1
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Knowles KA, Tolin DF. Reductions in Anxiety are Associated with Decreased Expressive Suppression and Increased Cognitive Reappraisal After Cognitive-Behavioral Treatment: A Naturalistic Study in Youth. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01684-4. [PMID: 38530590 DOI: 10.1007/s10578-024-01684-4] [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] [Accepted: 02/15/2024] [Indexed: 03/28/2024]
Abstract
Broad deficits in emotion regulation skills have been observed in children with anxiety-related disorders. These deficits typically improve during cognitive-behavioral therapy (CBT), but few studies have examined changes in expressive suppression and cognitive reappraisal in youth with anxiety disorders and/or obsessive-compulsive disorder (OCD) during CBT, especially in real-world settings. In a naturalistic treatment-seeking sample, 123 youth completed measures of anxiety, depression, and emotion regulation strategy use before and after 15 sessions of CBT. For anxious youth, anxiety and expressive suppression decreased over treatment, while cognitive reappraisal increased. Reductions in expressive suppression and increases in cognitive reappraisal were significantly associated with improvements in anxiety and remained significantly associated with post-treatment anxiety after accounting for baseline anxiety and depression. Changes in expressive suppression and cognitive reappraisal over the course of treatment were not found for youth with primary OCD. Thus, CBT improves emotion regulation abilities in anxious youth, and these improvements are associated with anxiety reduction; improvements in emotion regulation do not appear to drive changes in OCD symptoms. Further research is needed to determine whether changes in emotion regulation strategies mediate changes in anxiety among youth receiving CBT.
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Affiliation(s)
- Kelly A Knowles
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA.
| | - David F Tolin
- Anxiety Disorders Center, The Institute of Living/Hartford Hospital, 200 Retreat Avenue, Hartford, CT, 06106, USA
- Yale University School of Medicine, 333 Cedar St, New Haven, CT, 06510, USA
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2
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Etkin RG, Juel EK, Lebowitz ER, Silverman WK. Does Cognitive-Behavioral Therapy for Youth Anxiety Disorders Improve Social Functioning and Peer Relationships? Clin Child Fam Psychol Rev 2023; 26:1052-1076. [PMID: 37838627 DOI: 10.1007/s10567-023-00454-3] [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] [Accepted: 08/26/2023] [Indexed: 10/16/2023]
Abstract
Child and adolescent anxiety disorders (ADs) contribute to impairment in social functioning and peer relationships, exacerbating anxiety and related difficulties. The extent to which the AD treatment with the strongest evidence-base, cognitive-behavioral therapy (CBT), improves social functioning and peer relationships is unclear. In this article, we report results of the first systematic narrative review of this topic. Randomized clinical trials of CBT for child and/or adolescent ADs were included if they used at least one measure of social functioning or peer relationships as a treatment outcome. Sixteen studies met our inclusion criteria. From each study, we extracted the sample characteristics, treatment arms, social and/or peer outcome measures, and statistical findings. Results show that social functioning and/or peer relationships improved over time in the majority of studies, highlighting an important aspect of treatment efficacy beyond anxiety reduction. There were also several treatment-specific effects, but considerable variability across studies' samples, methods, and findings, makes it difficult to draw firm conclusions about which specific treatments improve specific outcomes. We recommend next steps for research to reconcile these findings, including improved operationalization and standardization of social and peer outcomes, and research on treatment specificity and mechanisms.
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Affiliation(s)
- Rebecca G Etkin
- Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06520, USA
| | - Emily K Juel
- Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06520, USA
| | - Eli R Lebowitz
- Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06520, USA
| | - Wendy K Silverman
- Yale Child Study Center, Yale University School of Medicine, 230 S. Frontage Rd., New Haven, CT, 06520, USA.
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3
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Howe-Davies H, Hobson C, Waters C, van Goozen SHM. Emotional and socio-cognitive processing in young children with symptoms of anxiety. Eur Child Adolesc Psychiatry 2023; 32:2077-2088. [PMID: 35861892 PMCID: PMC10533571 DOI: 10.1007/s00787-022-02050-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 07/10/2022] [Indexed: 11/24/2022]
Abstract
Many children with anxiety disorders exhibit significant and persistent impairments in their social and interpersonal functioning. Two components essential for successful social interaction are empathy and theory of mind (ToM). Both constructs develop rapidly in childhood, but no study has simultaneously examined these skills in young children with emerging mental health problems, including those with symptoms of anxiety. This study investigated empathy and ToM in children with anxiety symptomatology and examined their relationship with anxiety severity. A cross-sectional study was carried out with 174 children aged 4-8 years with emerging mental health difficulties who were referred by school teachers for an assessment because of emotional, cognitive, or behavioural problems at school. Participants completed empathy and ToM tasks. Parents were interviewed and rated children's emotional and behavioural problems. Correlational analyses indicated that elevated anxiety was associated with better cognitive ToM and worse affective empathy; there were no associations between anxiety and either cognitive empathy or affective ToM. Subsequent regression analyses demonstrated that whilst enhanced cognitive ToM was explained by age and verbal IQ, anxiety symptoms uniquely predicted impaired affective empathy. These results indicate that children with symptoms of anxiety have difficulty in sharing in other people's emotions. As a result, they may find it difficult to behave in socially adequate ways in interactions with others that involve affective sharing. These findings encourage the use of early and targeted interventions that improve affective empathy development in children with anxiety symptoms.
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Affiliation(s)
| | | | | | - Stephanie H M van Goozen
- School of Psychology, Cardiff University, Wales, UK.
- Department of Clinical Child and Adolescent Studies, Leiden University, Leiden, Netherlands.
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4
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Zahl-Olsen R, Severinsen L, Shahar B, Stiegler JR, Bertelsen TB. Emotion-focused skills training for parents with anxious children. A pilot study. JOURNAL OF MARITAL AND FAMILY THERAPY 2023. [PMID: 37087673 DOI: 10.1111/jmft.12643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
Anxiety disorders are common among children and adolescents. Effective treatments exist, but meta-analyses indicate that 40% of children continue to have significant symptoms posttreatment. Alternative therapeutic interventions are needed. Emotion-focused parental interventions have been found to be effective in targeting children's internalizing difficulties, but no research has examined remission. In this pilot trial, we examined whether Emotion Focused Skills Training (EFST) was associated with remission of diagnosis in children with anxiety. Nine 8-14-year-olds diagnosed with anxiety were recruited at a mental health clinic in Norway. Both parents of each child attended a 2-day EFST program followed by five 1-hour weekly sessions. Pre- and posttreatment diagnosis and severity were evaluated using a multiinformant approach using the Spence Children's Anxiety Scale and the Anxiety Disorders Interview Schedule. After treatment, 33% no longer met criteria for any anxiety diagnosis, 66% obtained remission from their primary anxiety diagnosis, and 89% from at least one.
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Affiliation(s)
- Rune Zahl-Olsen
- Department of Child and Adolescent Mental Health, Sorlandet Hospital, Kristiansand, Norway
| | - Linda Severinsen
- Department of Child and Adolescent Mental Health, Sorlandet Hospital, Kristiansand, Norway
- Department of Psychology, Norway and University of Oslo, Oslo, Norway
| | - Ben Shahar
- The Paul Baerwald School of Social Work and Social Welfare, Hebrew University of Jerusalem, Jerusalem, Israel
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5
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Shariatpanahi M, Faramarzi M, Barat S, Farghadani A, Shirafkan H. Acceptability, feasibility, and effectiveness of internet-based emotion-focused cognitive behavior therapy with husband participation for Iranian pregnant women with anxiety disorder. INTERNATIONAL JOURNAL OF SYSTEMIC THERAPY 2023. [DOI: 10.1080/2692398x.2023.2174773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Affiliation(s)
- Mojgan Shariatpanahi
- Psychology, Department of Psychology, Saveh Branch, Islamic Azad University, Saveh, Iran
| | - Mahbobeh Faramarzi
- Psychology, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Shahnaz Barat
- Obstetrics and Gynecology, Infertility and Health Reproductive Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Azadeh Farghadani
- Department of Psychology, Saveh Branch, Islamic Azad University, Saveh, Iran
| | - Hoda Shirafkan
- Biostatistics, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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6
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Helland SS, Baardstu S, Kjøbli J, Aalberg M, Neumer SP. Exploring the Mechanisms in Cognitive Behavioural Therapy for Anxious Children: Does Change in Emotion Regulation Explain Treatment Effect? PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:214-225. [PMID: 35089507 DOI: 10.1007/s11121-022-01341-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/11/2022] [Indexed: 12/14/2022]
Abstract
Cognitive behavioural therapy (CBT) for childhood anxiety has shown moderate effects. However, inconsistency in findings during the last decades of treatment research and lack of measurable treatment gains over time has led to a call for optimizing interventions by identifying the active mechanisms involved and for whom such interventions are effective. It has been suggested that the moderate effects may be explained by the fact that emotion regulation rarely is directly targeted in CBT-interventions and that interventions may be more effective for children with a certain level of problems with emotion regulation. Using data from a randomized controlled trial with 160 children and their mothers at baseline (t1) and posttreatment (t2), we examined whether being randomized to CBT predicted change in anxiety symptoms from t1 to t2 and whether this change was mediated by change in emotion regulation from t1 to t2. We also investigated whether the strength of this indirect pathway depended on the level of emotion regulation problems at baseline. Latent baseline target moderated mediation analyses within a structural equation modelling framework were conducted. Results showed a significant indirect pathway between receiving CBT to improved emotion regulation, which again was significantly associated with reductions in anxiety symptoms. The findings suggest that the effect of CBT is similar for children irrespective of initial levels of emotion regulation measured broadly, whereas there was some evidence of a baseline moderation effect of the subdomain emotional control. Emotion regulation, and especially emotional control, seems to be an underlying mechanism for positive effects of CBT for anxiety disorders in children, possibly indicating that a greater emphasis on emotion regulation may optimize the intervention.
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Affiliation(s)
- S S Helland
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway.
| | - S Baardstu
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway.,Norwegian Institute of Public Health, Oslo, Norway
| | - J Kjøbli
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway.,Institute of Education, University of Oslo, Oslo, Norway
| | - M Aalberg
- Akershus University Hospital, Lorenskog, Norway
| | - S P Neumer
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Gullhaugveien 1-3, 0484, Oslo, Norway.,The Regional Centre for Child and Youth Mental Health and Child Welfare - Northern Norway, RKBU Nord, The Arctic University of Norway, Tromso, Norway
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7
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The Role of Emotion Regulation and Executive Functioning in the Intervention Outcome of Children with Emotional and Behavioural Problems. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10010139. [PMID: 36670689 PMCID: PMC9857297 DOI: 10.3390/children10010139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 01/08/2023] [Accepted: 01/08/2023] [Indexed: 01/13/2023]
Abstract
Emotional and behavioural problems are closely associated with impairments in regulating emotions and in executive functions (EF). To examine this further, the aim of the present study was to determine whether EF and emotion regulation at baseline would predict emotional and behavioural problem scores post-intervention, and further explore the extent to which emotion regulation mediates these outcomes. Participants were 41 primary school children who exhibited emotional and/or behavioural problems, aged 8 to 11 years. All the children completed measures of emotional and behavioural problems, cognitive emotion regulation, anxiety symptoms, and performed two experimental tasks to measure working memory and response inhibition before and after participating in a transdiagnostic Cognitive Behaviour Therapy-based programme, "Super Skills for Life" (SSL), and at 3-months follow-up. Results revealed significant reduction in the use of maladaptive emotion regulation strategy catastrophising and other blame following the intervention. Additionally, EF and emotion regulation was associated with outcomes for emotional problems and conduct problems. More specifically maladaptive emotion regulation strategy such as catastrophising and other blame was closely related with self-reports of emotional problems, likewise other blame, was also linked with scores of conduct problems. This study provides preliminary empirical support for EF and emotion regulation in predicting outcomes of emotional and behavioural problems in children following intervention.
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8
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Kazemi M, Amidi Mazaheri M, Hasan Zadeh A. Investigating the effect of cognitive-behavioral educational intervention on the development of female teenagers' social skills in Khomeini Shahr. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:378. [PMID: 36618484 PMCID: PMC9818698 DOI: 10.4103/jehp.jehp_1844_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/07/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Social skills are necessary for teenagers to have good interactions, accept roles, and adapt to conditions in the community. The present study investigated the effect of cognitive-behavioral educational intervention on students' social skills. MATERIALS AND METHODS This experimental study was completed on 102 female students in Khomeini Shahr, Isfahan. Fifty-seven students participated in the online cognitive-behavioral educational program of social skills for five sessions, and 57 students were assigned to the control group. The data from the Matson Evaluation of Social Skills with Youngsters (for subjects aged 4-18 years old) were collected before and 1 month after the interventional program. The data were analyzed using SPSS 25, independent t-test, Mann-Whitney test, and Chi-squared test. RESULTS The independent t-test showed that before the intervention, the total mean score of social skills and its variables were not significantly different between the intervention and control groups (P > 0.05). However, after the intervention, the total mean score of social skills and the variables of appropriate communication skills, relationship with peers, and impulsive behaviors in the intervention group was significantly more than the control group, but the mean scores of antisocial and arrogant behaviors (haughtiness) were not significantly different between the two times in the intervention and control groups. CONCLUSIONS The results show that participation in educational intervention significantly increased student's social skills development; it is suggested to incorporate cognitive-behavioral intervention in educational programs for adolescents.
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Affiliation(s)
- Masoomeh Kazemi
- Department of Health Education and Promotion Student Research Committee, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Amidi Mazaheri
- Department of Health Education and Promotion, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Akbar Hasan Zadeh
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
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9
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Richard Y, Tazi N, Frydecka D, Hamid MS, Moustafa AA. A systematic review of neural, cognitive, and clinical studies of anger and aggression. CURRENT PSYCHOLOGY 2022; 42:1-13. [PMID: 35693838 PMCID: PMC9174026 DOI: 10.1007/s12144-022-03143-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2022] [Indexed: 01/23/2023]
Abstract
Anger and aggression have large impact on people's safety and the society at large. In order to provide an intervention to minimise aggressive behaviours, it is important to understand the neural and cognitive aspects of anger and aggression. In this systematic review, we investigate the cognitive and neural aspects of anger-related processes, including anger-related behaviours and anger reduction. Using this information, we then review prior existing methods on the treatment of anger-related disorders as well as anger management, including mindfulness and cognitive behavioural therapy. At the cognitive level, our review that anger is associated with excessive attention to anger-related stimuli and impulsivity. At the neural level, anger is associated with abnormal functioning of the amygdala and ventromedial prefrontal cortex. In conclusions, based on cognitive and neural studies, we here argue that mindfulness based cognitive behavioural therapy may be better at reducing anger and aggression than other behavioural treatments, such as cognitive behavioural therapy or mindfulness alone. We provide key information on future research work and best ways to manage anger and reduce aggression. Importantly, future research should investigate how anger related behaviours is acquired and how stress impacts the development of anger.
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Affiliation(s)
| | - Nadia Tazi
- Arabian Gulf University, Manama, Bahrain
- Universite Med 5th, Rabat, Morocco
| | - Dorota Frydecka
- Department of Psychiatry, Wroclaw Medical University, Pasteur Street 10, 50-367 Wroclaw, Poland
| | | | - Ahmed A. Moustafa
- Department of Human Anatomy and Physiology, the Faculty of Health Sciences, University of Johannesburg, Johannesburg, 2193 South Africa
- School of Psychology, Faculty of Society and Design, Bond University, Gold Coast, QLD Australia
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10
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Combined Emotional Socialization Training and Family Accommodation Modification: Impact on Emotional Regulation and Anxiety Symptoms in Anxious Children. Behav Ther 2022; 53:281-293. [PMID: 35227404 DOI: 10.1016/j.beth.2021.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 09/12/2021] [Accepted: 09/16/2021] [Indexed: 11/21/2022]
Abstract
Past studies show that emotional socialization and family accommodation are involved in children's anxiety, but research has yet to investigate whether targeting emotional socialization training (EST), family accommodation modification (FAM), or EST and FAM in tandem can reduce anxiety in children. The purpose of this study was to evaluate the efficacy of a combination of EST and FAM on improving emotion regulation (ER) and reducing anxiety symptoms in anxious children. The sample consisted of 80 children with an anxiety disorder (Mage = 6.7, SD = 0.1) and their mothers. Mothers were randomly assigned to an EST (n = 17), FAM (n = 16), Combined (n = 17), or a waitlist control (WLC) (n = 16) groups. Mothers completed The Emotion Regulation Checklist (ERC) and Spence Children's Anxiety Scale (SCAS) at pre-test, post-test, and at 6-month of follow-up. The results showed that the EST, FAM, and Combined groups were more effective than WLC in improving ER and reducing anxiety severity at post-test and follow-up. Among the intervention groups, children in the combined group showed greater reductions in the severity of anxiety symptoms and emotion dysregulation than the other two groups. Assisting parents to use strategies that encourage healthy emotion regulation and decrease family accommodation might help reduce the severity of children's anxiety symptoms.
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11
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Cooley JL, Fite PJ, Hoffman L. Interactive Effects of Coping Strategies and Emotion Dysregulation on Risk for Peer Victimization. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 2022; 78:101356. [PMID: 35058670 PMCID: PMC8765728 DOI: 10.1016/j.appdev.2021.101356] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The aim of the current longitudinal study was to examine the interactive effects of six common coping strategies (i.e., adult support seeking, friend support seeking, problem solving, humor, passive coping, and cognitive distancing) and emotion (i.e., anger and sadness) dysregulation on concurrent levels and subsequent trajectories of peer victimization over a 2-year period. Participants were 287 predominantly Caucasian students (53.7% boys; ages 6-9) from an elementary school located in the Midwestern United States. Self-reported coping strategies and emotion dysregulation were assessed at baseline; children also provided ratings of peer victimization annually over a 2-year period. Results indicated that the effectiveness of particular coping strategies may depend on children's overt, undercontrolled displays of anger and sadness. Consistent with recent recommendations, these findings suggest that some youth may require interventions that focus on both enhancing emotion regulation skills and teaching strategies for responding to peer victimization in a more adaptive manner.
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Affiliation(s)
- John L. Cooley
- Department of Psychological Sciences, Texas Tech University, Lubbock, TX, USA
| | - Paula J. Fite
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Lesa Hoffman
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa City, IA
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12
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Moustafa AA, Al-Emadi AA, Megreya AM. The Need to Develop an Individualized Intervention for Mathematics Anxiety. Front Psychol 2021; 12:723289. [PMID: 34744889 PMCID: PMC8563601 DOI: 10.3389/fpsyg.2021.723289] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ahmed A Moustafa
- School of Psychology, Western Sydney University, Sydney, NSW, Australia.,Department of Human Anatomy and Physiology, The Faculty of Health Sciences, University of Johannesburg, Johannesburg, South Africa
| | - Ahmed A Al-Emadi
- Department of Psychological Sciences, College of Education, Qatar University, Doha, Qatar
| | - Ahmed M Megreya
- Department of Psychological Sciences, College of Education, Qatar University, Doha, Qatar
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13
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Effectiveness of Positive Mindfulness Therapy and Emotion-Focused Cognitive-Behavioral Therapy in Improving Pain Perception and Sleep Quality in Fibromyalgia Patients. INTERNATIONAL JOURNAL OF MUSCULOSKELETAL PAIN PREVENTION 2021. [DOI: 10.52547/ijmpp.6.4.564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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14
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Are young people with primary social anxiety disorder less likely to recover following generic CBT compared to young people with other primary anxiety disorders? A systematic review and meta-analysis. Behav Cogn Psychother 2020; 49:352-369. [PMID: 33298222 PMCID: PMC8293629 DOI: 10.1017/s135246582000079x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background: Social anxiety disorder (SoAD) in youth is often treated with a generic form of cognitive behavioural therapy (CBT). Some studies have suggested that primary SoAD is associated with lower recovery rates following generic CBT compared with other anxiety disorders. Aims: This systematic review and meta-analysis investigated recovery rates following generic CBT for youth with primary SoAD versus other primary anxiety disorders. Method: Five databases (PsycINFO, Web of Science, PubMed, Embase, Medline) were searched for randomised controlled trials of generic CBT for child and/or adolescent anxiety. Results: Ten trials met criteria for inclusion in the systematic review, six of which presented sufficient data for inclusion in the meta-analysis. Sixty-seven did not report data on recovery rates relative to primary diagnosis. While most individual studies included in the systematic review were not sufficiently powered to detect a difference in recovery rates between diagnoses, there was a pattern of lower recovery rates for youth with primary SoAD. Across the trials included in the meta-analysis, the post-CBT recovery rate from primary SoAD (35%) was significantly lower than the recovery rate from other primary anxiety disorders (54%). Conclusions: Recovery from primary SoAD is significantly less likely than recovery from any other primary anxiety disorder following generic CBT in youth. This suggests a need for research to enhance the efficacy of CBT for youth SoAD.
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15
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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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16
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Harris TB, Udoetuk SC, Webb S, Tatem A, Nutile LM, Al-Mateen CS. Achieving Mental Health Equity: Children and Adolescents. Psychiatr Clin North Am 2020; 43:471-485. [PMID: 32773075 DOI: 10.1016/j.psc.2020.06.001] [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] [Indexed: 02/07/2023]
Abstract
This article briefly reviews the influences of protective and risk factors of child and adolescent mental health, and explores promising practices and outcomes of evidence-based programs designed to improve the mental health of youth, and the barriers for accessing quality and evidence-based child and adolescent mental health service delivery systems. The authors provide recommendations for individual practice improvements and policy, funding, and organizational practice improvements that will support mental health equity in child and adolescent populations.
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Affiliation(s)
- Toi Blakley Harris
- Psychiatry, Institutional Diversity, Inclusion and Equity & Student and Trainee Services, Center of Excellence in Health Equity, Training and Research, PI/PD, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Pediatrics, Institutional Diversity, Inclusion and Equity & Student and Trainee Services, Center of Excellence in Health Equity, Training and Research, PI/PD, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA; Family and Community Medicine, Institutional Diversity, Inclusion and Equity & Student and Trainee Services, Center of Excellence in Health Equity, Training and Research, PI/PD, Baylor College of Medicine, 1 Baylor Plaza, Houston, TX 77030, USA
| | - Sade C Udoetuk
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS Stop 350, Houston, TX 77030, USA
| | - Sala Webb
- Behavioral Health, Comprehensive Medical & Dental Plan, Arizona Department of Child Safety, 3003 North Central Avenue, Phoenix, AZ 85012, USA
| | - Andria Tatem
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, 6701 Fannin Street, Suite 1540, Houston, TX 77030, USA. https://twitter.com/doc2be2014
| | - Lauren M Nutile
- Department of Psychiatry, Virginia Treatment Center for Children, PO Box 980489, Richmond, VA 23298-0489, USA
| | - Cheryl S Al-Mateen
- Department of Psychiatry, Virginia Treatment Center for Children, Virginia Commonwealth University, PO Box 980489, Richmond, VA 23298-0489, USA; Department of Pediatrics, Virginia Treatment Center for Children, Virginia Commonwealth University, Richmond, VA, USA.
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17
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Stoll RD, Pina AA, Schleider J. Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2020; 49:435-459. [PMID: 32285692 PMCID: PMC7473445 DOI: 10.1080/15374416.2020.1738237] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
In 1998, Ost published [One-session treatment of specific phobias-a rapid and effective method] [in Swedish] giving rise to the idea that brief, intensive, and concentrated psychosocial interventions could exhibit public health impact. At this juncture, and per criteria of the Society for Clinical Child and Adolescent Psychology, there are data supporting that brief, non-pharmacological intervention [prescriptions] for pediatric anxiety can be considered well-established or probably efficacious. In addition, data from 76 randomized controlled trials (N = 17,203 youth) yield an overall mean effect size of 0.19 on pediatric anxiety outcomes (pre-post). Note, however, that effect sizes vary significantly. These data point to the capacity for clinical change coming from in-vivo exposures for specific phobias (~3 h, one session), CBT with social skills training (~3 h, six sessions for indicated prevention and early intervention), and CBT-based parent training (~6 h, eight digital modules with clinician support). Given such evidence, we recommend efforts be made to establish ways to position such treatment innovations for rapid deployment facilitated by high-quality training, monitoring, technical assistance, and ongoing disclosures.
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Affiliation(s)
- Ryan D Stoll
- Department of Psychology, Arizona State University
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Sigurvinsdóttir AL, Jensínudóttir KB, Baldvinsdóttir KD, Smárason O, Skarphedinsson G. Effectiveness of cognitive behavioral therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis. Nord J Psychiatry 2020; 74:168-180. [PMID: 31738631 DOI: 10.1080/08039488.2019.1686653] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aim: Pediatric Anxiety Disorders (AD) are common. Cognitive behavioral therapy (CBT) is one of two first-line treatments of youth AD and it has previously been shown to be superior to wait-list but not placebo therapy. This study consists of a systematic review and meta-analysis of the literature to assess the efficacy of CBT modalities in comparison to control contingencies for pediatric anxiety disorders.Methods: Studies were included if they were randomized controlled trials, and if CBT was manualized or modular, alone or in combination with medication. CBT was required to include behavioral treatment, exposure treatment, or cognitive elements. Eligible studies included participants aged 18 years or younger.Results: Eighty-one studies were included, with 3386 CBT participants and 2527 control participants. The overall results indicated that CBT is an effective treatment for childhood AD. The results showed that individual-based CBT is superior to wait-list and attention control. Group-based CBT is superior to wait-list control and treatment as usual. Remote-based CBT was superior to attention control and wait-list control. Family-based CBT was superior to treatment as usual, wait-list control, and attention control. Selective serotonin reuptake inhibitors were no more effective than individual-based CBT. Combination treatment was, however, more effective than individual-based CBT.Conclusion: To the best of our knowledge, no meta-analysis has thus far disentangled the effects of CBT modalities across various comparisons. This meta-analysis hence provides an important update to the literature on the efficacy of CBT for treating anxiety disorders in young people.
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Affiliation(s)
| | | | | | - Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland.,Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
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Ab Ghaffar SF, Mohd Sidik S, Ibrahim N, Awang H, Gyanchand Rampal LR. Effect of a School-Based Anxiety Prevention Program among Primary School Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16244913. [PMID: 31817328 PMCID: PMC6950005 DOI: 10.3390/ijerph16244913] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/16/2022]
Abstract
Anxiety is one of the most common mental health disorders in childhood, and children with anxiety have an increased risk of psychiatric disorders during adulthood. This study aimed to evaluate the effectiveness of a school-based anxiety prevention program for reducing anxiety among primary school students relative to a school-as-usual control group. Secondary to this, the current study aimed to examine the effect of a school-based prevention program on worry coping skills and self-esteem. A two-group parallel cluster randomized controlled trial of a single-blinded study was conducted to evaluate the effectiveness of the program, with schools as the unit of allocation and individual participants as the unit of analysis. The intervention program was conducted between May 2016 and December 2017. The primary outcome was anxiety, whereas the secondary outcomes were worry coping skills and self-esteem measured at three months post-intervention. Data were analyzed by using a generalized linear mixed model, accounting for the clustering effect. Subgroup analyses were performed for children with anxiety. A total of 461 students participated in this study. At baseline, there was no significant difference between groups for anxiety score, worry coping skills score, and self-esteem score (p > 0.05). The intervention was effective in reducing anxiety for the whole sample (p = 0.001) and the anxiety subgroup (p = 0.001). However, it was not effective in improving worry coping skills and self-esteem. These findings suggest that the program could be effective for reducing symptoms of anxiety when delivered in schools and provide some support for delivering this type of program in primary school settings.
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Affiliation(s)
- Siti Fatimah Ab Ghaffar
- Faculty of Hospitality, Tourism and Wellness, City Campus, Pengkalan Chepa, Locked Bag 36, Kota Bharu 16100, Kelantan, Malaysia;
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43300, Malaysia;
| | - Sherina Mohd Sidik
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
- Cancer Resource & Education Center, Faculty of Medicine and Health Sciences Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia
- Correspondence: ; Tel.: +60-3-8947-1011
| | - Normala Ibrahim
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
| | - Hamidin Awang
- Department of Psychiartry, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43400, Malaysia; (N.I.); (H.A.)
| | - Lekhraj Rampal Gyanchand Rampal
- Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang Selangor 43300, Malaysia;
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Abstract
The current study examined emotional awareness as a predictor of differential outcomes for youth treated for an anxiety disorder. 37 youth ages 7-15 received either individual cognitive-behavioral therapy or family cognitive-behavioral therapy to treat generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Diagnoses were determined by independent evaluators, following semi-structured interviews (ADIS-IV-C/P) with youth and their parents. Self-report questionnaires, including the multidimensional anxiety scale for children and the emotion expressivity scale for children, were completed at pre- and posttreatment. Youth with higher levels of pretreatment emotional awareness had better treatment outcomes than youth with lower levels of emotional awareness, with specific regard to improved ability to cope with worry. Findings suggest that higher levels of emotional awareness facilitate better specific outcomes for anxious youth. Findings highlight the importance of understanding the emotions associated with worry during the treatment process.
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Whitehead M, Jones A, Bilms J, Lavner J, Suveg C. Child social and emotion functioning as predictors of therapeutic alliance in cognitive-behavioral therapy for anxiety. J Clin Psychol 2018; 75:7-20. [PMID: 29696647 DOI: 10.1002/jclp.22633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 11/05/2022]
Abstract
OBJECTIVE This study examined baseline child social and emotional functioning as predictors of therapeutic alliance during a cognitive-behavioral therapy (CBT) program for children with anxiety disorders. It was hypothesized that better social and emotional functioning at baseline would be related to stronger alliance initially and over the course of treatment. METHOD Ninety-two anxious youth, ages 7-11 years (M age = 8.93 years, SD = 1.64; 42% female) participated. Children, caregivers, and teachers completed measures of child social and emotional functioning. Therapeutic alliance was measured using therapist-rated and observer-coded reports. RESULTS Receiving prosocial support from peers and emotion regulation (ER) were both related to initial rating and slope of alliance. CONCLUSIONS Child social and emotional functioning enhances our understanding of how the alliance is formed and in identifying children who might be at risk for difficulties in developing a strong therapeutic relationship.
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Suveg C, Kingery JN, Davis M, Jones A, Whitehead M, Jacob ML. Still lonely: Social adjustment of youth with and without social anxiety disorder following cognitive behavioral therapy. J Anxiety Disord 2017; 52:72-78. [PMID: 29069628 DOI: 10.1016/j.janxdis.2017.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/18/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
Social experiences are an integral part of normative development for youth and social functioning difficulties are related to poor outcomes. Youth with anxiety disorders, and particularly social anxiety disorder, experience difficulties across many aspects of social functioning that may place them at risk for maladjustment. The goal of this paper was to compare social experiences of youth across anxiety diagnoses and examine whether treatment is helpful in improving social functioning. Ninety-two children (age 7-12 years; 58% male; 87.0% White) with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, and/or social anxiety disorder participated in cognitive behavioral therapy. At both pre- and post-treatment, children with social anxiety disorder self-reported greater loneliness than youth without social anxiety disorder, though levels of peer victimization and receipt of prosocial behavior were similar across groups. Parents reported greater social problems for youth with social anxiety disorder compared to those without social anxiety disorder. All youth experienced improved social functioning following treatment per child- and parent-reports. The results call for an increased focus on the social experiences of youth with anxiety disorders, and particularly loneliness, for children with social anxiety disorder. The results document ways that evidenced-based practice can improve social functioning for youth with anxiety disorders.
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Affiliation(s)
- Cynthia Suveg
- University of Georgia, 125 Baldwin St, Athens, GA, 30602, United States.
| | - Julie Newman Kingery
- Hobart and William Smith Colleges, Gulick Hall, Geneva, NY 14456, United States.
| | - Molly Davis
- University of Georgia, 125 Baldwin St, Athens, GA, 30602, United States.
| | - Anna Jones
- University of Georgia, 125 Baldwin St, Athens, GA, 30602, United States.
| | - Monica Whitehead
- University of Georgia, 125 Baldwin St, Athens, GA, 30602, United States.
| | - Marni L Jacob
- 1200 N. Federal Highway, Suite 200, Boca Raton, FL 33432, United States.
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Jones AM, West KB, Suveg C. Anxiety in the School Setting: A Framework for Evidence-Based Practice. SCHOOL MENTAL HEALTH 2017. [DOI: 10.1007/s12310-017-9235-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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