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Alamiri B, Alkhamis MA, Naguy A, Alenezi HF, Al Shekaili M. Anxiety disorders among children and adolescents during COVID-19 lockdowns and school closures: a cross-sectional study in Kuwait. Front Psychiatry 2024; 15:1322745. [PMID: 38410676 PMCID: PMC10895000 DOI: 10.3389/fpsyt.2024.1322745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/29/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction Investigating the epidemiology of mental health disorders resulting from COVID-19 intervention measures, primary school closures, and social isolation in children and adolescents needs to be prioritized over adults at the post-pandemic stage. Most preliminary psychosocial studies conducted during the pandemic have demonstrated that younger age groups are the most vulnerable to such implications. Thus, this study aims to estimate the probable prevalence of specific anxiety disorders in children and quantify their relationships with relevant demographic risk factors. Methods We used a cross-sectional study comprising 430 children aged between 8- and 18 years old living in Kuwait during the period of school closures as well as full and partial lockdowns. The survey included questions about participants' characteristics, children's anxiety using the Screen for Child Anxiety Related Emotional Disorders Questionnaire (SCARED) scale, and children's emotions and behaviours using the Strengths and Difficulties Questionnaire (SDQ). Univariate and multivariate logistic regression analyses were used to summarize the demographic and characteristics of the participants and their association with general, social, and generalized anxieties, as well as behavioural and emotional difficulties. Results We inferred that 24.83% of our participants had at least one anxiety disorder, while 20.19% were classified as abnormal on the SDQ scale. Our multivariate analysis revealed that lockdown duration and sex of the child were consistently significant predictors (p-values < 0.05) of the broad spectrum of selected mental disorders. Additionally, we inferred notable increases in the likelihood of mental disorders associated with the increased duration of lockdowns. Conclusions Our findings revealed preliminary insights into the vulnerability of young populations to the indirect negative impacts of strict public health measures during pandemic emergencies. Thus, authorities should consider such implications when planning and implementing similar interventions in future pandemics.
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Affiliation(s)
- Bibi Alamiri
- Almanara, Kuwait Center for Mental Health, Ministry of Health, Kuwait City, Kuwait
| | - Moh A. Alkhamis
- Department of Epidemiology and Biostatistics, Faculty of Public Health, Health Sciences Centre, Kuwait University, Kuwait City, Kuwait
| | - Ahmed Naguy
- Almanara, Kuwait Center for Mental Health, Ministry of Health, Kuwait City, Kuwait
| | - Hend F. Alenezi
- General Adult Psychiatry Department, Kuwait Center for Mental Health, Kuwait City, Kuwait
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Wang B, Skarphedinsson G, Weidle B, Babiano-Espinosa L, Wolters L, Arntzen J, Skokauskas N. Secondary outcomes of enhanced cognitive behavioral therapy (eCBT) for children and adolescents with obsessive-compulsive disorder. Front Hum Neurosci 2024; 17:1330435. [PMID: 38259330 PMCID: PMC10800953 DOI: 10.3389/fnhum.2023.1330435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is a debilitating mental health condition usually presenting with a high degree of comorbid symptoms in the majority of cases. Although face-to-face cognitive-behavioral therapy (CBT) is considered the therapeutic golden standard for pediatric OCD, its accessibility, availability, and consistency in delivery are still limited. To address some of these challenges, an enhanced CBT (eCBT) package was created and introduced. This study explored eCBT's broad-based impact on OCD-related comorbid symptoms, functional impairment, quality of life and family accommodation among youth with OCD. Methods This open trial involved 25 pediatric patients with OCD (7-17 years), assessed between January 2018 to February 2020. All patients received eCBT for 14 weeks. Secondary outcomes were assessed at baseline, post-treatment, and 3-, 6-, and 12-month follow-up co-occurring symptoms were evaluated using the Strengths and Difficulties Questionnaire (SDQ), Screen for Child Anxiety-Related Emotional Disorders (SCARED), and Mood and Feelings Questionnaire (MFQ). Quality of life was measured using the KINDL-R, functional impairment through the Child Obsessive-Compulsive Impact Scale Revised (COIS-R), and family accommodation by the Family Accommodation Scale (FAS). Linear mixed-effects models were applied to analyze treatment effects. Results Results indicated a significant decrease in OCD-related comorbid symptoms post-treatment, with SDQ mean reduce of 3.73 (SE = 1.10, child) and 4.14 (SE = 1.19, parent), SCARED mean reduce of 10.45 (SE = 2.52, child) and 8.40 (SE = 2.82, parent), MFQ mean reduce of 3.23 (SE = 1.11, child) and 2.69 (SE = 1.18, parent). Family accommodation declined with clinician scored FAS mean reduction of 13.25 (SE = 2.31). Quality-of-Life improved significantly post-treatment, with KINDL mean increase of 8.15 (SE = 2.87, children), and 10.54 (SE = 3.07, parents). These positive improvements were further amplified at the 3-month follow-up and remained consistent at the 12-month follow-up. Conclusion A significant reduction was observed in all secondary outcomes employed and OCD-related functional impairments from baseline to post-treatment, which was maintained through 12-month follow-up. These results imply that after receiving eCBT, children and adolescents experienced substantial decrease in the negative impacts of OCD-related symptoms on their daily life, including home, school, and social interactions.
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Affiliation(s)
- Bo Wang
- Norwegian Centre for E-health Research, University Hospital of North Norway, Tromsø, Norway
| | | | - Bernhard Weidle
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Lucía Babiano-Espinosa
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | | | - Jostein Arntzen
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
- Department of Child and Adolescent Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Norbert Skokauskas
- Department of Mental Health, Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU Central Norway), Norwegian University of Science and Technology, Trondheim, Norway
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Ahadianfard P, Gharraee B, Aghebati A, Asgarabad MH. Effectiveness of unified protocol for trans diagnostic treatment in children with anxiety disorders: A randomized control trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:387. [PMID: 38333174 PMCID: PMC10852158 DOI: 10.4103/jehp.jehp_1578_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/24/2022] [Indexed: 02/10/2024]
Abstract
BACKGROUND The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) is a theory-derived approach that can target the common underlying processes, such as the cognitive, emotional, and behavioral processes in emotional disorders in children aged 8-12 years. This study aimed to investigate UP-C's efficacy in treating children's anxiety disorders compared to cognitive behavior therapy (CBT). MATERIALS AND METHODS In this randomized control trial (RCT), with pre-test, post-test, and follow-up, 34 participants aged 8-12 with anxiety disorders were selected through the restricted randomization method and allocated to intervention (UP-C) or control (CBT) groups by random allocation rule. UP-C group consisted of 15 weekly individual sessions, and CBT included 16 weekly individual sessions. The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) and The Screen for Child Anxiety Related Disorders (SCARED-71) were completed in the pre-test, post-test, and three-month follow-up stages. The data of participants were analyzed using the repeated measure analysis of variance. A P- value under. 05 was regarded as significant. RESULTS Based on the repeated measures ANOVA, UP-C, and CBT significantly reduced anxiety symptoms (P = .002) and emotional suppression (P = .032). Moreover, UP-C and CBT significantly increased emotion regulation (P = .000) and cognitive reappraisal (P = .000). CONCLUSION The individual UP-C can be effective as anxiety-oriented CBT in treating anxiety disorders. Also, in the three months follow-up, the UP-C's effects were more stable and progressive than the CBT.
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Affiliation(s)
- Pantea Ahadianfard
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Banafsheh Gharraee
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Asma Aghebati
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
- Positive Youth Development Lab, Human Development and Family Sciences, Texas Tech University, Texas, U.S.A
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Lawson GM, Jawad AF, Comly R, Khanna M, Glick HA, Beidas RS, Goldstein J, Brizzolara-Dove S, Wilson T, Rabenau-McDonnell Q, Eiraldi R. A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness. Front Psychiatry 2023; 14:1105630. [PMID: 37426105 PMCID: PMC10328418 DOI: 10.3389/fpsyt.2023.1105630] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 05/16/2023] [Indexed: 07/11/2023] Open
Abstract
Background Cognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists. Objectives Friends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support. Materials and methods First, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors. Results The mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. Conclusion Relatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support.
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Affiliation(s)
- Gwendolyn M. Lawson
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Abbas F. Jawad
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rachel Comly
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | - Muniya Khanna
- OCD and Anxiety Institute, Bryn Mawr, PA, United States
| | - Henry A. Glick
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Rinad S. Beidas
- Department of Medical Social Sciences, Feinberg School of Medicine Northwestern University, Chicago, IL, United States
| | - Jessica Goldstein
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Tara Wilson
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
| | | | - Ricardo Eiraldi
- Children’s Hospital of Philadelphia, Philadelphia, PA, United States
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Baca SA, Goger P, Glaser D, Rozenman M, Gonzalez A, Dickerson JF, Lynch FL, Porta G, Brent DA, Weersing VR. Reduction in avoidance mediates effects of brief behavioral therapy for pediatric anxiety and depression. Behav Res Ther 2023; 164:104290. [PMID: 36965232 DOI: 10.1016/j.brat.2023.104290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/23/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023]
Abstract
Brief behavioral therapy (BBT) is an efficacious transdiagnostic intervention for pediatric anxiety and depression that targets behavioral avoidance as a key mechanism. It is unknown if change in avoidance mediates treatment effects, as theorized. Data on avoidance at baseline and Week 16 were available on 52 youth (ages 8-16 years) from a randomized controlled trial (Weersing, Jeffreys, et al., 2017) comparing BBT and assisted referral to community care (ARC). BBT had significant effects on youth-reported behavioral avoidance, and significant indirect effects on functioning and anxiety, statistically mediated through changes in youth-reported behavioral avoidance. Change in youth-reported avoidance was not a significant mediator of depression. Parent-report of avoidance was not impacted by treatment and was not a significant mediator. Overall, BBT appears to be an effective treatment for targeting behavioral avoidance, which in turn, may improve functioning and lessen anxiety. CLINICAL TRIAL REGISTRATION INFORMATION: https://clinicaltrials.gov; NCT01147614.
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Affiliation(s)
- Selena A Baca
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA
| | - Pauline Goger
- Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California - San Diego, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA
| | - Dale Glaser
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA
| | - Michelle Rozenman
- Department of Psychology, University of Denver, 2155 S. Race St, Denver, CO, 80210, USA
| | - Araceli Gonzalez
- Psychology Department, California State University Long Beach, 1250 Bellflower Blvd, PSY-100, Long Beach, CA, 90840-0901, USA
| | - John F Dickerson
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, 3800 N Interstate Ave, Portland, OR, 97227, USA
| | - Giovanna Porta
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, 100 N. Bellefield Ave, Pittsburgh, PA, 15213, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, 311 Bellefield Towers, Pittsburgh, PA, 15213, USA
| | - David A Brent
- University of Pittsburgh Medical Center, Western Psychiatric Hospital, 100 N. Bellefield Ave, Pittsburgh, PA, 15213, USA; Department of Psychiatry, University of Pittsburgh School of Medicine, 3811 O'Hara Street, 311 Bellefield Towers, Pittsburgh, PA, 15213, USA
| | - V Robin Weersing
- Department of Psychology, San Diego State University, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA; Joint Doctoral Program in Clinical Psychology, San Diego State University, University of California - San Diego, 6363 Alvarado Court, Suite 200, San Diego, CA, 92120, USA.
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Adherence, Competence, and Alliance as Predictors of Long-term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders. Res Child Adolesc Psychopathol 2023; 51:761-773. [PMID: 36692616 DOI: 10.1007/s10802-023-01028-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2023] [Indexed: 01/25/2023]
Abstract
The present study investigated therapist adherence, therapist competence, and patient-therapist alliance as predictors of long-term outcomes of cognitive behavioral therapy (CBT) for anxiety disorders in youth. Potential differential effects for group versus individual CBT, for therapists with or without formal CBT training, and based on youth symptom severity were examined. Videotapes (n = 181) from treatment sessions in a randomized controlled effectiveness trial comprising youth (N = 170, M age = 11.6 years, SD = 2.1) with anxiety disorders were assessed for therapist adherence and competence. Alliance was rated by therapists and youth. Participants completed a diagnostic interview and an anxiety symptom measure at pre-treatment, post-treatment, one-year follow-up, and long-term follow-up (M = 3.9 years post-treatment, SD = 0.8, range = 2.2-5.9 years). The change in anxiety symptoms or diagnostic status from pre-treatment to long-term follow-up was not significantly related to any predictor variables. However, several interaction effects were found. For loss of principal diagnosis, therapist competence predicted positive outcome when therapist adherence also was high. Adherence was found to predict positive outcome if CBT was provided individually. Therapist-rated alliance was related to both loss of principal diagnosis and loss of all diagnoses when CBT was provided in groups. Interaction effects suggested that therapists displaying both high adherence and high competence produced better long-term outcomes. Further, the alliance may be particularly important for outcomes in group CBT, whereas adherence may be particularly important for outcomes in individual CBT.
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Kendall PC, Maxwell CA, Jakubovic RJ, Ney JS, McKnight DS, Baker S. CBT for Youth Anxiety: How Does It Fit Within Community Mental Health? Curr Psychiatry Rep 2023; 25:13-18. [PMID: 36484914 DOI: 10.1007/s11920-022-01403-7] [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: 11/13/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW We review (1) the empirical literature for cognitive behavioral therapy (CBT) for youth anxiety delivered in community settings, (2) the use of online delivery methods in this process, and (3) identified barriers and facilitators to implementation of CBT for youth anxiety in community mental health clinics (CMHCs). We provide suggestions for future work. RECENT FINDINGS Meta-analytic reviews of effectiveness studies suggest that outcomes comparable to those of efficacy studies can be achieved in community settings, particularly when in-session exposures occur. Several online programs support delivery of these services, with an evidence base that is promising. The notable barrier to the implementation of services is the cost of implementation and sustainability. Organizational factors such as leadership, culture, and climate are consistently identified as barriers and facilitators depending on their valence and appear to be related to implementation outcomes (e.g., on provider attitudes). The current findings need to be integrated into future studies, with a focus on further identifying facilitators (e.g., champions and online programs) of implementation. There is also the need for efforts to address organizational and individual barriers and to compare ways to reduce costs.
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Affiliation(s)
- Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA.
| | - Colleen A Maxwell
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA
| | - Rafaella J Jakubovic
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA
| | - Julia S Ney
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA
| | - Dominique S McKnight
- Department of Psychology and Neuroscience, Temple University, 1701 N. 13thStreet, Philadelphia, PA, 19122, USA
| | - Samantha Baker
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine, 4170 City Avenue, Philadelphia, PA, 19131, USA
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Kendall PC, Ney JS, Maxwell CA, Lehrbach KR, Jakubovic RJ, McKnight DS, Friedman AL. Adapting CBT for youth anxiety: Flexibility, within fidelity, in different settings. Front Psychiatry 2023; 14:1067047. [PMID: 36937729 PMCID: PMC10014836 DOI: 10.3389/fpsyt.2023.1067047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 01/30/2023] [Indexed: 03/05/2023] Open
Abstract
Anxiety disorders are common in youth, associated with impairments in daily functioning, and often persist into adulthood when untreated. Cognitive behavioral therapy (CBT) for youth anxiety is a well-established intervention and has been modified to fit several treatment settings. Despite decades of results supporting the efficacy of CBT, there is a large gap in access to this treatment and a need to consider how it can best be administered flexibly to increase uptake and personalization. We first discuss the core components of treatment for CBT through the lens of the Coping Cat treatment. Next, we review the empirical findings regarding adjustments made for CBT for youth anxiety delivered (a) in schools, (b) in community settings, (c) through telehealth, (d) through online computer programs, and (e) by caregivers at home. In each setting, we provide specific suggestions for how to implement CBT with flexibility while maintaining fidelity.
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Weitz N, Opre A. Combining Dance/Movement Therapy with Cognitive Behavioral Therapy in Treatment of Children with Anxiety Disorders: Factors Explaining Therapists' Attitudes. AMERICAN JOURNAL OF DANCE THERAPY 2022; 44:186-209. [PMID: 36124161 PMCID: PMC9472729 DOI: 10.1007/s10465-022-09369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 12/04/2022]
Abstract
Anxiety disorders (ADs) are among the most common psychiatric disorders and they may appear as early on as in childhood. The current study addressed the combination of two treatments approaches for ADs: Dance/movement therapy (DMT) and cognitive behavioral therapy (CBT), focusing on factors that explain the therapists' attitudes towards actually combining the two therapies. The study utilized a quantitative design, with a perceptions survey administered via an online questionnaire. Ninety-nine therapists participated in the study (DMT-only n = 35, CBT-only n = 42, and DMT + CBT, n = 22). Following preliminary analysis (comparison between the groups, correlations and factor analysis), the structural equation model (SEM, confirmatory factor analysis) revealed a good fit between the theoretical model and the empirical data. First, it was found that the reported actual use of the combined approaches (DMT + CBT) in treatment of children with ADs, was significantly explained by therapists who had experience practicing DMT but not CBT perceiving this combination as efficient. Second, the therapists' use of the combined therapy (DMT + CBT) approaches was not related to their sense of efficacy as therapists of children with ADs. The model represents concordance between the components of the therapists' attitudes: Affective—belief that it is efficient, cognitive—perception of it as effective, and behavioral—their actual use.
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Vaughn S, Grills AE, Capin P, Roberts G, Fall AM, Daniel J. Examining the Effects of Integrating Anxiety Management Instruction Within a Reading Intervention for Upper Elementary Students With Reading Difficulties. JOURNAL OF LEARNING DISABILITIES 2022; 55:408-426. [PMID: 34753334 PMCID: PMC9085973 DOI: 10.1177/00222194211053225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We present findings from the first cohort of third- and fourth-grade students with reading difficulties (128 students from 31 classrooms) who participated in a 2-year intervention examining the effects of a reading intervention with and without anxiety management. Using a randomized controlled trial, students were assigned to one of three conditions: (a) small-group reading intervention with anxiety management instruction (RANX), (b) small-group reading intervention with math fact practice (RMATH), and (c) business-as-usual (BAU) comparison condition (no researcher provided treatment). Personnel from the research team provided participants in the RANX and RMATH the same reading intervention with the variation in the two treatments being whether the same amount of time per lesson was allocated to anxiety management (RANX) or practicing math facts (RMATH). Students in the RANX significantly outperformed students in the BAU on reading comprehension (effect size [ES] = 1.22) and students in the RMATH outperformed BAU on reading comprehension (ES = 0.77). Groups did not differ significantly on other reading outcomes. Reading anxiety moderated the main effect of the RANX intervention on the Test of Word Reading Efficiency (TOWRE) word reading when contrasted against the BAU group, indicating a significant difference favoring RANX where treatment's effect decreased by 0.94 units (about 1 point on the outcome) on word reading for each additional point increase in reading anxiety.
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Psychological and Psychiatric Comorbidities in Youth with Serious Physical Illness. CHILDREN 2022; 9:children9071051. [PMID: 35884035 PMCID: PMC9316756 DOI: 10.3390/children9071051] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
An estimated one in six children in the United States suffers from a mental disorder, including mood, anxiety, or behavioral disorders. This rate is even higher in children with chronic medical illness. This manuscript provides a concise review of the symptoms that comprise mental conditions often observed in children with chronic illness or at the end of life. It further provides some guidance to help clinicians distinguish normative from pathological presentations. Evidence-based psychotherapy interventions, potentially applicable to the acute inpatient setting, are briefly summarized. Broad recommendations are made regarding both psychotherapeutic as well as pharmacotherapeutic interventions, with a review of common or serious medication side effects. Finally, delirium recognition and management are summarized.
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Abstract
In recent years, educational researchers and practitioners have become increasingly interested in new technologies for teaching and learning, including augmented reality (AR). The literature has already highlighted the benefit of AR in enhancing learners’ outcomes in natural sciences, with a limited number of studies exploring the support of AR in social sciences. Specifically, there have been a number of systematic and scoping reviews in the AR field, but no peer-reviewed review studies on the contribution of AR within interventions aimed at teaching or training behavioral skills have been published to date. In addition, most AR research focuses on technological or development issues. However, limited studies have explored how technology affects social experiences and, in particular, the impact of using AR on social behavior. To address these research gaps, a scoping review was conducted to identify and analyze studies on the use of AR within interventions to teach behavioral skills. These studies were conducted across several intervention settings. In addition to this research question, the review reports an investigation of the literature regarding the impact of AR technology on social behavior. The state of the art of AR solutions designed for interventions in behavioral teaching and learning is presented, with an emphasis on educational and clinical settings. Moreover, some relevant dimensions of the impact of AR on social behavior are discussed in more detail. Limitations of the reviewed AR solutions and implications for future research and development efforts are finally discussed.
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Radtke SR, Muskett A, Coffman MF, Ollendick TH. Bibliotherapy for Specific Phobias of Dogs in Young Children: A Pilot Study. JOURNAL OF CHILD AND FAMILY STUDIES 2022; 32:373-383. [PMID: 35462941 PMCID: PMC9015284 DOI: 10.1007/s10826-022-02304-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/18/2022] [Indexed: 06/14/2023]
Abstract
Bibliotherapy, particularly when supplemented with therapist contact, has emerged as an effective treatment for anxiety symptoms in children. However, its effectiveness in treating specific phobias in young children has been explored in only one study which targeted nighttime fears. The current study tested a novel bibliotherapy for fears of dogs in four to seven-year-old children. The therapy was conducted over four weeks and was supplemented with brief, weekly videoconference calls with a therapist. A non-concurrent multiple baseline design was used to evaluate the effectiveness of this treatment in a sample of seven children between four and seven years of age. Significant reductions in specific phobia diagnostic severity, parent and child fear ratings, and child avoidance during a behavioral approach task were all observed. Additionally, treatment adherence, retention, and satisfaction were all high. Future research is needed to replicate the findings in larger, more heterogeneous samples and to explore possible predictive variables; however, this study provides initial support for bibliotherapy as a non-intensive, first-line intervention for specific phobias in young children.
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Affiliation(s)
- Sarah R. Radtke
- Child Study Center, Virginia Tech, 460 Turner Street, Suite 207, Blacksburg, VA 24060 USA
| | - Ashley Muskett
- Child Study Center, Virginia Tech, 460 Turner Street, Suite 207, Blacksburg, VA 24060 USA
| | | | - Thomas H. Ollendick
- Child Study Center, Virginia Tech, 460 Turner Street, Suite 207, Blacksburg, VA 24060 USA
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Andrea Salvaris C, Wade C, Galea S, Bee Hui Yap M, Lawrence KA. Children’s Perspectives of an Enhanced Cognitive-Behavioral Treatment for Child–Parent Dyads With Anxiety Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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15
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Friedberg RD. Pediatrician-friendly perspectives on cognitive behavioral therapy for anxious youth: Current status and clinical implications for the next normal. World J Clin Pediatr 2021; 10:112-123. [PMID: 34868888 PMCID: PMC8603637 DOI: 10.5409/wjcp.v10.i6.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/04/2021] [Accepted: 09/01/2021] [Indexed: 02/06/2023] Open
Abstract
Pediatric anxiety disorders are common and often debilitating conditions. Cognitive is a psychosocial intervention that represents a potentially powerful antidote to these disorders. This article reviews data from treatment outcome studies, meta-analyses, and systematic reviews as well as from moderation/mediational investigations. The literature supports the efficacy, effectiveness, and durability of positive treatment outcomes for pediatric anxiety disorders. Recommendations for clinical applications are suggested.
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Affiliation(s)
- Robert D Friedberg
- Center for the Study and Treatment of Anxious Youth, Palo Alto University, San Jose, CA 95136, United States
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16
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Zaboski BA, Romaker EK. Using Cognitive-Behavioral Therapy with Exposure for Anxious Students with Classroom Accommodations. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2021. [DOI: 10.1080/87568225.2021.1961110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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17
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Luntamo T, Korpilahti-Leino T, Ristkari T, Hinkka-Yli-Salomäki S, Kurki M, Sinokki A, Lamminen K, Saanakorpi K, Saarinen S, Maunuksela M, Sourander S, Toivonen K, Zadkova A, Suilamo M, Casagrande L, Palmroth J, Sourander A. Internet-assisted cognitive behavioural therapy with telephone coaching for anxious Finnish children aged 10-13 years: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e045474. [PMID: 34162641 PMCID: PMC8230974 DOI: 10.1136/bmjopen-2020-045474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Childhood anxiety is common, causes significant functional impairment and may lead to psychosocial problems by adulthood. Although cognitive behavioural therapy (CBT) is effective for treating anxiety, its availability is limited by the lack of trained CBT therapists and easily accessible local services. To address the challenges in both recognition and treatment, this study combines systematic anxiety screening in the general population with a randomised controlled trial (RCT) on internet-assisted CBT (ICBT) with telephone coaching. Child, family and intervention-related factors are studied as possible predictors or moderators, together with the COVID-19 pandemic. METHODS AND ANALYSIS The study is an open two-parallel group RCT, stratified by sex, that compares ICBT with telephone coaching to an education control. Children aged 10-13 are screened at yearly school healthcare check-ups using five items from the Screen for Child Anxiety Related Disorders (SCARED) Questionnaire. The families of children who screen positive for anxiety are contacted to assess the family's eligibility for the RCT. The inclusion criteria include scoring at least 22 points in the 41-item SCARED Questionnaire. The primary outcome is the SCARED child and parent reports. The secondary outcomes include the impact of anxiety, quality of life, comorbidity, peer relationships, perceptions of school, parental well-being and service use. Additional measures include demographics and life events, anxiety disorder diagnoses, as well as therapeutic partnerships, the use of the programme and general satisfaction among the intervention group. ETHICS AND DISSEMINATION The study has been approved by the research ethics board of the Hospital District of South West Finland and local authorities. Participation is voluntary and based on informed consent. The anonymity of the participants will be protected and the results will be published in a scientific journal and disseminated to healthcare professionals and the general public. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT03310489, pre-results, initially released on 30 September 2017.
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Affiliation(s)
- Terhi Luntamo
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Tarja Korpilahti-Leino
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Terja Ristkari
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Sanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Marjo Kurki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Atte Sinokki
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Kaisa Lamminen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Kristiina Saanakorpi
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Susanna Saarinen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Marjukka Maunuksela
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Saana Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Katja Toivonen
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Anna Zadkova
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Miia Suilamo
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Linda Casagrande
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - Johanna Palmroth
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
| | - A Sourander
- Department of Child Psychiatry, University of Turku and Turku University Hospital; INVEST Research Flagship Center, University of Turku, Finland
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18
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Ingul JM, Martinsen K, Adolfsen F, Sund AM, Ytreland K, Bania EV, Lisøy C, Rasmussen LMP, Haug IM, Patras J, Collins LM, Kendall PC, Neumer SP. Inside the Clockwork of the ECHO Factorial Trial: A Conceptual Model With Proposed Mediators for Prevention of Emotional Problems in Children. Front Psychol 2021; 12:703224. [PMID: 34234731 PMCID: PMC8255930 DOI: 10.3389/fpsyg.2021.703224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 05/25/2021] [Indexed: 11/13/2022] Open
Abstract
Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the total interventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8-12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention.
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Affiliation(s)
- Jo Magne Ingul
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristin Martinsen
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Frode Adolfsen
- Faculty of Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare North, UiT The Arctic University of Norway, Tromsø, Norway
| | - Anne Mari Sund
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,St Olav's University Hospital, Trondheim, Norway
| | - Kristin Ytreland
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Elisabeth Valmyr Bania
- Regional Centre for Child and Youth Mental Health and Child Welfare (RKBU), Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Carina Lisøy
- Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Norway.,Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Lene-Mari Potulski Rasmussen
- Faculty of Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare North, UiT The Arctic University of Norway, Tromsø, Norway
| | - Ida Mari Haug
- Faculty of Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare North, UiT The Arctic University of Norway, Tromsø, Norway
| | - Joshua Patras
- Faculty of Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare North, UiT The Arctic University of Norway, Tromsø, Norway
| | - Linda M Collins
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, United States
| | - Philip C Kendall
- Department of Psychology, Temple University, Philadelphia, PA, United States
| | - Simon Peter Neumer
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.,Faculty of Health Sciences, Regional Centre for Child and Youth Mental Health and Child Welfare North, UiT The Arctic University of Norway, Tromsø, Norway
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19
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Petts RA, Gaynor ST. Behavioral Health in Primary Care: Brief Screening and Intervention Strategies for Pediatric Clinicians. Pediatr Clin North Am 2021; 68:583-606. [PMID: 34044987 DOI: 10.1016/j.pcl.2021.02.010] [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] [Indexed: 11/30/2022]
Abstract
Despite the high prevalence of behavioral health concerns presenting in pediatric primary care and the growing support for integrating behavioral health services into this setting, a majority of primary care providers do not have access to on-site behavioral health specialists. Fortunately, primary care providers can implement some services typically provided by behavioral health clinicians. This article outlines screening, brief intervention, and referral guidelines for prominent behavioral health problems seen in primary care. The evidence-based approaches have the potential to supplement typical management of behavioral health problems in primary care and provide a foundation for future integrated behavioral health practice.
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Affiliation(s)
- Rachel A Petts
- Department of Psychology, Wichita State University, 1845 Fairmount Street, Wichita, KS 67260, USA.
| | - Scott T Gaynor
- Department of Psychology, Western Michigan University, 1903 West Michigan Avenue, Kalamazoo, MI 49008, USA
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20
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Social Anxiety in Victimization and Perpetration of Cyberbullying and Traditional Bullying in Adolescents with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115728. [PMID: 34073617 PMCID: PMC8198472 DOI: 10.3390/ijerph18115728] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/24/2021] [Indexed: 11/17/2022]
Abstract
Victimization and perpetration of cyberbullying and traditional bullying are prevalent among adolescents with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). The aims of this study were to examine the role of social anxiety in victimization and perpetration of cyberbullying and traditional bullying in adolescents with ASD and ADHD in Taiwan. A total of 219 adolescents with ASD and 287 adolescents with ADHD aged 11–18 years and their caregivers were recruited from the child psychiatry outpatient clinics into this study. The associations of social anxiety with victimization and perpetration of cyberbullying and traditional bullying were examined using logistic regression analysis. The results indicated that after the effects of sex, age, and autistic social impairment were controlled, social anxiety increased the risk of being a victim of cyberbullying (Odds Ratios (OR) = 1.048; 95% Confidence Interval (CI): 1.013–1.084), a victim of traditional bullying (OR = 1.066; 95% CI: 1.036–1.097), and a perpetrator of traditional bullying (OR = 1.061; 95% CI: 1.027–1.096) in adolescents with ASD. After the effects of sex, age, and ADHD symptoms were controlled for, social anxiety increased the risk of being a victim of traditional bullying in adolescents with ADHD (OR = 1.067; 95% CI: 1.039–1.096). Social anxiety was significantly associated with several forms of bullying involvement in adolescents with ASD and ADHD and warrants being considered into prevention and intervention programs for bullying involvement.
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21
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Oerbeck B, Overgaard KR, Attwood T, Bjaastad JF. "Less stress": a pilot study on a cognitive behavioral treatment program for anxiety in children with autism spectrum disorders. Scand J Child Adolesc Psychiatr Psychol 2021; 9:30-40. [PMID: 33928052 PMCID: PMC8077410 DOI: 10.21307/sjcapp-2021-005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background: Comorbid anxiety disorders are prevalent in children with autism spectrum disorders (ASD), but only a minority receives adequate treatment for anxiety. Cognitive behavioral therapy (CBT) has been shown to be effective in treating anxiety disorders. The objectives of the present pilot study were to test the feasibility of the CBT program “Less stress” for comorbid anxiety disorders in children with ASD and explore whether an improvement in diagnostic outcomes for anxiety disorders and symptoms of anxiety was found after treatment. Methods: Participants were ten children diagnosed with ASD and anxiety disorders (eight boys, mean age = 9.5 years, range 8 - 12 years). The “Less Stress” program includes three months of weekly treatment sessions followed by three monthly booster sessions. Five therapists participated. A standardized semi-structured diagnostic interview with the mothers was used to assess comorbid disorders. Child anxiety symptoms were measured with the Revised Child Anxiety and Depression Scale (RCADS). Results: The therapists found the manual easy to use but adaptations were necessary, particularly shorter sessions due to frequent (n = 7) comorbid Attention-Deficit/Hyperactivity Disorder. The participants found the program useful and the parents noted that they had learned methods they could continue using after the end of the program. Eight of ten children completed the treatment. Seven of the eight completers benefited from the program. Five of those seven children were free from all anxiety disorders, while two had fewer anxiety disorders. On a group level, a significant mean reduction of anxiety symptoms (RCADS) was found after treatment. Conclusion: The therapists found the “Less stress” program to be a feasible intervention in a sample of children with ASD and comorbid anxiety. The significant reduction of anxiety after treatment is promising, but a replication in a larger and more rigorous study is needed to investigate the effectiveness of the intervention.
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Affiliation(s)
- Beate Oerbeck
- Oslo University Hospital, Division of Mental Health and Addiction, Oslo, Norway
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22
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Khan AN, Bilek E, Tomlinson RC, Becker-Haimes EM. Treating Social Anxiety in an Era of Social Distancing: Adapting Exposure Therapy for Youth During COVID-19. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:669-678. [PMID: 33564222 PMCID: PMC7862041 DOI: 10.1016/j.cbpra.2020.12.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 12/19/2020] [Indexed: 11/21/2022]
Abstract
The novel coronavirus (COVID-19) pandemic has caused widespread disruption to our traditional way of life and mental health therapy has not been spared. A combination of increased anxiety, diminished social opportunities, and the shift to telehealth service provision presents particular challenges for the treatment of social anxiety in youth, which relies heavily on exposures to social situations with peers, adults, or other feared social stimuli. The objective of this commentary is to provide guidance to clinicians working with youth with social anxiety on how to maintain ethical, evidence-informed provision of exposure therapy in light of these unusual circumstances. We first present an overview of how COVID-19 may uniquely impact youth with social anxiety and highlight the importance of continuing to provide exposure-based treatments during this time. We then discuss guiding principles for delivering exposure therapy during COVID-19. We focus on providing practical examples of how common social anxiety exposures can be adapted and delivered successfully through telehealth while abiding by COVID-19 social distancing guidelines. Finally, we discuss key recommendations to assist clinicians in moving treatment forward while considering changing safety guidelines pertaining to COVID-19.
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Affiliation(s)
- Anika N Khan
- University of Pennsylvania and Hall Mercer Community Mental Health, University of Pennsylvania Health System
| | | | | | - Emily M Becker-Haimes
- University of Pennsylvania and Hall Mercer Community Mental Health, University of Pennsylvania Health System
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23
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Luo A, McAloon J. Potential mechanisms of change in cognitive behavioral therapy for childhood anxiety: A meta-analysis. Depress Anxiety 2021; 38:220-232. [PMID: 33225527 DOI: 10.1002/da.23116] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 09/24/2020] [Accepted: 11/01/2020] [Indexed: 11/06/2022] Open
Abstract
Cognitive-behavioral therapy (CBT) is regarded as an effective treatment for anxiety disorders in childhood. Researchers have begun to investigate potential mechanisms of change that drive these positive outcomes, including shifts in cognitions, behavior, and affect. However, few studies have established the mediational effects of these factors as a proxy for establishing mechanistic change. This meta-analysis attempts to synthesize the literature on potential mechanisms of change in CBT for childhood anxiety and investigates the mediational effects of these factors on treatment outcomes. Seventeen studies met the inclusion criteria. Across studies, five potential mediators were identified: externalizing difficulties, negative self-talk, coping, fear, and depression. Results indicated that CBT was effective in improving outcomes on all potential mediators, except for fear. Mediational analyses showed that externalizing difficulties, negative self-talk, coping, and depression mediated anxiety following treatment. Fear did not mediate the relationship. Implications for future mechanisms of change research are proposed.
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Affiliation(s)
- Aileen Luo
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia.,Department of Psychology, Macquarie University, NSW, Australia
| | - John McAloon
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, NSW, Australia
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24
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Morrissette M. School Closures and Social Anxiety During the COVID-19 Pandemic. J Am Acad Child Adolesc Psychiatry 2021; 60:6-7. [PMID: 32890669 PMCID: PMC7467010 DOI: 10.1016/j.jaac.2020.08.436] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/13/2020] [Accepted: 08/31/2020] [Indexed: 11/19/2022]
Abstract
In their recent systematic review, Loades et al.1 reported on the effects that social isolation and loneliness may have on children and adolescents during the global 2019 novel coronavirus disease (COVID-19) pandemic, with their findings suggesting associations between social anxiety and loneliness/social isolation. While this is undoubtedly true for many children and adolescents, it is also worth commenting on the subset of children and youths with social phobia for whom a temporary lessening of distress may be observed while schools are closed owing to a lack of exposure to anxiety-provoking situations in the school environment.
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25
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Hirshfeld-Becker DR, Henin A, Rapoport SJ, Wilens TE, Carter AS. Very early family-based intervention for anxiety: two case studies with toddlers. Gen Psychiatr 2019; 32:e100156. [PMID: 31922092 PMCID: PMC6936974 DOI: 10.1136/gpsych-2019-100156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 11/30/2022] Open
Abstract
Anxiety disorders represent the most common category of psychiatric disorder in children and adolescents and contribute to distress, impairment and dysfunction. Anxiety disorders or their temperamental precursors are often evident in early childhood, and anxiety can impair functioning, even during preschool age and in toddlerhood. A growing number of investigators have shown that anxiety in preschoolers can be treated efficaciously using cognitive-behavioural therapy (CBT) administered either by training the parents to apply CBT strategies with their children or through direct intervention with parents and children. To date, most investigators have drawn the line at offering direct CBT to children under the age of 4. However, since toddlers can also present with impairing symptoms, and since behaviour strategies can be applied in older preschoolers with poor language ability successfully, it ought to be possible to apply CBT for anxiety to younger children as well. We therefore present two cases of very young children with impairing anxiety (ages 26 and 35 months) and illustrate the combination of parent-only and parent-child CBT sessions that comprised their treatment. The treatment was well tolerated by parents and children and showed promise for reducing anxiety symptoms and improving coping skills.
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Affiliation(s)
- Dina R Hirshfeld-Becker
- Child CBT Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Aude Henin
- Child CBT Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Stephanie J Rapoport
- Child CBT Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Timothy E Wilens
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Alice S Carter
- Department of Psychology, University of Massachusetts Boston, Boston, Massachusetts, USA
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26
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Samsel C, Tapsak S, Thomson K, McKenna K, McGregor K, Forbes P, Ibeziako P. Psychotropic medication use trends in a large pediatric and young adult solid organ transplant population. Pediatr Transplant 2019; 23:e13380. [PMID: 30786113 DOI: 10.1111/petr.13380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/08/2019] [Accepted: 01/18/2019] [Indexed: 01/30/2023]
Abstract
INTRODUCTION This study describes psychotropic medication use in a pediatric and young adult solid organ transplant population. METHODS We conducted a retrospective review of the lifetime incidence of psychotropic medication use and associated characteristics in patients seen over a 6-year period at a large pediatric transplant center utilizing univariate and multivariate statistical analyses. RESULTS The lifetime incidence of psychotropic medication use was 36.5% in 393 patients. Transplant psychiatry provided psychopharmacological consultation to 21.9% of patients. Controlling for age and sex, there were significant associations between psychotropic use and thoracic organ disease (heart/lung) (AOR = 2.14; 95% CI: 1.2-3.8; P = 0.01), White race (P = 0.0002), histories of depressive/mood disorders (AOR = 3.68; 95% CI: 1.8-7.7; P = 0.0005), attention/learning disorders (AOR = 3.30; 95% CI: 1.6-6.9; P = 0.001), acute and post-traumatic stress disorders (AOR = 10.54; 95% CI: 2.6-42.8; P = 0.001), and experiencing bullying (AOR = 2.16; 95% CI: 1.03-4.55; P = 0.04). In unadjusted tests, significant associations were found between lifetime psychotropic usage and patient anxiety history (OR = 2.26; 95% CI: 1.5-3.5; P = 0.0002), end-of-life disease progression (OR = 3.04; 95% CI: 1.7-5.4; P = 0.0002), family psychiatric history (OR = 2.17; 95% CI: 1.4-3.4; P = 0.0007), and adherence concerns (OR = 2.67; 95% CI: 1.7-4.1; P < 0.0001). DISCUSSION The lifetime incidence of psychotropic medication use among pediatric and young adult transplant patients is substantial. Patients with thoracic organ disease, end-of-life illness, individual/family psychiatric histories, trauma, and bullying histories have particularly high rates. Integrating child psychiatry as part of pediatric transplant teams should be an important consideration for the care of these patients.
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Affiliation(s)
- Chase Samsel
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Boston Children's Hospital Pediatric Transplant Center, Boston, Massachusetts.,Dana-Farber Cancer Institute Department of Psychosocial Oncology and Palliative Care, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Sara Tapsak
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Katharine Thomson
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Kristine McKenna
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Boston Children's Hospital Pediatric Transplant Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Kerry McGregor
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Peter Forbes
- Boston Children's Hospital Clinical and Translational Research Program, Boston, Massachusetts
| | - Patricia Ibeziako
- Boston Children's Hospital Department of Psychiatry, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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27
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Abstract
PURPOSE OF REVIEW This review describes (a) key features of the metacognitive model as they relate to anxiety and related disorders, (b) central components of metacognitive therapy (MCT), (c) the current empirical status of MCT, (d) recent developments, (e) controversies and (f) future research directions. RECENT FINDINGS Evidence is accumulating that MCT is effective for anxiety and related disorders. Emerging evidence suggests that MCT may be effective with children and adolescents and compares well to other evidence-supported treatments such as cognitive behaviour therapy and mindfulness-based approaches. Evidence for distinct mechanisms across therapies is mixed. While MCT appears to be effective for anxiety and related disorders, more research is required to evaluate (a) efficacy and unique (vs. common) mechanisms of change compared to other therapies, (b) effectiveness for children and adolescents, (c) alternative delivery methods (e.g., via internet, group vs. individual), (d) transdiagnostic impacts and (e) applications to a broader array of disorders.
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