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Rabner J, Olino TM, Albano AM, Keeton CP, Sakolsky D, Birmaher B, Piacentini J, Peris TS, Compton SN, Gosch E, Ginsburg GS, Pinney EL, Kendall PC. Substance use outcomes from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). J Child Psychol Psychiatry 2024; 65:910-920. [PMID: 38217328 DOI: 10.1111/jcpp.13926] [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] [Accepted: 10/06/2023] [Indexed: 01/15/2024]
Abstract
BACKGROUND Substance use problems and anxiety disorders are both highly prevalent and frequently cooccur in youth. The present study examined the benefits of successful anxiety treatment at 3-12 years after treatment completion on substance use outcomes (i.e. diagnoses and lifetime expected use). METHODS The sample was from the Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS), a naturalistic follow-up study to the Child/Adolescent Anxiety Multimodal Study (CAMS) which randomized youth to cognitive behavioral therapy (CBT; Coping cat), medication (sertraline), their combination, or pill placebo. The first CAMELS visit occurred an average of 6.5 years following CAMS randomization. Participants were 319 youth (65.4% of the CAMS sample), aged 7-17 years at CAMS baseline assessment with a mean age of 17.6 years (range: 11-26 years) at the time of the first CAMELS follow-up. Substance use outcomes included diagnoses as well as lifetime substance use (i.e. alcohol and tobacco use). RESULTS Eleven of 319 (3.4%) CAMELS participants were diagnosed with a substance use disorder at the initial follow-up visit. When compared to the population lifetime rate of 11.4%, the rate of diagnoses in the posttreated sample was significantly lower. Additionally, rates of lifetime alcohol use were lower than population rates at the initial and final follow-up visits. Rates of lifetime tobacco use were similarly lower than lifetime population rates at the initial visit (driven by significantly lower rates in the CBT treatment condition), but higher by the final visit. Furthermore, treatment remission (but not treatment response) was associated with a lower rate of substance use diagnoses at the initial follow-up visit, although rates of lifetime alcohol and tobacco use did not differ by treatment outcome. CONCLUSIONS Anxiety treatments confer a beneficial impact on problematic substance use (i.e. diagnoses) as well as on expected substance use (i.e. alcohol and tobacco use) for on average, a period of 6.5 years.
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Affiliation(s)
- Jonathan Rabner
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
| | - Thomas M Olino
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
| | - Anne Marie Albano
- Department of Psychiatry, New York State Psychiatric Institute, Columbia University Medical Center, New York, NY, USA
| | - Courtney P Keeton
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, USA
- Western Psychiatric Institute & Clinic, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Tara S Peris
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles School of Medicine, Los Angeles, CA, USA
| | - Scott N Compton
- Department of Psychiatry, Duke University Medical Center, Durham, NC, USA
| | - Elizabeth Gosch
- Department of Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| | | | - Philip C Kendall
- Department of Psychology and Neuorscience, Temple University, Philadelphia, PA, USA
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Ahadianfard P, Gharraee B, Aghebati A, Asgarabad MH. Effectiveness of unified protocol for trans diagnostic treatment in children with anxiety disorders: A randomized control trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:387. [PMID: 38333174 PMCID: PMC10852158 DOI: 10.4103/jehp.jehp_1578_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/24/2022] [Indexed: 02/10/2024]
Abstract
BACKGROUND The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) is a theory-derived approach that can target the common underlying processes, such as the cognitive, emotional, and behavioral processes in emotional disorders in children aged 8-12 years. This study aimed to investigate UP-C's efficacy in treating children's anxiety disorders compared to cognitive behavior therapy (CBT). MATERIALS AND METHODS In this randomized control trial (RCT), with pre-test, post-test, and follow-up, 34 participants aged 8-12 with anxiety disorders were selected through the restricted randomization method and allocated to intervention (UP-C) or control (CBT) groups by random allocation rule. UP-C group consisted of 15 weekly individual sessions, and CBT included 16 weekly individual sessions. The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) and The Screen for Child Anxiety Related Disorders (SCARED-71) were completed in the pre-test, post-test, and three-month follow-up stages. The data of participants were analyzed using the repeated measure analysis of variance. A P- value under. 05 was regarded as significant. RESULTS Based on the repeated measures ANOVA, UP-C, and CBT significantly reduced anxiety symptoms (P = .002) and emotional suppression (P = .032). Moreover, UP-C and CBT significantly increased emotion regulation (P = .000) and cognitive reappraisal (P = .000). CONCLUSION The individual UP-C can be effective as anxiety-oriented CBT in treating anxiety disorders. Also, in the three months follow-up, the UP-C's effects were more stable and progressive than the CBT.
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Affiliation(s)
- Pantea Ahadianfard
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Banafsheh Gharraee
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Asma Aghebati
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
- Positive Youth Development Lab, Human Development and Family Sciences, Texas Tech University, Texas, U.S.A
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Kagan ER, Frank HE, Knepley MJ, Kendall PC. Beyond 16 Sessions: Extending Manualized Treatment of Anxious Youth. JOURNAL OF CHILD AND FAMILY STUDIES 2021; 30:493-501. [PMID: 34335000 PMCID: PMC8317605 DOI: 10.1007/s10826-020-01872-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 06/13/2023]
Abstract
Cognitive behavioral therapy (CBT) is well established as an efficacious treatment for anxious youth, yet a number of youth remain symptomatic after the 10-16 sessions of treatment stipulated by most CBT treatment manuals. While a significant minority do not respond, no study has examined the frequency and impact of additional therapy sessions. This study examined youth receiving outpatient therapy at an anxiety clinic who were offered the option to continue treatment after completing 16 sessions of manual-based CBT. Fifty-nine percent of participants chose to continue treatment, with an average of approximately 20 total sessions across participants. Therapist ratings demonstrated a significant overall improvement between session 16 and the final session. No pre-treatment measure of symptom severity differed between those who extended treatment and those who ended at session 16. Parent-rated anxiety differed between groups at session 16, as did the length of time between the pre-treatment assessment and week 16 assessments. Findings indicate that extending treatment is not uncommon, is typically limited to several additional sessions, and is associated with an increase in treatment gains. Current results suggest that two factors at session 16, parental perceptions of anxiety and time to complete 16 sessions, are influential and may be central to the decision to continue treatment past this point. Clinical implications and future directions are discussed.
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Spencer AE, Valentine SE, Sikov J, Yule AM, Hsu H, Hallett E, Xuan Z, Silverstein M, Fortuna L. Principles of Care for Young Adults With Co-Occurring Psychiatric and Substance Use Disorders. Pediatrics 2021; 147:229-239. [PMID: 33386320 PMCID: PMC8276159 DOI: 10.1542/peds.2020-023523f] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/23/2020] [Indexed: 01/22/2023] Open
Abstract
Over 50% of young adults (defined as individuals aged 18-25 years) with substance use disorders (SUDs) have at least 1 co-occurring psychiatric disorder, and the presence of co-occurring disorders worsens SUD outcomes. Treatment of both co-occurring psychiatric disorders and SUDs in young adults is imperative for optimal treatment, yet many barriers exist to achieving this goal. We present a series of evidence-informed principles of care for young adults with co-occurring psychiatric disorders derived by a workgroup of experts convened by Boston Medical Center's Grayken Center for Addiction. The 3 principles are as follows: (1) young adults should receive integrated mental health and addiction care across treatment settings; (2) care should be responsive to the needs of young adults exposed to trauma and other adverse childhood experiences; and (3) treatment programs should regularly assess and respond to the evolving mental health needs, motivations, and treatment goals of young adults with co-occurring disorders. Our guidance for each principle is followed by a review of the evidence supporting that principle, as well as practice considerations for implementation. More research among young adults is critical to identify effective treatments and service systems for those with co-occurring disorders.
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Affiliation(s)
- Andrea E Spencer
- Departments of Psychiatry and
- Boston Medical Center, Boston, Massachusetts; and
| | - Sarah E Valentine
- Departments of Psychiatry and
- Boston Medical Center, Boston, Massachusetts; and
| | - Jennifer Sikov
- Departments of Psychiatry and
- Boston Medical Center, Boston, Massachusetts; and
| | - Amy M Yule
- Departments of Psychiatry and
- Boston Medical Center, Boston, Massachusetts; and
| | - Heather Hsu
- Boston Medical Center, Boston, Massachusetts; and
- Pediatrics, School of Medicine, and
| | | | - Ziming Xuan
- School of Public Health, Boston University, Boston, Massachusetts
| | - Michael Silverstein
- Boston Medical Center, Boston, Massachusetts; and
- Pediatrics, School of Medicine, and
| | - Lisa Fortuna
- Department of Psychiatry, University of California San Francisco, San Francisco, California
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An Analysis of the Child Behavior Checklist Anxiety Problems Scale's Predictive Capabilities. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2019; 41:249-256. [PMID: 31666760 DOI: 10.1007/s10862-019-09722-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The Child Behavior Checklist (CBCL) is widely used to assess behavioral and emotional problems in youth. The CBCL Diagnostic and Statistical Manual (DSM)-Oriented Anxiety Problems subscale (CBCL-AP) was developed for the identification of DSM-IV anxiety disorders. Using data from 298 youth aged 6- to 18, the CBCL-AP scale was examined to determine its ability to differentially predict, via Receiver Operating Characteristics (ROC) analysis, the presence of (a) generalized anxiety disorder (GAD), (b) separation anxiety disorder (SAD), (c) specific phobia (SPPH), or (d) the presence of any of these disorders. Independent Evaluators (IEs) administered the Anxiety Disorders Interview Schedule for Children (ADIS-C/P) to determine the presence of an anxiety disorder. The ability of the CBCL-AP to predict to anxiety disorders was compared to the ability of the CBCL Anxious/Depressed (CBCL-A/D) scale and the seven empirically derived CBCL syndrome subscales and five DSM-Oriented subscales to predict anxiety disorder diagnoses. Results revealed that CBCL-AP scores significantly predicted all diagnoses. CBCL-A/D scores significantly predicted SAD (AUC = 0.67), GAD (AUC = 0.69), and the presence of any of the three disorders (AUC = 0.72), but not the presence of SPPH (AUC = 0.52). Although the CBCL-AP scale may not be a substitute for extensive diagnostics, it has demonstrated utility as an instrument for assessing anxiety and can serve to identify anxious youth in need of mental health services.
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6
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Kodal A, Fjermestad KW, Bjelland I, Gjestad R, Öst LG, Bjaastad JF, Haugland BSM, Havik OE, Heiervang ER, Wergeland GJH. Predictors of long-term outcome of CBT for youth with anxiety disorders treated in community clinics. J Anxiety Disord 2018; 59:53-63. [PMID: 30273789 DOI: 10.1016/j.janxdis.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 08/20/2018] [Accepted: 08/31/2018] [Indexed: 01/14/2023]
Abstract
Cognitive behavioral therapy (CBT) has proven long-term effects in youth with anxiety disorders. However, only a few studies have examined predictors of long-term outcomes of CBT treatment. The present study investigated possible predictors of long-term treatment outcomes in youth with mixed anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder, social anxiety disorder, and/or generalized anxiety disorder were evaluated a mean of 3.9 years post-treatment (range 2.2-5.9 years). Outcomes were loss of all inclusion anxiety diagnoses, loss of the principal inclusion anxiety diagnosis, and changes in youth- and parent-rated youth anxiety symptoms. Predictors encompassed youth, parent and demographic factors, and post-treatment recovery. The most consistent finding was that low family social class predicted poorer outcomes. Higher treatment motivation was associated with better outcome whereas a diagnosis of social anxiety was associated with poorer outcome. Identified predictors extend on previous findings from efficacy trials, and the results indicate a need for more specific treatment protocols.
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Affiliation(s)
- Arne Kodal
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, N-5020 Bergen, Norway; Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway.
| | - Krister W Fjermestad
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Psychology, University of Oslo, N-0371 Oslo, Norway
| | - Ingvar Bjelland
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, N-5020 Bergen, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway
| | - Lars-Göran Öst
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden
| | - Jon F Bjaastad
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, N-4068 Stavanger, Norway; Uni Research Health, Regional Center for Child and Youth Mental Health and Child Welfare, N-5008 Bergen, Norway
| | - Bente S M Haugland
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Uni Research Health, Regional Center for Child and Youth Mental Health and Child Welfare, N-5008 Bergen, Norway
| | - Odd E Havik
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, N-5020 Bergen, Norway
| | - Einar R Heiervang
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, N-0450 Oslo, Norway
| | - Gro Janne H Wergeland
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Uni Research Health, Regional Center for Child and Youth Mental Health and Child Welfare, N-5008 Bergen, Norway
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7
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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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8
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Kodal A, Fjermestad K, Bjelland I, Gjestad R, Öst LG, Bjaastad JF, Haugland BSM, Havik OE, Heiervang E, Wergeland GJ. Long-term effectiveness of cognitive behavioral therapy for youth with anxiety disorders. J Anxiety Disord 2018; 53:58-67. [PMID: 29195188 DOI: 10.1016/j.janxdis.2017.11.003] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 11/22/2017] [Accepted: 11/22/2017] [Indexed: 11/17/2022]
Abstract
Cognitive behavioral therapy (CBT) has demonstrated favorable long-term outcomes in youth with anxiety disorders in efficacy trials. However, long-term outcomes of CBT delivered in a community setting are uncertain. This study examined the long-term outcomes of individual (ICBT) and group CBT (GCBT) in youth with anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder (SAD), social anxiety disorder (SOP), and/or generalized anxiety disorder (GAD) were evaluated, on average, 3.9 years post-treatment (range 2.2-5.9 years). Outcomes included loss of all inclusion anxiety diagnoses, loss of the principal anxiety diagnosis and changes in youth- and parent-rated youth anxiety symptoms. At long-term follow-up, there was loss of all inclusion anxiety diagnoses in 53%, loss of the principal anxiety diagnosis in 63% of participants as well as significant reductions in all anxiety symptom measures. No statistical significant differences in outcome were obtained between ICBT and GCBT. Participants with a principal diagnosis of SOP had lower odds for recovery, compared to those with a principal diagnosis of SAD or GAD. In conclusion, outcomes of CBT for youth anxiety disorders delivered in community mental health clinics were improved at nearly 4 years post-treatment, and recovery rates at long-term follow-up were similar to efficacy trials.
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Affiliation(s)
- Arne Kodal
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway.
| | - Krister Fjermestad
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Psychology, University of Oslo, N-0373 Oslo, Norway
| | - Ingvar Bjelland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, N-5020 Bergen, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway
| | - Lars-Göran Öst
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden
| | - Jon F Bjaastad
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, N-5008 Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, N-4068 Stavanger, Norway
| | - Bente S M Haugland
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, N-5008 Bergen, Norway
| | - Odd E Havik
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, N-5020 Bergen, Norway
| | - Einar Heiervang
- Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Institute of Clinical Medicine, University of Oslo, and Oslo University Hospital, N-0450 Oslo, Norway
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Anxiety Research Network, Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway; Regional Center for Child and Youth Mental Health and Child Welfare, Uni Research Health, N-5008 Bergen, Norway
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9
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Barriers and facilitators to parents seeking and accessing professional support for anxiety disorders in children: qualitative interview study. Eur Child Adolesc Psychiatry 2018; 27:1023-1031. [PMID: 29372331 PMCID: PMC6060962 DOI: 10.1007/s00787-018-1107-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 01/04/2018] [Indexed: 10/31/2022]
Abstract
Anxiety disorders are among the most common mental health disorders experienced by children, but only a minority of these children access professional help. Understanding the difficulties parents face seeking support for child anxiety disorders could inform targeted interventions to improve treatment access. The aims of the study were to identify barriers and facilitators to seeking and accessing professional support for child anxiety disorders, and ways to minimise these barriers. A qualitative interview study was conducted with parents of 16 children (aged 7-11 years) with anxiety disorders identified through screening in schools. Barriers and facilitators were identified in relation to four distinct stages in the help-seeking process: parents recognising the anxiety difficulty, parents recognising the need for professional support, parents contacting professionals, and families receiving professional support. Barriers and facilitators at each stage related to the child's difficulties, the role of the parent, and parent perceptions of professionals and services. Findings illustrate the need (1) for readily available tools to help parents and professionals identify clinically significant anxiety in children, (2) to ensure that families and professionals can easily access guidance on the help-seeking process and available support, and (3) to ensure existing services offer sufficient provision for less severe difficulties that incorporates direct support for parents.
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10
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Haugland BSM, Raknes S, Haaland AT, Wergeland GJ, Bjaastad JF, Baste V, Himle J, Rapee R, Hoffart A. School-based cognitive behavioral interventions for anxious youth: study protocol for a randomized controlled trial. Trials 2017; 18:100. [PMID: 28259171 PMCID: PMC5336667 DOI: 10.1186/s13063-017-1831-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 02/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background Anxiety disorders are prevalent among adolescents and may have long-lasting negative consequences for the individual, the family and society. Cognitive behavioral therapy (CBT) is an effective treatment. However, many anxious youth do not seek treatment. Low-intensity CBT in schools may improve access to evidence-based services. We aim to investigate the efficacy of two CBT youth anxiety programs with different intensities (i.e., number and length of sessions), both group-based and administered as early interventions in a school setting. The objectives of the study are to examine the effects of school-based interventions for youth anxiety and to determine whether a less intensive intervention is non-inferior to a more intensive intervention. Methods/design The present study is a randomized controlled trial comparing two CBT interventions to a waitlist control group. A total of 18 schools participate and we aim to recruit 323 adolescents (12-16 years). Youth who score above a cutoff on an anxiety symptom scale will be included in the study. School nurses recruit participants and deliver the interventions, with mental health workers as co-therapists and/or supervisors. Primary outcomes are level of anxiety symptoms and anxiety-related functional impairments. Secondary outcomes are level of depressive symptoms, quality of life and general psychosocial functioning. Non-inferiority between the two active interventions will be declared if a difference of 1.4 or less is found on the anxiety symptom measure post-intervention and a difference of 0.8 on the interference scale. Effects will be analyzed by mixed effect models, applying an intention to treat procedure. Discussion The present study extends previous research by comparing two programs with different intensity. A brief intervention, if effective, could more easily be subject to large-scale implementation in school health services. Trial registration ClinicalTrials.gov, NCT02279251. Registered on 15 October 2014. Retrospectively registered. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1831-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bente Storm Mowatt Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway.
| | - Solfrid Raknes
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway
| | - Aashild Tellefsen Haaland
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sorlandet Hospital HF, Kristiansand, Norway
| | - Gro Janne Wergeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway.,Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon Fauskanger Bjaastad
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway.,Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway
| | - Valborg Baste
- Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Pb 7810, 5020, Bergen, Norway
| | - Joe Himle
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sorlandet Hospital HF, Kristiansand, Norway.,Department of Psychiatry, University of Michigan, Ann Arbor, USA
| | - Ron Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Modum, Norway.,Department of Psychology, University of Oslo, Oslo, Norway
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Substance Abuse Prevention, Assessment, and Treatment for Lesbian, Gay, Bisexual, and Transgender Youth. Pediatr Clin North Am 2016; 63:1057-1077. [PMID: 27865333 DOI: 10.1016/j.pcl.2016.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Knowing how to manage substance abuse in all youth is an important aspect of pediatric care, including providing clinically appropriate anticipatory guidance, monitoring, assessment, and treatment. Although most lesbian, gay, bisexual, and transgender (LGBT) youth do not abuse substances, as a group they experience unique challenges in self-identity development that put them at an increased risk for substance abuse. This article addresses prevention and management of substance use in LGBT youth relevant to pediatrics and allied professions as an aspect of their overall health care. It reviews basic information about substance abuse in youth and special considerations for LGBT youth.
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Wolk CB, Kendall PC, Beidas RS. Cognitive-behavioral therapy for child anxiety confers long-term protection from suicidality. J Am Acad Child Adolesc Psychiatry 2015; 54:175-9. [PMID: 25721182 PMCID: PMC4344955 DOI: 10.1016/j.jaac.2014.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 10/28/2014] [Accepted: 12/15/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Evidence for an independent relationship between anxiety and suicidality has been mixed. Few studies have examined this relationship in youth seeking treatment for anxiety. The present study examined the relationship between response to treatment for an anxiety disorder in childhood and suicidal ideation, plans, and attempts at a follow-up interval of 7 to 19 years. We hypothesized that successful treatment for an anxiety disorder in childhood would be protective against later suicidality. METHOD The present study was a 7- to 19-year (mean = 16.24 years; SD = 3.56 years) follow-up study. Adults (N = 66) completed cognitive-behavioral treatment (CBT) for anxiety as children. Information regarding suicidality at follow-up was obtained via the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview (CIDI) and the Beck Depression Inventory-II (BDI-II). RESULTS Results indicate that participants who responded favorably to CBT during childhood were less likely to endorse lifetime, past-month, and past-2-week suicidal ideation than treatment nonresponders. This was consistent across self-report and interview-report of suicidal ideation. Treatment response was not significantly associated with suicide plans or attempts, although the infrequent occurrence of both limited the ability to detect findings. CONCLUSION Results suggest more chronic and enduring patterns of suicidal ideation among individuals with anxiety in childhood that is not successfully treated. This study adds to the literature that suggests that successful CBT for childhood anxiety confers long-term benefits and underscores the importance of the identification and evidence-based treatment of youth anxiety.
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Affiliation(s)
- Courtney Benjamin Wolk
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Philip C Kendall
- Child and Adolescent Anxiety Disorders Clinic, Temple University, Philadelphia
| | - Rinad S Beidas
- Center for Mental Health Policy and Services Research, Perelman School of Medicine, University of Pennsylvania, Philadelphia
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Read KL, Settipani CA, Peterman J, Kendall PC, Compton S, Piacentini J, McCracken J, Bergman L, Walkup J, Sakolsky D, Birmaher B, Albano AM, Rynn M, Ginsburg G, Keeton C, Gosch E, Suveg C, Sherrill J, March J. Predicting Anxiety Diagnoses and Severity with the CBCL-A: Improvement Relative to Other CBCL Scales? JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2015; 37:100-111. [PMID: 26257470 PMCID: PMC4527577 DOI: 10.1007/s10862-014-9439-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The Child Behavior Checklist (CBCL) is a widely used parent-report of child and adolescent behavior. We examined the ability of the CBCL-A scale, a previously published subset of CBCL items, to predict the presence of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and social phobia (SoP), as well as anxiety severity, among 488 youth randomized in the Child Anxiety Multimodal Study (CAMS). We predicted that the CBCL-A's unique inclusion of items related to somatic symptoms would better identify anxiety disorder and severity than other CBCL scales, given that somatic complaints are often key features of anxiety among youth. Results support the use of the anxiety-based CBCL subscales as first-line screeners for generally elevated symptoms of anxiety, rather than tools to identify specific anxiety disorders. Although somatic symptoms are often reported and included in diagnostic criteria for certain anxiety disorders (e.g., SAD, GAD), the unique combination of somatic and non-somatic symptoms for the CBCL-A subscale did not increase its ability to consistently predict the presence of specific anxiety disorders.
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Piacentini J, Bennett S, Compton S, Kendall P, Birmaher B, Albano AM, March J, Sherrill J, Sakolsky D, Ginsburg G, Rynn M, Bergman RL, Gosch E, Waslick B, Iyengar S, McCracken J, Walkup J. 24- and 36-week outcomes for the Child/Adolescent Anxiety Multimodal Study (CAMS). J Am Acad Child Adolesc Psychiatry 2014; 53:297-310. [PMID: 24565357 PMCID: PMC3982864 DOI: 10.1016/j.jaac.2013.11.010] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 11/06/2013] [Accepted: 11/26/2013] [Indexed: 12/27/2022]
Abstract
OBJECTIVE We report active treatment group differences on response and remission rates and changes in anxiety severity at weeks 24 and 36 for the Child/Adolescent Anxiety Multimodal Study (CAMS). METHOD CAMS youth (N = 488; 74% ≤ 12 years of age) with DSM-IV separation, generalized, or social anxiety disorder were randomized to 12 weeks of cognitive-behavioral therapy (CBT), sertraline (SRT), CBT+SRT (COMB), or medication management/pill placebo (PBO). Responders attended 6 monthly booster sessions in their assigned treatment arm; youth in COMB and SRT continued on their medication throughout this period. Efficacy of COMB, SRT, and CBT (n = 412) was assessed at 24 and 36 weeks postrandomization. Youth randomized to PBO (n = 76) were offered active CAMS treatment if nonresponsive at week 12 or over follow-up and were not included here. Independent evaluators blind to study condition assessed anxiety severity, functioning, and treatment response. Concomitant treatments were allowed but monitored over follow-up. RESULTS The majority (>80%) of acute responders maintained positive response at both weeks 24 and 36. Consistent with acute outcomes, COMB maintained advantage over CBT and SRT, which did not differ, on dimensional outcomes; the 3 treatments did not differ on most categorical outcomes over follow-up. Compared to COMB and CBT, youth in SRT obtained more concomitant psychosocial treatments, whereas those in SRT and CBT obtained more concomitant combined (medication plus psychosocial) treatment. CONCLUSIONS COMB maintained advantage over CBT and SRT on some measures over follow-up, whereas the 2 monotherapies remained indistinguishable. The observed convergence of COMB and monotherapy may be related to greater use of concomitant treatment during follow-up among youth receiving the monotherapies, although other explanations are possible. Although outcomes were variable, most CAMS-treated youth experienced sustained treatment benefit. Clinical trial registration information-Child and Adolescent Anxiety Disorders (CAMS); URL: http://clinicaltrials.gov. Unique identifier: NCT00052078.
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Affiliation(s)
- John Piacentini
- University of California-Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior.
| | | | | | | | - Boris Birmaher
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center
| | - Anne Marie Albano
- New York State Psychiatric Institute–Columbia University Medical Center
| | | | - Joel Sherrill
- Division of Services and Intervention Research, National Institute of Mental Health (NIMH)
| | - Dara Sakolsky
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center
| | | | - Moira Rynn
- New York State Psychiatric Institute–Columbia University Medical Center
| | - R. Lindsey Bergman
- University of California–Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior
| | | | | | - Satish Iyengar
- Western Psychiatric Institute and Clinic-University of Pittsburgh Medical Center
| | - James McCracken
- University of California–Los Angeles (UCLA) Semel Institute for Neuroscience and Human Behavior
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Complementary medicine, exercise, meditation, diet, and lifestyle modification for anxiety disorders: a review of current evidence. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:809653. [PMID: 22969831 PMCID: PMC3434451 DOI: 10.1155/2012/809653] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Accepted: 06/01/2012] [Indexed: 12/11/2022]
Abstract
Use of complementary medicines and therapies (CAM) and modification of lifestyle factors such as physical activity, exercise, and diet are being increasingly considered as potential therapeutic options for anxiety disorders. The objective of this metareview was to examine evidence across a broad range of CAM and lifestyle interventions in the treatment of anxiety disorders. In early 2012 we conducted a literature search of PubMed, Scopus, CINAHL, Web of Science, PsycInfo, and the Cochrane Library, for key studies, systematic reviews, and metaanalyses in the area. Our paper found that in respect to treatment of generalized anxiety or specific disorders, CAM evidence revealed current support for the herbal medicine Kava. One isolated study shows benefit for naturopathic medicine, whereas acupuncture, yoga, and Tai chi have tentative supportive evidence, which is hampered by overall poor methodology. The breadth of evidence does not support homeopathy for treating anxiety. Strong support exists for lifestyle modifications including adoption of moderate exercise and mindfulness meditation, whereas dietary improvement, avoidance of caffeine, alcohol, and nicotine offer encouraging preliminary data. In conclusion, certain lifestyle modifications and some CAMs may provide a beneficial role in the treatment of anxiety disorders.
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Abstract
Anxiety disorders and substance use disorders are highly comorbid, and such comorbidity complicates treatment and worsens prognosis. The mechanisms underlying the relationship between anxiety and substance use disorders are poorly understood. This paper reviews recent research attempting to explain these associations. Cognitive factors, such as attentional bias, expectancies, and anxiety sensitivity, appear to impact on the relation between anxiety and substance misuse. Temporality of the anxiety and substance use disorder may also indicate whether the substance use disorder is primary (anxiety may be a result of use) or secondary (substances may be used to self-medicate). Social phobia has been predominantly identified as a primary disorder preceding substance use, while the temporality of other anxiety and substance use disorders is less clear. The efficacy of concurrent treatment compared with separate treatment of either anxiety or substance use disorder is unclear and requires further research.
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Affiliation(s)
- Sonja Pasche
- Department of Psychiatry and Mental Health, University of Cape Town, Groote Schuur Hospital, Rondebosch, South Africa.
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Kendall PC, Settipani CA, Cummings CM. No Need to Worry: The Promising Future of Child Anxiety Research. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2012; 41:103-15. [DOI: 10.1080/15374416.2012.632352] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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