703 DOI: 10.5664/jcsm.8488] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES This study tested whether parental cry tolerance (PCT) and distress-attribution cognitions predict outcomes of behavioral interventions for infant sleep problems. It additionally examined intervention effects on these parental factors. METHODS Participants were 91 infants aged 9-18 months (61% boys) with sleep-related problems and their parents. Families were randomized to 1 of 2 behavioral interventions for infant sleep problems: Checking-in or Camping-out. Assessments were completed at baseline and 1-month post-treatment. Infant sleep was assessed using actigraphy and parent reports on the Brief Infant Sleep Questionnaire. PCT was measured using the Intervention Delay to Infant Crying Video laboratory paradigm, and parental distress-attribution cognitions were assessed via the Infant Sleep Vignettes Interpretation Scale. RESULTS Higher PCT and lower parental distress-attribution cognitions at baseline predicted greater improvement in parent-reported sleep problems post-treatment, and higher PCT additionally predicted larger reductions in the number of reported nighttime awakenings. Moreover, PCT increased, and distress-attribution decreased, following the interventions. CONCLUSIONS Parent factors both predict and are predicted by behavioral interventions for infant sleep problems. This study's findings suggest that parents with low cry tolerance and high distress-attribution cognitions derive less benefit from these interventions and may thus require augmented care. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: Interventions for sleep problems in early childhood; URL: https://clinicaltrials.gov/ct2/show/NCT01489215;Identifier: NCT01489215.
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Affiliation(s)
- Michal Kahn
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Efrat Livne-Karp
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | | | - Haim Omer
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Liat Tikotzky
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | | | - Avi Sadeh
- School of Psychological Sciences, Tel Aviv University, Tel-Aviv, Israel
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Crane ME, Norris LA, Frank HE, Klugman J, Ginsburg GS, Keeton C, Albano AM, Piacentini J, Peris TS, Compton SN, Sakolsky D, Birmaher B, Kendall PC. Impact of treatment improvement on long-term anxiety: Results from CAMS and CAMELS. J Consult Clin Psychol 2021; 89:126-133. [PMID: 33705168 PMCID: PMC7959050 DOI: 10.1037/ccp0000523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This article examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. METHOD Participants (N = 488; age 7-17 years; 45% male; 82% white) were randomized to 12 weeks of cognitive behavioral therapy (Coping Cat), medication (sertraline), their combination, or pill placebo in the Child/Adolescent Anxiety Multimodal Study (CAMS). A subset participated in the naturalistic follow-up Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS; n = 319; 3.70-11.83 years post-treatment). The current secondary analyses examined how change in anxiety severity (Child Global Impression-Severity), overall functioning (Children's Global Assessment Scale), caregiver psychopathology (Brief Symptom Inventory), caregiver strain (Family Burden Assessment Scale), and family dysfunction (Brief Family Assessment Measure) during CAMS was associated with anxiety severity and overall functioning years later (M = 7.72 years). CAMS procedures were registered on clinialtrials.gov. RESULTS Improvements in factors related to functioning (i.e., overall functioning, family dysfunction, caregiver strain) were associated with improvements in anxiety severity in CAMELS (|βys| ≥ .04, ps ≤ .04). Improvements in factors related to psychopathology (i.e., anxiety severity, caregiver psychopathology) were associated with improvements in overall functioning in CAMELS (|βys| ≥ .23, ps ≤ .04). It was changes in each of the variables examined (rather than baseline values) that predicted anxiety severity and overall functioning. CONCLUSIONS Both youth and family factors play a significant role in long-term treatment outcomes. Therapists would be wise to monitor how these factors change throughout treatment. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | - Hannah E. Frank
- Department of Psychology, Temple University, Philadelphia, PA
| | - Joshua Klugman
- Department of Sociology, Temple University, Philadelphia, PA
| | - Golda S. Ginsburg
- Department of Psychiatry University of Connecticut of Medicine, Farmington, CT
| | - Courtney Keeton
- Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Anne Marie Albano
- Department of Psychiatry, Division of Child & Adolescent Psychiatry, Columbia University Medical Center, New York, NY
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | | | - Scott N. Compton
- Department of Psychiatry and Biobehavioral Sciences, Duke University, Durham, NC
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA
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James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2020; 11:CD013162. [PMID: 33196111 PMCID: PMC8092480 DOI: 10.1002/14651858.cd013162.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous Cochrane Reviews have shown that cognitive behavioural therapy (CBT) is effective in treating childhood anxiety disorders. However, questions remain regarding the following: up-to-date evidence of the relative efficacy and acceptability of CBT compared to waiting lists/no treatment, treatment as usual, attention controls, and alternative treatments; benefits across a range of outcomes; longer-term effects; outcomes for different delivery formats; and amongst children with autism spectrum disorders (ASD) and children with intellectual impairments. OBJECTIVES To examine the effect of CBT for childhood anxiety disorders, in comparison with waitlist/no treatment, treatment as usual (TAU), attention control, alternative treatment, and medication. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (all years to 2016), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO (each to October 2019), international trial registries, and conducted grey literature searches. SELECTION CRITERIA We included randomised controlled trials of CBT that involved direct contact with the child, parent, or both, and included non-CBT comparators (waitlist/no treatment, treatment as usual, attention control, alternative treatment, medication). Participants were younger than age 19, and met diagnostic criteria for an anxiety disorder diagnosis. Primary outcomes were remission of primary anxiety diagnosis post-treatment, and acceptability (number of participants lost to post-treatment assessment), and secondary outcomes included remission of all anxiety diagnoses, reduction in anxiety symptoms, reduction in depressive symptoms, improvement in global functioning, adverse effects, and longer-term effects. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We used GRADE to assess the quality of the evidence. MAIN RESULTS We included 87 studies and 5964 participants in quantitative analyses. Compared with waitlist/no treatment, CBT probably increases post-treatment remission of primary anxiety diagnoses (CBT: 49.4%, waitlist/no treatment: 17.8%; OR 5.45, 95% confidence interval (CI) 3.90 to 7.60; n = 2697, 39 studies, moderate quality); NNTB 3 (95% CI 2.25 to 3.57) and all anxiety diagnoses (OR 4.43, 95% CI 2.89 to 6.78; n = 2075, 28 studies, moderate quality). Low-quality evidence did not show a difference between CBT and TAU in post-treatment primary anxiety disorder remission (OR 3.19, 95% CI 0.90 to 11.29; n = 487, 8 studies), but did suggest CBT may increase remission from all anxiety disorders compared to TAU (OR 2.74, 95% CI 1.16 to 6.46; n = 203, 5 studies). Compared with attention control, CBT may increase post-treatment remission of primary anxiety disorders (OR 2.28, 95% CI 1.33 to 3.89; n = 822, 10 studies, low quality) and all anxiety disorders (OR 2.75, 95% CI 1.22 to 6.17; n = 378, 5 studies, low quality). There was insufficient available data to compare CBT to alternative treatments on post-treatment remission of primary anxiety disorders, and low-quality evidence showed there may be little to no difference between these groups on post-treatment remission of all anxiety disorders (OR 0.89, 95% CI 0.35 to 2.23; n = 401, 4 studies) Low-quality evidence did not show a difference for acceptability between CBT and waitlist/no treatment (OR 1.09, 95% CI 0.85 to 1.41; n=3158, 45 studies), treatment as usual (OR 1.37, 95% CI 0.73 to 2.56; n = 441, 8 studies), attention control (OR 1.00, 95% CI 0.68 to 1.49; n = 797, 12 studies) and alternative treatment (OR 1.58, 95% CI 0.61 to 4.13; n=515, 7 studies). No adverse effects were reported across all studies; however, in the small number of studies where any reference was made to adverse effects, it was not clear that these were systematically monitored. Results from the anxiety symptom outcomes, broader outcomes, longer-term outcomes and subgroup analyses are provided in the text. We did not find evidence of consistent differences in outcomes according to delivery formats (e.g. individual versus group; amount of therapist contact time) or amongst samples with and without ASD, and no studies included samples of children with intellectual impairments. AUTHORS' CONCLUSIONS CBT is probably more effective in the short-term than waiting lists/no treatment, and may be more effective than attention control. We found little to no evidence across outcomes that CBT is superior to usual care or alternative treatments, but our confidence in these findings are limited due to concerns about the amount and quality of available evidence, and we still know little about how best to efficiently improve outcomes.
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Affiliation(s)
- Anthony C James
- Department of Psychiatry, University of Oxford, Oxford, UK
- Highfield Unit, Warneford Hospital, Oxford, UK
| | - Tessa Reardon
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | | | | | - Cathy Creswell
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
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Norris LA, Kendall PC. Moderators of Outcome for Youth Anxiety Treatments: Current Findings and Future Directions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:450-463. [PMID: 33140992 DOI: 10.1080/15374416.2020.1833337] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Objective: To improve outcomes and create more personalized interventions, the field has sought to identify moderators of treatment response (variables that specify which treatments work for whom and under what conditions).Method: The current review examines moderators of youth anxiety treatments.Results: The majority of studies to date have examined variables of convenience, including demographics (age, sex, race, ethnicity, socioeconomic status), pretreatment youth clinical characteristics (anxiety severity, principal diagnosis, comorbidity) and pretreatment parent variables (parent psychopathology, parenting). Findings indicate few consistent moderators.Conclusions: Future directions are discussed, including (a) group to individual generalizability, (b) power considerations, and (c) updates to study design and measure selection.
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Cervin M, Storch EA, Piacentini J, Birmaher B, Compton SN, Albano AM, Gosch E, Walkup JT, Kendall PC. Symptom-specific effects of cognitive-behavioral therapy, sertraline, and their combination in a large randomized controlled trial of pediatric anxiety disorders. J Child Psychol Psychiatry 2020; 61:492-502. [PMID: 31471911 DOI: 10.1111/jcpp.13124] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Pediatric anxiety disorders are highly prevalent and associated with significant functional disabilities and lifelong morbidity. Cognitive-behavioral therapy (CBT), sertraline, and their combination are effective treatments, but little is known about how these treatments exert their effects. METHODS Using network intervention analysis (NIA), we analyzed data from the largest randomized controlled treatment trial of pediatric anxiety disorders (Child/Adolescent Anxiety Multimodal Study, NCT00052078, clinicaltrials.gov/ct2/show/NCT00052078) and outlined the causal symptom domain-specific effects of CBT, sertraline, and their combination over the course of the 12-week treatment while taking into account both specificity and overlap between symptom domains. RESULTS All active treatments produced positive effects with the most pronounced and consistent effects emerging in relation to psychological distress, family interference, and avoidance. Psychological distress was consistently the most and physical symptoms the least central symptom domain in the disorder network. CONCLUSIONS All active treatments showed beneficial effects when compared to placebo, and NIA identified that these effects were exerted similarly across treatments and primarily through a reduction of psychological distress, family interference, and avoidance. CBT and sertraline may have differential mechanisms of action in relation to psychological distress. Given the lack of causal effects on interference outside family and physical symptoms, interventions tailored to target these domains may aid in the building of more effective treatments. Psychological distress and avoidance should remain key treatment focuses because of their central roles in the disorder network. The findings inform and promote developing more effective interventions.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences Lund, Lund University and Skåne Child and Adolescent Psychiatry, Lund, Sweden
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, Los Angeles, CA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | | | - Elizabeth Gosch
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - John T Walkup
- Department of Psychiatry, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, USA
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15
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Silverman WK, Marin CE, Rey Y, Kurtines WM, Jaccard J, Pettit JW. Group- versus Parent-Involvement CBT for Childhood Anxiety Disorders: Treatment Specificity and Long-term Recovery Mediation. Clin Psychol Sci 2019; 7:840-855. [PMID: 33758679 DOI: 10.1177/2167702619830404] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objective Treatment specificity and long-term recovery mediation of peer-involvement group cognitive behavioral therapy (GCBT) and parent-involvement CBT (PCBT) were investigated for youth anxiety disorders. Method 240 youths with primary anxiety diagnoses participated in a randomized controlled efficacy trial. Youth anxiety and peer variables/mediators (positive peer-youth relationships; social skills), and parent variables/mediators (psychological control; negative parent-youth relationships) were assessed. Results At posttreatment and 12-month follow up, positive peer-youth relationships were significantly higher in GCBT than PCBT (specificity). At posttreatment, not follow up, parental psychological control was significantly lower in PCBT than GCBT (specificity). Parental psychological control and positive peer-youth relationships were putative mediators. The two CBTs produced similar anxiety reductions through different mechanisms. Conclusions CBT targets show specificity and mediation, providing insight into specific mechanisms through which GCBT and PCBT bring about anxiety reduction and guidance for streamlining these CBTs in practice.
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16
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Escovar EL, Drahota A, Hitchcock C, Chorpita BF, Chavira DA. Vicarious Improvement Among Parents Participating in Child-Focused Cognitive-Behavioral Therapy for Anxiety. CHILD & FAMILY BEHAVIOR THERAPY 2019; 41:16-31. [PMID: 31920215 PMCID: PMC6952065 DOI: 10.1080/07317107.2019.1571770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Revised: 05/10/2017] [Accepted: 05/20/2017] [Indexed: 06/10/2023]
Abstract
Parental variables likely have important and bidirectional influences on the etiology of child anxiety. Although some child-focused cognitive-behavioral therapy (CCBT) anxiety trials have found vicarious improvements among parents who participated in their children's treatment, this is an understudied area. We hypothesized that parental variables (psychopathology, stress, and burden) will significantly decrease from pre-to post-CCBT and will be associated with child treatment response. We explored whether intervention delivery method-in-person CCBT versus parent-mediated bibliotherapy-influenced vicarious parental improvements. Parental variables decreased from pre- to post-CCBT and were associated with child treatment response. Effects did not interact with delivery method. Parent participation in anxiety CCBT may result in vicarious improvements for parents.
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Affiliation(s)
- Emily L Escovar
- Clinical Psychology Doctoral Program, Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, USA
| | - Carla Hitchcock
- Child and Adolescent Services Research Center, San Diego, CA, USA
- Alexandria Veterans Affairs Health Care System, Pineville, LA, USA
| | - Bruce F Chorpita
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
| | - Denise A Chavira
- Department of Psychology, University of California, Los Angeles, Los Angeles, CA, USA
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17
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Kreuze LJ, Pijnenborg GHM, de Jonge YB, Nauta MH. Cognitive-behavior therapy for children and adolescents with anxiety disorders: A meta-analysis of secondary outcomes. J Anxiety Disord 2018; 60:43-57. [PMID: 30447493 DOI: 10.1016/j.janxdis.2018.10.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 10/01/2018] [Accepted: 10/22/2018] [Indexed: 01/18/2023]
Abstract
Anxiety-focused cognitive-behavioral therapy (CBT) effectively reduces anxiety in children and adolescents. An important remaining question is to what extent anxiety-focused CBT also affects broader outcome domains. Additionally, it remains unclear whether parental involvement in treatment may have impact on domains other than anxiety. A meta-analysis (nstudies = 42, nparticipants = 3239) of the effects of CBT and the moderating role of parental involvement was conducted on the following major secondary outcomes: depressive symptoms, externalizing behaviors, general functioning, and social competence. Randomized controlled trials were included when having a waitlist or active control condition, a youth sample (aged<19) with a primary anxiety disorder diagnosis receiving anxiety-focused CBT and reported secondary outcomes. Controlled effect sizes (Cohen's d) were calculated employing random effect models. CBT had a large effect on general functioning (-1.25[-1.59;0.90], nstudies = 17), a small to moderate effect on depressive symptoms (-0.31[-0.41;-0.22], nstudies = 31) and a small effect on externalizing behaviors (-0.23[-0.38;-0.09], nstudies = 12) from pre-to post-treatment. Effects remained or even further improved at follow-up. Social competence only improved at follow-up (nstudies = 6). Concluding, anxiety-focused CBT has a positive effect on broader outcome domains than just anxiety. Higher parental involvement seemed to have beneficial effects at follow-up, with improvements in general functioning and comorbid symptoms.
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Affiliation(s)
- L J Kreuze
- Department of Psychology, University of Groningen, Groningen, the Netherlands.
| | - G H M Pijnenborg
- Department of Psychology, University of Groningen, Groningen, the Netherlands; GGZ Drenthe, Department of Psychotic Disorders, Assen, The Netherlands.
| | - Y B de Jonge
- Department of Psychology, University of Groningen, Groningen, the Netherlands.
| | - M H Nauta
- Department of Psychology, University of Groningen, Groningen, the Netherlands.
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18
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James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Hippokratia 2018. [DOI: 10.1002/14651858.cd013162] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Anthony C James
- University of Oxford; Department of Psychiatry; Oxford UK OX3 7JX
- Warneford Hospital; Highfield Unit; Oxford UK
| | - Tessa Reardon
- University of Reading; School of Psychology & Clinical Language Sciences; Reading UK
| | | | | | - Cathy Creswell
- University of Reading; School of Psychology & Clinical Language Sciences; Reading UK
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19
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Riordan DM, Singhal D. Anxiety-related disorders: An overview. J Paediatr Child Health 2018; 54:1104-1109. [PMID: 30294986 DOI: 10.1111/jpc.14167] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 12/14/2022]
Abstract
Anxiety-related disorders are common in the child and adolescent population. They cause significant distress, which can affect social, emotional, family and academic functioning. They frequently present in general paediatric and primary care settings. Comprehensive assessment should include the child as well as parent and family functioning because anxiety-related disorders in other family members are common and, if untreated, can affect outcomes for the child. There are good evidence-based psychological interventions available, which should be the first line of treatment offered; accessing appropriate therapies for an adequate duration of treatment can, however, be challenging. Medication, particularly selective serotonin reuptake inhibitors, may have a role to play but should be used in the context of psychologically based therapies. Prevention of anxiety-related disorders in childhood is a major public health issue. Prevention programmes are available and should commence in the antenatal period through infancy, early childhood and adolescence, promoting positive attachments and resilience.
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Affiliation(s)
- Denise M Riordan
- Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Deepa Singhal
- ACT Health, Mental Health Justice Health Alcohol and Drug Services, Canberra, Australian Capital Territory, Australia
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20
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Maughan AL, Weiss JA. Parental Outcomes Following Participation in Cognitive Behavior Therapy for Children with Autism Spectrum Disorder. J Autism Dev Disord 2018; 47:3166-3179. [PMID: 28762160 DOI: 10.1007/s10803-017-3224-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Children with autism spectrum disorder (ASD) benefit from parent involvement in their therapy, and there is evidence that this involvement may improve parent functioning as well. We examined changes in parent mental health, parenting, and expressed emotion, following participation in a randomized controlled trial of cognitive behavior therapy for 57 children with ASD. Post-intervention, improvements occurred in the treatment group in parent depression and emotion regulation, compared to waitlisted parents. Treatment effects also occurred across all parents in depression, emotion regulation, perceptions of their children and mindful parenting. Though preliminary, these results have implications for intervention development and evaluation by focusing on parent outcomes in child treatment.
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Affiliation(s)
- Andrea L Maughan
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
| | - Jonathan A Weiss
- Department of Psychology, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada.
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Abstract
OBJECTIVE This study documents the prevalence and impact of anxiety and depression in US children based on the parent report of health care provider diagnosis. METHODS National Survey of Children's Health data from 2003, 2007, and 2011-2012 were analyzed to estimate the prevalence of anxiety or depression among children aged 6 to 17 years. Estimates were based on the parent report of being told by a health care provider that their child had the specified condition. Sociodemographic characteristics, co-occurrence of other conditions, health care use, school measures, and parenting aggravation were estimated using 2011-2012 data. RESULTS Based on the parent report, lifetime diagnosis of anxiety or depression among children aged 6 to 17 years increased from 5.4% in 2003 to 8.4% in 2011-2012. Current anxiety or depression increased from 4.7% in 2007 to 5.3% in 2011-2012; current anxiety increased significantly, whereas current depression did not change. Anxiety and depression were associated with increased risk of co-occurring conditions, health care use, school problems, and having parents with high parenting aggravation. Children with anxiety or depression with effective care coordination or a medical home were less likely to have unmet health care needs or parents with high parenting aggravation. CONCLUSION By parent report, more than 1 in 20 US children had current anxiety or depression in 2011-2012. Both were associated with significant comorbidity and impact on children and families. These findings may inform efforts to improve the health and well-being of children with internalizing disorders. Future research is needed to determine why child anxiety diagnoses seem to have increased from 2007 to 2012.
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Hunger C, Hilzinger R, Bergmann NL, Mander J, Bents H, Ditzen B, Schweitzer J. Bezugspersonenbelastung erwachsener Patienten mit sozialer Angststörung. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0281-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Becker-Haimes EM, Jensen-Doss A, Birmaher B, Kendall PC, Ginsburg GS. Parent-youth informant disagreement: Implications for youth anxiety treatment. Clin Child Psychol Psychiatry 2018; 23:42-56. [PMID: 28191794 PMCID: PMC5988273 DOI: 10.1177/1359104516689586] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Greater parent-youth disagreement on youth symptomatology is associated with a host of factors (e.g., parental psychopathology, family functioning) that might impede treatment. Parent-youth disagreement may represent an indicator of treatment prognosis. Using data from the Child/Adolescent Anxiety Multimodal Study, this study used polynomial regression and longitudinal growth modeling to examine whether parent-youth agreement prior to and throughout treatment predicted treatment outcomes (anxiety severity, youth functioning, responder status, and diagnostic remission, rated by an independent evaluator). When parents reported more symptoms than youth prior to treatment, youth were less likely to be diagnosis-free post-treatment; this was only true if the youth received cognitive-behavioral therapy (CBT) alone, not if youth received medication, combination, or placebo treatment. Increasing concordance between parents and youth over the course of treatment was associated with better treatment outcomes across all outcome measures ( ps < .001). How parents and youth "co-report" appears to be an indicator of CBT outcome. Clinical implications and future directions are discussed.
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Affiliation(s)
- Emily M Becker-Haimes
- 1 Department of Psychology, University of Miami, USA
- 2 Perelman School of Medicine, University of Pennsylvania, USA
| | | | - Boris Birmaher
- 3 Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center, USA
| | | | - Golda S Ginsburg
- 5 Department of Psychiatry, University of Connecticut Health Center, USA
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24
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Wang Z, Whiteside SPH, Sim L, Farah W, Morrow AS, Alsawas M, Barrionuevo P, Tello M, Asi N, Beuschel B, Daraz L, Almasri J, Zaiem F, Larrea-Mantilla L, Ponce OJ, LeBlanc A, Prokop LJ, Murad MH. Comparative Effectiveness and Safety of Cognitive Behavioral Therapy and Pharmacotherapy for Childhood Anxiety Disorders: A Systematic Review and Meta-analysis. JAMA Pediatr 2017; 171:1049-1056. [PMID: 28859190 PMCID: PMC5710373 DOI: 10.1001/jamapediatrics.2017.3036] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/08/2017] [Indexed: 01/15/2023]
Abstract
Importance Childhood anxiety is common. Multiple treatment options are available, but existing guidelines provide inconsistent advice on which treatment to use. Objectives To evaluate the comparative effectiveness and adverse events of cognitive behavioral therapy (CBT) and pharmacotherapy for childhood anxiety disorders. Data Sources We searched MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and SciVerse Scopus from database inception through February 1, 2017. Study Selection Randomized and nonrandomized comparative studies that enrolled children and adolescents with confirmed diagnoses of panic disorder, social anxiety disorder, specific phobias, generalized anxiety disorder, or separation anxiety and who received CBT, pharmacotherapy, or the combination. Data Extraction and Synthesis Independent reviewers selected studies and extracted data. Random-effects meta-analysis was used to pool data. Main Outcomes and Measures Primary anxiety symptoms (measured by child, parent, or clinician), remission, response, and adverse events. Results A total of 7719 patients were included from 115 studies. Of these, 4290 (55.6%) were female, and the mean (range) age was 9.2 (5.4-16.1) years. Compared with pill placebo, selective serotonin reuptake inhibitors (SSRIs) significantly reduced primary anxiety symptoms and increased remission (relative risk, 2.04; 95% CI, 1.37-3.04) and response (relative risk, 1.96; 95% CI, 1.60-2.40). Serotonin-norepinephrine reuptake inhibitors (SNRIs) significantly reduced clinician-reported primary anxiety symptoms. Benzodiazepines and tricyclics were not found to significantly reduce anxiety symptoms. When CBT was compared with wait-listing/no treatment, CBT significantly improved primary anxiety symptoms, remission, and response. Cognitive behavioral therapy reduced primary anxiety symptoms more than fluoxetine and improved remission more than sertraline. The combination of sertraline and CBT significantly reduced clinician-reported primary anxiety symptoms and response more than either treatment alone. Head-to-head comparisons were sparse, and network meta-analysis estimates were imprecise. Adverse events were common with medications but not with CBT and were not severe. Studies were too small or too short to assess suicidality with SSRIs or SNRIs. One trial showed a statistically nonsignificant increase in suicidal ideation with venlafaxine. Cognitive behavioral therapy was associated with fewer dropouts than pill placebo or medications. Conclusions and Relevance Evidence supports the effectiveness of CBT and SSRIs for reducing childhood anxiety symptoms. Serotonin-norepinephrine reuptake inhibitors also appear to be effective based on less consistent evidence. Head-to-head comparisons between various medications and comparisons with CBT represent a need for research in the field.
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Affiliation(s)
- Zhen Wang
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | | - Leslie Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota
| | - Wigdan Farah
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Allison S. Morrow
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mouaz Alsawas
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Patricia Barrionuevo
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Mouaffaa Tello
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Noor Asi
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Bradley Beuschel
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Lubna Daraz
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Jehad Almasri
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Feras Zaiem
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Laura Larrea-Mantilla
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Oscar J. Ponce
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Annie LeBlanc
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | | | - Mohammad Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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Pella J, Drake K, Tein JY, Ginsburg G. Child Anxiety Prevention Study: Impact on Functional Outcomes. Child Psychiatry Hum Dev 2017; 48:400-410. [PMID: 27392728 PMCID: PMC5219954 DOI: 10.1007/s10578-016-0667-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This study examined the impact of a selective anxiety prevention program for offspring of clinically anxious parents on three domains of child functioning: (1) social, (2) familial, and (3) emotional/behavioral. Dyads were randomized into either the Coping and Promoting Strength program (CAPS; n = 70) or Information Monitoring (IM; n = 66) comparison group. Multi-informant assessments were conducted at baseline, post intervention, and 6 and 12 months follow-ups. Random effects mixed models under the linear growth modeling (LGM) framework was used to assess the impact of CAPS on growth trajectories. Over time, children in the CAPS group had significantly lower anxiety, anxious/depressed symptoms, and lower total behavior problems (parent report), compared to children in IM group. The intervention did not impact other domains assessed (e.g., social functioning), which may be due to "floor effects" on these measures. Longitudinal follow-up data is needed to provide valuable information about this high risk population.
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Affiliation(s)
- Jeffrey Pella
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
| | - Kelly Drake
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jenn-Yun Tein
- Prevention Research Center, Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Golda Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, West Hartford, CT, USA
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Whitlock J, Lloyd-Richardson E, Fisseha F, Bates T. Parental Secondary Stress: The Often Hidden Consequences of Nonsuicidal Self-Injury in Youth. J Clin Psychol 2017; 74:178-196. [PMID: 28493555 DOI: 10.1002/jclp.22488] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 12/22/2016] [Accepted: 03/22/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study aims to deepen understanding of the effects on parents of having a self-injuring child by (a) analyzing differences in dimensions of caregiver strain between caregivers of youth with nonsuicidal self-injury (NSSI+) and parents of youth with no known mental health history (MH-); (b) identifying factors that contribute to caregiver strain; and (c) examining parent outcome expectancies. METHOD Participants were 196 NSSI+ parents and 57 MH- parents. Quantitative measures of psychosocial variables, parent mental health and support variables, and child self-injury characteristics were assessed in relation to caregiver strain, and NSSI+ parental expectancies were assessed via mixed methods. RESULTS Parents with a NSSI+ youth were more likely to exhibit all forms of objective and subjective strain than parents of youth with no mental health challenges. Despite this, many parents expressed beliefs that their child would experience personal growth as a result of their NSSI experience. CONCLUSION Findings reveal the important role of mindful parenting practices and informal social support.
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Swan AJ, Kendall PC. Fear and missing out: Youth anxiety and functional outcomes. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/cpsp.12169] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Guo X, Slesnick N, Feng X. Changes in Family Relationships among Substance Abusing Runaway Adolescents: A Comparison between Family and Individual Therapies. JOURNAL OF MARITAL AND FAMILY THERAPY 2016; 42:299-312. [PMID: 25981755 DOI: 10.1111/jmft.12128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Eligible adolescents (12-17 years old) were recruited from a short-term crisis shelter for runaway adolescents in a large Midwestern city. Adolescents (N = 179) were randomly assigned to Ecologically-Based Family Therapy (EBFT, n = 61), the Community Reinforcement Approach (CRA, n = 57), or brief Motivational Enhancement Therapy (MET, n = 61) with the primary focus on substance abuse. A significant increase in perceived family cohesion and a significant reduction in perceived family conflict were found among all treatment conditions from baseline to the 24-month follow-up. Adolescents who received EBFT demonstrated more improvement in family cohesion after treatment than those who received CRA or MET, and more reduction in family conflict during treatment than those who received MET.
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Kozlowski JL, Lusk P, Melnyk BM. Pediatric Nurse Practitioner Management of Child Anxiety in a Rural Primary Care Clinic With the Evidence-Based COPE Program. J Pediatr Health Care 2015; 29:274-82. [PMID: 25801377 DOI: 10.1016/j.pedhc.2015.01.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 11/02/2014] [Accepted: 01/23/2015] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Anxiety is the most common mental health disorder in children. Many communities have shortages of mental health providers, and the majority of children with anxiety are not receiving the evidence-based treatment they need. The purpose of this pilot study was to assess the feasibility and effects of a brief seven-session cognitive behavioral skills-building intervention, Creating Opportunities for Personal Empowerment (COPE), which was delivered to anxious children by a pediatric nurse practitioner in a primary care setting. METHODS A pre-experimental, one-group, pretest and post-test design was used. RESULTS Children who participated had a significant decrease in anxiety symptoms (13.88 points, SD = 17.96, 95% confidence interval [CI] = -1.13-28.89), as well as an increase in knowledge of cognitive-behavioral coping skills (M = 11.38, CI = 5.99-8.26, p = .00) and improved functioning (at school and at home). Evaluations by parents and children were positive. DISCUSSION COPE is a promising evidence-based intervention for children with anxiety with feasible delivery by pediatric nurse practitioners in primary care.
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Sallee FR. Child/Adolescent Anxiety Multimodal Study safety. J Am Acad Child Adolesc Psychiatry 2015; 54:162-3. [PMID: 25721180 DOI: 10.1016/j.jaac.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/22/2014] [Indexed: 10/24/2022]
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Gonzalez A, Peris TS, Vreeland A, Kiff CJ, Kendall PC, Compton SN, Albano AM, Birmaher B, Ginsburg GS, Keeton CP, March J, McCracken J, Rynn M, Sherrill J, Walkup JT, Piacentini J. Parental anxiety as a predictor of medication and CBT response for anxious youth. Child Psychiatry Hum Dev 2015; 46:84-93. [PMID: 24610431 PMCID: PMC4159442 DOI: 10.1007/s10578-014-0454-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aim of this investigation was to evaluate how parental anxiety predicted change in pediatric anxiety symptoms across four different interventions: cognitive-behavioral therapy, medication (sertraline; SRT), their combination (COMB), and pill placebo. Participants were 488 youths (ages 7-17) with separation anxiety disorder, generalized anxiety disorder, and/or social phobia and their primary caregivers. Latent growth curve modeling assessed how pre-treatment parental trait anxiety symptoms predicted trajectories of youth anxiety symptom change across 12 weeks of treatment at four time points. Interactions between parental anxiety and treatment condition were tested. Parental anxiety was not associated with youth's pre-treatment anxiety symptom severity. Controlling for parental trait anxiety, youth depressive symptoms, and youth age, youths who received COMB benefitted most. Counter to expectations, parental anxiety influenced youth anxiety symptom trajectory only within the SRT condition, whereas parental anxiety was not significantly associated with youth anxiety trajectories in the other treatment conditions. Specifically, within the SRT condition, higher levels of parental anxiety predicted a faster and greater reduction in youth anxiety over the acute treatment period compared to youths in the SRT condition whose parents had lower anxiety levels. While all active treatments produced favorable outcomes, results provide insight regarding the treatment-specific influence of parental anxiety on the time course of symptom change.
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Affiliation(s)
- Araceli Gonzalez
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, 760 Westwood Plaza, Semel Room 67-467, Los Angeles, CA, 90024, USA,
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Schleider JL, Ginsburg GS, Keeton CP, Weisz JR, Birmaher B, Kendall PC, Piacentini J, Sherrill J, Walkup JT. Parental psychopathology and treatment outcome for anxious youth: roles of family functioning and caregiver strain. J Consult Clin Psychol 2014; 83:213-24. [PMID: 25222799 DOI: 10.1037/a0037935] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Research has examined the effects of parental psychopathology, family functioning, and caregiver strain on treatment response in anxious youths. Although these variables have shown individual links to youth treatment response, theoretical models for their combined effects remain unexplored. This study tested the hypothesis that improvements in family functioning and reductions in caregiver strain explained the effects of parental psychopathology on youth treatment outcome in an anxiety treatment trial. METHOD A multiple mediation technique was used to test the proposed model across independent evaluator (IE), parent, and youth informants in 488 youths, aged 7-17 years (50% female; mean age = 10.7) meeting Diagnostic and Statistical Manual of Mental Disorders criteria for social phobia, separation anxiety, and/or generalized anxiety disorder. Youths were randomized to receive 12 weeks of cognitive-behavioral treatment (Coping Cat), medication (sertraline), their combination, or a pill placebo. At pre- and posttreatment, parents completed self-report measures of global psychopathology symptoms, family functioning, and caregiver strain; parents, youths, and IEs rated youths' anxiety symptom severity. RESULTS Changes in family functioning and caregiver strain jointly explained relations between parental psychopathology and reductions in youth anxiety. Specifically, across IE and parent informants, families with higher pretreatment parental psychopathology showed more improvement in family functioning and caregiver strain, which in turn predicted greater youth anxiety reductions. Further, higher pretreatment parental psychopathology predicted greater caregiver strain reductions and, in turn, greater youth anxiety reductions, based on youths' reports of their own anxiety. CONCLUSIONS Findings suggest that improvements in family functioning and reductions in caregiver strain can influence treatment outcomes for anxious youths, especially among youths with more distressed parents.
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Affiliation(s)
| | - Golda S Ginsburg
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine
| | - Courtney P Keeton
- Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine
| | | | | | | | - John Piacentini
- Division of Child and Adolescent Psychiatry, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Joel Sherrill
- Division of Services and Intervention Research, National Institute of Mental Health
| | - John T Walkup
- Department of Psychiatry, Weill Cornell Medical College
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Peris TS, Galván A. Contextual modulation of medial prefrontal cortex to neutral faces in anxious adolescents. BIOLOGY OF MOOD & ANXIETY DISORDERS 2013; 3:18. [PMID: 24229444 PMCID: PMC3828586 DOI: 10.1186/2045-5380-3-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 08/29/2013] [Indexed: 06/02/2023]
Abstract
BACKGROUND Although interpretation biases are well documented among youth with anxiety disorders, understanding of their neural correlates is limited. In particular, there has been little study of how anxious youth neurobiologically represent changing contextual cues that may trigger anxiety. This study examined neural responses during a task in which participants viewed neutral faces paired with experimentally manipulated contextual stimuli. METHODS Participants (16 youth with a primary anxiety disorder diagnosis and 15 age- and gender-matched controls) passively viewed neutral faces that were paired with either neutral descriptive vignettes or with vignettes that were potentially anxiety provoking (for example, those that involved performance/social evaluation). RESULTS The two groups were differentiated by their medial prefrontal cortex (mPFC) responses, such that context modulated mPFC activation in anxious youth while non-anxious youth demonstrated no such differentiation. Counter to expectations, the performance/evaluation frames were not associated with amygdala reactivity for either group. CONCLUSIONS The present investigation is among the first to identify how context modulates mPFC responding to neutral stimuli among anxious youth. It takes an important step toward understanding the neurobiological correlates underlying interpretation biases of neutral stimuli in this population.
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Affiliation(s)
- Tara S Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Room 67-439, Los Angeles, CA 90095, USA
| | - Adriana Galván
- Department of Psychology, University of California, Los Angeles, USA
- Brain Research Institute, University of California, Los Angeles, USA
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