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Galí D, Forcadell E, Primé-Tous M, Puig O, Lera-Miguel S. Cool Kids: Cognitive Behavioral Therapy in a Spanish Sample of Children and Adolescents with Anxiety Disorders. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01579-w. [PMID: 37672194 DOI: 10.1007/s10578-023-01579-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 09/07/2023]
Abstract
Anxiety disorders (ADs) negatively impact functioning and life quality. Studies on cognitive behavioral therapy (CBT) have demonstrated its short- and long-term efficacy. Cool Kids (CK) is a 10-session CBT-based group program administered to participants with ADs aged 7-17 years and their parents, and it has demonstrated efficacy compared with control groups. This study analyzes the effectiveness of CK in a clinical cohort of Spanish children and adolescents with ADs. CK was offered to 57 patients with AD and their caregivers at the Hospital Clínic, Barcelona. In all global registered measures, the results demonstrated a reduction of symptoms and their interference in daily functioning. Moreover, a significant improvement was observed in participants who completed more sessions. Thus, CK reduced the severity of anxiety and its interference over individual and family functioning.
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Affiliation(s)
- Dafne Galí
- University of Barcelona, Barcelona, Spain.
| | - Eduard Forcadell
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Mireia Primé-Tous
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
| | - Olga Puig
- Departament of Child and Adolescent Psychiatry and Psychology, Hospital Clínic of Barcelona, 2021SGR01319, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Sara Lera-Miguel
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain
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2
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Carlton CN, Garcia KM, Honaker M, Richey JA, Ollendick TH. 5-year follow-up of adolescents with social anxiety disorder: Current functioning during COVID-19. Psychiatry Res 2023; 322:115118. [PMID: 36842399 PMCID: PMC9940468 DOI: 10.1016/j.psychres.2023.115118] [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: 03/16/2022] [Revised: 01/06/2023] [Accepted: 02/17/2023] [Indexed: 02/22/2023]
Abstract
The present study followed-up adolescents with social anxiety disorder (SAD) during the COVID-19 pandemic, approximately 5-years following their participation in an Attention Bias Modification Training (ABMT) program (Ollendick et al., 2019). The current study aimed to evaluate current functioning and quality of life (QoL) during the emerging adulthood period. Participants included 27 young adults who completed a randomized controlled trial of ABMT and were available for follow-up. Participants filled out self-report measures of QoL and functioning and underwent a clinical interview to assess current severity of social anxiety. Clinician-rated symptoms of SAD significantly decreased from post-treatment to 5-year follow-up. Additionally, results demonstrated that social anxiety severity was significantly related to poorer self-reported physical and psychological health as well as poorer functioning with regard to social distancing fears during COVID-19. Lastly, when evaluating change in symptoms over time, increases in social anxiety severity over a 5-year period significantly predicted worsened social distancing fears during COVID-19.
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Affiliation(s)
- Corinne N Carlton
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States.
| | - Katelyn M Garcia
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - Makayla Honaker
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - John A Richey
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
| | - Thomas H Ollendick
- Department of Psychology, Virginia Tech, Child Study Center, 460 Turner St, Blacksburg, VA 24061, United States
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Rasouli S, Gupta G, Nilsen E, Dautenhahn K. Potential Applications of Social Robots in Robot-Assisted Interventions for Social Anxiety. Int J Soc Robot 2022; 14:1-32. [PMID: 35096198 PMCID: PMC8787185 DOI: 10.1007/s12369-021-00851-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2021] [Indexed: 12/31/2022]
Abstract
AbstractSocial anxiety disorder or social phobia is a condition characterized by debilitating fear and avoidance of different social situations. We provide an overview of social anxiety and evidence-based behavioural and cognitive treatment approaches for this condition. However, treatment avoidance and attrition are high in this clinical population, which calls for innovative approaches, including computer-based interventions, that could minimize barriers to treatment and enhance treatment effectiveness. After reviewing existing assistive technologies for mental health interventions, we provide an overview of how social robots have been used in many clinical interventions. We then propose to integrate social robots in conventional behavioural and cognitive therapies for both children and adults who struggle with social anxiety. We categorize the different therapeutic roles that social robots can potentially play in activities rooted in conventional therapies for social anxiety and oriented towards symptom reduction, social skills development, and improvement in overall quality of life. We discuss possible applications of robots in this context through four scenarios. These scenarios are meant as ‘food for thought’ for the research community which we hope will inspire future research. We discuss risks and concerns for using social robots in clinical practice. This article concludes by highlighting the potential advantages as well as limitations of integrating social robots in conventional interventions to improve accessibility and standard of care as well as outlining future steps in relation to this research direction. Clearly recognizing the need for future empirical work in this area, we propose that social robots may be an effective component in robot-assisted interventions for social anxiety, not replacing, but complementing the work of clinicians. We hope that this article will spark new research, and research collaborations in the highly interdisciplinary field of robot-assisted interventions for social anxiety.
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Affiliation(s)
- Samira Rasouli
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
| | - Garima Gupta
- Department of Psychology, University of Waterloo, Waterloo, Ontario Canada
| | - Elizabeth Nilsen
- Department of Psychology, University of Waterloo, Waterloo, Ontario Canada
| | - Kerstin Dautenhahn
- Department of Electrical and Computer Engineering, University of Waterloo, 200 University Avenue West, Waterloo, Ontario N2L 3G1 Canada
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario Canada
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The Cool Kids as a School-Based Universal Prevention and Early Intervention Program for Anxiety: Results of a Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19020941. [PMID: 35055763 PMCID: PMC8775776 DOI: 10.3390/ijerph19020941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 01/07/2022] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
The efficacy of the Cool Kids program has been consistently demonstrated both within Australia and internationally, but limited data are available on the use of Cool Kids as a universal program. The purpose of the study is to evaluate Cool Kids as a universal program for preventing childhood anxiety in the school context. There were 73 Italian children (35 boys and 36 girls, ages 10–13 years) attending the last year of primary school and the first year of middle school who participated in an active intervention based on a school adaptation of the Cool Kids protocol. Results of t-test analyses highlighted a downward trend of anxiety symptoms, especially in total anxiety, somatic anxiety, generalized anxiety, separation anxiety, social anxiety and school phobia at post-treatment assessed by children. Even the score of depression symptoms, measured as a second outcome measure, decreased after the treatment. This study contributes to the evidence base for the Cool Kids program as a universal program for preventing childhood anxiety in the school context. Although these preliminary results show some promise, their replication in future research is necessary given current study limitations.
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Cordier R, Speyer R, Mahoney N, Arnesen A, Mjelve LH, Nyborg G. Effects of interventions for social anxiety and shyness in school-aged children: A systematic review and meta-analysis. PLoS One 2021; 16:e0254117. [PMID: 34242303 PMCID: PMC8270412 DOI: 10.1371/journal.pone.0254117] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/20/2021] [Indexed: 11/19/2022] Open
Abstract
In school, shyness is associated with psychosocial difficulties and has negative impacts on children's academic performance and wellbeing. Even though there are different strategies and interventions to help children deal with shyness, there is currently no comprehensive systematic review of available interventions. This systematic review and meta-analysis aim to identify interventions for shy children and to evaluate the effectiveness in reducing psychosocial difficulties and other impacts. The methodology and reporting were guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and checklist. A total of 4,864 studies were identified and 25 of these met the inclusion criteria. These studies employed interventions that were directed at school-aged children between six and twelve years of age and described both pre- and post-intervention measurement in target populations of at least five children. Most studies included an intervention undertaken in a school setting. The meta-analysis revealed interventions showing a large effect in reducing negative consequences of shyness, which is consistent with extant literature regarding shyness in school, suggesting school-age as an ideal developmental stage to target shyness. None of the interventions were delivered in a classroom setting, limiting the ability to make comparisons between in-class interventions and those delivered outside the classroom, but highlighting the effectiveness of interventions outside the classroom. The interventions were often conducted in group sessions, based at the school, and involved activities such as play, modelling and reinforcement and clinical methods such as social skills training, psychoeducation, and exposure. Traditionally, such methods have been confined to a clinic setting. The results of the current study show that, when such methods are used in a school-based setting and involve peers, the results can be effective in reducing negative effects of shyness. This is consistent with recommendations that interventions be age-appropriate, consider social development and utilise wide, school-based programs that address all students.
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Affiliation(s)
- Reinie Cordier
- Department of Social Work, Education and Community Wellbeing, Northumbria University, Newcastle upon Tyne, United Kingdom
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Renée Speyer
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
- Department of Special Needs Education, University of Oslo, Oslo, Norway
- Department of Otorhinolaryngology and Head and Neck Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | - Natasha Mahoney
- Faculty of Health Sciences, School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Anne Arnesen
- The Norwegian Center for Child Behavioral Development (NUBU), Oslo, Norway
| | - Liv Heidi Mjelve
- Department of Special Needs Education, University of Oslo, Oslo, Norway
| | - Geir Nyborg
- Department of Special Needs Education, University of Oslo, Oslo, Norway
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Asbrand J, Heinrichs N, Schmidtendorf S, Nitschke K, Tuschen-Caffier B. Experience Versus Report: Where Are Changes Seen After Exposure-Based Cognitive-Behavioral Therapy? A Randomized Controlled Group Treatment of Childhood Social Anxiety Disorder. Child Psychiatry Hum Dev 2020; 51:427-441. [PMID: 31960175 PMCID: PMC7235054 DOI: 10.1007/s10578-019-00954-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
A considerable number of children and adolescents with social anxiety disorder (SAD) do not benefit from treatment as much as expected. However, treatment success should not be measured with social anxiety reports alone; the cognitive, behavioral, and physiological components of social stress should also be assessed. The authors examined an exposure-based SAD-specific group cognitive behavioral therapy (CBT) in a randomized controlled trial (N = 67, age 9-13 years, blind randomized allocation to treatment [CBT; n = 31] and waitlist control [WLC; n = 36] groups). Success was operationalized as a clinically significant reduction of symptoms measured with SAD-specific questionnaires, structured interviews, and changes in response to the Trier Social Stress Test (TSST). In the CBT group, there was a trend toward a significant increase in positive cognitions in the TSST after treatment (d = 0.37), whereas these positive cognitions decreased in the WLC group (d = 0.40). No significant results involving group appeared for negative cognitions, behavior and physiology. Children in the CBT group, but not parents, further reported less social anxiety in one questionnaire from pre- to post-treatment (d = 0.89). A structured interview confirmed a decrease in severity of SAD in the CBT group. While the gold standard of a blind interview showed efficacy of treatment, not all trait and state measures demonstrated similar success patterns.Trial registration Eligibility criteria and some of the dependent variables (cognitions, physiology) for treatment success were registered with the German Research Foundation (TU 78/5-2, HE 3342/4-2) prior to recruitment. Clinical assessment of diagnosis and behavioral data were not a priori planned as outcome measures for this trial and therefore analyzed in a post-hoc approach.
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Affiliation(s)
- Julia Asbrand
- Department of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Freiburg im Breisgau, Germany.
| | - Nina Heinrichs
- Department of Psychology, University of Bremen, Bremen, Germany
- Department of Psychology, University of Braunschweig, Braunschweig, Germany
| | | | - Kai Nitschke
- Department of Psychology, University of Freiburg, Freiburg im Breisgau, Germany
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Pelissolo A, Abou Kassm S, Delhay L. Therapeutic strategies for social anxiety disorder: where are we now? Expert Rev Neurother 2019; 19:1179-1189. [PMID: 31502896 DOI: 10.1080/14737175.2019.1666713] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Introduction: Classical well-established treatments of social anxiety disorder (SAD) are now complemented by more recent therapeutic strategies. This review aims to summarize available therapies for SAD and discuss recent evidence-based findings on the management of this disorder.Areas covered: Recent guidelines recommend psychotherapy, particularly cognitive-behavioral therapy (CBT), and pharmacotherapy, as first-line treatments of patients with SAD, without a clear superiority of one option over the other. CBT includes classical approaches such as in vivo exposure to social situations and cognitive therapy, but new modalities and techniques have been recently developed: third-wave approaches, internet-delivered therapy, virtual reality exposure, and cognitive bias modification. Selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors have been also extensively studied and shown to be effective in SAD. Two alternative strategies have been developed to treat SAD with disappointing results: cognitive bias modification, and pharmacological augmentation of psychotherapy using D-cycloserine during exposure sessions.Expert opinion: Personalized treatments for SAD patients are now available. Innovative strategies such as online psychotherapy and virtual reality exposure are useful alternatives to CBT and SSRIs. Future developments and optimization of attention bias modification and of pharmacological augmentation of psychotherapy can be promising.
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Affiliation(s)
- Antoine Pelissolo
- AP-HP, Psychiatry Department, Hôpitaux Universitaires Henri-Mondor, Faculté de médecine, Créteil, France
| | - Sandra Abou Kassm
- Faculty of Medical Sciences, Psychiatry Department, Lebanese University, Beirut, Lebanon
| | - Lauriane Delhay
- AP-HP, Psychiatry Department, Hôpitaux Universitaires Henri-Mondor, Créteil, France
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Swan AJ, Kendall PC, Olino T, Ginsburg G, Keeton C, Compton S, Piacentini J, Peris T, Sakolsky D, Birmaher B, Albano AM. Results from the Child/Adolescent Anxiety Multimodal Longitudinal Study (CAMELS): Functional outcomes. J Consult Clin Psychol 2018; 86:738-750. [PMID: 30138013 PMCID: PMC6110105 DOI: 10.1037/ccp0000334] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To report functional outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), which examined the impact of youth anxiety treatment (cognitive-behavioral therapy [CBT], coping cat; Sertraline, SRT; COMB [CBT + SRT]; pill placebo) on (a) global and (b) domain-specific functioning assessed an average of 3.1 times, 3- to 12-years postrandomization (first assessment = mean 6.5 years postrandomization). METHOD Three-hundred and 19 of 488 families from the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008) participated. Growth curve modeling examined the impact of treatment condition and acute treatment outcomes (i.e., response, remission) on global functioning, global and domain-specific impairment, and life satisfaction across follow-up visits. Logistic regressions explored the impact of treatment remission and condition on low frequency events (arrests/convictions) and education. RESULTS Treatment responders and remitters demonstrated better global functioning, decreased overall impairment, and increased life satisfaction at follow-up. Treatment remission, but not response, predicted decreased domain-specific impairment (social relationships, self-care/independence, academic functioning), and maintenance of increased life satisfaction across follow-ups. Participants in the CBT condition, compared with pill placebo, demonstrated improved trajectories pertaining to life satisfaction, overall impairment, and impairment in academic functioning. Randomization to CBT or COMB treatment was associated with increasing employment rates. Trajectories for participants randomized to SRT was not significantly different from placebo. Treatment outcome and condition did not predict legal outcomes, school/work variables, or family life. CONCLUSION Positive early intervention outcomes are associated with improved overall functioning, life satisfaction, and functioning within specific domains 6.5 years posttreatment. Treatment type differentially predicted trajectories of functioning. Findings support the positive impact of pediatric anxiety treatment into adolescence and early adulthood. (PsycINFO Database Record
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Affiliation(s)
- Anna J Swan
- Department of Child and Adolescent Psychiatry, Hassenfeld Children's Hospital at NYU Langone
| | | | | | - Golda Ginsburg
- Child Division of Department of Psychiatry, University of Connecticut Health
| | - Courtney Keeton
- Department of Psychiatry and Behavioral Services, Johns Hopkins University School of Medicine
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles
| | - Tara Peris
- Division of Child and Adolescent Psychiatry, University of California, Los Angeles
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Leigh E, Clark DM. Understanding Social Anxiety Disorder in Adolescents and Improving Treatment Outcomes: Applying the Cognitive Model of Clark and Wells (1995). Clin Child Fam Psychol Rev 2018; 21:388-414. [PMID: 29654442 PMCID: PMC6447508 DOI: 10.1007/s10567-018-0258-5] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. There are clear potential benefits to delivering effective interventions during adolescence. However, there is limited evidence on the specific efficacy of available therapies. This is in contrast to adults, for whom we have interventions with very specific treatment effects. One such treatment is individual cognitive therapy. Cognitive therapy is based on the cognitive model of social anxiety proposed by Clark and Wells (in: Heimberg, Leibowitz, Hope, Scheiber (eds) Social phobia: diagnosis, assessment and treatment, The Guilford Press, New York, 1995). The present review examines the potential application of this adult cognitive model to the understanding of adolescent social anxiety and considers additional adolescent-specific factors that need to be accommodated. It is suggested that a developmentally sensitive adoption of the cognitive model of social anxiety disorder (Clark and Wells 1995) for adolescents may lead to better treatment outcomes.
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Affiliation(s)
- Eleanor Leigh
- Department of Experimental Psychology, University of Oxford, Oxford, UK.
- Oxford Centre for Anxiety Disorders and Trauma, The Old Rectory, Paradise Square, Oxford, OX1 1TW, UK.
| | - David M Clark
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Gibby BA, Casline EP, Ginsburg GS. Long-Term Outcomes of Youth Treated for an Anxiety Disorder: A Critical Review. Clin Child Fam Psychol Rev 2018; 20:201-225. [PMID: 28181040 DOI: 10.1007/s10567-017-0222-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU) studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2-19 years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies. Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after treatment for anxiety.
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Affiliation(s)
- Brittany A Gibby
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32303, USA
| | - Elizabeth P Casline
- University of Connecticut Health, 65 Kane Street, West Hartford, CT, 06119, USA
| | - Golda S Ginsburg
- University of Connecticut Health, 65 Kane Street, West Hartford, CT, 06119, USA.
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Spence SH, Donovan CL, March S, Kenardy JA, Hearn CS. Generic versus disorder specific cognitive behavior therapy for social anxiety disorder in youth: A randomized controlled trial using internet delivery. Behav Res Ther 2016; 90:41-57. [PMID: 27988427 DOI: 10.1016/j.brat.2016.12.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 10/14/2016] [Accepted: 12/05/2016] [Indexed: 12/01/2022]
Abstract
The study examined whether the efficacy of cognitive behavioral treatment for Social Anxiety Disorder for children and adolescents is increased if intervention addresses specific cognitive and behavioral factors linked to the development and maintenance of SAD in young people, over and above the traditional generic CBT approach. Participants were 125 youth, aged 8-17 years, with a primary diagnosis of SAD, who were randomly assigned to generic CBT (CBT-GEN), social anxiety specific CBT (CBT-SAD) or a wait list control (WLC). Intervention was delivered using a therapist-supported online program. After 12-weeks, participants who received treatment (CBT-SAD or CBT-GEN) showed significantly greater reduction in social anxiety and post-event processing, and greater improvement in global functioning than the WLC but there was no significant difference between CBT-SAD and CBT-GEN on any outcome variable at 12-weeks or 6-month follow-up. Despite significant reductions in anxiety, the majority in both treatment conditions continued to meet diagnostic criteria for SAD at 6-month follow-up. Decreases in social anxiety were associated with decreases in post-event processing. Future research should continue to investigate disorder-specific interventions for SAD in young people, drawing on evidence regarding causal or maintaining factors, in order to enhance treatment outcomes for this debilitating condition.
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Affiliation(s)
- Susan H Spence
- Australian Institute of Suicide Research and Prevention (AISRAP) and School of Applied Psychology, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, QLD, 4122, Australia
| | - Sonja March
- School of Psychology and Counselling & Institute for Resilient Regions, University of Southern Queensland, Springfield, QLD, Australia, 4300
| | - Justin A Kenardy
- School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Cate S Hearn
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, QLD, 4122, Australia
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12
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Swan AJ, Kendall PC. Fear and missing out: Youth anxiety and functional outcomes. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/cpsp.12169] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Kothgassner OD, Felnhofer A, Hlavacs H, Beutl L, Palme R, Kryspin-Exner I, Glenk LM. Salivary cortisol and cardiovascular reactivity to a public speaking task in a virtual and real-life environment. COMPUTERS IN HUMAN BEHAVIOR 2016. [DOI: 10.1016/j.chb.2016.03.081] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Scaini S, Belotti R, Ogliari A, Battaglia M. A comprehensive meta-analysis of cognitive-behavioral interventions for social anxiety disorder in children and adolescents. J Anxiety Disord 2016; 42:105-12. [PMID: 27399932 DOI: 10.1016/j.janxdis.2016.05.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 05/19/2016] [Accepted: 05/26/2016] [Indexed: 11/19/2022]
Abstract
The effectiveness of different types of CBT for children and adolescents suffering from Social Anxiety Disorder (SAD) is generally supported. However, no systematic efforts have been made to quantitatively summarize and analyse the impact of specific variables on therapeutic outcome. Here, we assessed the magnitude and duration of CBT effectiveness in children and adolescents with SAD. The effectiveness of CBT was supported by the effect sizes of studies that had examined pre-post (g=0.99), between-group (g=0.71), and follow-up responses (follow-up vs. pre-test mean g=1.18, follow-up vs. post-test mean g=0.25). A significant moderating effect was found for the variable "number of treatment sessions". In addition, larger effect sizes were found in studies that included "Social Skills Training" sessions in the intervention package. Data support the effectiveness of CBT interventions and its durability for SAD in children and adolescents. Adding social skills training to the intervention package can further enhance the impact of treatment.
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Affiliation(s)
- Simona Scaini
- Faculty of Psychology, Sigmund Freud University, Milan, Italy; Developmental Psychopathology Unit, 'Vita-Salute' San Raffaele University, Milan, Italy.
| | - Raffaella Belotti
- The Department of Clinical Neurosciences, San Raffaele Hospital, Milan, Italy.
| | - Anna Ogliari
- Developmental Psychopathology Unit, 'Vita-Salute' San Raffaele University, Milan, Italy; The Department of Clinical Neurosciences, San Raffaele Hospital, Milan, Italy.
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Canada; The Division of Child and Youth Psychiatry at the Centre for Addiction and Mental Health (CAMH), Toronto, Canada.
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Swain D, Scarpa A, White S, Laugeson E. Emotion Dysregulation and Anxiety in Adults with ASD: Does Social Motivation Play a Role? J Autism Dev Disord 2016; 45:3971-7. [PMID: 26319254 DOI: 10.1007/s10803-015-2567-6] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Young adults with ASD and no intellectual impairment are more likely to exhibit clinical levels of anxiety than typically developing peers (DSM-5, American Psychiatric Association, 2013). This study tests a mechanistic model in which anxiety culminates via emotion dysregulation and social motivation. Adults with ASD (49 males, 20 females) completed self-report measures on emotion regulation, caregivers completed measures on ASD severity and both on social anxiety. Results indicated that emotion dysregulation (p < .001; p < .05) and social motivation (p < .05, p < .001) significantly predicted social anxiety as reported by caregivers and young adults respectively. However, social motivation did not appear to play a moderating role in the relationship between emotion regulation and anxiety, even when controlling for social awareness. Significant predictor variables of social anxiety varied based on reporter (i.e. caregiver versus young adult), with difficulty engaging in goal-directed behaviors during negative emotions serving as the only shared predictor.
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Affiliation(s)
- Deanna Swain
- Department of Psychology (MC 0436), Virginia Polytechnic Institute and State University, 109 Williams Hall, Virginia Tech, 890 Drillfield Drive, Blacksburg, VA, 24061, USA.
| | - Angela Scarpa
- Department of Psychology (MC 0436), Virginia Polytechnic Institute and State University, 109 Williams Hall, Virginia Tech, 890 Drillfield Drive, Blacksburg, VA, 24061, USA
| | - Susan White
- Department of Psychology (MC 0436), Virginia Polytechnic Institute and State University, 109 Williams Hall, Virginia Tech, 890 Drillfield Drive, Blacksburg, VA, 24061, USA
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16
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Lee SS, Victor AM, James MG, Roach LE, Bernstein GA. School-Based Interventions for Anxious Children: Long-Term Follow-Up. Child Psychiatry Hum Dev 2016; 47:183-93. [PMID: 26003419 PMCID: PMC4658320 DOI: 10.1007/s10578-015-0555-x] [Citation(s) in RCA: 8] [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] [Indexed: 11/28/2022]
Abstract
This study examined the long-term outcomes of a nonclinical sample of anxious children (N = 61) who were randomized by school to 9 weeks of group cognitive-behavioral therapy (CBT) for children, group CBT for children plus parent training, or no-treatment control. Parents and children completed measures of anxiety symptoms at baseline, posttreatment, and at 3-, 6-, 12-month, 2-, and 3-year posttreatment follow-ups. Piecewise longitudinal growth curve analyses were applied to the data. When the two CBT groups were combined and compared with control, the combined treatment group showed significantly greater reduction in children's anxiety severity based on the parent ratings in the first longitudinal phase. However, on the parent Clinician Severity Rating, gains were maintained to 3 years. Child report revealed no significant differences between groups on anxiety reduction. This study maintained a small no-treatment control group during the entire follow-up period. From parental perspective only, school-based group CBT appeared to be beneficial in decreasing severity of anxiety symptoms and maintaining gains over time.
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Affiliation(s)
- Susanne S Lee
- Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA.
| | - Andrea M Victor
- Chicago Neurodevelopmental Center, 601 Skokie Blvd, #203, Northbrook, IL, 60062, USA.
| | - Matthew G James
- Park Nicollet Health Services, 3850 Park Nicollet Blvd., St. Louis Park, MN, 55416, USA.
| | - Lauren E Roach
- Department of Pediatrics, Section of Hematology/Oncology, University of Chicago, 5721 South Maryland Avenue, MC8000, Suite K160, Chicago, IL, 60637, USA.
| | - Gail A Bernstein
- Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, F282/2A West, 2450 Riverside Avenue, Minneapolis, MN, 55454, USA.
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Bein LA, Petrik ML, Saunders SM, Wojcik JV. Discrepancy between parents and children in reporting of distress and impairment: Association with critical symptoms. Clin Child Psychol Psychiatry 2015; 20:515-24. [PMID: 24763969 DOI: 10.1177/1359104514532185] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND We examined discrepant parent-child reports of subjective distress and psychosocial impairment. METHOD Parent-child pairs (N = 112 pairs) completed the Health Dynamics Inventory at intake for outpatient therapy. RESULTS Average parent scores were significantly higher than average child scores on distress, impairment, and externalizing symptoms, but not internalizing symptoms. There were significant associations between parent-child discrepancy (i.e. children who reported greater distress or impairment than parents or vice versa) and child endorsement of several notable symptoms (rapid mood swings, panic, nightmares, and suicidal ideation). CONCLUSION Parents tended to report more externalizing symptoms, distress, and impairment than children reported; however, when children report more distress and impairment than parents, this may indicate serious psychological problems.
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Affiliation(s)
- Laura A Bein
- Department of Psychology, Marquette University, USA
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18
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Sweeney C, Warner CM, Brice C, Stewart C, Ryan J, Loeb KL, McGrath RE. Identification of Social Anxiety in Schools: The Utility of a Two-Step Screening Process. ACTA ACUST UNITED AC 2015; 19:268-275. [PMID: 26609497 DOI: 10.1007/s40688-015-0055-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Social anxiety disorder (SAD) is highly prevalent yet largely undetected and untreated in adolescents despite the availability of effective treatments. Implementing interventions in schools enhances recognition and access to treatment for SAD. However, without reliable means to accurately identify youth in need of services, school-based interventions are not feasible. The purpose of this study is to evaluate the utility of a two-step, school-based screening approach to identify youth with SAD. Students at three public high schools were screened with self-report questionnaires or nominated by school personnel. Subsequently, a brief telephone assessment of student symptoms was completed with students' parents. Results showed that using both questionnaires and telephone assessments yielded acceptable detection rates, while school staff nominations were not beneficial. This study provides support for the use of a two-step screening procedure consisting of student self-reports followed by brief parent telephone interviews to identify youth with clinically impairing social anxiety. Implications for enhancing school-based detection of and intervention for socially anxious adolescents are discussed.
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Affiliation(s)
| | - Carrie Masia Warner
- William Paterson University, New York University Langone Medical Center, and Nathan S. Kline Institute for Psychiatric Research
| | - Chad Brice
- New York University Langone Medical Center
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James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2015; 2015:CD004690. [PMID: 25692403 PMCID: PMC6491167 DOI: 10.1002/14651858.cd004690.pub4] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND A previous Cochrane review (James 2005) showed that cognitive behavioural therapy (CBT) was effective in treating childhood anxiety disorders; however, questions remain regarding (1) the relative efficacy of CBT versus non-CBT active treatments; (2) the relative efficacy of CBT versus medication and the combination of CBT and medication versus placebo; and (3) the long-term effects of CBT. OBJECTIVES To examine (1) whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison with (a) wait-list controls; (b) active non-CBT treatments (i.e. psychological placebo, bibliotherapy and treatment as usual (TAU)); and (c) medication and the combination of medication and CBT versus placebo; and (2) the long-term effects of CBT. SEARCH METHODS Searches for this review included the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Group Register, which consists of relevant randomised controlled trials from the bibliographic databases-The Cochrane Library (1970 to July 2012), EMBASE, (1970 to July 2012) MEDLINE (1970 to July 2012) and PsycINFO (1970 to July 2012). SELECTION CRITERIA All randomised controlled trials (RCTs) of CBT versus waiting list, active control conditions, TAU or medication were reviewed. All participants must have met the criteria of the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD) for an anxiety diagnosis, excluding simple phobia, obsessive-compulsive disorder, post-traumatic stress disorder and elective mutism. DATA COLLECTION AND ANALYSIS The methodological quality of included trials was assessed by three reviewers independently. For the dichotomous outcome of remission of anxiety diagnosis, the odds ratio (OR) with 95% confidence interval (CI) based on the random-effects model, with pooling of data via the inverse variance method of weighting, was used. Significance was set at P < 0.05. Continuous data on each child's anxiety symptoms were pooled using the standardised mean difference (SMD). MAIN RESULTS Forty-one studies consisting of 1806 participants were included in the analyses. The studies involved children and adolescents with anxiety of mild to moderate severity in university and community clinics and school settings. For the primary outcome of remission of any anxiety diagnosis for CBT versus waiting list controls, intention-to-treat (ITT) analyses with 26 studies and 1350 participants showed an OR of 7.85 (95% CI 5.31 to 11.60, Z = 10.26, P < 0.0001), but with evidence of moderate heterogeneity (P = 0.04, I² = 33%). The number needed to treat (NNT) was 6.0 (95% CI 7.5 to 4.6). No difference in outcome was noted between individual, group and family/parental formats. ITT analyses revealed that CBT was no more effective than non-CBT active control treatments (six studies, 426 participants) or TAU in reducing anxiety diagnoses (two studies, 88 participants). The few controlled follow-up studies (n = 4) indicate that treatment gains in the remission of anxiety diagnosis are not statistically significant. AUTHORS' CONCLUSIONS Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow-up, is limited and inconclusive.
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Affiliation(s)
- Anthony C James
- University of Oxford Department of Psychiatry, University of Oxford, Oxford, UK, OX3 7JX.
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20
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Can parent training for parents with high levels of expressed emotion have a positive effect on their child's social anxiety improvement? J Anxiety Disord 2014; 28:812-22. [PMID: 25265549 DOI: 10.1016/j.janxdis.2014.09.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 08/24/2014] [Accepted: 09/03/2014] [Indexed: 10/24/2022]
Abstract
The role that parents' involvement may play in improving their child's social anxiety is still under debate. This paper aimed to investigate whether training parents with high expressed emotion (EE) could improve outcomes for adolescent social anxiety intervention. Fifty-two socially anxious adolescents (aged 13-18 years), whose parents exhibited high levels of expressed emotion, were assigned to either (a) a school-based intervention with an added parent training component, or (b) a school-based program focused solely on intervening with the adolescent (no parental involvement). Post-treatment and 12-month follow-up findings showed that school-based intervention with parent training was superior to the adolescent-specific program, yielding significant reductions in diagnosis remission, social and depressive symptomatology, particularly when the EE status of parents changed. Overall, the findings suggest that high-EE parents of children with social anxiety need to be involved in their child's therapy.
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Ingul JM, Aune T, Nordahl HM. A randomized controlled trial of individual cognitive therapy, group cognitive behaviour therapy and attentional placebo for adolescent social phobia. PSYCHOTHERAPY AND PSYCHOSOMATICS 2014; 83:54-61. [PMID: 24281563 DOI: 10.1159/000354672] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 07/25/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Very few studies have investigated the effects of individual disorder-specific treatment of social phobia (SP) in adolescents. The objective of this study was to compare the effects of individual cognitive therapy for SP, group cognitive behavioural therapy (CBTG) and attentional placebo (AP) among adolescents with a primary diagnosis of SP. METHODS A randomized controlled design was used, and a total of 279 adolescents were assessed. Fifty-seven adolescents, between 13 and 16 years old, were allocated to individual cognitive therapy, CBTG or AP. The participants were assessed before treatment, at the end of treatment and at a 12-month follow-up using both self-report and a semi-structured interview. RESULTS The individual cognitive therapy showed significant reductions in symptoms, impairment and diagnostic criteria both at the end of treatment and at the 12-month follow-up. Compared with CBTG and AP, the individual cognitive therapy group demonstrated significantly greater effects on both symptom reduction and impairment. There were no significant differences between CBTG and AP. CONCLUSIONS In a direct comparison between the most commonly used treatments for adolescent SP, we found that individual therapy was the most effective, yielding better effects than both CBTG and AP.
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Affiliation(s)
- Jo Magne Ingul
- Department of Child and Adolescent Psychiatry, Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway
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22
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Selles RR, Arnold EB, Phares V, Lewin AB, Murphy TK, Storch EA. Cognitive-behavioral therapy for anxiety in youth with an autism spectrum disorder: A follow-up study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2014; 19:613-21. [DOI: 10.1177/1362361314537912] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive-behavioral therapy for anxiety in youth with an autism spectrum disorder appears efficacious; however, maintenance of treatment gains has not yet been studied. Using a sample of 32 youth who had benefited at least minimally from a past trial of cognitive-behavioral therapy for anxiety in autism spectrum disorder, this study assessed anxiety symptoms in youth 10–26 months following treatment completion. Compared to baseline, follow-up scores were associated with large effects for treatment. Relative to post-treatment, a small effect for return in symptoms was present and significantly fewer individuals were rated as responders at follow-up. Future studies should investigate factors associated with poor treatment maintenance and modifications or additions to treatment that may help maintain treatment gains.
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23
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Gearing RE, Schwalbe CSJ, Lee R, Hoagwood KE. The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depress Anxiety 2013; 30:800-8. [PMID: 23596102 DOI: 10.1002/da.22118] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 03/11/2013] [Accepted: 03/22/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To investigate the effects of booster sessions in cognitive behavioral therapy (CBT) for children and adolescents with mood or anxiety disorders, whereas controlling for youth demographics (e.g., gender, age), primary diagnosis, and intervention characteristics (e.g., treatment modality, number of sessions). METHODS Electronic databases were searched for CBT interventions for youth with mood and anxiety disorders. Fifty-three (k = 53) studies investigating 1,937 youth met criteria for inclusion. Booster sessions were examined using two case-controlled effect sizes: pre-post and pre-follow-up (6 months) effect sizes and employing weighted least squares (WLSs) regressions. RESULTS Meta-analyses found pre-post studies with booster sessions had a larger effect size r = .58 (k = 15; 95% CI = 0.52-0.65; P < .01) than those without booster sessions r = .45 (k = 38; 95% CI = 0.41-0.49; P < .001). In the WLS regression analyses, controlling for demographic factors, primary diagnosis, and intervention characteristics, studies with booster sessions showed larger pre-post effect sizes than those without booster sessions (B = 0.13, P < .10). Similarly, pre-follow-up studies with booster sessions showed a larger effect size r = .64 (k = 10; 95% CI = 0.57-0.70; P < .10) than those without booster sessions r = .48 (k = 20; 95% CI = 0.42-0.53; P < .01). Also, in the WLS regression analyses, pre-follow-up studies showed larger effect sizes than those without booster sessions (B = 0.08, P < .01) after accounting for all control variables. CONCLUSIONS Result suggests that CBT interventions with booster sessions are more effective and the effect is more sustainable for youth managing mood or anxiety disorders than CBT interventions without booster sessions.
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Affiliation(s)
- Robin E Gearing
- Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA.
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24
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James AC, James G, Cowdrey FA, Soler A, Choke A. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2013:CD004690. [PMID: 23733328 DOI: 10.1002/14651858.cd004690.pub3] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND A previous Cochrane review (James 2005) showed that cognitive behavioural therapy (CBT) was effective in treating childhood anxiety disorders; however, questions remain regarding (1) the relative efficacy of CBT versus non-CBT active treatments; (2) the relative efficacy of CBT versus medication and the combination of CBT and medication versus placebo; and (3) the long-term effects of CBT. OBJECTIVES To examine (1) whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison with (a) wait-list controls; (b) active non-CBT treatments (i.e. psychological placebo, bibliotherapy and treatment as usual (TAU)); and (c) medication and the combination of medication and CBT versus placebo; and (2) the long-term effects of CBT. SEARCH METHODS Searches for this review included the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Group Register, which consists of relevant randomised controlled trials from the bibliographic databases-The Cochrane Library (1970 to July 2012), EMBASE, (1970 to July 2012) MEDLINE (1970 to July 2012) and PsycINFO (1970 to July 2012). SELECTION CRITERIA All randomised controlled trials (RCTs) of CBT versus waiting list, active control conditions, TAU or medication were reviewed. All participants must have met the criteria of the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD) for an anxiety diagnosis, excluding simple phobia, obsessive-compulsive disorder, post-traumatic stress disorder and elective mutism. DATA COLLECTION AND ANALYSIS The methodological quality of included trials was assessed by three reviewers independently. For the dichotomous outcome of remission of anxiety diagnosis, the odds ratio (OR) with 95% confidence interval (CI) based on the random-effects model, with pooling of data via the inverse variance method of weighting, was used. Significance was set at P < 0.05. Continuous data on each child's anxiety symptoms were pooled using the standardised mean difference (SMD). MAIN RESULTS Forty-one studies consisting of 1806 participants were included in the analyses. The studies involved children and adolescents with anxiety of mild to moderate severity in university and community clinics and school settings. For the primary outcome of remission of any anxiety diagnosis for CBT versus waiting list controls, intention-to-treat (ITT) analyses with 26 studies and 1350 participants showed an OR of 0.13 (95% CI 0.09 to 0.19, Z = 10.26, P < 0.0001), but with evidence of moderate heterogeneity (P = 0.04, I² = 33%). The number needed to treat (NNT) was 6.0 (95% CI 7.5 to 4.6). No difference in outcome was noted between individual, group and family/parental formats. ITT analyses revealed that CBT was no more effective than non-CBT active control treatments (six studies, 426 participants) or TAU in reducing anxiety diagnoses (two studies, 88 participants). The few controlled follow-up studies (n = 4) indicate that treatment gains in the remission of anxiety diagnosis are not statistically significant. AUTHORS' CONCLUSIONS Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow-up, is limited and inconclusive.
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Benjamin CL, Harrison JP, Settipani CA, Brodman DM, Kendall PC. Anxiety and related outcomes in young adults 7 to 19 years after receiving treatment for child anxiety. J Consult Clin Psychol 2013; 81:865-76. [PMID: 23688146 DOI: 10.1037/a0033048] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE This study evaluated follow-up outcomes associated with cognitive behavioral therapy (CBT) for childhood anxiety by comparing successfully and unsuccessfully treated participants 6.72 to 19.17 years after treatment. METHOD Participants were a sample of 66 youths (ages 7-14 years at time of treatment, ages 18-32 years at present follow-up) who had been diagnosed with an anxiety disorder and randomized to treatment in a randomized clinical trial on average 16.24 (SD = 3.56, range = 6.72-19.17) years prior. The present follow-up included self-report measures and a diagnostic interview to assess anxiety, depression, and substance misuse. RESULTS Compared with those who responded successfully to CBT for an anxiety disorder in childhood, those who were less responsive had higher rates of panic disorder, alcohol dependence, and drug abuse in adulthood. Relative to a normative comparison group, those who were less responsive to CBT in childhood had higher rates of several anxiety disorders and substance misuse problems in adulthood. Participants remained at particularly increased risk, relative to the normative group, for generalized anxiety disorder and nicotine dependence regardless of initial treatment outcome. CONCLUSIONS The present study is the first to assess the long-term follow-up effects of CBT treatment for an anxiety disorder in youth on anxiety, depression, and substance abuse through the period of young adulthood when these disorders are often seen. Results support the presence of important long-term benefits of successful early CBT for anxiety.
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Affiliation(s)
- Courtney L Benjamin
- Department of Psychology and Child and Adolescent Anxiety Disorders Clinic, Temple University
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26
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Outcome domains in child mental health research since 1996: have they changed and why does it matter? J Am Acad Child Adolesc Psychiatry 2012; 51. [PMID: 23200282 PMCID: PMC3513697 DOI: 10.1016/j.jaac.2012.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Child mental health treatment and services research yields more immediate public health benefit when they focus on outcomes of relevance to a broader group of stakeholders. We reviewed all experimental studies of child and adolescent treatment and service effectiveness published in the last 15 years (1996-2011) and compared the distribution and types of outcome domains to a prior review that focused on studies from the prior 15 years (1980-1995). METHOD Studies were included if they focused on children from birth to 18 years of age with specific or general psychiatric conditions, employed randomized designs, and examined intervention effects with a six-month or longer post-treatment assessment in treatment studies or a 6-month or longer post-baseline assessment for services studies. Two hundred (n=200) studies met criteria. Reported outcome measures were coded into conceptual categories drawn from the 1980-1995 review. RESULTS There was a five-fold increase in the total number of studies (38 versus 200) across the two 15-year time periods, with the largest increase in the number of studies that focused on consumer-oriented outcomes (from eight to 47 studies, an almost sixfold increase); two new domains, parent symptoms and health-related outcomes, were identified. The majority of studies (more than 95%) continued to focus on symptoms and diagnoses as an outcome. Impact ratings were higher among studies examining four or more outcomes versus one to two outcomes in all categories with the exception of Posttraumatic Stress Disorder. CONCLUSIONS Given major shifts in health care policy affecting mental health services, the emergence of health and parent-related outcomes as well as greater attention to consumer perspectives parallels emerging priorities in health care and can enhance the relevance of child outcome studies for implementation in the real world.
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Tulbure BT, Szentagotai A, Dobrean A, David D. Evidence based clinical assessment of child and adolescent social phobia: a critical review of rating scales. Child Psychiatry Hum Dev 2012; 43:795-820. [PMID: 22438106 DOI: 10.1007/s10578-012-0297-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Investigating the empirical support of various assessment instruments, the evidence based assessment approach expands the scientific basis of psychotherapy. Starting from Hunsley and Mash's evaluative framework, we critically reviewed the rating scales designed to measure social anxiety or phobia in youth. Thirteen of the most researched social anxiety scales for children and adolescents were identified. An overview about the scientific support accumulated by these scales is offered. Our main results are consistent with recent reviews that consider the Social Phobia and Anxiety Scale for Children (SPAI-C) and the Social Anxiety Scale for Adolescents (SAS-A) among the most pertinent and empirically supported measures of social anxiety for youngsters. However, after considering the existing evidence, we highly recommend another couple of scales that proved to be empirically supported (i.e., the Social Phobia Inventory-SPIN, and the Liebowitz Social Anxiety Scale for Children and Adolescents-LSAS-CA).
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Affiliation(s)
- Bogdan T Tulbure
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Cluj-Napoca, Romania.
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28
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Siegel RS, Dickstein DP. Anxiety in adolescents: Update on its diagnosis and treatment for primary care providers. ADOLESCENT HEALTH MEDICINE AND THERAPEUTICS 2011; 3:1-16. [PMID: 24600282 PMCID: PMC3916014 DOI: 10.2147/ahmt.s7597] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Anxiety disorders are the most prevalent mental health concern facing adolescents today, yet they are largely undertreated. This is especially concerning given that there are fairly good data to support an evidence-based approach to the diagnosis and treatment of anxiety, and also that untreated, these problems can continue into adulthood, growing in severity. Thus, knowing how to recognize and respond to anxiety in adolescents is of the utmost importance in primary care settings. To that end, this article provides an up-to-date review of the diagnosis and treatment of anxiety disorders geared towards professionals in primary care settings. Topics covered include subtypes, clinical presentation, the etiology and biology, effective screening instruments, evidence-based treatments (both medication and therapy), and the long-term prognosis for adolescents with anxiety. Importantly, we focus on the most common types of anxiety disorders, often known as phobias, which include generalized anxiety disorder, social anxiety/social phobia, separation anxiety disorder, panic disorder, and specific phobias. In summary, anxiety is a common psychiatric problem for adolescents, but armed with the right tools, primary care providers can make a major impact.
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Affiliation(s)
- Rebecca S Siegel
- Pediatric Mood, Imaging, and NeuroDevelopment Program, EP Bradley Hospital, East Providence, RI, USA
| | - Daniel P Dickstein
- Pediatric Mood, Imaging, and NeuroDevelopment Program, EP Bradley Hospital, East Providence, RI, USA
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Garcia-Lopez LJ, Inglés CJ, García-Fernández JM, Hidalgo MD, Bermejo R, Puklek Levpušček M. Psychometric properties and clinical cut-off scores of the Spanish version of the Social Anxiety Scale for Adolescents. J Pers Assess 2011; 93:474-82. [PMID: 21859287 DOI: 10.1080/00223891.2011.594126] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examined the reliability and validity evidence drawn from the scores of the Spanish version of the Slovenian-developed Social Anxiety Scale for Adolescents (SASA; Puklek, 1997; Puklek & Vidmar, 2000) using a community sample (Study 1) and a clinical sample (Study 2). Confirmatory factor analysis in Study 1 replicated the 2-factor structure found by the original authors in a sample of Slovenian adolescents. Test-retest reliability was adequate. Furthermore, the SASA correlated significantly with other social anxiety scales, supporting concurrent validity evidence in Spanish adolescents. The results of Study 2 confirmed the correlations between the SASA and other social anxiety measures in a clinical sample. In addition, findings revealed that the SASA can effectively discriminate between adolescents with a clinical diagnosis of social anxiety disorder (SAD) and those without this disorder. Finally, cut-off scores for the SASA are provided for Spanish adolescents.
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30
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Mörtberg E, Clark DM, Bejerot S. Intensive group cognitive therapy and individual cognitive therapy for social phobia: sustained improvement at 5-year follow-up. J Anxiety Disord 2011; 25:994-1000. [PMID: 21763101 DOI: 10.1016/j.janxdis.2011.06.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Revised: 06/15/2011] [Accepted: 06/15/2011] [Indexed: 11/25/2022]
Abstract
Little is known about the long-term outcome of treatments for social phobia. At 5 years post-treatment we contacted the 67 patients who had been treated with intensive group cognitive therapy (IGCT) or individual cognitive therapy (ICT) in a randomized controlled trial (Mörtberg, Clark, Sundin, & Åberg Wistedt, 2007) that originally compared IGCT, ICT, and treatment as usual (n=100 for the full trial). Seventy-two percent (48 patients) who received IGCT or ICT agreed to participate in the follow-up assessment. All re-completed the original self-report measures of symptoms and disability and a quality of life measure. A subset was also interviewed. Seventy-five percent (36 patients) had sought no further treatment for social phobia. Comparisons between post-treatment and 5-year follow-up indicated that patients who had received either treatment showed further improvement in social phobia symptoms and disability during the follow-up period. These improvements were present in patients who had no additional treatment, as well as in the total sample. In conclusion, it appears that the effects of IGCT and ICT are maintained and improved upon at 5 years post-treatment.
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Affiliation(s)
- Ewa Mörtberg
- Karolinska Institute, Department of Clinical Neuroscience/Centre for Psychiatry Research, Stockholm, Sweden.
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Cederlund R, Öst LG. Perception of Threat in Children With Social Phobia: Comparison to Nonsocially Anxious Children Before and After Treatment. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2011; 40:855-63. [DOI: 10.1080/15374416.2011.618448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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Melfsen S, Kühnemund M, Schwieger J, Warnke A, Stadler C, Poustka F, Stangier U. Cognitive behavioral therapy of socially phobic children focusing on cognition: a randomised wait-list control study. Child Adolesc Psychiatry Ment Health 2011; 5:5. [PMID: 21356037 PMCID: PMC3058082 DOI: 10.1186/1753-2000-5-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 02/28/2011] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Although literature provides support for cognitive behavioral therapy (CBT) as an efficacious intervention for social phobia, more research is needed to improve treatments for children. METHODS Forty four Caucasian children (ages 8-14) meeting diagnostic criteria of social phobia according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; APA, 1994) were randomly allocated to either a newly developed CBT program focusing on cognition according to the model of Clark and Wells (n = 21) or a wait-list control group (n = 23). The primary outcome measure was clinical improvement. Secondary outcomes included improvements in anxiety coping, dysfunctional cognitions, interaction frequency and comorbid symptoms. Outcome measures included child report and clinican completed measures as well as a diagnostic interview. RESULTS Significant differences between treatment participants (4 dropouts) and controls (2 dropouts) were observed at post test on the German version of the Social Phobia and Anxiety Inventory for Children. Furthermore, in the treatment group, significantly more children were free of diagnosis than in wait-list group at post-test. Additional child completed and clinician completed measures support the results. DISCUSSION The study is a first step towards investigating whether CBT focusing on cognition is efficacious in treating children with social phobia. Future research will need to compare this treatment to an active treatment group. There remain the questions of whether the effect of the treatment is specific to the disorder and whether the underlying theoretical model is adequate. CONCLUSION Preliminary support is provided for the efficacy of the cognitive behavioral treatment focusing on cognition in socially phobic children. Active comparators should be established with other evidence-based CBT programs for anxiety disorders, which differ significantly in their dosage and type of cognitive interventions from those of the manual under evaluation (e.g. Coping Cat).
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Affiliation(s)
- Siebke Melfsen
- Clinic and Polyclinic for Psychiatry, Psychosomatic and Psychotherapy for Children and Adolescents, University of Wuerzburg, Fuechsleinstr, 15, 97080 Wuerzburg, Germany.
| | | | | | - Andreas Warnke
- Clinic and Polyclinic for Psychiatry, Psychosomatic and Psychotherapy for Children and Adolescents, University of Wuerzburg, Fuechsleinstr. 15, 97080 Wuerzburg, Germany
| | - Christina Stadler
- Clinic and Polyclinic for Psychiatry and Psychotherapy for Children and Adolescents, University of Frankfurt, Germany
| | - Fritz Poustka
- Clinic and Polyclinic for Psychiatry and Psychotherapy for Children and Adolescents, University of Frankfurt, Germany
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Ingles CJ, La Greca AM, Marzo JC, Garcia-Lopez LJ, Garcia-Fernandez JM. Social Anxiety Scale for Adolescents: factorial invariance and latent mean differences across gender and age in Spanish adolescents. J Anxiety Disord 2010; 24:847-55. [PMID: 20609560 DOI: 10.1016/j.janxdis.2010.06.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2009] [Revised: 06/08/2010] [Accepted: 06/10/2010] [Indexed: 10/19/2022]
Abstract
Little is known about the factorial invariance across gender and age for self-report measures of social anxiety in adolescence. This study examined the factorial invariance and latent mean differences of the Social Anxiety Scale for Adolescents (SAS-A) across gender and age groups in 1570 Spanish adolescents (54% girls), ranging in age from 14 to 17 years. Equality of factor structures was compared using multi-group confirmatory factor analyses. Measurement invariance for the correlated three-factor model of the SAS-A was found across gender and age samples. Analyses of latent mean differences revealed that girls exhibited higher means than boys on two SAS-A subscales, Fear of Negative Evaluation and Social Avoidance and Distress-New (SAD-New). In addition, on the SAD-New subscale, the structured means significantly diminished from 14-year olds to 16- and 17-year olds and from 15-year olds to 17-year olds. Findings are discussed in terms of the use of the SAS-A with Spanish adolescents.
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Affiliation(s)
- Candido J Ingles
- Department of Health Psychology, Miguel Hernandez University of Elche, Avda de la Universidad, s/n, 03202 Elche, Alicante, Spain.
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The Social Phobia Inventory: screening and cross-cultural validation in Spanish adolescents. SPANISH JOURNAL OF PSYCHOLOGY 2010; 13:970-80. [PMID: 20977044 DOI: 10.1017/s1138741600002614] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Availability of brief, self-report measures to be used as screening instruments is crucial to detect correctly youth with social anxiety disorder and therefore, reach those otherwise under-detected and under-treated. A previous study revealed that the Social Phobia Inventory (SPIN) was potentially an appropriate measure for screening social anxiety among US adolescents. However, there is a lack of information concerning its properties as a screening test in other cultures and languages. This is the main objective of this study, although further validity of the scale is provided as well. The sample consisted of 192 adolescents (a sample composed of 114 subjects with a principal diagnosis of social anxiety disorder; and a group consisting of 78 subjects with no diagnosis of social phobia). Results suggest that the Social Phobia Inventory has demonstrated good psychometric properties and indeed may be used as a screening tool in Spanish-speaking adolescents.
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Beidas RS, Benjamin CL, Puleo CM, Edmunds JM, Kendall PC. Flexible Applications of the Coping Cat Program for Anxious Youth. COGNITIVE AND BEHAVIORAL PRACTICE 2010; 17:142-153. [PMID: 20936081 PMCID: PMC2950324 DOI: 10.1016/j.cbpra.2009.11.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The current article offers suggestions for ways to adapt empirically supported treatments (ESTs). A specific manualized EST (Coping Cat; Kendall & Hedtke, 2006a) is used to illustrate the concept of "flexibility within fidelity" (Kendall & Beidas, 2007; Kendall, Gosch, Furr, & Sood, 2008). Flexibility within fidelity stresses the importance of using ESTs while considering and taking into account individual client presentations. In this discussion, recommendations are offered for the use of the Coping Cat with younger youth, adolescents, and youth with secondary comorbidities (i.e., social skills deficits, inattentive symptoms, and depressive symptoms).
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Nevo GA, Manassis K. Outcomes for treated anxious children: a critical review of Long-Term-Follow-Up studies. Depress Anxiety 2009; 26:650-60. [PMID: 19496175 DOI: 10.1002/da.20584] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Anxiety disorders are the most common psychiatric disorders of childhood, generating significant distress in the individual and an economic burden to society. They are precursors to diverse psychiatric illnesses and have an impact on development. Childhood anxiety's reach into the future accentuates the importance of studying the long-term effect of treatment. The purpose of this paper is to examine existing Long-Term-Follow-Up (LTFU) studies' capacity to inform us on the impact of anxiety treatment on development. METHOD Medline, PsycInfo, SciSearch, SocScisearch, Cinhal, Embase, and the Cochrane library were searched. Bibliographies of relevant book chapters and review articles and information from colleagues with expertise in anxiety were also a source of information. The search produced more than a thousand citations. Only eight studies met inclusion criteria: follow-up of a cohort of treated anxious youth for more than 2 years. RESULTS follow-up ranged from 2 to 7.4 years. The studies were methodologically rigorous and, in general, showed maintenance of or improvement in acute treatment gains. The studies reviewed could not outline course of recovery or control for pivotal confounding variables such as maturation. Seven of the eight studies employed a Cognitive Behavioral intervention and one employed a manualized, time-limited, psychodynamic intervention. No LTFU trial for medication was found. CONCLUSION ample evidence exists for the short-term benefit of pediatric anxiety treatment, but evidence is still lacking for the understanding of treatment's role in the facilitation of healthy development into adulthood. Recommendations for future research are proposed.
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Affiliation(s)
- Gili Adler Nevo
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Ontario, Canada.
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Exploring the relevance of expressed emotion to the treatment of social anxiety disorder in adolescence. J Adolesc 2009; 32:1371-6. [DOI: 10.1016/j.adolescence.2009.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Revised: 08/10/2009] [Accepted: 08/18/2009] [Indexed: 11/17/2022]
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Herbert JD, Gaudiano BA, Rheingold AA, Moitra E, Myers VH, Dalrymple KL, Brandsma LL. Cognitive behavior therapy for generalized social anxiety disorder in adolescents: a randomized controlled trial. J Anxiety Disord 2009; 23:167-77. [PMID: 18653310 PMCID: PMC4356535 DOI: 10.1016/j.janxdis.2008.06.004] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2008] [Revised: 06/12/2008] [Accepted: 06/13/2008] [Indexed: 11/18/2022]
Abstract
Early identification and treatment of social anxiety disorder (SAD) is critical to prevent development of a chronic course of symptoms, persistent functional impairment, and progressive psychiatric comorbidity. A small but growing literature supports the effectiveness of cognitive behavior therapy (CBT) for anxiety disorders, including SAD, in adolescence. The present randomized controlled trial evaluated the efficacy of group vs. individual CBT for adolescents with generalized SAD in relation to an educational/supportive psychotherapy that did not contain specific CBT elements. All three treatments were associated with significant reductions in symptoms and functional impairment, and in improved social skills. No differences between treatments emerged on measures of symptoms, but the CBT conditions demonstrated greater gains on behavioral measures. The implications of the findings are discussed.
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Affiliation(s)
- James D Herbert
- Department of Psychology, Drexel University, Philadelphia, PA 19102-1192, USA.
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Chu BC. Empirically supported training approaches: The who, what, and how of disseminating psychological interventions. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1468-2850.2008.00142.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Silverman WK, Pina AA, Viswesvaran C. Evidence-based psychosocial treatments for phobic and anxiety disorders in children and adolescents. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2008; 37:105-30. [PMID: 18444055 DOI: 10.1080/15374410701817907] [Citation(s) in RCA: 333] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The article reviews psychosocial treatments for phobic and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's (1998) criteria. Findings from a series of meta-analyses of the studies that used waitlists also are reported. In accordance with Nathan and Gorman, the majority of the studies were either methodologically robust or fairly rigorous. In accordance with Chambless and colleagues, although no treatment was well-established, Individual Cognitive Behavior Therapy, Group Cognitive Behavior Therapy (GCBT), GCBT with Parents, GCBT for social phobia (SOP), and Social Effectiveness Training for children with SOP each met criteria for probably efficacious. The other treatments were either possibly efficacious or experimental. Meta-analytic results revealed no significant differences between individual and group treatments on diagnostic recovery rates and anxiety symptom reductions, as well as other youth symptoms (i.e., fear, depression, internalizing and externalizing problems). Parental involvement was similarly efficacious as parental noninvolvement in individual and group treatment formats. The article also provides a summary of the studies that have investigated mediators, moderators, and predictors of treatment outcome. The article concludes with a discussion of the clinical representativeness and generalizability of treatments, practice guidelines, and future research directions.
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Affiliation(s)
- Wendy K Silverman
- Child and Family Psychosocial Research Center, Child Anxiety and Phobia Program, Department of Psychology, University Park, Florida International University, Miami, FL 33199, USA.
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Abstract
BACKGROUND There is little consensus on the extent to which psychiatric disorders or syndromes are universal or the extent to which they differ on their core definitions and constellation of symptoms as a result of cultural or contextual factors. This controversy continues due to the lack of biological markers, imprecise measurement and the lack of a gold standard for validating most psychiatric conditions. METHOD Empirical studies were used to present evidence in favor of or against a universalist or relativistic view of child psychiatric disorders using a model developed by Robins and Guze to determine the validity of psychiatric disorders. RESULTS The prevalence of some of the most common specific disorders and syndromes as well as its risk and protective factors vary across cultures, yet comorbid patterns and response to treatments vary little across cultures. Cross-cultural longitudinal data on outcomes is equivocal. CONCLUSIONS The cross-cultural validity of child disorders may vary drastically depending on the disorder, but empirical evidence that attests for the cross-cultural validity of diagnostic criteria for each child disorder is lacking. There is a need for studies that investigate the extent to which gene-environment interactions are related to specific disorders across cultures. Clinicians are urged to consider culture and context in determining the way in which children's psychopathology may be manifested independent of their views. Recommendations for the upcoming classificatory system are provided so that practical or theoretical considerations are addressed about how culture and ethnic issues affect the assessment or treatment of specific disorders in children.
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Affiliation(s)
- Glorisa Canino
- University of Puerto Rico Medical School, Medical Sciences Campus, Behavioral Research Institute, San Juan, Puerto Rico 00936-5067, USA.
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