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Klein A, Hagen A, Rahemenia J, de Gier E, Rapee R, Nauta M, de Bruin E, Biesters J, van Rijswijk L, Bexkens A, Baartmans J, Mobach L, Zimmermann R, Krause K, Bögels S, Ollendick T, Schneider S. Combining one-session treatment with a homework program including app-based technology to enhance the treatment of childhood specific phobias: A study protocol of a multicenter pragmatic randomized controlled trial. Contemp Clin Trials Commun 2024; 41:101346. [PMID: 39188411 PMCID: PMC11345506 DOI: 10.1016/j.conctc.2024.101346] [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: 02/10/2024] [Revised: 07/24/2024] [Accepted: 07/27/2024] [Indexed: 08/28/2024] Open
Abstract
Introduction Childhood specific phobias are among the most common and earliest onset mental disorders with a lifetime prevalence of more than ten percent. Brief intensive cognitive behavioral therapy (CBT) programs such as the One-Session Treatment (OST) are found to be effective in the remission of the specific phobias following treatment, but there is still room for improvement. The goal of the current study is to examine whether the long-term efficacy of OST increases by using a homework program supported by an app specifically designed for children; the Kids Beat Anxiety (KibA) homework program. Methods Children aged between 7 and 14 years with a specific phobia receive OST preceded by a three-week baseline phase to control for time-effects. Directly following OST, children are randomized to either a four-week homework period supported by an app (OST + app), or standard One-Session Treatment with a four-week homework period that is only supported by therapist instructions (OST-only). Primary outcome variables are diagnosis and severity of the specific phobia. Secondary outcomes include behavioral avoidance, self-reported fear, and functional impairment. Data will be analyzed based on intention-to-treat and per protocol samples using mixed-effects multilevel linear models. Ethics and dissemination The current study was approved by the METC of the Academic Medical Center, Amsterdam, The Netherlands (number: NL72697.018.20) and the Ethical Committee of the Ruhr University, Bochum, Germany (number: 663). Results of this trial will be published in peer-reviewed journals. Trial registration The study was pre-registered at the Dutch Trial Register, number: NL 9216.
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Affiliation(s)
- A.M. Klein
- Developmental and Educational Psychology, Leiden University, the Netherlands
| | - A. Hagen
- Developmental and Educational Psychology, Leiden University, the Netherlands
| | - J. Rahemenia
- Developmental and Educational Psychology, Leiden University, the Netherlands
| | | | - R.M. Rapee
- Centre for Emotional Health, Macquarie University, Australia
| | - M. Nauta
- Faculty of Behavioral and Social Sciences, University of Groningen, the Netherlands
- Accare Child Study Center, Groningen, the Netherlands
| | - E. de Bruin
- UvA Minds, Amsterdam, the Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, the Netherlands
| | | | | | - A. Bexkens
- Developmental and Educational Psychology, Leiden University, the Netherlands
| | | | - L. Mobach
- Developmental Psychology, University of Amsterdam, the Netherlands
| | - R. Zimmermann
- Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Germany
| | - K. Krause
- Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Germany
| | - S.M. Bögels
- Developmental Psychology, University of Amsterdam, the Netherlands
| | - T.H. Ollendick
- Child Study Center, Department of Psychology, Virginia Tech, USA
| | - S. Schneider
- Mental Health Research and Treatment Center (FBZ), Ruhr University Bochum, Germany
- German Center for Mental Health (DZPG), Germany
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Gittins Stone DI, Elkins RM, Gardner M, Boger K, Sperling J. Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis. Child Psychiatry Hum Dev 2024; 55:1398-1412. [PMID: 36749490 PMCID: PMC9902833 DOI: 10.1007/s10578-023-01500-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2023] [Indexed: 02/08/2023]
Abstract
Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.
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Affiliation(s)
| | - R Meredith Elkins
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | | | - Kathryn Boger
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Jacqueline Sperling
- McLean Hospital Belmont, Belmont, MA, USA
- Harvard Medical School, Cambridge, MA, USA
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3
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Siegel P, Peterson BS. Advancing the treatment of anxiety disorders in transition-age youth: a review of the therapeutic effects of unconscious exposure. J Child Psychol Psychiatry 2024. [PMID: 39128857 DOI: 10.1111/jcpp.14037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND The real-world effectiveness of exposure-based therapies for youth depends on the willingness and ability of young people to tolerate confronting their fears, which can be experienced as highly aversive and create problems with treatment engagement and acceptance. Recently, neuroscientific research on the nonconscious basis of fear has been translated into novel exposure interventions that bypass conscious processing of feared stimuli and that thus do not cause phobic youth to experience distress. We present a review of these unconscious exposure interventions. METHODS A PRISMA-based search yielded 20 controlled experiments based on three paradigms that tested if fear-related responses could be reduced without conscious awareness in highly phobic, transition-age youth: 14 randomized controlled trials (RCTs), 5 fMRI studies (1 was also an RCT), 4 psychophysiological studies (3 were also RCTs), and 1 ERP study. We conducted meta-analyses of outcomes where feasible. RESULTS Unconscious exposure interventions significantly (1) reduced avoidance behavior (range of Cohen's d = 0.51-0.95) and self-reported fear (d = 0.45-1.25) during in vivo exposure to the feared situation; (2) reduced neurobiological indicators of fear (d = 0.54-0.62) and concomitant physiological arousal (d = 0.55-0.64); (3) activated neural systems supporting fear regulation more strongly than visible exposure to the same stimuli (d = 1.2-1.5); (4) activated regions supporting fear regulation that mediated the reduction of avoidance behavior (d = 0.70); (5) evoked ERPs suggesting encoding of extinction memories (d = 2.13); and (6) had these effects without inducing autonomic arousal or subjective fear. CONCLUSIONS Unconscious exposure interventions significantly reduce a variety of symptomatic behaviors with mostly moderate effect sizes in transition-age youth with specific phobias. fMRI and physiological findings establish a neurophysiological basis for this efficacy, and suggest it occurs through extinction learning. Unconscious exposure was well tolerated, entirely unassociated with drop out, and is highly scalable for clinical practice. However, a number of limitations must be addressed to assess potential clinical impacts, including combining unconscious exposure with exposure therapy to boost treatment acceptance and efficacy.
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Affiliation(s)
- Paul Siegel
- Department of Psychology, Purchase College, State University of New York, Purchase, NY, USA
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Bradley S Peterson
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Psychiatry, Children's Hospital Los Angeles, Institute for the Developing Mind, Los Angeles, CA, USA
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Cohen KA, Ito S, Ahuvia IL, Yang Y, Zhang Y, Renshaw TL, Larson M, Cook C, Hill S, Liao J, Rapoport A, Smock A, Yang M, Schleider JL. Brief School-Based Interventions Targeting Student Mental Health or Well-Being: A Systematic Review and Meta-Analysis. Clin Child Fam Psychol Rev 2024:10.1007/s10567-024-00487-2. [PMID: 38884838 DOI: 10.1007/s10567-024-00487-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2024] [Indexed: 06/18/2024]
Abstract
Brief, school-based mental health interventions hold promise for reducing barriers to mental health support access, a critical endeavor in light of increasing rates of mental health concerns among youth. However, there is no consensus on whether or not brief school-based interventions are effective at reducing mental health concerns or improving well-being. This systematic review and meta-analysis aims to provide consensus and determine directions for future work. Articles were included if they examined a brief (≤ four sessions or 240 min of intervention time) psychosocial intervention, were conducted within a Pre-K through 12th-grade school setting, included at least one treatment outcome evaluating mental health or well-being, and were published since 2000. A total of 6,702 papers were identified through database searching, of which 81 papers (k studies = 75) were ultimately selected for inclusion. A total of 40,498 students were included across studies and a total of 75 unique interventions were examined. A total of 324 effect sizes were extracted. On average, interventions led to statistically significant improvements in mental health/well-being outcomes versus control conditions up to one-month (g = .18, p = .004), six-month (g = .15, p = .006), and one-year (g = .10, p = .03) post-intervention. There may be benefits to brief school-based interventions from a preventative public health standpoint; future research may focus on how to optimize their real-world utility. Prospero pre-registration: CRD42021255079.
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Affiliation(s)
- Katherine A Cohen
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Sakura Ito
- Department of Psychology, Stony Brook University, Stony Brook, USA
| | - Isaac L Ahuvia
- Department of Psychology, Stony Brook University, Stony Brook, USA
| | | | - Yanchen Zhang
- Department of Psychological and Quantitative Foundations, University of Iowa, Iowa, USA
| | | | | | | | - Shannon Hill
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Jessica Liao
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Andy Rapoport
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Amanda Smock
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Michelle Yang
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA
| | - Jessica L Schleider
- Department of Medical Social Sciences, Northwestern University, 625 N Michigan Ave, Chicago, IL, 60611, USA.
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Davis TE, Brennan J. Specific Phobia, Fear, and the Autism Spectrum in Children and Adolescents: Adapting OST for ASD. Clin Child Fam Psychol Rev 2024; 27:509-522. [PMID: 38632150 DOI: 10.1007/s10567-024-00475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/19/2024]
Abstract
Fears and phobias are a common mental health concern for youth, and particularly for autistic youth. The following review briefly summarizes the extant literature on specific phobias and specific phobias in autistic youth. The evidence base is briefly highlighted pointing to the strong base behind behavioral and cognitive-behavioral treatments and techniques. A broad discussion of key evidence-based treatment findings is presented, leading up to the impactful work of Thomas H. Ollendick in researching Öst's One-Session Treatment (OST) with children and adolescents. OST for child specific phobias is discussed, and particular emphasis is given to this treatment's ongoing adaptation for use with youth on the autism spectrum.
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Affiliation(s)
- Thompson E Davis
- Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall, Box 870348, Tuscaloosa, AL, 35487, USA.
- Department of Psychology, Louisiana State University, Baton Rouge, LA, USA.
| | - Justine Brennan
- Department of Psychology, The University of Alabama, 348 Gordon Palmer Hall, Box 870348, Tuscaloosa, AL, 35487, USA
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Klein AM, Hagen A, Mobach L, Zimmermann R, Baartmans JMD, Rahemenia J, de Gier E, Schneider S, Ollendick TH. The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology. Clin Child Fam Psychol Rev 2024; 27:602-625. [PMID: 38616213 PMCID: PMC11222243 DOI: 10.1007/s10567-024-00476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043-1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303-311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138-144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616-629, 2013; Kendall et al. Cogn Behav Pract 12:136-148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34-43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.
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Affiliation(s)
- Anke M Klein
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands.
| | - Annelieke Hagen
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | - Lynn Mobach
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Pro Persona Institute for Integrated Mental Health Care, Wolfheze, The Netherlands
| | - Robin Zimmermann
- Mental Health Research and Treatment Center (FBZ), Ruhr University, Bochum, Germany
| | | | - Jasmin Rahemenia
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | | | - Silvia Schneider
- Mental Health Research and Treatment Center (FBZ), Ruhr University, Bochum, Germany
| | - Thomas H Ollendick
- Department of Psychology, Child Study Center, Virginia Tech, Blacksburg, USA
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7
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Koet LBM, Gerger H, Jansen W, Bindels PJE, de Schepper EIT. Evaluation of practice nurses' management of paediatric psychosocial problems in general practice. J Public Health (Oxf) 2024; 46:e261-e268. [PMID: 38299893 PMCID: PMC11141612 DOI: 10.1093/pubmed/fdae008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/18/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Child mental health services are under major pressure worldwide. In the Netherlands, Youth Mental Health Practice Nurses (YMHPNs) have been introduced in general practice to improve access to care. In this study, we evaluated care delivered by YMHPNs. METHODS We used medical records of a population-based cohort (21 717 children, 0-17 years). Characteristics of children consulting a YMHPN, type of problem, care delivered by YMHPNs and referrals were assessed using quantitative content analysis. RESULTS Records of 375 children (mean age 12.9 years, 59.2% girl) were analysed. These children were often in their adolescence (57.3% was between 13 and 17 years), and more often female than male (59.2% vs 40.8%). YMHPNs had a median of four consultations (IQR 2-7) with the child. YMHPNs managed a variety of psychosocial problems. YMHPNs managed 22.4% of children without need of referral, 52.0% were eventually referred for additional care. 13.3% of children dropped out during the treatment trajectory. In the remaining 12.3% of children, the treatment trajectory was stopped because the child was already attending specialized services, the treatment trajectory was still ongoing or the medical record was inconclusive. CONCLUSIONS YMHPNs successfully managed one in four children with psychosocial problems without need for referral. Nevertheless, most children were eventually referred for additional care.
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Affiliation(s)
- Lukas B M Koet
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
| | - Heike Gerger
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
- Department of Clinical Psychology, Open University, 6419 AT Heerlen, the Netherlands
| | - Wilma Jansen
- Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
- Department of Youth, City of Rotterdam, Rotterdam, The Netherlands
| | - Patrick J E Bindels
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC, University Medical Centre Rotterdam, 3000 CA Rotterdam, the Netherlands
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McCarty RJ, Downing ST, Guastello AD, Lazaroe LM, Ordway AR, MirHosseini T, Barthle-Herrera MA, Cooke DL, Mathews CA, McNamara JPH. Implementation and Preliminary Outcomes of an Exposure-Based Summer Camp for Pediatric OCD and Anxiety. Behav Ther 2024; 55:543-557. [PMID: 38670667 DOI: 10.1016/j.beth.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 04/28/2024]
Abstract
Despite the high prevalence of anxiety disorders in children and adolescents and the existence of effective evidence-based treatments for them, access to psychological care remains a major public health concern. Summer camps may provide an effective treatment avenue for youth who might not otherwise have access to care. This study describes the design and implementation of Fear Facers, a semistructured, 5-day, daytime exposure-therapy-based summer camp designed for youth with a primary diagnosis of obsessive-compulsive disorder (OCD), social anxiety, separation anxiety, or a specific phobia. Preliminary data regarding feasibility and patient outcomes is also reported. Among 52 children and adolescents aged 7 to 16 who attended one of six camp sessions between 2018 and 2021, significant reductions in anxiety (d = 0.54) and OCD symptoms (d = 0.57) were observed from pre-camp to immediately post-camp. A subset of campers who were followed for an additional 3 months post-camp (n = 22) showed maintenance of treatment gains. Retention rates for the intervention were high. Our investigation provides further support for the use of a camp-based design for cognitive-behavioral approaches, and may provide a unique setting to maximize elements of inhibitory learning in exposures. We also discuss a number of elements regarding feasibility that need consideration for those hoping to develop similar interventions.
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Affiliation(s)
- Ryan J McCarty
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders.
| | - Seth T Downing
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Andrea D Guastello
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Lacie M Lazaroe
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Ashley R Ordway
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Tannaz MirHosseini
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Megan A Barthle-Herrera
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Danielle L Cooke
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Carol A Mathews
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Joseph P H McNamara
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
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9
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Baartmans JMD, van Steensel BFJA, Kossakowski JJ, Klein AM, Bögels SM. Intergenerational relations in childhood anxiety: A network approach. Scand J Psychol 2024; 65:346-358. [PMID: 37966048 DOI: 10.1111/sjop.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE Family factors are assumed to play a central role in the development of childhood anxiety disorders. How child and parental anxiety symptoms are intertwined on a symptom and family level has not yet been examined. Such knowledge may lead to a more detailed understanding of the intergenerational relation in anxiety problems. The current study investigated the relation between anxiety in children and their parents at a symptom level using a network approach. METHOD Parents of 1,452 clinically referred children in the Netherlands completed questionnaires on anxiety about their children and themselves. We examined relations on a symptom level both within persons and between parents and children. In addition, we also compared the relations between parental and child anxiety symptoms in families with children with an anxiety disorder (n = 350) versus families with children who displayed other psychiatric diagnoses (n = 1,102). RESULTS Anxiety symptom relations within persons were more intertwined than the symptom relations between family members. Between-person relations were found among similar anxiety symptoms, suggesting specific intergenerational relations. The feeling of being fearful was found to be a central and connecting symptom in all family members (fathers, mothers, and children). The relations between parental and child anxiety symptoms were more specific (i.e., among similar symptoms) in families with children with an anxiety disorder than in families with children with other types of psychopathologies. CONCLUSIONS This study found that anxiety symptom associations are present within the family on a detailed (symptom) level. This stresses the importance of future studies to examine factors responsible for this family-anxiety transmission.
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Affiliation(s)
- Jeanine M D Baartmans
- UvA Minds, Academic Treatment Centre, Amsterdam, The Netherlands
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Anke M Klein
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | - Susan M Bögels
- Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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Khaleghi A, Narimani A, Aghaei Z, Khorrami Banaraki A, Hassani-Abharian P. A Smartphone-Gamified Virtual Reality Exposure Therapy Augmented With Biofeedback for Ailurophobia: Development and Evaluation Study. JMIR Serious Games 2024; 12:e34535. [PMID: 38446522 PMCID: PMC10955409 DOI: 10.2196/34535] [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: 10/28/2021] [Revised: 10/17/2022] [Accepted: 07/10/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND To the best of our knowledge, no specialized research has been conducted to address ailurophobia (fear of cats) in Iran or globally. This has driven our project, along with the prevalence of ailurophobia and the absence of a gamified virtual reality exposure therapy (VRET) that incorporates affordable and easily accessible biofeedback (BF) tools. We hypothesize that a gamified VRET augmented with BF will yield more positive effects than a similar device lacking BF. OBJECTIVE This study primarily focuses on the development and preliminary evaluation of a smartphone-gamified VRET integrated with BF, targeting animal phobia, with a specific case study on ailurophobia. The secondary objectives are using affordable and readily available BF found in devices such as smart bands and smartwatches and creating a mobile virtual reality gamified app to improve patients' adherence to treatments while simultaneously enhancing the app's accessibility, scalability, and outreach. METHODS Evaluations encompassed 3 methods. First, we identified the tool's potential positive effects on phobia interventions, exploring 4 effects: intrinsic motivation, simulation of fearful situations, management of stressful circumstances without therapists' presence and mitigation of catastrophic thoughts, and preliminary effects on ailurophobia treatment. Participants were divided into BF and non-BF groups. Second, we gathered user preferences and opinions about the treatment. Third, we conducted heuristic evaluations using 44 heuristics from existing system usability scales assessing user interfaces, virtual reality platforms, and video games' playability. To interpret the data, mean scores; ANOVA, single factor; and ANOVA, 2-factor with replication were used. A total of 29 individuals were identified, of which 10 met the eligibility criteria or were accessible. RESULTS The smartphone-gamified VRET augmented with BF exhibited better results on the identified effects compared with the non-BF version and contributed to normalizing encounters with cats. Moreover, 41 of the 44 heuristics achieved a percentage above 62%, indicating its potential as a therapeutic product and its ability to enhance patient adherence to treatments. Patient preferences on the treatment and its strengths and weaknesses were provided for further improvement. CONCLUSIONS The tool has the potential to evolve into a comprehensive solution by incorporating various types of cats and their behaviors, simulating environments in which they are commonly found, and enhancing its appeal through an increased sense of adventure without inducing unrealistic fears. By adapting fear elements, the game can be tailored to treat various animal phobias. Phobia-focused games should avoid action and combat scenarios to prevent reinforcement of fear responses. After rigorous evaluation, further exploration is required to provide remote use beyond clinical settings.
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Affiliation(s)
- Ali Khaleghi
- Iranian Light Source Facility, Institute for Research in Fundamental Sciences, Tehran, Iran
| | - Abbas Narimani
- Department of Computer Engineering, Imam Khomeini International University, Qazvin, Iran
| | - Zahra Aghaei
- Department of Computer Engineering, Bu-Ali Sina University, Hamedan, Iran
| | - Anahita Khorrami Banaraki
- Brain and Cognition Clinic, Institute for Cognitive Science Studies, Tehran, Iran
- Department of Cognitive Psychology and Rehabilitation, Institute for Cognitive Science Studies, Tehran, Iran
| | - Peyman Hassani-Abharian
- Brain and Cognition Clinic, Institute for Cognitive Science Studies, Tehran, Iran
- Department of Cognitive Psychology and Rehabilitation, Institute for Cognitive Science Studies, Tehran, Iran
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11
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Hansen B, Eide TO, Reiråskag MA, Tjelle KA, Solem S, Hagen K. The Bergen 4-day treatment for social anxiety disorder: a pilot study. BMC Psychiatry 2024; 24:145. [PMID: 38383324 PMCID: PMC10880199 DOI: 10.1186/s12888-024-05607-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Few studies have examined the use of concentrated and intensified cognitive behaviour therapy for treating social anxiety disorder (SAD). The aim of this study was to examine the feasibility of the Bergen 4-Day Treatment (B4DT) for treating SAD. METHODS This study adopted an open trial design without a control group. Thirty consecutively referred patients who were diagnosed with SAD were treated and assessed at pre-treatment, at post-treatment, and at the 3-month follow-up. The Liebowitz Social Anxiety Scale was used to assess symptoms of SAD; the Generalized Anxiety Disorder-7 scale was used to assess anxiety symptoms; and the Patient Health Questionnaire-9 was used to assess symptoms of anxiety and depression. The Client Satisfaction Questionnaire-8 was administered posttreatment. RESULTS Overall, patients reported a high level of satisfaction with the B4DT. Large effect sizes were observed for symptoms of SAD (d = 1.94-2.66) and for the secondary outcomes, i.e., generalized anxiety (d = 0.86-0.99) and depression (d = 0.62-0.83). The remission rate was 55.2% at follow-up, while the treatment response rate was 89.7%. CONCLUSIONS The B4DT is a promising treatment approach for patients with SAD. In the future, controlled trials should be performed to compare the efficacy of this treatment approach with standard outpatient treatment. Practical consequences, policy implications, and suggestions for future research are discussed herein.
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Affiliation(s)
- Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Thorstein Olsen Eide
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway
| | | | - Kristian August Tjelle
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Department of Psychiatry, Molde Hospital, Møre Og Romsdal Hospital Trust, Molde, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
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Skjold SH, Hagen K, Wheaton MG, Hjelle KM, Björgvinsson T, Hansen B. The effectiveness and acceptability of the Bergen 4-day treatment for adolescents with OCD: a replication and extension. BMC Psychiatry 2024; 24:148. [PMID: 38383351 PMCID: PMC10882780 DOI: 10.1186/s12888-024-05601-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/08/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND B4DT is a concentrated treatment format with prolonged sessions of exposure and ritual prevention (ERP) delivered over four consecutive days. Two previous open trials demonstrated promising results of the Bergen 4-day treatment (B4DT) for adolescents with obsessive-compulsive disorder (OCD). The aim of the current study was to replicate the initial results with a new sample of adolescents and different therapists at different sites across Norway. METHODS Forty-three youths participated in treatment program. At pretreatment, posttreatment, and the three-month follow-up, OCD symptoms were assessed using the CY-BOCS interview, while the GAD-7 and PHQ-9 were administered to rate general anxiety symptoms and depressive symptoms. Acceptability and patient satisfaction with the treatment were rated with the CSQ-8. RESULTS All symptoms were significantly reduced at posttreatment and follow-up. At posttreatment, 36 patients (85.71%) were defined as responders, while 29 patients (69.05%) achieved remission. At the three-month follow-up, 36 patients (92.3%) were defined as responders, while 33 patients (84.62%) were in remission. CSQ-8 scores indicated that the patients were highly satisfied with the treatment. CONCLUSIONS The B4DT was successfully replicated in a new sample at different sites across Norway, which indicates that this treatment is generalizable, effective and acceptable to adolescents with OCD.
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Affiliation(s)
- Solvei Harila Skjold
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- OCD-team, Haukeland University Hospital, Bergen, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Møre and Romsdal Hospital Trust, Hospital of Molde, Molde, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Michael G Wheaton
- Department of Psychology, Barnard College, Columbia University, New York, USA
- Center for OCD and Related Disorders, Massachusetts General Hospital, Boston, USA
| | - Kay Morten Hjelle
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Thröstur Björgvinsson
- Department of Psychiatry, Harvard Medical School, Boston, USA
- Behavioral Health Partial Hospital Program, McLean Hospital, Belmont, USA
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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Öst LG, Brattmyr M, Finnes A, Ghaderi A, Havnen A, Hedman-Lagerlöf M, Parling T, Welch E, Wergeland GJ. Cognitive behavior therapy for adult eating disorders in routine clinical care: A systematic review and meta-analysis. Int J Eat Disord 2024; 57:249-264. [PMID: 38098336 DOI: 10.1002/eat.24104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 02/10/2024]
Abstract
OBJECTIVE Cognitive behavior therapy (CBT) is a recommended treatment for eating disorders (ED) in adults given its evidence, mainly based on efficacy studies. However, little is known about how CBT works in routine clinical care. The goal of the present meta-analysis is to investigate how CBT works for various ED when carried out in routine clinical settings. METHOD Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for articles published until June 2023. The outcome of CBT, methodological quality, risk of bias (RoB), and moderators of treatment outcome were examined and benchmarked by meta-analytically comparing with efficacy studies for ED. Fifty studies comprising 4299 participants who received CBT were included. RESULTS Large within-group effect sizes (ES) were obtained for ED-psychopathology at post-treatment (1.12), and follow-up (1.22), on average 9.9 months post-treatment. Attrition rate was 25.5% and RoB was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had very similar ESs as efficacy studies (1.20 at post-treatment and 1.28 at follow-up). CONCLUSION CBT for ED is an effective treatment when delivered in routine clinical care, with ESs comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution due to the RoB in a high proportion of studies. PUBLIC SIGNIFICANCE Eating disorders are common in the population and often lead to multiple negative consequences. CBT has been found effective for ED and is recommended in clinical guidelines. Since these recommendations are primarily based on university studies we wanted to investigate how CBT performs in routine clinical care. Our meta-analysis found that CBT worked as well in routine care as in university setting studies.
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Affiliation(s)
- Lars-Göran Öst
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Brattmyr
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Finnes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Academic Primary Care Center, Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - Maria Hedman-Lagerlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Parling
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm, Sweden
| | - Elisabeth Welch
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
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Cobham VE, Radtke SR, Hawkins I, Jordan M, Ali NR, Ollendick TH, Sanders MR. Piloting a one-day parent-only intervention in the treatment of youth with anxiety disorders: child and family-level outcomes. Child Adolesc Psychiatry Ment Health 2024; 18:8. [PMID: 38218829 PMCID: PMC10787495 DOI: 10.1186/s13034-023-00702-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/29/2023] [Indexed: 01/15/2024] Open
Abstract
OBJECTIVE Parent-only cognitive-behavioural therapy (CBT) interventions have promise for youth with anxiety disorders. Fear-Less Triple P (FLTP) is one such intervention that has been found comparable to child-focused CBT. Although traditionally administered in six sessions, a one-day workshop format of FLTP was developed to improve accessibility. The current study compared the effectiveness of the six-session and one-day workshop formats. METHOD Seventy-three youth (mean age, 8.4 years; 74% male) were randomized to traditional FLTP (6-week group) or the one-day workshop format. Anxiety diagnostic status, self- and parent-reported anxiety symptoms scores, independent evaluator-rated improvement, treatment satisfaction, and measures of family functioning were included to assess treatment outcome. Data were collected prior to treatment, and 1-week, 6-months, and 12-months following treatment. RESULTS Both conditions resulted in significant improvement in child anxiety symptom scores per parent report (on both questionnaire and diagnostic interview measures). Furthermore, significant decreases in sibling anxiety were observed in both treatment conditions. There were no statistically significant differences between conditions on any outcome measure. CONCLUSIONS Results of this study add to the growing evidence that brief, low-intensity, parent-only interventions can effectively target child psychopathology. These brief interventions are ideal for families for whom the resources and time required to commit to a standard multi-week intervention are prohibitive. REGISTRATION OF CLINICAL TRIALS This trial was registered with the Australian and New Zealand Clinical Trials Registry (ACTRN 12615001284550).
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Affiliation(s)
- Vanessa E Cobham
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia.
| | - Sarah R Radtke
- Virginia Tech: Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Ingrid Hawkins
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Michele Jordan
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Nasriah Rizman Ali
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
| | - Thomas H Ollendick
- Virginia Tech: Virginia Polytechnic Institute and State University, Blacksburg, USA
| | - Matthew R Sanders
- School of Psychology, University of Queensland, St. Lucia, QLD, 4072, Australia
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Koper N, Boin Y, Creemers HE, van Dam L, Stams GJJM, Branje S. Effectiveness of a multidisciplinary treatment with youth-initiated mentoring for youths with mental health needs from multi-problem families: a quasi-experimental study. BMC Public Health 2024; 24:1. [PMID: 38166901 PMCID: PMC10759347 DOI: 10.1186/s12889-023-17506-6] [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] [Received: 03/29/2023] [Accepted: 12/15/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Children from multi-problem families have an increased risk for experiencing mental health problems. These families face problems in several domains that are often found to be chronic and intergenerational. Yet, the effects of mental health care for youths from multi-problem families are small at best, urging research on new treatment programs. The InConnection approach is an integrated care program to improve resilience of youths with mental health needs from multi-problem families by connecting professional expertise from multiple disciplines with the informal social network of the youth. Youths are asked to nominate a youth-initiated mentor (YIM) from the supportive adults in their network. METHODS This quasi-experimental study compared the effectiveness of the InConnection approach to treatment as usual in a sample of 107 families (n = 66 intervention group, n = 41 control group) with n = 115 youths receiving treatment (cases). Youths (n = 102 reports, Mage = 15.59 years), parents (n = 85 reports) and case managers (n = 107 reports) responded to questionnaires four times over 15 months. Using these data, we measured youth resilience as the primary outcome, seven secondary outcomes, and three intermediate outcomes. RESULTS Latent growth models showed only one significant change in outcomes over time across conditions, namely a decrease in case manager-reported child unsafety, and only two condition effects, which were both parent-reported. Parents in the InConnection group reported improvements over time in youth's emotional and behavioral problems and their own positive parenting, whereas control parents reported no changes (ps ≤ 0.013). DISCUSSION The treatment conditions were not effective in improving most of the youth and parental outcomes over time, except for child safety reported by the case manager. The InConnection approach only outperformed care as usual on two parent-reported outcomes. Future research should examine for whom and under what circumstances the InConnection approach works more convincingly. TRIAL REGISTRATION Netherlands Trial Register NL7565. Retrospectively registered on 05/03/2019.
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Affiliation(s)
- Natasha Koper
- Department of Youth and Family, Utrecht University, PO box 80140, Utrecht, 3508TC, the Netherlands.
- Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, the Netherlands.
- YIM Foundation, Amersfoort, the Netherlands.
| | - Yukiko Boin
- Department of Youth and Family, Utrecht University, PO box 80140, Utrecht, 3508TC, the Netherlands
| | - Hanneke E Creemers
- Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Levi van Dam
- Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, the Netherlands
- YIM Foundation, Amersfoort, the Netherlands
- Levvel youth and family care, Amsterdam, the Netherlands
| | - Geert Jan J M Stams
- Department of Forensic Child and Youth Care Sciences, University of Amsterdam, Amsterdam, the Netherlands
| | - Susan Branje
- Department of Youth and Family, Utrecht University, PO box 80140, Utrecht, 3508TC, the Netherlands
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de Jong R, Lommen MJJ, van Hout WJPJ, Kuijpers RCWM, Stone L, de Jong P, Nauta MH. Better together? A randomized controlled microtrial comparing different levels of therapist and parental involvement in exposure-based treatment of childhood specific phobia. J Anxiety Disord 2023; 100:102785. [PMID: 37832323 DOI: 10.1016/j.janxdis.2023.102785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION Exposure is often limited to homework assignments in routine clinical care. The current study compares minimally-guided (MGE) and parent-guided (PGE) out-session homework formats to the 'golden standard' of therapist-guided in-session exposure with minimally-guided exposure at home (TGE). METHODS Children with specific phobia (N = 55, age 8-12, 56% girls) participated in a single-blind, randomized controlled microtrial with a four-week baseline-treatment period design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. RESULTS TGE resulted in a larger decline of specific phobia severity from baseline to post-treatment compared to MGE but not compared to PGE. Parental anxiety was found to be a moderator of less treatment efficacy of PGE from baseline to post-treatment. Overall, there was no meaningful difference in efficacy of TGE versus MGE or PGE from baseline to follow-up. CONCLUSIONS These findings suggest that for improving short-term treatment gains, exposure exercises can best be conducted with the help of a therapist within the therapy session before they are conducted as homework assignments outside the therapy session. However, for long-term treatment gains exposure exercises can be handled by the child itself or with help of its parents.
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Affiliation(s)
- Rachel de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands.
| | - Miriam J J Lommen
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Wiljo J P J van Hout
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | | | - Lisanne Stone
- Karakter Child and Youth Psychiatry, Nijmegen, the Netherlands
| | - Peter de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands; Radboud University Nijmegen, Department of Pedagogical Sciences, the Netherlands; Karakter Child and Youth Psychiatry, Nijmegen, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
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Gliske K, Ballard J, Berry KR, Killian M, Kroll E, Fenkel C. Reduction of Mental Health-Related Emergency Department Admissions for Youth and Young Adults Following a Remote Intensive Outpatient Program: Quality Improvement Analysis. JMIR Form Res 2023; 7:e47895. [PMID: 37943600 PMCID: PMC10667974 DOI: 10.2196/47895] [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: 04/04/2023] [Revised: 09/12/2023] [Accepted: 10/03/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Pediatric mental health emergency department (ED) visits are increasing at 6% to 10% per year, at substantial cost, while 13% of youth with psychiatric hospitalizations are readmitted in the following weeks. Hospitals do not have the resources to meet escalating youth's mental health needs. Intensive outpatient (IOP) programs, which provide multiple hours of care each week, have the power to reduce the number of patients in need of hospitalized care and provide a step-down option for patients discharging from ED's in order to prevent readmissions. OBJECTIVE The purpose of this program evaluation was to assess (1) whether youth and young adult ED admission rates decreased following participation in a remote IOP program and (2) whether there were differences in readmission rates between youth and young adults by gender identity, sexual orientation, race, or ethnicity. METHODS Data were collected from intake and 3-month postdischarge surveys for 735 clients who attended at least 6 sessions of a remote IOP program for youth and young adults. Patients reported if they had been admitted to an ED within the previous 30 days and the admission reason. Over half (407/707, 57.6%) of clients were adolescents and the rest were young adults (300/707, 42.4%; mean age 18.25, SD 4.94 years). The sample was diverse in gender identity (329/687, 47.9% female; 196/687, 28.5% male; and 65/669, 9.7% nonbinary) and sexual orientation (248/635, 39.1% heterosexual; 137/635, 21.6% bisexual; 80/635, 10.9% pansexual; and 170/635, 26.8% other sexual orientation) and represented several racial (9/481, 1.9% Asian; 48/481, 10% Black; 9/481, 1.9% Indigenous; 380/481, 79% White; and 35/481, 7.2% other) and ethnic identities (112/455, 24.6% Hispanic and 28/455, 6.2% other ethnic identity). RESULTS Mental health-related ED admissions significantly decreased between intake and 3 months after discharge, such that 94% (65/69) of clients with a recent history of mental health-related ED admissions at IOP intake reported no mental health-related ED admissions at 3 months after discharge from treatment (χ21=38.8, P<.001). There were no differences in ED admissions at intake or in improvement at 3 months after discharge by age, gender, sexuality, race, or ethnicity. CONCLUSIONS This study documents a decrease in ED admissions between intake and 3 months after discharge among both youth and young adults who engage in IOP care following ED visits. The similar outcomes across demographic groups indicate that youth and young adults experience similar decreases after the current tracks of programming. Future research could conduct a full return-on-investment analysis for intensive mental health services for youth and young adults.
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Affiliation(s)
- Kate Gliske
- Charlie Health Inc, Bozeman, MT, United States
| | - Jaime Ballard
- Center For Applied Research and Educational Improvement, University of Minnesota, Saint Paul, MN, United States
| | | | - Michael Killian
- College of Social Work, Florida State University, Tallahassee, FL, United States
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Szkody E, Chang YW, Schleider JL. Serving the Underserved? Uptake, Effectiveness, and Acceptability of Digital SSIs for Rural American Adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-14. [PMID: 37931065 PMCID: PMC11070444 DOI: 10.1080/15374416.2023.2272935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
OBJECTIVE Rural teens are less likely to access care for depression than urban teens. Evidence-based digital single-session interventions (SSIs), offered via social media advertisements, may be well suited to narrowing this gap in treatment access and increasing access to support for adolescents living in rural areas. We evaluated the viability of using social media-based advertisements to equitably recruit adolescents living in rural areas with elevated depression symptoms to digital SSIs; we sought to characterize and assess whether SSI completion rates and acceptability differed for adolescents living in rural versus more urban areas, across three intervention conditions (two active, evidence-based SSIs; one placebo control); and we tested whether digital SSIs differentially reduced depressive symptoms. METHOD We used pre-intervention and three-month follow up data from 13- to 16-year-old adolescents (N = 2,322; 88% female; 55% non-Hispanic White) within a web-based randomized control trial of three free, digital SSIs (ClinicalTrials.gov identifier: NCT04634903) collected eight months into the COVID-19 pandemic in the United States. RESULTS Digital SSIs reached adolescents at population-congruent rates; however, social media ads resulted in relative underrepresentation of youths from rural areas who hold minoritized racial/ethnic identities. Adolescents living in rural areas also completed digital SSIs at similar rates to their urban peers, found SSIs equivalently as acceptable, and reported comparable depression symptom reductions as youth living in urban areas. CONCLUSION Digital SSIs and their dissemination through social media may offer a promising means of narrowing the gap between access to evidence-based mental health support between adolescents living in rural and urban areas; however, targeted efforts are warranted to reach racially minoritized youths in rural U.S. counties.
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Affiliation(s)
- Erica Szkody
- Department of Psychology, Stony Brook University
| | - Ya-Wen Chang
- Department of Psychology, Stony Brook University
| | - Jessica L Schleider
- Department of Psychology, Stony Brook University
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
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Wergeland GJH, Haaland ÅT, Fjermestad KW, Öst LG, Gjestad R, Bjaastad JF, Hoffart A, Husabo E, Raknes S, Haugland BSM. Predictors of school-based cognitive behavior therapy outcome for youth with anxiety. Behav Res Ther 2023; 169:104400. [PMID: 37690362 DOI: 10.1016/j.brat.2023.104400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents' credibility and expectancy of interventions should be targeted to optimize school-based CBT.
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Affiliation(s)
- Gro Janne H Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Åshild T Haaland
- Department of Child and Adolescence Mental Health, Sørlandet Hospital, Kristiansand, Norway
| | | | | | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Elisabeth Husabo
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway
| | | | - Bente S M Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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Tien HLS, Su YN, Zhang A, Kaichi I, Koshiba T, Okawa S, Urao Y, Shimizu E. The effects of a Journey of the Brave Counseling Program on anxiety, well-being, and life adjustment in Taiwanese children. BMC Psychiatry 2023; 23:657. [PMID: 37674157 PMCID: PMC10481491 DOI: 10.1186/s12888-023-05134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023] Open
Abstract
The purposes of the current study are two-fold. Study 1 aimed to examine the psychometric properties of the Spence Children's Anxiety Scale (SCAS) in a Taiwanese sample. Study 2 aimed to explore the immediate and follow-up effects of Journey of the Brave Counseling Program (JBCP) on children's' anxiety, well-being, and life adjustment. A review and suggestions were provided for future research and practitioners in educational and counseling fields as reference. In Study 1, the pilot study included 150 to 200 children between ages 11 and 12 in Taoyuan City. In Study 2, we conducted a pretest-posttest nonequivalent groups quasi-experimental design. The participants in this stage were 16 children in an elementary school in Taoyuan City, between ages 11 and 12. After obtaining consent forms from the participants' guardians, we randomly assigned these participants to an experimental group (N = 8) and a control group (N = 8). The experimental group received a 40-minute JBCP session weekly for ten weeks. The control group received a 40-minute career exploration small group counseling weekly for ten weeks. We administered the SCAS, Psychological Well-Being Scale, and School Life Adjustment Scale in the pretest, posttest, and follow-up test to measure change of anxiety, well-being, and life adjustment of the participants. In addition, the current study implemented some qualitative data, such as group progress notes, group member feedback questionnaires, and semi-structured interviews with participants' homeroom teachers as supplementary data to clarify the effects of the JBCP. In Study 1, we found that the SCAS had a good validity and reliability for Taiwanese children. The results of Study 2 indicated that the JBCP had immediate and follow-up effects on the separation anxiety in the experimental group. With the pretest impact eliminated, the immediate and follow-up effects on overall anxiety in the experimental group were better than those on the control group. However, even though the immediate and follow-up effects of the JBCP on the experimental group were better than the control group but were not significant. Besides, the group member feedback questionnaires and participants' homeroom teachers all indicated that the experimental group participants had positive attitude toward the JBCP, and they also positively improved their emotions and interpersonal relationships with others.
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Affiliation(s)
- Hsiu-Lan Shelley Tien
- Department of Educational Psychology and Counseling, National Taiwan Normal University, 162 Hoping East Road, Section 1, Taipei, 10610, Taiwan.
| | - Yi-Ning Su
- Department of Educational Psychology and Counseling, National Taiwan Normal University, 162 Hoping East Road, Section 1, Taipei, 10610, Taiwan
| | - Aizi Zhang
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Isana Kaichi
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo ku, Chiba-shi, Chiba, 260-8670, Japan
- United Graduate School of Child Development, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Takako Koshiba
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo ku, Chiba-shi, Chiba, 260-8670, Japan
| | - Sho Okawa
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo ku, Chiba-shi, Chiba, 260-8670, Japan
- Department of Experimental Psychology , University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, 272-8533, UK
- Japan Society for the Promotion of Science, 5-3-1, Koujimachi, Chiyoda ku, Tokyo, 102-0083, Japan
| | - Yuko Urao
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo ku, Chiba-shi, Chiba, 260-8670, Japan
- United Graduate School of Child Development, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, 1-8-1, Inohana, Chuo ku, Chiba-shi, Chiba, 260-8670, Japan
- United Graduate School of Child Development, Osaka University, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan
- Department of Cognitive Behavioral Physiology, Chiba University, 1-8-1, Inohana, Chuo ku, Chiba-shi, Chiba, 260-8670, Japan
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21
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Farrell LJ, Waters AM, Storch EA, Simcock G, Perkes IE, Grisham JR, Dyason KM, Ollendick TH. Closing the Gap for Children with OCD: A Staged-Care Model of Cognitive Behavioural Therapy with Exposure and Response Prevention. Clin Child Fam Psychol Rev 2023; 26:642-664. [PMID: 37405675 PMCID: PMC10465687 DOI: 10.1007/s10567-023-00439-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2023] [Indexed: 07/06/2023]
Abstract
Childhood obsessive-compulsive disorder (OCD) is among the most prevalent and disabling mental health conditions affecting children and adolescents. Although the distress and burden associated with childhood OCD are well documented and empirically supported treatments are available, there remains an unacceptable "treatment gap" and "quality gap" in the provision of services for youth suffering from OCD. The treatment gap represents the large number of children who never receive mental health services for OCD, while the quality gap refers to the children and young people who do access services, but do not receive evidence-based, cognitive behavioural therapy with exposure and response prevention (CBT-ERP). We propose a novel staged-care model of CBT-ERP that aims to improve the treatment access to high-quality CBT-ERP, as well as enhance the treatment outcomes for youth. In staged care, patients receive hierarchically arranged service packages that vary according to the intensity, duration, and mix of treatment options, with provision of care from prevention, early intervention, through to first and second-line treatments. Based on a comprehensive review of the literature on treatment outcomes and predictors of treatments response, we propose a preliminary staging algorithm to determine the level of clinical care, informed by three key determinants: severity of illness, comorbidity, and prior treatment history. The proposed clinical staging model for paediatric OCD prioritises high-quality care for children at all stages and levels of illness, utilising empirically supported CBT-ERP, across multiple modalities, combined with evidence-informed, clinical decision-making heuristics. While informed by evidence, the proposed staging model requires empirical validation before it is ready for prime time.
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Affiliation(s)
- Lara J Farrell
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
| | - Allison M Waters
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Mount Gravatt Campus, Mount Gravatt, Australia
| | | | - Gabrielle Simcock
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia
| | - Iain E Perkes
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- Discipline of Paediatrics and Child Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Katelyn M Dyason
- Department of Psychological Medicine, Sydney Children's Hospitals Network, Westmead, NSW, Australia
- Discipline of Psychiatry and Mental Health, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, NSW, Australia
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22
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Emerson LM, Adams D. Brief Report: Family Accommodation is Associated with the Impact of Childhood Anxiety in Autism. J Autism Dev Disord 2023; 53:3710-3716. [PMID: 35362802 DOI: 10.1007/s10803-022-05534-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2022] [Indexed: 10/18/2022]
Abstract
Anxiety is commonly experienced by children on the autism spectrum, and can negatively impact their lives. Family accommodation has been linked to the impact of anxiety on the child's life in non-autistic children. This study tested whether the same relationship holds for children on the autism spectrum. A community sample (n = 118) of parents of children on the spectrum completed questionnaires on their child's autism characteristics and severity and impact of their child's anxiety, their own anxiety and family accommodation behaviours. Family accommodation was associated with the impact of child anxiety, over and above anxiety severity of the child and parent. Findings support the involvement of parents in psychosocial support for children on the autism spectrum experiencing anxiety.
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Affiliation(s)
- Lisa Marie Emerson
- School of Health Sciences, University of Canterbury, Kirkwood Avenue, Christchurch, 8041, New Zealand.
| | - Dawn Adams
- Autism Centre of Excellence, Griffith University, Brisbane, Australia
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23
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Lorenzo-Luaces L. Identifying active ingredients in cognitive-behavioral therapies: What if we didn't? Behav Res Ther 2023; 168:104365. [PMID: 37453179 PMCID: PMC10534234 DOI: 10.1016/j.brat.2023.104365] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 06/24/2023] [Accepted: 07/02/2023] [Indexed: 07/18/2023]
Abstract
Identifying active ingredients of psychological interventions is a major goal of psychotherapy researchers that is often justified by the promise that it will lead to improved patient outcomes. Much of this "active ingredients" research is conducted within randomized controlled trials (RCTs) with patient populations, putting it in Phase T2 of the clinical-translational spectrum. I argue that RCTs in patient populations are very "messy laboratories" in which to conduct active ingredient work and that T0 and T1 research provide more controlled contexts. However, I call attention to the long road from identifying active ingredients of CBTs, whether in T0, T1, or T2 research, to improving outcomes. Dissemination and implementation research (T3 and T4 approaches) may be conceptually closer to improving outcomes. Given how common and disabling mental health symptoms are, I argue that if researchers want to improve patient outcomes, these research programs must receive more attention including work on the uptake of psychological interventions as well as work on optimal ordering of existing interventions.
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24
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Byrne S, Cobham V, Richardson M, Imuta K. Do Parents Enhance Cognitive Behavior Therapy for Youth Anxiety? An Overview of Systematic Reviews Over Time. Clin Child Fam Psychol Rev 2023; 26:773-788. [PMID: 37217646 PMCID: PMC10465628 DOI: 10.1007/s10567-023-00436-5] [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: 05/01/2023] [Indexed: 05/24/2023]
Abstract
The last 20 years has seen debate regarding the merits of involving parents in cognitive behavior therapy (CBT) for youth anxiety played out across systematic reviews which have high impact. These reviews examined varying treatment formats in relation to parent involvement, including youth only CBT (Y-CBT), parent only CBT (P-CBT) and family CBT (youth and parent; F-CBT). This is a novel overview of systematic reviews examining evidence for parental involvement in CBT for youth anxiety over the period this was studied. Two independent coders systematically searched for studies in medical and psychological databases using the categories "Review", "Youth", "Anxiety", "Cognitive Behavior Therapy" and "Parent/Family". Of the 2,189 unique articles identified, there were 25 systematic reviews since 2005 which compared the effects of CBT for youth anxiety with varying parent involvement. Despite systematically studying the same phenomenon, the reviews were heterogeneous in outcome, design, inclusion criteria and often had methodological limitations. Of the 25 reviews, 21 found no difference between formats and 22 reviews were considered inconclusive. Yet while there were typically no statistical differences, consistent patterns in the direction of effects were detected over time. P-CBT was less effective than other formats, suggesting the importance of directly treating anxious youths. Early reviews favored F-CBT over Y-CBT, however, later reviews did not show this trend. We consider the effects of moderators including exposure therapy, long-term outcomes and the child's age. We consider how to manage heterogeneity in primary studies and reviews to better detect treatment differences where they exist.Trial registration This protocol is registered with the Open Science Framework: osf.io/2u58t.
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Affiliation(s)
- S Byrne
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.
| | - V Cobham
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- Parenting and Family Support Centre, University of Queensland, Brisbane, QLD, Australia
| | - M Richardson
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
| | - K Imuta
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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25
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Hjelle KM, Eide TO, Thorsen AL, Kvale G, Hagen K, Snorrason I, Björgvinsson T, Hansen B. The Bergen 4-day treatment for panic disorder: adapting to COVID-19 restrictions with a hybrid approach of face-to-face and videoconference modalities. BMC Psychiatry 2023; 23:570. [PMID: 37550696 PMCID: PMC10408203 DOI: 10.1186/s12888-023-05062-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/28/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The Bergen 4-day treatment (B4DT) is a concentrated exposure-based therapy that has been shown to be effective in the treatment of anxiety disorders. The current study sought to examine the effectiveness of B4DT for panic disorder (PD), when delivered with a combination of face-to-face sessions and videoconferencing. METHODS Treatment was delivered to 50 patients from April 2020 to May 2021. Because of regulations during the pandemic, a significant portion of the treatment was conducted via videoconference. The primary outcome measure was the clinician-rated Panic Disorder Severity Scale (PDSS), and secondary measures included patient-rated symptoms of panic disorder, agoraphobia, generalized anxiety, depression, and treatment satisfaction. Changes in symptom levels over time were estimated using multilevel models. RESULTS Patients showed a significant reduction in clinician-rated symptoms of panic disorder (Measured by PDSS) from before treatment to post treatment (d = 2.18) and 3-month follow-up (d = 2.01). At three months follow-up 62% of patients were classified as in remission, while 70% reported a clinically significant response. We also found a reduction in symptoms of depression and generalized anxiety, and the patients reported high satisfaction with the treatment. CONCLUSION The current study suggests that B4DT delivered in a combination of videoconference and face-to-face meetings may be a useful treatment approach. As the study is uncontrolled, future studies should also include more strictly designed investigations.
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Affiliation(s)
- Kay Morten Hjelle
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
| | - Thorstein Olsen Eide
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Møre and Romsdal Hospital Trust, Molde, Norway
| | - Anders Lillevik Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Møre and Romsdal Hospital Trust, Molde, Norway
| | - Ivar Snorrason
- Center for OCD and Related Disorders, Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | | | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
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26
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Waters AM, Ryan KM, Luck CC, Craske MG, Lipp OV. Approximating exposure therapy in the lab: Replacing the CS+ with a similar versus a different stimulus and including additional stimuli resembling the CS+ during extinction. Behav Res Ther 2023; 167:104357. [PMID: 37364363 DOI: 10.1016/j.brat.2023.104357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 05/24/2023] [Accepted: 06/14/2023] [Indexed: 06/28/2023]
Abstract
Recent studies have shown that extinction training including the conditional stimulus (CS+) and stimuli that are similar to the CS + enhances extinction retention and generalisation to novel stimuli. However, in a clinical setting, the CS+ is rarely available for use during exposure therapy. The aim of the present study was to determine if replacing the CS+ with a similar versus different stimulus, and including other similar stimuli during extinction, could reduce fear at test on par with extinction using the original CS+ with and without other similar stimuli. In an experiment conducted in a single session, participants completed a habituation phase followed by an acquisition phase using two dog images presented with (CS+) and without (CS-) an acoustic unconditional stimulus (US). Participants were randomly allocated to four extinction conditions: similar CS + dog with novel dog images (Similar replacement extinction condition); different CS + dog with novel dog images (Different replacement extinction condition); original CS + dog with novel dog images (Multiple extinction control condition); and original CS + without novel dog images (Standard extinction control condition). All participants completed a test phase with the original CSs followed by a generalisation test with another two novel dog images. All groups acquired, and then extinguished differential skin conductance responses (SCRs) with no differences observed between groups. Whereas the Similar replacement extinction group and the Multiple and Standard extinction control groups did not exhibit significant differential SCRs when re-exposed to the original CS + relative to the CS- at test, differential responding to the CSs was significant at test in the Different replacement extinction group. There were no significant differences between groups in SCRs to the two novel dog images during the generalisation phase and in between-phase subjective ratings. Findings suggest that replacement stimuli used during extinction should be as similar as possible to the CS + to reduce physiological arousal to the original CS+.
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Affiliation(s)
| | | | | | - Michelle G Craske
- Department of Psychology & Department of Psychiatry & Biobehavioral Sciences, UCLA, United States
| | - Ottmar V Lipp
- School of Psychology and Counselling, Queensland University of Technology, Australia
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27
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Lorenzo-Luaces L, Howard J. Efficacy of an Unguided, Digital Single-Session Intervention for Internalizing Symptoms in Web-Based Workers: Randomized Controlled Trial. J Med Internet Res 2023; 25:e45411. [PMID: 37418303 PMCID: PMC10362424 DOI: 10.2196/45411] [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] [Received: 12/30/2022] [Revised: 03/31/2023] [Accepted: 05/10/2023] [Indexed: 07/08/2023] Open
Abstract
BACKGROUND The Common Elements Toolbox (COMET) is an unguided digital single-session intervention (SSI) based on principles of cognitive behavioral therapy and positive psychology. Although unguided digital SSIs have shown promise in the treatment of youth psychopathology, the data are more mixed regarding their efficacy in adults. OBJECTIVE This study aimed to investigate the efficacy of COMET-SSI versus a waiting list control in depression and other transdiagnostic mental health outcomes for Prolific participants with a history of psychopathology. METHODS We conducted an investigator-blinded, preregistered randomized controlled trial comparing COMET-SSI (n=409) with an 8-week waiting list control (n=419). Participants were recruited from the web-based workspace Prolific and assessed for depression, anxiety, work and social functioning, psychological well-being, and emotion regulation at baseline and at 2, 4, and 8 weeks after the intervention. The main outcomes were short-term (2 weeks) and long-term (8 weeks) changes in depression and anxiety. The secondary outcomes were the 8-week changes in work and social functioning, well-being, and emotion regulation. Analyses were conducted according to the intent-to-treat principle with imputation, without imputation, and using a per-protocol sample. In addition, we conducted sensitivity analyses to identify inattentive responders. RESULTS The sample comprised 61.9% (513/828) of women, with a mean age of 35.75 (SD 11.93) years. Most participants (732/828, 88.3%) met the criteria for screening for depression or anxiety using at least one validated screening scale. A review of the text data suggested that adherence to the COMET-SSI was near perfect, there were very few inattentive respondents, and satisfaction with the intervention was high. However, despite being powered to detect small effects, there were negligible differences between the conditions in the various outcomes at the various time points, even when focusing on subsets of individuals with more severe symptoms. CONCLUSIONS Our results do not support the use of the COMET-SSI in adult Prolific participants. Future work should explore alternate ways of intervening with paid web-based participants, including matching individuals to SSIs they may be most responsive to. TRIAL REGISTRATION ClinicalTrials.gov NCT05379881, https://clinicaltrials.gov/ct2/show/NCT05379881.
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Affiliation(s)
- Lorenzo Lorenzo-Luaces
- Department of Psychological and Brain Sciences, Indiana University-Bloomington, Bloomington, IN, United States
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28
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Stiede JT, Trent ES, Viana AG, Guzick AG, Storch EA, Hershfield J. Cognitive Behavioral Therapy for Children and Adolescents with Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:543-558. [PMID: 37201966 PMCID: PMC11177010 DOI: 10.1016/j.chc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Anxiety disorders are the most common class of psychiatric conditions among children and adolescents. The cognitive behavioral model of childhood anxiety has a strong theoretic and empirical foundation that provides the basis for effective treatment. Cognitive behavioral therapy (CBT), with an emphasis on exposure therapy, is the gold standard treatment for childhood anxiety disorders, with strong empirical support. A case vignette demonstrating CBT for childhood anxiety disorders in practice, as well as recommendations for clinicians, are also provided.
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Affiliation(s)
- Jordan T Stiede
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA.
| | - Erika S Trent
- University of Houston, 4849 Calhoun Road, Room 373, Houston, TX 77204, USA
| | - Andres G Viana
- University of Houston, 4849 Calhoun Road, Room 373, Houston, TX 77204, USA
| | - Andrew G Guzick
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Eric A Storch
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
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29
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Öst LG, Enebrink P, Finnes A, Ghaderi A, Havnen A, Kvale G, Salomonsson S, Wergeland GJ. Cognitive behavior therapy for adult post-traumatic stress disorder in routine clinical care: A systematic review and meta-analysis. Behav Res Ther 2023; 166:104323. [PMID: 37257304 DOI: 10.1016/j.brat.2023.104323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 03/25/2023] [Accepted: 04/26/2023] [Indexed: 06/02/2023]
Abstract
Although different cognitive behavioral therapies (CBT) have strong research support for treatment of adult post-traumatic stress disorder (PTSD) more knowledge is needed about the performance of CBT in routine clinical care. The present study is a systematic review and meta-analysis of CBT for PTSD in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until the end of May 2022. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for PTSD. Thirty-three studies, comprising 6482 participants, were included. The within-group effect sizes (ES) for PTSD-severity at post-treatment (1.75), and follow-up (1.70), on average 6 months post-treatment, were large. The effectiveness studies had very similar ESs as efficacy studies at post-treatment (1.75 vs. 1.72) and follow-up (1.70 vs. 2.02), based on the benchmarking analysis. As the heterogeneity was large, we can only cautiously consider CBT for PTSD an effective treatment when delivered in routine clinical care. The outcomes of effectiveness studies for PTSD seem to be comparable to the results obtained in efficacy studies. PROSPERO REGISTRATION ID: CRD42021228828.
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Affiliation(s)
- Lars-Göran Öst
- Department of Psychology, Stockholm University, Sweden; Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Pia Enebrink
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Finnes
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Academic Primary Care Center, Region Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
| | - Sigrid Salomonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
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30
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Byrne S, Richardson M, Riba M, Imuta K. Parent Versus Individual Cognitive Behavioral Therapy for Youth Anxiety: Protocol for an Overview of Systematic Reviews Over Time. JMIR Res Protoc 2023; 12:e48077. [PMID: 37384370 PMCID: PMC10365617 DOI: 10.2196/48077] [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: 04/23/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has shown to be highly effective for treating youth anxiety; yet, there is ongoing debate as to whether involving parents improves outcomes. For example, parents who attend may learn CBT skills to help their child in an ongoing way; yet, they could also distract their child from treatment depending on how they interact. As evidence has accumulated, reviews and meta-analyses have attempted to examine the most effective treatment format. These reviews often have high impact in the field; however, they use varied methodologies and draw on different primary studies. Different formats of CBT for youth anxiety have been developed in relation to parental involvement, including youth-only CBT (Y-CBT; where the youth alone attends treatment), youth and parent or family CBT (F-CBT; where youths and their parents attend together), and, most recently, parent-only CBT (P-CBT; where the parent alone attends). OBJECTIVE This protocol describes an overview of systematic reviews comparing the relative efficacy of different formats of CBT for youth anxiety (Y-CBT, F-CBT, and P-CBT) over the study period. The protocol will also examine the moderating effects of variables on the efficacy of different formats; for example, youths' age and long-term outcomes. METHODS We will analyze the results of systematic reviews that compare different levels and types of parental involvement in CBT for youth anxiety over the study period. A systematic review of medical and psychological databases (PsycINFO, PubMed, SCOPUS, Web of Science, Cochrane Library, and Embase) will identify reviews comparing the efficacy of different formats of parent involvement in CBT for youth anxiety. Data extraction will include (1) author names (and year of publication), (2) review design, (3) age range, (4) analysis type, (5) conclusions, and (6) moderators. This overview will present the relative efficacy of formats chronologically in a table and then describe the main results longitudinally in a narrative summary. A Measurement Tool to Assess Systematic Reviews, 2nd Edition (AMSTAR 2), quality rating will be given to each review, and the amount of primary study overlap across reviews will be quantified. RESULTS The last search was conducted on July 1, 2022. The reviews were published between 2005 and 2022. We found a total of 3529 articles, of which we identified 25 for the final analysis. CONCLUSIONS This overview will compare and report the relative efficacy of Y-CBT, P-CBT, and F-CBT for youth anxiety over the study period, describe the heterogeneity across reviews and primary studies, and consider the moderating effect of relevant variables. It will describe the limitations of an overview, including the potential for nuance in the data to be lost, and provide conclusions and recommendations for conducting systematic reviews regarding parental involvement for CBT for youth anxiety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/48077.
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Affiliation(s)
- Simon Byrne
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Meg Richardson
- School of Psychology, University of Queensland, Brisbane, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Marcos Riba
- University of Queensland Library, Brisbane, Australia
| | - Kana Imuta
- School of Psychology, University of Queensland, Brisbane, Australia
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Taliercio JR, Wigod T, Shen J, Yang L, Davino S, Servidio E, McGinn LK, Miller AL. Coping with Transitions: A Promising Intensive Outpatient DBT Program for Emerging Adults and Their Families. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2023:1-9. [PMID: 37363718 PMCID: PMC10193327 DOI: 10.1007/s10879-023-09583-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/28/2023]
Abstract
Emerging adulthood is a period of significant exploration, transformation, variability, and growth. Simultaneously, this developmental period presents unique challenges as emerging adults work to achieve developmental milestones including self-identity formation, the establishment of long-term intimate relationships, career advancement, and independence from parents. For those who are vulnerable, this period is also marked by the development of significant mental health problems and associated impairment, which prevents individuals from successfully reaching these developmental milestones. To address the various challenges unique to this developmental period, we created and implemented a multifaceted DBT treatment protocol to specifically address emotional dysregulation within emerging adults. The current study presents an evaluation of a novel, intensive, outpatient DBT program called System for Adult Growth and Emergence-Foundations (SAGE-F). We aim to first introduce the SAGE-F treatment protocol, and then to assess both its short and long-term therapeutic value. Participants enrolled in SAGE-F were administered a testing battery assessing symptom severity, functioning capacities, and coping strategies at intake, upon completion of the program 6-weeks later, and at 3-month follow-up. It was found participants who completed SAGE-F reported significant reductions in depression and anxiety symptoms, as well as non-suicidal self-injurious behaviors. Simultaneously, participants also reported improvements in their daily functioning and coping capacities. Follow-up assessments indicated therapeutic progress remained.
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Affiliation(s)
- Joseph R. Taliercio
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
| | - Talia Wigod
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
| | - Joy Shen
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY USA
| | | | - Suzanne Davino
- White Cedar Cognitive and Behavioral Health, Ridgefield, CT USA
| | - Elaina Servidio
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
| | - Lata K. McGinn
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY USA
- Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY USA
| | - Alec L. Miller
- Cognitive and Behavioral Consultants, 1 North Broadway, Suite 704, White Plains, NY 10601 USA
- Montefiore Medical Center-Albert Einstein College of Medicine, Bronx, NY USA
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Schleider JL, Smith AC, Ahuvia I. Realizing the untapped promise of single-session interventions for eating disorders. Int J Eat Disord 2023; 56:853-863. [PMID: 36815724 PMCID: PMC10159985 DOI: 10.1002/eat.23920] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/12/2023] [Accepted: 02/12/2023] [Indexed: 02/24/2023]
Abstract
OBJECTIVE Multilevel treatment barriers prevent up to 80% of individuals experiencing eating disorders (EDs) from accessing care. This treatment gap creates a critical need to identify interventions that are accessible, easily completable, and optimized for effectiveness by targeting core mechanisms linked to ED onset and maintenance. We propose single-session interventions (SSIs) as a promising path toward catalyzing innovation in the development of accessible, effective ED interventions. SSIs are structured programs that intentionally involve one encounter with a program or provider; they may serve as stand-alone or adjunctive clinical supports. All SSIs are built to acknowledge that any session might be someone's last-and that any single session can nonetheless yield meaningful clinical benefit. METHOD We define SSIs, summarize research supporting their utility for ED symptoms and other mental health problems, and recommend future directions for work in this domain. RESULTS Single-session interventions may hold promise to reduce some ED symptoms and risk factors, including restrictive eating and negative body image. Steps toward realizing this promise include (1) testing whether existing evidence-based SSIs (e.g., for depression) can also reduce EDs, risk factors, and symptoms; (2) developing novel SSIs that target modifiable ED risk factors and symptoms largely unaddressed by SSIs, such as purging and binge eating; (3) studying diverse implementation pathways; (4) capitalizing on SSIs' transdiagnostic utility to broaden funding opportunities; and (5) educating ED researchers and clinicians about SSIs. DISCUSSION Understanding the strengths and limits of mechanism-targeted SSIs for ED-related problems could be a low-risk, high-reward avenue toward reducing EDs at scale. PUBLIC SIGNIFICANCE Most individuals experiencing EDs never access any form of treatment, creating an urgent need to identify ED interventions built to overcome barriers to engaging with care. This Forum article introduces SSIs as a promising path to rapidly developing and testing accessible, evidence-based ED supports; supplementing existing ED treatment models; and reducing the individual, familial, and societal burdens of EDs at scale.
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Affiliation(s)
| | | | - Isaac Ahuvia
- Department of Psychology, Stony Brook University
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Eide TO, Hjelle KM, Sætre IU, Solem S, Olsen T, Sköld RO, Kvale G, Hansen B, Hagen K. The Bergen 4-day treatment for panic disorder: implementation in a rural clinical setting. BMC Psychiatry 2023; 23:305. [PMID: 37127598 PMCID: PMC10152771 DOI: 10.1186/s12888-023-04812-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 04/22/2023] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION The Bergen 4-Day Treatment (B4DT) is a concentrated treatment with individually tailored exposure exercises. The format has shown promising results in the treatment of panic disorder. AIM The aim of the current study was to investigate the effectiveness of the B4DT in a large sample in a rural clinical setting. METHOD Fifty-eight patients with panic disorder were consecutively included using an open trial design. The primary outcome measure was the Panic Disorder Severity Scale. The Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9 were used as secondary outcome measures. Assessments were conducted at pretreatment, posttreatment, and 3-month follow-up. Treatment satisfaction was measured at posttreatment using the Client Satisfaction Questionnaire-8. RESULTS There was a significant reduction in symptoms of panic disorder from pre- to posttreatment (d = 3.36) and from pretreatment to follow-up (d = 3.63). At posttreatment and follow-up, 72.4% and 81.0% of patients, respectively, were classified as in remission. Patients reported high treatment satisfaction, and there were significant reductions in symptoms of generalized anxiety and depression. CONCLUSION The results from the current study replicated the findings from previous studies using a larger sample size. The findings indicate that the B4DT is a promising treatment format for panic disorder. The study also demonstrated that the treatment format can be successfully implemented in new rural clinics.
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Affiliation(s)
- Thorstein Olsen Eide
- Molde Hospital, Møre og Romsdal Hospital Trust, Molde, Norway.
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
| | - Kay Morten Hjelle
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | | | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Kristen Hagen
- Molde Hospital, Møre og Romsdal Hospital Trust, Molde, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
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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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Jong RD, Hofs A, Lommen MJJ, van Hout WJPJ, Jong PJD, Nauta MH. Treating specific phobia in youth: A randomized controlled microtrial comparing gradual exposure in large steps to exposure in small steps. J Anxiety Disord 2023; 96:102712. [PMID: 37043895 DOI: 10.1016/j.janxdis.2023.102712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 02/17/2023] [Accepted: 04/04/2023] [Indexed: 04/14/2023]
Abstract
INTRODUCTION Exposure may be especially effective when within exercises, there is a strong violation of threat expectancies and much opportunity for fear reduction. Outcomes of exposure may therefore improve when exposure is conducted in large steps (LargeSE) relative to small steps (SmallSE). METHODS Children and young people with a specific phobia (SP) (N = 50, age 8-17, 64 % girls) participated in a preregistered single-blind, randomized controlled microtrial comparing LargeSE and SmallSE in a four-week baseline-treatment design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. RESULTS Within exercises, LargeSE resulted in higher initial fear levels and more within-session expectancy violation. Nevertheless, SmallSE resulted in a larger decline of SP severity from baseline to post-treatment and follow-up, and a larger decline of anxiety and avoidance towards one's individual goal from baseline to follow-up. There were no differences between LargeSE and SmallSE regarding changes in general self-efficacy or behavioral avoidance. Although session duration was standardized and similar for both conditions, participants in SmallSE received more (shorter) exercises. DISCUSSION SmallSE might be more effective in reducing SP severity because children in SmallSE were exposed to a larger number and variety of exercises than children in LargeSE.
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Affiliation(s)
- Rachel de Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Annemieke Hofs
- Accare Child Study Center, University Center for Child and Adolescent Psychiatry, Groningen, the Netherlands
| | - Miriam J J Lommen
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Wiljo J P J van Hout
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Peter J De Jong
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands
| | - Maaike H Nauta
- University of Groningen, Department of Clinical Psychology and Experimental Psychopathology, the Netherlands; Accare Child Study Center, University Center for Child and Adolescent Psychiatry, Groningen, the Netherlands.
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36
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Coleman E, Rice M, Smith TS. Addressing Anxiety in Primary Care With Cognitive Behavioral Therapy. J Nurse Pract 2023. [DOI: 10.1016/j.nurpra.2023.104583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
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Kjøbli J, Melendez-Torres GJ, Gardner F, Backhaus S, Linnerud S, Leijten P. Research review: Effects of parenting programs for children's conduct problems on children's emotional problems - a network meta-analysis. J Child Psychol Psychiatry 2023; 64:348-356. [PMID: 36097742 PMCID: PMC10087885 DOI: 10.1111/jcpp.13697] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND Specific programs are often implemented for specific child mental health problems, while many children suffer from comorbid problems. Ideally, programs reduce a wider range of mental health problems. The present study tested whether parenting programs for children's conduct problems, and which individual and clusters of program elements, have additional effects on children's emotional problems. METHODS We updated the search of a previous systematic review in 11 databases (e.g., PsycINFO and MEDLINE) and included studies published until July 2020 with keywords relating to 'parenting', 'program', and 'child behavioral problems'. Also, we searched for recent trials in four trial registries and contacted protocol authors. Studies were eligible for inclusion if they used a randomized controlled trial to evaluate the effects of a parenting program for children aged 2-10 years which was based on social learning theory and included a measure of children's emotional problems postintervention. RESULTS We identified 69 eligible trials (159 effect sizes; 6,240 families). Robust variance estimation showed that parenting programs had small significant parent-reported additional effects on emotional problems immediately postintervention (Cohen's d = -0.14; 95% CI, -0.21, -0.07), but these effects faded over time. Teachers and children did not report significant effects. Additional effects on emotional problems were larger in samples with clinical baseline levels of such problems. No individual program elements predicted larger additional effects. Of the clusters of elements, combining behavior management and relationship enhancement elements was most likely to yield the strongest additional effects. CONCLUSIONS The additional effects on emotional problems of parenting programs designed to reduce conduct problems are limited, but some clusters of elements predict larger effects. Our findings may contribute to realistic expectations of the benefits of parenting programs for children's conduct problems and inform the development of programs with wider benefits across mental health problems.
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Affiliation(s)
- John Kjøbli
- Regional Center for Child and Adolescent Mental Health, Oslo, Norway.,Department of Education, University of Oslo, Oslo, Norway
| | | | - Frances Gardner
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Sophia Backhaus
- Department of Social Policy and Intervention, University of Oxford, Oxford, UK
| | - Siv Linnerud
- Regional Center for Child and Adolescent Mental Health, Oslo, Norway
| | - Patty Leijten
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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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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Farrell LJ, Nabinger de Diaz NA, Mathieu S, McKenzie ML, Miyamoto T, Donovan CL, Waters AM, March S, Bothma N, Kroon R, Simcock G, Ware RS, Selles RR, Storch EA, Ollendick T. FAST CBT for pediatric OCD: A multiple-baseline controlled pilot trial of parent training in exposure and response prevention delivered via telehealth. Front Psychol 2022; 13:1009735. [PMID: 36591101 PMCID: PMC9795832 DOI: 10.3389/fpsyg.2022.1009735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The current study utilized a single case series, non-concurrent multiple baseline design to examine the efficacy of training parents via telehealth videoconferencing in exposure and response prevention (ERP) for home delivery of the treatment for their children and adolescents with obsessive compulsive disorder (OCD). Method There were nine participants aged 8 to 14 years who had received a primary diagnosis of OCD. The design involved a series of AB replications, whereby following pre-treatment assessments participants were randomly assigned to either a 2-week (n = 4) or 3-week (n = 5) baseline condition with weekly monitoring of their child's OCD symptoms. Following baseline, parents participated four weekly telehealth parent-training modules in delivering FAST (Families Accessing Skills Training) cognitive behavior therapy (CBT) with ERP (CBT-ERP) to children with OCD via videoconferencing with the clinician. Primary outcome measures were OCD symptom severity, diagnostic severity, and global functioning, which were assessed post-treatment and at 2 month follow-up. Results The stability of the baseline period from pre-treatment to week 2 (for the 2-week condition) or to week 3 (for the 3-week condition) was established as there were no significant differences across baseline scores for parent target obsessions or parent target compulsions ratings. Significant improvements on the primary outcomes of clinician assessed symptom severity, diagnostic ratings, and global functioning were observed from baseline to post-treatment, and continued to 2 months follow-up. Conclusion These data suggest that brief, parent training in FAST CBT-ERP via telehealth provides an overall effective intervention that is likely to be of most benefit to children and youth who are mild to moderate in severity.
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Affiliation(s)
- Lara J. Farrell
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia,*Correspondence: Lara J. Farrell,
| | - Natalja A. Nabinger de Diaz
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Sharna Mathieu
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Matthew L. McKenzie
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Taka Miyamoto
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Caroline L. Donovan
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Mount Gravatt, QLD, Australia
| | - Allison M. Waters
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Mount Gravatt, QLD, Australia
| | - Sonja March
- Centre for Health Research & School of Psychology and Wellbeing, University of Southern Queensland (USQ), Darling Heights, QLD, Australia
| | - Nicole Bothma
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Rianca Kroon
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Gabrielle Simcock
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, South Port, QLD, Australia
| | - Robert R. Selles
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Thomas Ollendick
- Child Study Centre, Virginia Polytechnic University, Blacksburg, VA, United States
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Öst LG, Enebrink P, Finnes A, Ghaderi A, Havnen A, Kvale G, Salomonsson S, Wergeland GJ. Cognitive behavior therapy for obsessive-compulsive disorder in routine clinical care: A systematic review and meta-analysis. Behav Res Ther 2022; 159:104170. [PMID: 36302283 DOI: 10.1016/j.brat.2022.104170] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 06/11/2022] [Accepted: 07/25/2022] [Indexed: 12/14/2022]
Abstract
Cognitive behavioral therapy (CBT) has strong research support for obsessive-compulsive disorder (OCD). However, less is known about how CBT performs when delivered in routine clinical care. A systematic review and meta-analysis was conducted of CBT for OCD in adults treated in routine clinical care. Ovid MEDLINE, Embase OVID, and PsycINFO were systematically searched for studies published until July 2021. The effectiveness of CBT, methodological quality, and moderators of treatment outcome were examined, and benchmarked by meta-analytically comparing with efficacy studies for OCD. Twenty-nine studies (8 randomized controlled trials) were included, comprising 1669 participants. Very large within-group effect sizes (ES) were obtained for OCD-severity at post-treatment (2.12), and follow-up (2.30), on average 15 months post-treatment. Remission rates were 59.2% post-treatment and 57.0% at follow-up. Attrition rate was 15.2%. Risk of bias was considerable in the majority of studies. The benchmarking analysis showed that effectiveness studies had almost exactly the same ES as efficacy studies at post-treatment and somewhat higher at follow-up. Furthermore, effectiveness studies had significantly higher remission rates than efficacy studies, both at post- and follow-up assessment. CBT for OCD is an effective treatment when delivered in routine clinical care, with ES comparable to those found in efficacy studies. However, the evidence needs to be interpreted with caution because of the risk of bias in a high proportion of studies. PROSPERO REGISTRATION ID: CRD42021228828.
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Affiliation(s)
- Lars-Göran Öst
- Department of Psychology, Stockholm University, Sweden; Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Pia Enebrink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Anna Finnes
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Academic Primary Care Center, Region Stockholm, Sweden
| | - Ata Ghaderi
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Audun Havnen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway; Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Norway
| | - Sigrid Salomonsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway
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Odgers K, Kershaw KA, Li SH, Graham BM. The relative efficacy and efficiency of single- and multi-session exposure therapies for specific phobia: A meta-analysis. Behav Res Ther 2022; 159:104203. [PMID: 36323055 DOI: 10.1016/j.brat.2022.104203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 08/22/2022] [Accepted: 09/20/2022] [Indexed: 12/14/2022]
Abstract
Exposure therapy is the preferred treatment for specific phobia (SP), with evidence supporting its efficacy whether delivered over multiple sessions or as a single session, such as One-Session Treatment. In this meta-analysis, we compared the efficiency and effectiveness of single- and multi-session exposure for SP. PsycINFO, Embase, MEDLINE, and Cochrane were systematically searched for peer-reviewed articles reporting the effects of multi-session (k = 30) and/or single-session (k = 55) in vivo exposure on SP symptoms in clinical populations (n = 1758 participants). A random-effects model was used to synthesise and compare the pre-post treatment effects (Hedges' g) on approach behaviour and self-reported SP symptoms. Mean total treatment time was significantly longer for multi-session exposure than for single-session. There were no significant differences in the pooled effect sizes of single-session and multi-session exposure at post-treatment and follow-up assessments; effect sizes were large for all outcomes. Phobia subtype significantly moderated the effect size for both treatment approaches, although the direction of association differed according to the outcome measures. Results suggest no evidence for differences in the effectiveness of single- and multi-session exposure, but single-session is more time efficient. These outcomes suggest that policies to facilitate access to single-session exposure would be beneficial.
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Affiliation(s)
- Katarzyna Odgers
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Kelly A Kershaw
- School of Psychology, University Of New South Wales, Sydney, Australia
| | - Sophie H Li
- Black Dog Institute, University Of New South Wales, Sydney, Australia
| | - Bronwyn M Graham
- School of Psychology, University Of New South Wales, Sydney, Australia.
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Iversen HM, Eide TO, Harvold M, Solem S, Kvale G, Hansen B, Hagen K. The Bergen 4-day treatment for panic disorder: replication and implementation in a new clinic. BMC Psychiatry 2022; 22:728. [PMID: 36418989 PMCID: PMC9686090 DOI: 10.1186/s12888-022-04380-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 11/09/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bergen 4-day treatment (B4DT) is a concentrated exposure-based treatment (cET), where the patient receives concentrated, individually tailored cognitive behavioral therapy (CBT) during four consecutive days. Previous findings have indicated that B4DT could be a promising treatment for panic disorder (PD). AIM The aim of the present study was to evaluate the implementation of B4DT for panic disorder with- and without agoraphobia, at a new clinic. This is the first replication study for B4DT on panic disorder. METHOD Thirty consecutively recruited patients with PD were included in an open trial design. Assessment of symptoms of panic disorder were measured with Panic Disorder Severity Scale (PDSS), while symptoms of generalized anxiety were assessed by Generalized Anxiety Disorder-7 (GAD-7) and depressive symptoms by Patient Health Questionnaire (PHQ-9) pre-treatment, post-treatment and at 3-month follow-up. Treatment satisfaction was measured with Client Satisfaction Questionnaire (CSQ-8) post-treatment. RESULTS The results showed a significant reduction in symptom severity from pre-treatment to post-treatment (d = 4.32), and at 3-month follow-up (d = 4.91). The proportion of patients classified as fulfilling the criteria for remission was 80.0% at post-treatment and 86.7% at follow up. There was a significant reduction in symptoms of depression and generalized anxiety. Treatment satisfaction was high and none of the patients dropped out. CONCLUSION The current study replicated the results from the original study and indicate that the treatment can be successfully implemented at new clinics. B4DT may be a promising treatment for panic disorder and comorbid symptoms of generalized anxiety and depression. Larger and more controlled studies are needed to establish the efficacy of B4DT for panic disorder.
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Affiliation(s)
- Hanne Moe Iversen
- grid.416049.e0000 0004 0627 2824Molde Hospital, Møre og Romsdal Hospital Trust, 6412 Molde, Norway
| | - Thorstein Olsen Eide
- grid.416049.e0000 0004 0627 2824Molde Hospital, Møre og Romsdal Hospital Trust, 6412 Molde, Norway ,grid.7914.b0000 0004 1936 7443Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Mathea Harvold
- grid.416049.e0000 0004 0627 2824Molde Hospital, Møre og Romsdal Hospital Trust, 6412 Molde, Norway
| | - Stian Solem
- grid.412008.f0000 0000 9753 1393Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway ,grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gerd Kvale
- grid.412008.f0000 0000 9753 1393Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- grid.7914.b0000 0004 1936 7443Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Kristen Hagen
- Molde Hospital, Møre og Romsdal Hospital Trust, 6412, Molde, Norway. .,Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway. .,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
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A Pilot Feasibility Study of an Intensive Summer Day Camp Intervention for Children with Selective Mutism. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9111732. [PMID: 36421181 PMCID: PMC9689151 DOI: 10.3390/children9111732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/29/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Cost, scheduling, and implementation competency are barriers to accessing traditional evidence-based behavioral interventions for childhood selective mutism (SM). Brief, or intensive, interventions are a disruptive innovation to traditional therapy given the use of fewer sessions during a short-term time period. This study explored the acceptability, integrity, and effectiveness (i.e., single-case replicated AB design) of an intensive summer camp consisting of a 5-day behavioral therapy for 25 children with SM. Caregiver-rated treatment acceptability ratings and family interviews support intensive summer day camp as an acceptable intervention approach for SM. Additionally, results revealed that counselors and parents implemented SM behavioral therapy during camp with impressive integrity (>90%) after receiving training about SM behavioral therapy from an SM expert clinician. Effect size calculations of counselor-rated daily behavior ratings revealed reductions in anxiety during camp for 18 of the 25 campers. Significant caregiver-rated improvements in speaking behaviors were reported for 9 out of 14 campers with data available for analysis at the 3-month follow-up. This pilot feasibility study is the first to investigate intensive summer day camp as a treatment approach for SM and implications for future research are discussed.
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Effective – and tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders. Behav Ther 2022; 54:427-443. [PMID: 37088502 DOI: 10.1016/j.beth.2022.11.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 09/19/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
Despite striking empirical support, exposure-based treatments for anxiety disorders are underutilized. This is partially due to clinicians' concerns that patients may reject exposure or experience severe side effects, particularly in intensive forms of exposure. We examined acceptance and side effects of two randomly assigned variants of prediction error-based exposure treatment differing in temporal density (1 vs. 3 sessions/week) in 681 patients with panic disorder, agoraphobia, social anxiety disorder, and multiple specific phobias. Treatment acceptance included treatment satisfaction and credibility, engagement (i.e., homework completion), and tolerability (i.e., side effects, dropout, and perceived treatment burden). Side effects were measured with the Inventory for the Balanced Assessment of Negative Effects of Psychotherapy (INEP). We found treatment satisfaction, credibility, and engagement to be equally high in both variants of exposure-based treatment, despite higher treatment burden (β = 0.25) and stronger side effects (β = 0.15) in intensified treatment. 94.1% of patients reported positive effects in the INEP. 42.2% reported side effects, with treatment stigma (16.6%), low mood (14.8%) and the experience to depend on the therapist (10.9%) being the most frequently reported. The mean intensity of side effects was low. We conclude that prediction error-based exposure treatment is well accepted by patients with different anxiety disorders and that patients also tolerate temporally intensified treatment, despite higher perceived treatment burden and stronger side effects. Clinicians should be aware of the most frequent side effects to take appropriate countermeasures. In sum, temporal intensification appears to be an acceptable strategy to achieve faster symptom reduction, given patients' well-informed consent.
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Szigethy EM, Silfee V, Marroquin MA, Pavlick AN, Wallace ML, Williams KR, Hoberman AM. A Digital Cognitive-Behavioral Intervention for Depression and Anxiety Among Adolescents and Young Adults. Psychiatr Serv 2022; 74:437-440. [PMID: 36164775 DOI: 10.1176/appi.ps.202200045] [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
Adolescents and young adults frequently experience anxiety and depression. The authors evaluated engagement in and effects of a coach-enhanced digital cognitive-behavioral intervention (dCBI; RxWell) targeting emotional distress in this age group. The dCBI app was prescribed to 506 adolescents and young adults at 35 pediatric practices; 278 enrolled in the app, of whom 58% engaged and 63% messaged their coach. Patients completed monthly General Anxiety Disorder-7 and eight-item Patient Health Questionnaire assessments, and a subset completed qualitative interviews. The dCBI app was associated with a significant reduction in anxiety and depression at 1 and 3 months. A dCBI is feasible as part of routine pediatric care and associated with reduced emotional distress.
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Affiliation(s)
- Eva M Szigethy
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Valerie Silfee
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Maria A Marroquin
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Alexa N Pavlick
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Meredith L Wallace
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Kelly R Williams
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
| | - Alejandro M Hoberman
- Departments of Psychiatry (Szigethy, Marroquin, Pavlick, Wallace) and Pediatrics (Szigethy, Hoberman), University of Pittsburgh, Pittsburgh; UPMC Insurance Services Division (Silfee) and UPMC Center for High Value Health Care (Williams), Pittsburgh
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Godina-Flores NL, Gutierrez-Gómez YY, García-Botello M, López-Cruz L, Moreno-García CF, Aceves-Martins M. Obesity and its association with mental health among Mexican children and adolescents: systematic review. Nutr Rev 2022; 81:658-669. [PMID: 36164834 PMCID: PMC10170326 DOI: 10.1093/nutrit/nuac083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
CONTEXT Obesity and mental health issues increasingly affect children and adolescents, but whether obesity is a risk factor for mental health issues is unclear. OBJECTIVE To systematically review the association between obesity and mental health issues (ie, anxiety and/or depression) among Mexican children and adolescents. DATA SOURCING, EXTRACTION, AND SYNTHESIS A literature search of 13 databases and 1 search engine was conducted. Population, exposure, comparison, outcomes, and study design data were extracted, analyzed, and narratively synthesized. The JBI critical appraisal tool was used to evaluate evidence quality. RESULTS A total of 16 studies with 12 103 participants between 8 and 18 years old were included. Four studies focused on anxiety outcomes, 10 on depression, and 2 on both (ie, anxiety and depression). Evidence is unclear about the association of obesity with anxiety. However, most evidence shows that Mexican children and adolescents with overweight or obesity are more likely to have depression or report a higher number of depressive symptoms than normal-weight participants. Such likelihood is greater for females. CONCLUSION Health promotion interventions to treat or prevent obesity could also consider mental health outcomes. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration no. CRD42019154132.
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Affiliation(s)
- Naara L Godina-Flores
- Nutrition Department, School of Medicine and Health Sciences, Tecnológico de Monterrey, Mexico City, Mexico
| | | | | | - Lizet López-Cruz
- Universidad Europea del Atlantico, Parque Científico y Tecnologico de Cantabria, Santander, Spain
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Hudson K, Fenley AR, Pincus DB, Leyfer O. Intensive Cognitive-Behavioral Therapy for Anxiety Disorders in Adolescents: A Case Study. Clin Case Stud 2022. [DOI: 10.1177/15346501221113523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Anxiety disorders are one of the most common psychiatric conditions in youth and can contribute to impairment in social, academic, and family functioning. Cognitive-behavioral therapy (CBT) has been shown to be efficacious in treating youth anxiety disorders; however, for a multitude of reasons, fewer than 20% of adolescents with anxiety disorders receive services for anxiety-related problems. Intensive treatments, which rely on the same traditional components of CBT but are delivered over a shorter period of time or in a fewer number of sessions, may be particularly helpful for anxiety disorders and can offer a number of advantages over standard CBT. Despite emerging evidence supporting the advantages of the intensive approach, there are few established intensive treatment programs for youth with anxiety disorders. Further, no treatment to date has comprehensively targeted the entire spectrum of comorbid adolescent anxiety disorders in a combined intensive and transdiagnostic format, even though non-intensive (i.e., weekly delivered) CBT has been tested using a transdiagnostic approach. We developed an intensive, six-session intervention based on Angelosante and colleagues’ 2009 The Adolescent Panic Control Treatment with In-Vivo Exposures (Angelosante et al., 2009) and other empirically-supported treatments for youth to target all anxiety disorders in adolescents. We present a case study on an adolescent with multiple comorbid anxiety and related disorders who received intensive CBT treatment as a way to illustrate the clinical benefit and utility of an intensive, transdiagnostic approach. Findings support the acceptability and feasibility of transdiagnostic treatment of youth anxiety.
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Affiliation(s)
- Kelsey Hudson
- Climate Psychology Alliance of North America, New York, NY, USA
| | - Alicia R. Fenley
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - Donna B. Pincus
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
| | - Ovsanna Leyfer
- Center for Anxiety and Related Disorders, Boston University, Boston, MA, USA
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Gliske K, Berry KA, Ballard J, Evans-Chase M, Solomon PL, Fenkel C. Does Insurance Type Matter on the Computer Too? Comparing Outcomes for Youth with Public v Private Health Insurance Attending a Telehealth Intensive Outpatient Program: A Quality Improvement Analysis (Preprint). JMIR Form Res 2022; 6:e41721. [DOI: 10.2196/41721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/21/2022] [Accepted: 10/14/2022] [Indexed: 11/06/2022] Open
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49
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Baartmans JMD, van Steensel FJA, Klein AM, Wiers RWHJ, Bögels SM. The role of parental anxiety symptoms in the treatment of childhood social anxiety disorder. Behav Res Ther 2022; 156:104157. [PMID: 35863242 DOI: 10.1016/j.brat.2022.104157] [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: 11/15/2020] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
The study investigated the role of parental anxiety symptoms in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. Participants were 152 children between 7 and 18 years and their parents (146 mothers, 123 fathers). Anxiety was assessed pretreatment, posttreatment, and at three months and one year follow ups. There were no baseline differences in parental anxiety symptoms between the two groups. In both groups parental anxiety symptoms decreased from pretreatment to posttreatment, and only mothers' anxiety symptoms decreased further from posttreatment to the one year follow up. Parental anxiety symptoms before the treatment were not related to the being free of all anxiety diagnoses in the children at posttreatment. However, some indications were found for greater improvements during treatment when parents had higher anxiety symptoms before treatment. Changes in parental anxiety symptoms were found to be related to changes in child anxiety symptoms. This was not found for the total clinical severity of all inclusion anxiety disorders. This relation was visible independently in fathers or mothers, or in groups of children with a primary social anxiety disorder or with another primary anxiety disorder. In conclusion, we did not find clear indications that parental anxiety symptoms explain the differences in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. More research with larger samples is needed to draw stronger conclusions.
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Affiliation(s)
- J M D Baartmans
- UvA Minds, Academic Treatment Centre, the Netherlands; Developmental Psychology, University of Amsterdam, the Netherlands.
| | - F J A van Steensel
- Child Development and Education, University of Amsterdam, the Netherlands
| | - A M Klein
- UvA Minds, Academic Treatment Centre, the Netherlands
| | - R W H J Wiers
- Developmental Psychology, University of Amsterdam, the Netherlands
| | - S M Bögels
- Child Development and Education, University of Amsterdam, the Netherlands
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Heijerman-Holtgrefe A, Huyser C, Verdellen C, van de Griendt J, Beljaars L, Kan KJ, Lindauer R, Cath D, Hoekstra P, Utens L. Effectiveness of 'Tackle Your Tics', a brief, intensive group-based exposure therapy programme for children with tic disorders: study protocol of a randomised controlled trial. BMJ Open 2022; 12:e058534. [PMID: 35768093 PMCID: PMC9240895 DOI: 10.1136/bmjopen-2021-058534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION This paper outlines the study protocol for the Dutch Tackle Your Tics study in youth with tic disorders. Tourette syndrome and chronic tic disorders are prevalent neurodevelopmental disorders, placing considerable burden on youth and their families. Behavioural treatment is the first-line, evidence-based intervention for tic disorders, but tic reduction and availability remain relatively low. Patient associations stress the need for more accessible high-quality treatments, also focusing on improving quality of life. Therefore, the brief, intensive group-based treatment Tackle Your Tics was developed. METHODS AND ANALYSIS Tackle Your Tics is a 4-day intensive and comprehensive group-based intervention for children and adolescents (9-17 years) with Tourette syndrome or a chronic tic disorder. The programme encompasses exposure and response prevention treatment and additional supporting components (coping strategies, relaxation exercises and parent support). To study the effectiveness of Tackle Your Tics and identify predictors/moderators at baseline, a single-blinded randomised controlled trial (n=104) is conducted, comparing Tackle Your Tics (n=52) with a waiting list condition lasting 3 months (n=52). Assessments are performed at similar time points for both groups: at baseline, after 4 weeks, and at 3 and 6 months of follow-up, on tic severity, quality of life and other psychosocial variables. ETHICS AND DISSEMINATION Ethics approval has been obtained from the medical ethical committee of the Amsterdam Medical Centre (METC nr NL66340.018.18, v3 June 2020). Findings will be presented on national and international conferences, peer-reviewed scientific journals, patient organisation meetings and public media. Patient representatives are fully integrated as part of the research team. If Tackle Your Tics proves to be effective, it can expand evidence-based treatment possibilities for children and adolescents with tic disorders. Identifying the psychosocial predictors/moderators for the effectiveness of this intervention can provide personalised treatment advice in the future. TRIAL REGISTRATION NUMBER NL8052.
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Affiliation(s)
- Annet Heijerman-Holtgrefe
- Department of Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
| | - Chaim Huyser
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
| | - Cara Verdellen
- PsyQ Nijmegen/Parnassia Group, Nijmegen, The Netherlands
- TicXperts, Heteren, The Netherlands
| | | | - Laura Beljaars
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Dutch Tourette Association, Haarlem, The Netherlands
- Parnassia Group, The Hague, The Netherlands
| | - Kees-Jan Kan
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Ramón Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
| | - Daniëlle Cath
- Department of Specialized Training, GGZ Drenthe, Assen, The Netherlands
- University Medical Center Groningen, Department of Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Pieter Hoekstra
- University Medical Center Groningen, Department of Child and Adolescent Psychiatry, University of Groningen, Groningen, The Netherlands
| | - Lisbeth Utens
- Levvel, Academic Center for Child and Adolescent Psychiatry and Specialized Youth Care, Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, the Netherlands
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