Indicated prevention and early intervention for childhood anxiety: a randomized trial with Caucasian and Hispanic/Latino youth

Social anxiety disorder in Black American adolescents: Cultural considerations in conceptualization, assessment, and treatment

Social anxiety disorder (SAD) is characterized by significant distress and avoidance surrounding social and performance situations, with marked interpersonal and academic impairment. This review article highlights cultural considerations relevant to the conceptualization, identification, and treatment of SAD in Black youth. Research evaluating the utility of evidence-based measures to assess SAD suggests they are culturally relevant; however, gaps in knowledge regarding the psychometric properties of even the most widely used instruments are evident. In regard to intervention, cognitive behavioral therapy (CBT) approaches hold promise, yet there is a lack of research on the use of CBT with Black adolescents. Recommendations to incorporate cultural factors into CBT are provided, and future work investigating culturally adapted interventions is needed. Finally, given significant disparities in access and utilization of mental health services among Black youth, strategies to increase treatment engagement, such as school-based services, are important to consider.

Parent Accommodation Contemporaneously Mediates the Association Between Youth Irritability and Youth Anxiety Treatment Outcome

Research documents that child and adolescent (youth) irritability and anxiety have high co-occurrence, and anxious-irritable presentations are associated with greater impairment than anxious nonirritable presentations. This study examines the association between irritability and youth anxiety treatment outcome and tests a conceptual model of the associations among youth irritability, parent accommodation, and youth anxiety severity following cognitive behavioral treatment (CBT). Participants were N = 128 clinic-referred youths ages 6 to 17 years (M = 9.76 years; 57% female) who met criteria for primary anxiety disorder diagnoses and completed a 12- to 14-week CBT anxiety protocol. Parent- and youth-report on youth irritability, parent accommodation of their child's anxiety, and youth anxiety severity were assessed pretreatment and posttreatment. Using parent-report, youth irritability at pretreatment was associated with high parent accommodation of youth anxiety and high youth anxiety severity at posttreatment. The association between irritability and youth anxiety outcome was mediated contemporaneously by parent accommodation at posttreatment. These findings show that parent accommodation of their anxious-irritable children's anxiety may account for high youth anxiety severity following treatment. Developing strategies to target irritability in anxious youth and/or reduce parent accommodation in the presence of youth irritability represent important directions for future research.

Brief Behavioral Therapy for Anxiety and Depression in Pediatric Primary Care: Breadth of Intervention Impact

OBJECTIVE

To report on broad-based outcomes of the Brief Behavioral Therapy (BBT) trial for pediatric anxiety and depression. Secondary data analyses expand on previous reports by assessing diagnostic remission and independent functioning, impact on targeted psychopathology, and spillover effects on non-targeted outcomes.

METHOD

Youth (N = 185; 8-16.9 years; 58% female; 78% White; 21% Hispanic) with anxiety and/or depression were eligible for this multi-site trial. Enrolled youth were randomly assigned to receive 8 to 12 sessions of BBT in primary care or assisted referral to outpatient care (ARC). Assessments were conducted 16 and 32 weeks post randomization.

RESULTS

BBT was superior to ARC on remission of all targeted diagnoses (week 16: 56.8% vs 28.2%, p < .001; week 32: 62.5% vs 38.9%, p = .004), clinician-rated independent functioning (week 16: 75.0% vs 45.7%, p < .001; week 32: 81.2% vs 55.7%, p < .001), and on measures of anxiety, depression, suicide items, total comorbid behavioral and emotional problems, and hyperactivity (d = 0.21-0.49). Moderation analyses revealed superior outcomes for Hispanic youth in BBT vs ARC for diagnostic remission, anxiety, emotional problems, and parent-child conflict. Youth depression at baseline moderated effects on peer problems and parent-child conflict, with effects favoring BBT. Significant main and moderated effects of BBT on change in non-targeted outcomes were largely mediated by change in anxiety (24.2%-49.3% of total effects mediated).

CONCLUSION

BBT has positive effects on youth, mediated by the strong impact of the intervention on anxiety. Analyses continue to support positive outcomes for Hispanic youth, suggesting that BBT is a broadly effective transdiagnostic treatment option for diverse populations.

CLINICAL TRIAL REGISTRATION INFORMATION

Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; https://clinicaltrials.gov; NCT01147614.

Streamlined pediatric anxiety program for school mental health services

There needs to be serious transformation of evidence-based interventions (EBIs) into real-world solutions; otherwise, EBIs will never achieve the intended public health impact. In a randomized trial, we reported effects of a redesigned anxiety program. Herein, we described the redesign process that led to the program. Survey data revealed provider preferences for school mental health anxiety services. Focus groups and prototype feedback sessions revealed service barriers to uptake, implementation, and sustainability along with corresponding enabling strategies. Prototype feedback sessions also focused on refinement and fine-tuning of the redesign. In the end, traditional EBI strategies were transformed and packaged into six lessons, lasting 20-30 minutes each, and amenable to delivery in small-group format. The redesign achieved the intended purpose of retaining elements from cognitive and behavior therapy and social skills training for the target population of the intervention (e.g., 3rd to 5th graders with heterogeneous anxiety problems - identified and referred). The streamlined EBI is accessible from PBS LearningMedia™ - a service that hosts public, research-based, and school-ready materials.

Recommendations for Diversifying Racial and Ethnic Representation in Autism Intervention Research: A Crossover Review of Recruitment and Retention Practices in Pediatric Mental Health

Disparities in diagnosis and access to healthcare and therapeutic services are well-documented for children with autism spectrum disorder (ASD) from minoritized races and ethnicities, but there is little empirical research to guide the selection and implementation of interventions and practices that will effectively support racially/ethnically diverse children with ASD and their families. This cross-over systematic review summarizes parent-mediated intervention research of children with or at risk for mental health disorders to identify potentially effective recruitment and retention strategies for diverse participants in parent-mediated intervention research for children with autism. Electronic database keyword, lead author name searches in PyschNet, MEDLINE, and ancestral searches were conducted to identify 68 relevant articles that used experimental designs to evaluate the effects of parent-mediated interventions on children with or at risk for mental health disorders. Articles were coded for participant demographics; intervention setting and type, recruitment and retention strategies, cultural adaptation of intervention, and reported attrition. Findings are discussed and applied to practices in autism parent-mediated intervention research. Suggestions for future research and limitations are discussed.

Parent involvement enhances CBTs for anxiety disorders in Hispanic/Latino youth: Acculturation as a moderator

OBJECTIVE

Although cognitive behavioral treatments (CBTs) are well-established evidence-based interventions for anxiety disorders in youth, there is long-standing underrepresentation of Hispanic/Latino (H/L) families in youth anxiety clinical trials research. The impact of such underrepresentation is that clinicians who work with H/L youth have minimal evidence-based guidance on best practices. The present study moves toward informing best practices for working with H/L youth with anxiety disorders by examining H/L parents' acculturation and enculturation as moderators of youth anxiety outcomes following CBTs.

METHOD

Two hundred eleven H/L youths ages 6-16 (M = 9.41 years, SD = 2.39 years; 43.8% female) and their parents were assigned to individual-youth CBT or one of two parent involvement CBTs: one targeted decreasing parent psychological control, the other targeted decreasing parent use of negative reinforcement. Parent acculturation and enculturation were measured at pretreatment; youth anxiety severity was measured at pretreatment, posttreatment, and 12-month follow-up evaluations.

RESULTS

Youth anxiety outcomes were enhanced in both parent involvement CBTs compared with individual-youth CBT. Parent acculturation, but not enculturation, significantly moderated outcomes. At lower levels of parent acculturation, youth anxiety outcomes were enhanced in the parent involvement CBT that targeted negative reinforcement. At higher levels of parent acculturation, youth anxiety outcomes were enhanced in the parent involvement CBT that targeted psychological control.

CONCLUSIONS

These findings further support the efficacy of CBTs for anxiety disorders in H/L youth and suggest guidance for tailoring parent involvement treatments based on parent acculturation levels. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Promoting Racial/Ethnic Equity in Psychosocial Treatment Outcomes for Child and Adolescent Anxiety and Depression

Anxiety and depression are the most prevalent and least treated pediatric mental health problems. Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden as they are less likely to receive adequate mental health services for these conditions or to have their needs met. Further, standard evidence‐based interventions for youth anxiety and depression may show diminished effects with racial/ethnic minority youths and with families of lower socioeconomic status. While community‐level interventions to combat structural racism and reduce population‐level risk are sorely needed, many youths will continue to require acute treatment services for anxiety and depression and interventionists must understand how to bring equity to the forefront of care. In this review, we adopt a health system framework to examine racial/ethnic disparities in system‐, intervention‐, provider‐, and patient‐level factors for psychosocial treatment of pediatric anxiety and depression. Current evidence on disparities in access and in efficacy of psychosocial intervention for anxious and depressed youths is summarized, and we use our work in primary care as a case example of adapting an intervention to mitigate disparities and increase equity. We conclude with recommendations for disparity action targets at each level of the health system framework and provide example strategies for intervening on these mechanisms to improve the outcomes of racial/ethnic minority youths.

Racial/ethnic minority youths face greater risks for developing anxiety and depression and experience higher burden from disorder as they are less likely to receive adequate mental health services for these conditions or to have their needs met.

Increasing access to services for anxiety and depression is of critical and immediate importance for racial/ethnic minority families. Issues of access may be associated with the physical location of services (e.g., primary care or telehealth) or with barriers of language, income, or financing.

Both service settings and research treatment protocols frequently require families of ethnic/racial minority youths to fit themselves to the demands of care, in ways that may not be culturally compatible (e.g., little parent involvement in treatment) or practically feasible (i.e., weekly sessions during parent working hours). Whenever possible, non‐essential aspects of intervention should be freed to match patient preferences and constraints, and interventions for anxiety and depression should be adopted that have broad impacts and options for personalization of goals.

Ethnic differences in behavioral and physiological indicators of sensitivity to threat

The clinical presentation of anxiety may differ between Hispanics/Latinx (H/L) and non-H/L, although findings on ethnic differences in self-reported anxiety symptoms have been mixed. Fewer studies have focused on ethnic differences in quick and relatively automatic laboratory-assessed indicators of anxiety symptoms, which have the potential to be more objective indicators than self-report. Therefore, the present study examined ethnic differences in two laboratory-assessed indicators of threat sensitivity (an important transdiagnostic mechanism of anxiety): attentional bias to threat and electromyography startle reactivity to threat. White H/L (n = 117) and White non-H/L (n = 168) adults who were matched on demographics and lifetime psychopathology (including anxiety) completed a dot-probe task to assess attentional bias to threat and the No-Predictable-Unpredictable threat (NPU) task to assess startle reactivity to threat. Results indicated that H/L displayed less Slow OrientationRB (β = -0.27, p = 0.032, R2β∗ = 0.02), and increased Slow DisengagementRB (β = 0.31, p = 0.016, R2β∗ = 0.02) compared to non-H/L. H/L exhibited blunted overall startle compared to non-H/L (β = -0.30, p = 0.014, R2β∗ = 0.02), but groups did not differ in startle reactivity to either predictable or unpredictable threat. In summary, H/L and non-H/L may differ in their experience and presentation of anxiety symptoms and such differences may vary across indicators of sensitivity to threat.

Family based treatment of anxiety disorders: A review of the literature (2010-2019)

Anxiety disorders are the most common and impairing mental health problems across the lifespan. Familial factors are strongly implicated in the onset and maintenance of anxiety, but available evidence-based treatments are usually individual-focused. The aim of this review was to evaluate the current evidence base (2010-2019) of family based interventions addressing youth and adult anxiety and highlight findings comparing family based and individual-focused treatments. A systematic literature search was conducted. Articles were considered if they targeted primarily anxiety-related issues and utilized a randomized controlled trial design, resulting in 22 included youth studies. No adult studies met criteria for inclusion. Overall, family based treatments performed better than no-treatment controls and as well as individual-based interventions, with some evidence that family based interventions might outperform individual-based ones in certain populations (i.e., autism). Family based interventions may represent a good alternative for anxiety treatment in youth. Additional research on family based treatment for anxiety is adults is needed.

Reducing mental health disparities among racially and ethnically diverse populations: A review of couple and family intervention research methods (2010-2019)

Racially and ethnically diverse and globally underserved populations continue to experience mental health disparities. The goal of this review was to examine the extent to which diverse populations were included in couple and family intervention research over the past decade and whether these studies were conducted with attention to issues of diversity. We performed a review of 271 articles reviewed in the current special issue on the efficacy and effectiveness of couple and family interventions across 11 mental health topics. Overall, only 68 of the 271 (25%) articles included predominately racial/ethnic minority samples or globally underserved populations. Among articles (n = 60) describing US-based research with racial/ethnic minority samples, there was a pattern of inattention to methodological considerations relevant to diverse populations. Although some progress was noted, more research is necessary. Specifically, we call for research that advances social justice by using critically conscious methods to promote mental health equity.

Cultural adaptations of cognitive behavioural therapy for Latin American patients: unexpected findings from a systematic review

The current literature extensively recommends making cultural adaptations to psychological therapies, in order to address the differences in values, beliefs and attitudes that patients from different ethnic groups might hold. Although this approach has shown positive outcomes in some settings, it is not well established yet whether such adaptations are needed for all therapies and in all cultures. Therefore, the main aim of this study was to systematically review the literature regarding culturally adapted and ‘conventional’ cognitive behavioural therapy (CBT) for Latin American patients, within Latin American and non-Latin American countries. Sixty empirical studies regarding the effectiveness of culturally adapted and conventional CBT were included in this review. The included studies were carried out in Latin American and non-Latin American countries. The information from all studies was synthesized and assessed, including intervention effect sizes, patient retention rates, methodological quality of the papers, and the type of cultural adaptation made to the therapy. There were no differences between the sets of studies in terms of effectiveness, retention rates, methodological quality, or proportion of statistically significant interventions. Most of the cultural adaptations were peripheral or unspecified. The evidence to date indicates that both conventional and culturally adapted CBT offer the same benefits for Latin American patients in terms of effectiveness and retention rates. Rather than focusing on cultural adaptations, clinicians are encouraged to improve the way they deliver CBT through training and supervision.

Key learning aims

(1)

Moderators of Outcome for Youth Anxiety Treatments: Current Findings and Future Directions

Objective: To improve outcomes and create more personalized interventions, the field has sought to identify moderators of treatment response (variables that specify which treatments work for whom and under what conditions).Method: The current review examines moderators of youth anxiety treatments.Results: The majority of studies to date have examined variables of convenience, including demographics (age, sex, race, ethnicity, socioeconomic status), pretreatment youth clinical characteristics (anxiety severity, principal diagnosis, comorbidity) and pretreatment parent variables (parent psychopathology, parenting). Findings indicate few consistent moderators.Conclusions: Future directions are discussed, including (a) group to individual generalizability, (b) power considerations, and (c) updates to study design and measure selection.

Latino and Non-Latino Parental Treatment Preferences for Child and Adolescent Anxiety Disorders

There is frequently a presumption that Latino parents have a greater preference for involvement in their child's treatment for anxiety compared to non-Latino white parents. However, parent involvement may increase burdens associated with treatment and research suggests that Latino individuals already face significantly greater barriers to obtaining mental health treatment. In the current study, we compared Latino and non-Latino parents' preferences for parental involvement and perceptions of burdens in cognitive behavioral therapy (CBT) for youth anxiety. 117 parents (57 Latino) completed measures to assess child anxiety, perceptions of treatment involvement, and burdens associated with treatment. There were no significant differences between Latino and non-Latino parents except for a trend toward Latino parents reporting more concerns about the feasibility of obtaining CBT for their child's anxiety. Because Latino parents expressed concern about potential treatment barriers, cultural adaptations for treatment should focus on decreasing burdens associated with treatment rather than increasing parental involvement.

Streamlined Prevention and Early Intervention for Pediatric Anxiety Disorders: A Randomized Controlled Trial

There is a need to optimize the fit between psychosocial interventions with known efficacy and the demands of real-word service delivery settings. However, adaptation of evidence-based interventions (EBI) raises questions about whether effectiveness can be retained. This randomized controlled trial (RCT) evaluated a streamlined package of cognitive, behavior, and social skills training strategies known to prevent and reduce anxiety symptom and disorder escalation in youth. A total of 109 youth (Mage = 9.72; 68% girls; 54% Latinx) at risk based on high anxiety were randomized to the streamlined prevention and early intervention (SPEI) (n = 59) or control (n = 50) and were assessed at pretest, posttest, and 12-month follow-up. A main objective was to determine whether our redesign could be delivered by community providers, with acceptable levels of fidelity, quality, and impact. In terms of process evaluation results, there was high protocol fidelity, excellent clinical process skills, few protocol adaptations, and high satisfaction with the SPEI. In terms of outcomes, there were no significant main or moderated effects of the SPEI at the immediate posttest. However, at the follow-up, youth in the SPEI reported greater self-efficacy for managing anxiety-provoking situations, greater social skills, and fewer negative cognitive errors relative to controls. Collectively, findings suggest that the redesigned SPEI might be an attractive and efficient solution for service delivery settings.

Test of an Anxiety Sensitivity Amelioration Program for at-risk youth (ASAP-Y)

OBJECTIVE

Adult research supports the efficacy of targeting the malleable risk factor of anxiety sensitivity (AS) in preventing anxiety and related psychopathology. However, very little work has evaluated the impact of AS reduction among youth, which is unfortunate given adolescence is a "core risk" period in terms of disorder onset.

METHOD

The primary project aim was to test the effects of an Anxiety Sensitivity Amelioration Program for Youth (ASAP-Y) among a sample of 88 youth aged 10-14 years with elevated AS. High AS youth and a parent were randomly assigned to either the ASAP-Y, which consisted of psychoeducation and experimenter-led and parent-led exposures, or a general health information control condition.

RESULTS

Youth in the intervention condition sustained low AS levels across the intervention period, and although AS levels in both conditions decreased from baseline to the one-month assessment, this decrease was more pronounced at one-month for youth in the intervention condition. Further, significant indirect effects of condition on one-month anxiety and depression symptoms via reduced AS were detected. Homework compliance rates and self-report data support the acceptability of the ASAP-Y. Contrary to hypotheses, differences between conditions in emotional reactivity elicited using experimental psychopathology methods were not observed.

CONCLUSIONS

The current findings offer preliminary support for the ASAP-Y as an acceptable selective preventive intervention for at-risk youth, with specific anxiety- and depression-related effects through reduced AS.

Predictors and moderators of recurring self-harm in adolescents participating in a comparative treatment trial of psychological interventions

BACKGROUND

In primary analyses, dialectical behavior therapy (DBT) was associated with greater reduction in self-harm during treatment than individual/group supportive therapy (IGST). The objective of this paper was to examine predictors and moderators of treatment outcomes for suicidal adolescents who participated in a randomized controlled trial evaluating DBT and IGST.

METHODS

Adolescents (N = 173) were included in the intent-to-treat sample and randomized to receive 6 months of DBT or IGST. Potential baseline predictors and moderators were identified within four categories: demographics, severity markers, parental psychopathology, and psychosocial variables. Primary outcomes were suicide attempts (SA) and nonsuicidal self-injury evaluated at baseline, midtreatment (3 months), and end of treatment (6 months) via the Suicide Attempt and Self-Injury Interview (Psychological Assessment, 18, 2006, 303). For each moderator or predictor, a generalized linear mixed model was conducted to examine main and interactive effects of treatment and the candidate variable on outcomes.

RESULTS

Adolescents with higher family conflict, more extensive self-harm histories, and more externalizing problems produced on average more reduction on SH frequency from baseline to post-treatment. Adolescents meeting BPD diagnosis were more likely to have high SH frequency at post-treatment. Analyses indicated significant moderation effects for emotion dysregulation on NSSI and SH. DBT was associated with better rates of improvement compared to IGST for adolescents with higher baseline emotion dysregulation and those whose parents reported greater psychopathology and emotion dysregulation. A significant moderation effect for ethnicity on SA over the treatment period was observed, where DBT produced better rate of improvement compared to IGST for Hispanic/Latino individuals.

CONCLUSIONS

These findings may help to inform salient treatment targets and guide treatment planning. Adolescents that have high levels of family conflict, externalizing problems, and increased level of severity markers demonstrated the most change in self-harm behaviors over the course of treatment and benefitted from both treatment interventions. Those with higher levels of emotion dysregulation and parent psychopathology may benefit more from the DBT.

Telephone-assisted, parent-mediated CBT for rural Latino youth with anxiety: A feasibility trial

OBJECTIVE

In this study, we tailor a child anxiety cognitive-behavior therapy (CBT) program to fit the needs of rural Latino/a Spanish-speaking families and examine the feasibility, acceptability, tolerability, and safety of this intervention using 2 modes of service delivery.

METHOD

Children (n = 31; age 8-13) with anxiety disorders were recruited from primary care settings and randomized to 1 of 2 modes of parent-mediated CBT bibliotherapy: (1) telephone-delivered, therapist-assisted bibliotherapy (TTB; n = 15), and (2) a more minimal contact, self-directed, bibliotherapy condition (SB; n = 16). Independent evaluators administered a diagnostic interview at baseline and posttreatment; demographic and engagement-related questionnaires were also administered.

RESULTS

In the TTB group, 10 of 15 parents (66.7%) completed the requisite number of therapist-assisted bibliotherapy sessions, and in the SB group, 4 of 16 parents (25%) completed the requisite number of self-directed bibliotherapy modules; this comparison was significant, χ2(1) = 5.43, p = .02. In the TTB condition, treatment length and session duration were longer than reported in previous studies. Barriers that were most strongly endorsed were stressors and obstacles competing with treatment, as well as treatment demandingness. Findings revealed good satisfaction across the conditions, although ratings were significantly higher in the TTB group, F = 5.67, p = .028. Remission rates (i.e., no anxiety disorder) for those that provided posttreatment data (N = 25) were 50% and 36% for the TTB and SB groups, respectively, χ2(1) = .465, p = .50.

CONCLUSIONS

Implications of these feasibility findings and suggestions for future research are discussed. (clinicaltrials.gov unique identifier: NCT01491880). (PsycINFO Database Record

Monotherapy Insufficient in Severe Anxiety? Predictors and Moderators in the Child/Adolescent Anxiety Multimodal Study

This secondary analysis of the Child/Adolescent Anxiety Multimodal Study (CAMS) used baseline patient characteristics to identify prognostic subgroups of children based on likelihood of remission. We also investigated predictors and moderators of outcome. CAMS randomized 488 youths with generalized, social, and separation anxiety disorders to cognitive behavioral therapy (CBT), sertraline, both, or pill placebo. Outcomes were Week 12 child, parent, and independent evaluator (IE) ratings of child anxiety. We used receiver operating characteristics analysis and stepwise regression to identify predictors and moderators of outcome. Severe anxiety, lower socioeconomic status, and comorbid obsessive-compulsive disorder predicted higher IE-rated anxiety posttreatment; child-rated social anxiety predicted poorer outcomes reported by all informants. Regarding moderators, Hispanic ethnicity predicted higher IE-rated anxiety after CBT and higher parent-rated anxiety after sertraline. In youths with severe anxiety (Pediatric Anxiety Rating Scale ≥ 20, <italic>n</italic> = 220), combination treatment increased remission (relative risk [RR] = 2.85, <italic>p</italic> < .001), 95% confidence interval (CI) [1.51, 5.39], whereas CBT (RR = 1.55, <italic>p</italic> = .20), 95% CI [0.77, 3.10], and sertraline (RR = 1.27, <italic>p</italic> = .53), 95% CI [0.59, 2.73], did not significantly increase remission relative to placebo. These are the first findings demonstrating that a combination of CBT and a selective serotonin reuptake inhibitor, not monotherapy, is likely key for achieving remission in severe anxiety. CAMS was not powered to detect treatment efficacy after stratification by anxiety severity, so further research is needed regarding effective treatments in severe anxiety. Our main effect findings suggest youth with severe anxiety (especially social phobia), low socioeconomic status and obsessive-compulsive disorder benefit less from current first-line treatments relative to other anxious youth. ClinicalTrials.gov: NCT00052078.

Usability of a Smartphone Application to Support the Prevention and Early Intervention of Anxiety in Youth

Anxiety disorders are among the most common psychiatric problems in youth, fail to spontaneously remit, and place some youth at risk for additional behavioral and emotional difficulties. Efforts to target anxiety have resulted in evidence-based interventions but the resulting prevention effects are relatively small, often weakening over time. Mobile health (mHealth) tools could be of use to strengthen the effects of anxiety prevention efforts. Although a large number of mHealth apps have been developed, few have been evaluated in terms of usability prior to clinical effectiveness testing. Because usability is one of the main barriers to mHealth usage and adoption, the objective of this research was to evaluate the usability of a smartphone application (app) corresponding to an indicated prevention and early intervention targeting youth anxiety. To accomplish this, 132 children (M age = 9.65; 63% girls) and 45 service providers (M age = 29.13, 87% female) rated our app along five established dimensions of usability (ease of use, ease of learning, quality of support information, satisfaction, and stigma) using a standardized group-based testing protocol. Findings showed that the app was highly and positively rated by both youth and providers, with some variations (lower ratings when errors occurred). Path analyses findings also showed that system understanding was significantly related to greater system satisfaction, but that such relation occurred through the quality of support information offered by the app.

Parental acculturation level moderates outcome in peer-involved and parent-involved CBT for anxiety disorders in Latino youth

Cognitive behavioral therapies (CBTs) are efficacious treatments for anxiety disorders in Latino youth. However, there is a gap in knowledge about moderators of CBT outcomes in Latino youth. This study addresses this gap by examining parental acculturation as a moderator of youth anxiety outcomes in a randomized controlled trial of parent-involved CBT (CBT/P) and peer-involved group CBT (GCBT) in 139 Latino youth (ages 6 to 16 years; mean age = 9.68 years). Comparable youth anxiety reduction effects were found for CBT/P and GCBT. Parental acculturation to majority US culture, but not identification with country of origin, significantly moderated youth anxiety outcomes: at low levels of parental acculturation to majority US culture, youth posttreatment anxiety scores were lower in GCBT than CBT/P; at high levels of parental acculturation to majority US culture, youth posttreatment anxiety scores were lower in CBT/P than GCBT. These findings provide further evidence for the efficacy of CBTs for anxiety disorders in Latino youth and also provide guidance for moving toward personalization of CBTs' selection depending on parental acculturation levels.

Control Over Anxiety and Dispositional Coping Tendencies Are Associated With Presleep Arousal Among Children Referred for Anxiety Problems

Anxious youth typically experience sleep-related difficulties, but little is known about the role children's coping and perceived control over anxiety may play in these relations. We examined children's perceived levels of control over external anxiety-provoking events and internal anxious emotional reactions, as well as two dispositional coping tendencies (avoidant, support-seeking), and whether these were associated with anxious children's (N = 86) presleep arousal. Low perceived control over anxiety was significantly associated with high levels of presleep arousal. For children with low perceived control, higher avoidance was associated with greater presleep arousal, whereas lower avoidance was associated with lower presleep arousal levels. Findings suggest that efforts to avoid stressful life events may contribute to presleep arousal, especially under conditions where anxious arousal seems uncontrollable.

Elternarbeit im Kontext der Angstbehandlung von Kindern

Zusammenfassung. Angststörungen sind im Kindes- und Jugendalter weit verbreitet. Die kognitive Verhaltenstherapie (CBT) hat sich als Intervention der Wahl erwiesen. Neben Psychoedukation, kognitiven Techniken und Expositionsübungen ist auch die therapeutische Arbeit mit den Eltern eine häufig eingesetzte Methode. In der vorliegenden Übersichtsarbeit wird der Frage nachgegangen, ob der Einsatz von Elternarbeit in der Therapie mit ängstlichen Kindern die Effektivität der Intervention steigert. Im Rahmen eines systematischen Reviews wurden 25 Studien identifiziert, die von wenigen Elternsitzungen bis hin zu reinen Elterntrainings ein großes Spektrum der Elternarbeit bei Kindern mit einer Angststörung abdecken. Es zeigt sich, dass die CBT Wartekontrollgruppen hinsichtlich der Remissionsrate der Angststörungen generell überlegen ist. Behandlungsansätze, die neben der kindbezogenen Intervention ein Elterntraining enthalten, erweisen sich nicht wirksamer im Vergleich zu ausschließlich kindbezogenen Interventionen. Mögliche Erklärungen für das Ausbleiben der Wirksamkeitssteigerung und daraus resultierende Konsequenzen werden diskutiert.

Delivering CBT to Rural Latino Children with Anxiety Disorders: A Qualitative Study

Qualitative methods were used to understand community perspectives about ways to deliver cognitive behavior therapy (CBT) to rural Latino youth with anxiety. First, four focus groups were conducted with 28 bilingual Latino mental health providers to examine perceptions of CBT using telephone based, therapist supported bibliotherapy, and bibliotherapy without therapist support. Second, qualitative interviews were conducted with 15 Latino parents from a rural community to better understand attitudes toward CBT, and modes of service delivery. Qualitative findings revealed that parents were mostly positive about psychotherapy, and the core elements of CBT for anxiety. However, both parents and providers emphasized the need for adaptations to address practical and perceived barriers to treatment, such as time, convenience, homework, and literacy. Many parents spoke favorably of a telephone-based approach that could address many of their perceived barriers, while providers were expressed more negative views. Such findings are important for data-driven treatment development efforts.

Prevention and intervention research with Latino families: a translational approach

The present paper takes a translational approach in applying the themes of the current special section to prevention and intervention science in Latino families. The paper reviews the current literature on cultural processes in prevention and intervention research with Latino families. Overall, many prevention and intervention programs have either been developed specifically for Latino families or have been modified for Latino families with great attention paid to the socio-cultural needs of these families. Nevertheless, few studies have tested the role of cultural values or acculturation processes on outcomes. We make recommendations based on findings within basic science and in particular this special section on the incorporation of these values and processes into prevention and intervention science with Latino families.

Treatment engagement and response to CBT among Latinos with anxiety disorders in primary care

OBJECTIVE

In the current study, we compared measures of treatment outcome and engagement for Latino and non-Latino White patients receiving a cognitive behavioral therapy (CBT) program delivered in primary care.

METHOD

Participants were 18-65 years old and recruited from 17 clinics at 4 different sites to participate in a randomized controlled trial for anxiety disorders, which compared the Coordinated Anxiety Learning and Management (CALM) intervention (consisting of CBT, medication, or both) with usual care. Of those participants who were randomized to the intervention arm and selected CBT (either alone or in combination with medication), 85 were Latino and 251 were non-Latino White; the majority of the Latino participants received the CBT intervention in English (n = 77). Blinded assessments of clinical improvement and functioning were administered at baseline and at 6, 12, and 18 months after baseline. Measures of engagement, including attendance, homework adherence, understanding of CBT principles, and commitment to treatment, were assessed weekly during the CBT intervention.

RESULTS

Findings from propensity-weighted linear and logistic regression models revealed no statistically significant differences between Latinos and non-Latino Whites on symptom measures of clinical improvement and functioning at almost all time points. There were significant differences on 2 of 7 engagement outcomes, namely, number of sessions attended and patients' understanding of CBT principles.

CONCLUSIONS

These findings suggest that CBT can be an effective treatment approach for Latinos who are primarily English speaking and likely more acculturated, although continued attention should be directed toward engaging Latinos in such interventions.

A personalized and control systems engineering conceptual approach to target childhood anxiety in the contexts of cultural diversity

In the child and adolescent anxiety area, some progress has been made to develop evidence-based prevention protocols, but less is known about how to best target these problems in children and families of color. In general, data show differential program effects with some minority children benefiting significantly less. Our preliminary data, however, show promise and suggest cultural parameters to consider in the tailoring process beyond language and cultural symbols. It appears that a more focused approach to culture might help activate intervention components and its intended effects by focusing, for example, on the various facets of familismo when working with some Mexican parents. However, testing the effects and nuances of cultural adaption vis-à-vis a focused personalized approach is methodologically challenging. For this reason, we identify control systems engineering design methods and provide example scenarios relevant to our data and recent intervention work.

Predictors of Initial Engagement in Child Anxiety Mental Health Specialty Services

BACKGROUND

Child and family mental health services remain largely underutilized despite the relatively high rate of youth suffering from mental, emotional, and behavioral (MEB) disorders. As such, it is important to address challenges and examine factors related to child mental health service use and engagement, especially when it comes to children in need of services for anxiety.

OBJECTIVE

Informed by the Behavioral Model of Health Services Use (BMHS), the present study sought to examine predictors of service use and engagement for families seeking assistance for their anxious children. Initial levels of engagement in culturally tailored services were predicted from predisposing characteristics (e.g., child age, ethnicity), enabling resources (e.g., Spanish services, transportation), and need characteristics (e.g., child clinical severity).

METHOD

Participants included Latino (n = 126) and Caucasian (n = 116) families who presented to a specialty clinic due to child emotional and behavior problems related to anxiety. Initial service utilization and engagement was assessed along the following levels toward services care: (1) initiated contact and completed a clinical intake, (2) completed a home screen, and (3) completed an on-site diagnostic assessment. All procedures were culturally tailored to the presenting needs of families.

RESULTS

Predisposing characteristics, enabling resources and need characteristics emerged as significant predictors of child mental health service use, with some variations. Child age, ethnicity, referral source, and enabling resources predicted completion of a home screen. Proximity to services predicted completion of the on-site diagnostic assessment.

CONCLUSION

Knowledge of factors that predict engagement in child mental health services can help identify avenues to promote service utilization, especially among ethnic minority children and families. Our culturally tailored approach to serving families appears to be promising in bridging the cross-ethnic services gap and therefore has implications for practice.