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López-Pinar C, Lara-Merín L, Macías J. Process of change and efficacy of acceptance and commitment therapy (ACT) for anxiety and depression symptoms in adolescents: A meta-analysis of randomized controlled trials. J Affect Disord 2025; 368:633-644. [PMID: 39303882 DOI: 10.1016/j.jad.2024.09.076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 09/11/2024] [Accepted: 09/13/2024] [Indexed: 09/22/2024]
Abstract
INTRODUCTION Recent literature suggests that acceptance and commitment therapy (ACT) may be an effective approach for treating symptoms of depression and anxiety symptoms in adolescents. This review meta-analyzes the efficacy of ACT on adolescent depression and anxiety, emphasizing the role of process variables (i.e., psychological flexibility). METHODS We systematically searched MedLine, PsycInfo and Scopus for randomized controlled trials (RCT) investigating the effect of ACT on anxiety/depression in adolescents. Studies were combined using the inverse variance method in a random effects model. Additional subgroup and meta-regression analyses were performed, and risk of bias was assessed. The review was pre-registered (PROSPERO registration number: CRD42023483300). RESULTS Our review included 27 RCTs with a total of 2860 participants. ACT did not outperform CBT but was significantly more effective than other active controls (e.g., treatment as usual) for depression symptoms and inactive controls for all outcomes. ACT was more effective than inactive controls for all outcomes. Improvements in psychological flexibility significantly predicted reductions in between-group depression and anxiety. Younger age and a higher percentage of women predicted better outcomes for some outcomes. LIMITATIONS It should be noted that this results may be limited by the fact that all included studies were rated as having a high risk of bias. This is mainly due to the self-reported nature of the measures and the lack of crucial methodological information (e.g., process of randomization and allocation, treatment fidelity assessment). CONCLUSION Our findings support ACT's efficacy for adolescents, particularly in treating depression symptoms. The proposed mechanism of change (psychological flexibility) plays a significant role in the improvements. ACT is comparable in efficacy to CBT, suggesting its potential as an alternative to traditional cognitive-behavioral approaches.
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Affiliation(s)
- Carlos López-Pinar
- Department of Psychology, European University of Valencia, Valencia, Spain.
| | - Lucía Lara-Merín
- Department of Psychology, European University of Valencia, Valencia, Spain
| | - Juanjo Macías
- Department of Psychology, European University of Valencia, Valencia, Spain
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2
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Miller ML, Steuber ER, McGuire JF. Clinical Considerations for an Evidence-Based Assessment of Anxiety Disorders in Children and Adolescents. Psychiatr Clin North Am 2024; 47:641-672. [PMID: 39505446 PMCID: PMC11541044 DOI: 10.1016/j.psc.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
This article provides an overview of evidence-based assessment (EBA) of anxiety disorders in children and adolescents. First, this article provides an overview of using clinician-rated scales in the diagnostic process. Second, this article reviews the clinical utility of clinician-rated measures, and parent-report and youth-report measures to characterize anxiety severity and monitor treatment response in clinical practice. Additionally, rating scales that capture clinical constructs that are relevant in anxiety disorders-such as accommodation and avoidance behaviors-are succinctly reviewed. Finally, the article concludes with recommendations for conducting an EBA for anxiety disorders in children and adolescents.
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Affiliation(s)
- Michelle L Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Elizabeth R Steuber
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA; Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Steuber ER, Miller ML, McGuire JF. Clinical Considerations for an Evidence-Based Assessment of Anxiety Disorders in Adults. Psychiatr Clin North Am 2024; 47:623-639. [PMID: 39505445 PMCID: PMC11541043 DOI: 10.1016/j.psc.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
Evidence-based assessment (EBA) is critical for successful diagnosis and treatment of adult anxiety disorders. First, diagnostic interviews are reviewed with emphasis on how these tools can be used inform clinical diagnoses. Second, clinician-rated measures and self-report scales used to characterize anxiety symptom severity in adults are discussed. Third, to further inform clinical care, rating scales that illustrate clinical profiles contributing to symptom maintenance and severity-namely accommodation and avoidance behaviors-are discussed. Lastly, a summary of recommendations for using EBA for the diagnosis and treatment of anxiety disorders in adults is shared.
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Affiliation(s)
- Elizabeth R Steuber
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA; Department of Psychiatry, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Michelle L Miller
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 1800 Orleans Street, Baltimore, MD 21287, USA.
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4
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Rabner JC, Olino TM, Albano AM, Ginsburg GS, Compton SN, Piacentini J, Sakolsky D, Birmaher B, Gosch E, Kendall PC. Do youth anxiety measures assess the same construct consistently throughout treatment? Results are...complicated. Child Psychiatry Hum Dev 2024; 55:1526-1540. [PMID: 36856912 DOI: 10.1007/s10578-023-01515-y] [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: 02/22/2023] [Indexed: 03/02/2023]
Abstract
Interventionists interpret changes in symptoms as reflecting response to treatment. However, changes in symptom functioning and the measurement of the underlying constructs may be reflected in reported change. Longitudinal measurement invariance (LMI) is a statistical approach that assesses the degree to which measures consistently capture the same construct over time. We examined LMI in measures of anxiety severity/symptoms [i.e., Pediatric Anxiety Rating Scale (PARS), Multidimensional Anxiety Scale for Children (MASC), Screen for Child Anxiety and Related Disorders (SCARED)] in anxious youth at baseline and posttreatment. Initial fit was inadequate for 27 of 38 baseline and posttreatment models, but model modifications resulted in acceptable fit. Tests of LMI supported scalar invariance for the PARS and many, but not all, MASC and SCARED subscales. Findings suggest that the PARS, and many MASC and SCARED subscales can accurately be used to measure change over time, however, others may reflect changes in measurement properties.
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Affiliation(s)
- Jonathan C Rabner
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA.
| | - Thomas M Olino
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
| | - Anne Marie Albano
- Department of Psychiatry, Columbia University, New York City, NY, USA
| | - Golda S Ginsburg
- Department of Psychiatry, University of Connecticut School of Medicine, West Hartford, CT, USA
| | - Scott N Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA, USA
| | - Dara Sakolsky
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Boris Birmaher
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Elizabeth Gosch
- Department of Clinical Psychology, Philadelphia College of Osteopathic Medicine, Philadelphia, PA, USA
| | - Philip C Kendall
- Department of Psychology and Neuroscience, Temple University, Philadelphia, PA, USA
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5
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Figueiredo DV, Salvador MDC, Rijo D, Vagos P. Acceptance and commitment therapy as a transdiagnostic approach to adolescents with different anxiety disorders: study protocol. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02608-2. [PMID: 39542901 DOI: 10.1007/s00787-024-02608-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 10/30/2024] [Indexed: 11/17/2024]
Abstract
Adolescence increases vulnerability to mental ill-health, particularly anxiety disorders like Social Anxiety Disorder (SAD) and Generalized Anxiety Disorder (GAD). Still, the understanding of Psychological Flexibility/Inflexibility (PF/PI) as a transdiagnostic framework relevant to explaining these difficulties and the efficacy of Acceptance and Commitment Therapy (ACT) in addressing adolescent SAD and GAD remains limited. Hence, this study has two aims: examining the role of PI/PF on adolescents' mental health and assessing ACT's efficacy for adolescent SAD and GAD. We will collect data from 400 community adolescents and employ network analysis to explore connections between PI/PF processes, anxiety, and flourishing. We will also investigate pathways linking PI/PF processes with flourishing and anxiety across samples (clinical SAD, clinical GAD, and mentally healthy groups), expecting to find similar patterns. Furthermore, a Randomized Controlled Trial with three groups (control, SAD experimental and GAD experimental), each comprising 29 participants, and four assessment moments (pre- and post-intervention and 3- and 6-months follow-up) will be conducted. Similar improvements are anticipated in both experimental groups, driven by changes in PI/PF processes. Findings from this work will provide valuable evidence to PI/PF as accurate conceptualizations of human suffering and expand the transdiagnostic application of ACT to adolescents with anxiety disorders.
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Affiliation(s)
- Diana Vieira Figueiredo
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal.
| | - Maria do Céu Salvador
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Daniel Rijo
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
| | - Paula Vagos
- Center for Research in Neuropsychology and Cognitive-Behavioral Intervention (CINEICC), Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal
- Departamento de Educação E Psicologia, William James Research Center, Universidade de Aveiro, Aveiro, Portugal
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6
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Marino F, Doria G, LoPresti A, Gismondo S, Failla C, Pioggia G. Case report: Advances in treating ligyrophobia with third-generation ACT approach. Front Psychiatry 2024; 15:1425872. [PMID: 39391078 PMCID: PMC11464357 DOI: 10.3389/fpsyt.2024.1425872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 08/28/2024] [Indexed: 10/12/2024] Open
Abstract
Background and aims Giulia, an 11-year-old girl diagnosed with ligyrophobia, has been experiencing intense anxiety related to loud noises since the age of two. This case report aims to explore the efficacy of Third-Wave Cognitive Behavioral Therapy, specifically Acceptance and Commitment Therapy (ACT), in addressing Giulia's anxiety and avoidance behaviors. The primary goal is to examine the impact of ACT on reducing ligyrophobic symptoms and enhancing psychological flexibility. Methods The therapeutic intervention spanned 24 sessions and was divided into two phases. The initial phase focused on emotional competence using characters from the movie "Inside Out," aiding Giulia in recognizing and understanding her emotions. The subsequent phase targeted the six processes of psychological inflexibility identified in ACT, fostering increased flexibility. Results Throughout the intervention, Giulia demonstrated significant improvements in anxiety symptoms, as evidenced by a decrease in Subjective Units of Distress (SUD) scores. Avoidance behaviors also diminished, and Giulia exhibited enhanced mindfulness skills. She became more cognizant of her emotional experiences and more certain of her personal ideals as a result of the therapy. Giulia's active participation and commitment to exposure exercises led to a substantial reduction in ligyrophobic reactions. Discussion The successful application of ACT in Giulia's case suggests that targeting psychological inflexibility through mindfulness and values clarification can be effective in treating ligyrophobia in children. The integration of metaphors and creative exercises proved valuable in engaging Giulia and fostering therapeutic progress. The findings underscore the importance of a tailored, third-wave therapeutic approach in addressing specific phobias in pediatric populations.
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Affiliation(s)
- Flavia Marino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Germana Doria
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Faculty of Psychology, International Telematic University Uninettuno, Roma, Italy
| | - Adele LoPresti
- Academy of Cognitive Behavioral Sciences of Calabria ASCoC, Calabria, Italy
| | - Stefania Gismondo
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
| | - Chiara Failla
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
- Classical Linguistic Studies and Education Department, Kore University of Enna, Enna, Italy
| | - Giovanni Pioggia
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy (CNR), Messina, Italy
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7
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Whiteside SPH, Biggs BK, Geske JR, Gloe LM, Reneson-Feeder ST, Cunningham M, Dammann JE, Brennan E, Ong ML, Olsen MW, Hofschulte DR. Parent-coached exposure therapy versus cognitive behavior therapy for childhood anxiety disorders. J Anxiety Disord 2024; 104:102877. [PMID: 38788593 DOI: 10.1016/j.janxdis.2024.102877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/30/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024]
Abstract
Cognitive-behavioral therapy (CBT) is the strongest evidenced-based therapy for childhood anxiety disorders (CADs). However, CBT's impact is limited by its lack of clear superiority over treatment as usual, excessive length, and greater than 50% of patients remaining symptomatic. Parent-coached exposure therapy (PCET) is designed to treat CADs more effectively and efficiently through a focus on exposure and working with parents and youth together. In a randomized controlled trial, 78 patients (78% female) aged 7 to 17 with CADs were assigned to PCET or the gold-standard CBT. The primary outcome was independent evaluator ratings of anxiety severity at mid- and post-treatment. Secondary outcomes were parent- and child-reported symptoms. Patients receiving PCET had significantly lower mean scores than those receiving CBT on the primary outcome measure at mid-treatment (3.03 ± 0.14, 95% CI, 2.75-3.32 vs. 3.77 ± 0.16 95% CI, 3.45-4.08, p = 0.0010) and post-treatment (2.79 ± 0.14, 95% CI, 2.50-3.07 vs. 3.33 ± 0.16, 95% CI, 2.02-3.64, p = 0.0153). Similar significant results were found with the secondary parent- and child-reported outcomes. These superior results were achieved in PCET with fewer sessions (6.62, SD = 2.8) than those in CBT (8.00, SD = 3.1), p = 0.041. The superior effectiveness and efficiency of PCET likely results from the greater focus on implementing exposure exercises compared to traditional CBT.
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Affiliation(s)
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jennifer R Geske
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN 55905, USA
| | - Lilianne M Gloe
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | | | - Megan Cunningham
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Julie E Dammann
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Elle Brennan
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mian Li Ong
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Mark W Olsen
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
| | - Deanna R Hofschulte
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, USA
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8
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Musanje K, Kasujja R, Camlin CS, Hooper N, Hope-Bell J, Sinclair DL, Kibanja GM, Mpirirwe R, Kalyango JN, Kamya MR. Effectiveness of a mindfulness and acceptance-based intervention for improving the mental health of adolescents with HIV in Uganda: An open-label trial. PLoS One 2024; 19:e0301988. [PMID: 38722926 PMCID: PMC11081388 DOI: 10.1371/journal.pone.0301988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 03/20/2024] [Indexed: 05/13/2024] Open
Abstract
Adolescents with HIV (AWH) face the double burden of dealing with challenges presented by their developmental phase while coping with stigma related to HIV, affecting their mental health. Poor mental health complicates adherence to daily treatment regimens, requiring innovative psychosocial support strategies for use with adolescents. We assessed the effectiveness of a mindfulness and acceptance-based intervention on the mental health of AWH in Uganda. One hundred and twenty-two AWH, mean age 17 ±1.59 (range 15 to 19 years), 57% female, receiving care at a public health facility in Kampala were enrolled in an open-label randomized trial (ClinicalTrials.gov: NCT05010317) with assessments at pre-and post-intervention. The mindfulness and acceptance-based intervention involved weekly 90-minute group sessions for four consecutive weeks facilitated by two experienced trainers. Sessions involved clarifying values, skillfully relating to thoughts, allowing and becoming aware of experiences non-judgmentally, and exploring life through trial and error. The control group received the current standard of care. Three mental health domains (depression, anxiety, and internalized stigma) were compared between the intervention and control groups. A linear mixed effects regression was used to analyze the effect of the intervention across the two time points. Results showed that the intervention was associated with a statistically significant reduction in symptoms of depression (β = -10.72, 95%CI: 6.25, -15.20; p < .0001), anxiety (β = -7.55, 95%CI: 2.66, -12.43; p = .0003) and stigma (β = -1.40, 95%CI: 0.66 to -2.15; p = .0004) over time. Results suggest that mindfulness and acceptance-based interventions have the potential to improve the mental health of AWH.
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Affiliation(s)
- Khamisi Musanje
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
- School of Psychology, Makerere University, Kampala, Uganda
| | - Rosco Kasujja
- School of Psychology, Makerere University, Kampala, Uganda
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, United States of America
| | - Nic Hooper
- School of Psychology, Cardiff University, Wales, United Kingdom
| | - Josh Hope-Bell
- School of Medicine, Cardiff University, Wales, United Kingdom
| | | | | | - Ruth Mpirirwe
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Joan N. Kalyango
- Clinical Epidemiology Unit, Makerere University, Kampala, Uganda
| | - Moses R. Kamya
- School of Medicine, Makerere University, Kampala, Uganda
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9
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Byrne G, Cullen C. Acceptance and Commitment Therapy for Anger, Irritability, and Aggression in Children, Adolescents, and Young Adults: A Systematic Review of Intervention Studies. TRAUMA, VIOLENCE & ABUSE 2024; 25:935-946. [PMID: 37129045 DOI: 10.1177/15248380231167393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
The onset of childhood disruptive behaviors is one of the most common presenting difficulties to clinics worldwide. Acceptance and commitment therapy (ACT) has shown to be effective in the reduction of anger and aggression among adults, however to date there has been no systematic review that has examined the effectiveness of ACT in addressing anger and aggression among children, adolescents, and young adults. The current systematic review aimed to evaluate the methodological standing and effectiveness of the peer-reviewed literature of ACT on anger and aggression for this population. PsycINFO, PubMed, and MEDLINE databases were searched systematically in June 2022 to identify studies in English published on the use of ACT for anger and aggression in children, adolescents, and young adults. Seven studies met the inclusion criteria with a combined sample of 305 participants across the interventions. The most common outcome measures used were self-report ratings of anger among participants. Studies were characterized by poor methodological rigor and findings were mixed as regards the effectiveness of ACT in addressing anger and aggression in this population. Some evidence suggests that group ACT may be effective in reducing self-report measures of anger, but no firm conclusions can be drawn from the extant literature due to the heterogeneous nature of the studies, and limited information about ACT protocols and treatment delivery. Further higher-powered studies comparing ACT to treatment as usual or waitlist are needed to clarify what ACT may add as a treatment to anger and aggression in this population.
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Affiliation(s)
- Gary Byrne
- HSE Community Healthcare East, Dublin, Ireland
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10
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Abstract
Anxiety disorders (ADs) frequently lead to significant impairment across important domains of youth functioning. Yet until recently, clinical research and assessment have largely neglected the measurement of anxiety-related impairment. In this article, we review the evidence for five extant rating scales of youth anxiety-related impairment, guided by widely used evaluative criteria. Emerging psychometric data show the potential utility of these rating scales for achieving different assessment functions. Of the five scales, the Child Anxiety Impact Scale, particularly the parent-report version, has been the most researched one. Promising psychometric data support its use for assessing anxiety-related impairment in school, social, and family/home domains of functioning. We conclude with recommendations for growing this research base and for incorporating these rating scales into the youth AD clinical and research assessment process.
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Affiliation(s)
- Rebecca G Etkin
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Eli R Lebowitz
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
| | - Wendy K Silverman
- Yale Child Study Center, Yale School of Medicine, New Haven, CT, USA
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11
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Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behav Res Ther 2023; 168:104376. [PMID: 37499294 DOI: 10.1016/j.brat.2023.104376] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/29/2023]
Abstract
Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in very similar ways to adults and that anxiety disorders in the paediatric years can predict a lifelong mental-health struggle. Given the vast array of specific studies in this field, the current review summarises current knowledge about these high prevalence disorders, points to overarching limitations, and suggests potentially important future directions. Following a brief historical overview, the review summarises knowledge about demographic and epidemiological characteristics, distal and proximal risk factors, current treatment directions, and prevention. There is still a great deal to learn about the causes and treatments of child and adolescent anxiety disorders. By amalgamating our current knowledge, this review provides a window to the research directions that are likely to lead to future advances.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Cathy Creswell
- Departments of Psychiatry and Experimental Psychology, University of Oxford, Oxford, UK
| | - Philip C Kendall
- Department of Psychology, Temple University, Child and Adolescent Anxiety Disorders Clinic, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program (NIMH-IRP), USA
| | - Allison M Waters
- School of Applied Psychology, Griffith University, Brisbane, Australia
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12
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Lodewyk K, Bagnell A, Courtney DB, Newton AS. Review: Adverse event monitoring and reporting in studies of pediatric psychosocial interventions: a systematic review. Child Adolesc Ment Health 2023. [PMID: 37463769 DOI: 10.1111/camh.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 07/20/2023]
Abstract
BACKGROUND Adverse event monitoring in studies of psychotherapy is crucial to clinical decision-making, particularly for weighing of benefits and harms of treatment approaches. In this systematic review, we identified how adverse events are defined, measured, and reported in studies of psychosocial interventions for children with mental disorders. METHOD Medline, PsycINFO, Embase, ProQuest Dissertations and Theses Global, and the Cochrane Library were searched from January 2011-January 2023, and Google Scholar from January 2011-February 2023. English language experimental and quasi-experimental studies that evaluated the efficacy or effectiveness of psychosocial interventions for childhood mental disorders were included. Information on the definition, assessment, and report of adverse events was extracted using a checklist based on Good Clinical Practice guidelines. RESULTS In this review, 117 studies were included. Studies most commonly involved treating anxiety disorders or obsessive-compulsive disorder (32/117; 27%); 44% of the experimental interventions tested (52/117) were cognitive behavioral therapies. Adverse events were monitored in 36 studies (36/117; 31%) with a protocol used in 19 of these studies to guide monitoring (19/36; 53%). Twenty-seven different events were monitored across the studies with hospitalization the most frequently monitored (3/36; 8%). Event severity was fully assessed in 6 studies (17%) and partially assessed in 12 studies (33%). Only 4/36 studies (11%) included assessing events for cause. CONCLUSIONS To date, adverse events have been inconsistently defined, measured and reported in psychosocial intervention studies of childhood mental health disorders. Information on adverse events is an essential knowledge component for understanding the potential impacts and risks of therapeutic interventions.
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Affiliation(s)
| | | | - Darren B Courtney
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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13
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Fang S, Ding D. The differences between acceptance and commitment therapy (ACT) and cognitive behavioral therapy: A three-level meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2023. [DOI: 10.1016/j.jcbs.2023.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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14
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Dickson SJ, Kuhnert RL, Lavell CH, Rapee RM. Impact of Psychotherapy for Children and Adolescents with Anxiety Disorders on Global and Domain-Specific Functioning: A Systematic Review and Meta-analysis. Clin Child Fam Psychol Rev 2022; 25:720-736. [PMID: 35794304 PMCID: PMC9622529 DOI: 10.1007/s10567-022-00402-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2022] [Indexed: 12/01/2022]
Abstract
A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom or diagnostic reduction provides an incomplete picture of clinically meaningful efficacy given that anxiety disorders in this age group are integrally associated with problems in functioning. A systematic review and meta-analysis (N studies = 40, N participants = 3094) evaluating the impacts of psychotherapy for anxiety was conducted on the following outcomes: global functioning, social functioning, academic functioning, and school attendance. Randomised controlled trials with a passive control condition, a child and/or adolescent sample (7-17 years) with a primary anxiety diagnosis, and receiving anxiety-focused psychotherapy were eligible for inclusion if they reported suitable outcome data. Results from the meta-analysis indicated that from pre- to post-treatment, psychotherapy led to significant improvements in global functioning according to clinician (d = 1.55), parent (d = 0.67), and child (d = 0.31) reports and on social functioning according to parent (d = 0.51), but not child (d = 0.31) reports. The qualitative review provided preliminary support psychotherapy's efficacy in increasing family functioning and school attendance, but not so much in enhancing academic performance. These results indicate that psychotherapy improves daily functioning in anxious children and adolescents. The study also highlighted the limited attention paid to measures of functioning in the empirical literature on treatment of childhood anxiety.Trial Registry: This study is registered with PROSPERO under the identification number CRD42021246565.
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Affiliation(s)
- Sophie J. Dickson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109 Australia
| | - Rebecca-Lee Kuhnert
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109 Australia
| | - Cassie H. Lavell
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109 Australia
| | - Ronald M. Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109 Australia
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15
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Byrne G, Connon G. The use of acceptance and commitment therapy in managing psychological symptoms in paediatric functional non-epileptic attacks: A clinical report. Clin Child Psychol Psychiatry 2022:13591045221143553. [PMID: 36448442 DOI: 10.1177/13591045221143553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Functional non-epileptic attacks (FNEA) are seizure like activities that occur without any organic cause. Although a debilitating and costly disorder, there is much debate within the clinical literature on the causes and prognosis of FNEA, as well as possible effective psychological interventions. This is especially true for FNEA occurring in paediatric populations. Limited evidence to date suggests that acceptance and commitment therapy (ACT) shows promise and has pragmatic benefits in the context of functional disorders for adults. This case study provides information of a brief (8-session) ACT protocol targeting FNEA and associated emotional difficulties in a 12-year child. Treatment aimed to promote psychological flexibility and reduce functional interference of FNEA symptoms using ACT consistent techniques. Post-treatment, the child demonstrated reliable/clinical recovery in psychological flexibility, symptom interference and anxiety, as well as a marked reduction in the frequency of FNEA episodes. The majority of these gains were evidenced at 5-month follow-up. Such promising findings need to be tempered by methodological considerations.
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Affiliation(s)
- Gary Byrne
- Department of Primary Care Psychology, 8004Health Service Executive (HSE), Dublin South, Ireland
| | - Graham Connon
- Department of Psychology, 8004Health Service Executive (HSE), Dublin North, Ireland
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16
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Pettitt RM, Brown EA, Delashmitt JC, Pizzo MN. The Management of Anxiety and Depression in Pediatrics. Cureus 2022; 14:e30231. [DOI: 10.7759/cureus.30231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
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17
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A Review of Acceptance and Commitment Therapy for Adolescents: Developmental and Contextual Considerations. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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18
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Petersen JM, Twohig MP. Acceptance and Commitment Therapy for a Child With Misophonia: A Case Study. Clin Case Stud 2022. [DOI: 10.1177/15346501221126136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Misophonia, a condition involving hypersensitivity, anger, and/or disgust in response to specific noises (e.g., chewing, tapping), is highly underresearched in children. Several case studies point towards the utility of cognitive behavioral therapy and related treatments (e.g., acceptance and commitment therapy [ACT]). ACT presents a particularly promising option, as it focuses on building psychological flexibility in response to difficult internal experiences, rather than trying to remove or change them (e.g., responding effectively to irritation provoked by chewing). The present case study describes “Kelly” (pseudonym), a 12-year-old girl with moderately severe misophonia symptoms, who received a 16-session course of ACT for misophonia. At post-treatment, Kelly reported a decline to the mild range of misophonia, as well as re-engagement in activities that were important to her and clinically significant reductions in depressive symptoms. These results suggest that ACT may be an appropriate treatment for children with misophonia; however, much more research is warranted.
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19
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Zemestani M, Hosseini M, Petersen JM, Twohig MP. A pilot randomized controlled trial of culturally-adapted, telehealth group acceptance and commitment therapy for iranian adolescent females reporting symptoms of anxiety. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Hämäläinen T, Kaipainen K, Keinonen K, Lappalainen P, Puolakanaho A, Lappalainen R, Kiuru N. The Roles of Adherence and Usage Activity in Adolescents' Intervention Gains During Brief Guided Online Acceptance and Commitment Therapy. J Cogn Psychother 2022; 37:JCP-2021-0038.R1. [PMID: 35470151 DOI: 10.1891/jcp-2021-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study investigated the roles of adherence and usage activity in adolescents' (n = 161) gains during a 5-week web intervention program based on acceptance and commitment therapy (ACT). METHOD Program adherence was calculated as adherence percentage in relation to intended usage, whereas completion percentage, usage time, and usage weeks were used as indicators for usage activity. Subjective well-being was measured by self-reported life satisfaction and stress before and after the intervention. RESULTS First, regression analysis results showed that higher adherence predicted an increase in life satisfaction during intervention. Second, three subgroups of adolescents were identified using K-means cluster analysis in regard to adherence, usage activity and intervention gains: (1) "Adhered, committed users with relatively large intervention gains" (35%), (2) "Less committed users with no intervention gains" (42%), and (3) "Non-committed users with no intervention gains" (23%). The results showed that the highest gains from the Youth Compass intervention program are most likely obtained when the program is used as intended in its design. In addition, time investment and engagement in doing exercises seem as important as filling the minimum adherence criterion. CONCLUSIONS The results support the feasibility of ACT-based web intervention programs in promoting adolescent well-being, although more attention should be paid to motivating adolescents to commit to them and invest enough time in them.
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Affiliation(s)
- Tetta Hämäläinen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Kirsikka Kaipainen
- Faculty Information of Technology and Communication Sciences, Tampere University, Finland
| | - Katariina Keinonen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Päivi Lappalainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Anne Puolakanaho
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Raimo Lappalainen
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
| | - Noona Kiuru
- Department of Psychology, Faculty of Education and Psychology, University of Jyväskylä, Finland
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21
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Petersen JM, Davis CH, Renshaw TL, Levin ME, Twohig MP. School-Based Acceptance and Commitment Therapy for Adolescents With Anxiety: A Pilot Trial. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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22
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Assessing Psychological Inflexibility in Adolescents: A Validation Study of the Portuguese Short Version of the Avoidance and Fusion Questionnaire for Youth. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-022-09679-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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23
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Stallard P. Evidence-based practice in cognitive-behavioural therapy. Arch Dis Child 2022; 107:109-113. [PMID: 34266878 DOI: 10.1136/archdischild-2020-321249] [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: 03/17/2021] [Revised: 04/20/2021] [Accepted: 04/24/2021] [Indexed: 11/03/2022]
Abstract
Cognitive-behavioural therapy (CBT) is a practical, goal-focused approach that helps children understand the relationship between their thoughts, feelings and behaviours. The aim is to identify the dysfunctional and distorted cognitions associated with their psychological problems and to create more functional and balanced cognitive patterns that create less emotional distress and more helpful behaviours. CBT has strong evidence as an effective intervention for children and adolescents with emotional problems. The benefits for children with physical health and chronic conditions appear promising, although further research is required to substantiate these gains.
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Affiliation(s)
- Paul Stallard
- Department of Child and Adolescent Mental Health Services, University of Bath Faculty of Humanities and Social Sciences, Bath, Bath and North East Somer, UK
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24
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Lawrence PJ, Parkinson M, Jasper B, Creswell C, Halligan SL. Supporting the parents of children and young people with anxiety and depressive disorders is an opportunity not to be missed: a scoping review. Lancet Psychiatry 2021; 8:909-918. [PMID: 34537101 DOI: 10.1016/s2215-0366(20)30315-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 05/27/2020] [Accepted: 06/11/2020] [Indexed: 10/20/2022]
Abstract
Guidance is scarce on whether and how to involve parents in treatment for anxiety and depressive disorders in children and young people. We did a scoping review of randomised controlled trials of psychological interventions for anxiety and depressive disorders in children and young people, in which parents were involved in treatment, to identify how parents and carers have been involved in such treatments, how this relates to both child and broader outcomes, and where research should focus. We identified 73 trials: 62 focused on anxiety and 11 on depressive disorders. How parents were involved in treatments varied greatly, with at least 13 different combinations of ways of involving parents in the anxiety trials and seven different combinations in the depression trials. Including parents in treatment did not impair children's and young people's outcomes, but the wide variability in how they were involved prevents clarity about why some trials favoured parent involvement and others did not. Studies must consider the long-term and wider benefits beyond children's and young people's mental health, such as enhanced engagement, family wellbeing, and economic gains.
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Affiliation(s)
- Peter J Lawrence
- School of Psychology, University of Southampton, Southampton, UK
| | - Monika Parkinson
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Bec Jasper
- Parents and Carers Together, Suffolk, UK
| | - Cathy Creswell
- Departments of Experimental Psychology and Psychiatry, University of Oxford, Oxford, UK.
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK; Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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25
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Vergara Pacheco AM, Ballesteros de Valderrama BP. La Terapia de Aceptación y Compromiso (ACT) en tres víctimas del conflicto armado en Colombia. UNIVERSITAS PSYCHOLOGICA 2021. [DOI: 10.11144/javeriana.upsy19.tacv] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Los daños psicológicos ocasionados por el conflicto sociopolítico de hace más de 60 años en Colombia justifican la evaluación de intervenciones psicológicas que contribuyan a su disminución. El objetivo del trabajo fue evaluar el efecto de la Terapia de Aceptación y Compromiso (ACT) en los problemas identificados en víctimas de este conflicto armado. Se utilizó un diseño AB con seguimiento, con tres víctimas, dos hombres y una mujer, con edades entre 37 y 52 años. Se realizó un análisis funcional de cada caso para ajustar la intervención a las necesidades individuales, y se aplicaron el Cuestionario de Aceptación y Acción (AAQ II), el Índice de bienestar psicológico de Dupuy, listas de chequeo y autorregistros. Los resultados mostraron a la evitación experiencial como patrón de conducta en función de las condiciones contextuales relacionadas con la historia de aprendizaje y la experiencia del conflicto. En los tres participantes, la intervención ACT tuvo un efecto favorable. Varias de las respuestas de las víctimas fueron indicadores asociados al diagnóstico de trastorno de estrés postraumático (TEPT), y la evitación experiencial fue la estrategia psicológica para afrontarlos. Se recomienda evaluar ACT con poblaciones de niños y jóvenes afectados por el conflicto armado y evaluar formatos grupales.
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26
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Namdar P, Mojabi NA, Mojabi B. Neuropsychological and Psychosocial Consequences of the COVID-19 Pandemic. NEUROPHYSIOLOGY+ 2021; 52:446-455. [PMID: 34400849 PMCID: PMC8357964 DOI: 10.1007/s11062-021-09903-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Indexed: 12/28/2022]
Abstract
The coronavirus disease designated as COVID-19 reached the level of a pandemic, affecting countries all across the world. Widespread outbreaks of COVID-19 are associated with psychological distress and symptoms of mental disorders. This article is a narrative review of the existing scientific literature on mental health of the society and interventions relevant to the COVID-19 pandemic. A search in the existing databases using the respective keywords has been carried out. It focuses on the consequences of the pandemic with respect to people’s mental health in different clusters of society, including children, health care workers and their relatives, and pregnant women and their families. The unpredictability of the virus pandemic and its high transmission rate is an emergency of psychological problems and certain neuropsychological symptoms, such as fear and abnormal high anxiety, with respect to the spread of the disease, depression, avoidant behaviors, sleep disturbance, irritability, post-traumatic stress disorder (PTSD), pathological anger, and suicide cases.
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Affiliation(s)
- P Namdar
- Social Determinant of Health Research Center, Research Institute for Prevention of Noncommunicable Diseases, Qazvin University of Medical Science, Qazvin, Iran
| | - N A Mojabi
- Science Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - B Mojabi
- Idaho State University College of Pharmacy, Pocatello, Idaho USA
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27
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Parmar A, Esser K, Barreira L, Miller D, Morinis L, Chong YY, Smith W, Major N, Church P, Cohen E, Orkin J. Acceptance and Commitment Therapy for Children with Special Health Care Needs and Their Parents: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158205. [PMID: 34360497 PMCID: PMC8345967 DOI: 10.3390/ijerph18158205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/28/2021] [Accepted: 07/31/2021] [Indexed: 11/23/2022]
Abstract
Context: Acceptance and Commitment Therapy (ACT) is an emerging treatment for improving psychological well-being. Objective: To summarize research evaluating the effects of ACT on psychological well-being in children with special health care needs (SHCN) and their parents. Data Sources: An electronic literature search was conducted in PubMed, Web of Science, Ovid/EMBASE and PsycINFO (January 2000–April 2021). Study Selection: Included were studies that assessed ACT in children with SHCN (ages 0–17y) and/or parents of children with SHCN and had a comparator group. Data Extraction: Descriptive data were synthesized and presented in a tabular format, and data on relevant outcomes (e.g., depressive symptoms, stress, avoidance and fusion) were used in the meta-analyses to explore the effectiveness of ACT (administered independently with no other psychological therapy) compared to no treatment. Results: Ten studies were identified (child (7) and parent (3)). In children with SHCN, ACT was more effective than no treatment at helping depressive symptoms (standardized mean difference [SMD] = −4.27, 95% CI: −5.20, −3.34; p < 0.001) and avoidance and fusion (SMD = −1.64, 95% CI: −3.24, −0.03; p = 0.05), but not stress. In parents of children with SHCN, ACT may help psychological inflexibility (SMD = −0.77, 95% CI: −1.07, −0.47; p < 0.01). Limitations: There was considerable statistical heterogeneity in three of the six meta-analyses. Conclusions: There is some evidence that ACT may help with depressive symptoms in children with SHCN and psychological inflexibility in their parents. Research on the efficacy of ACT for a variety of children with SHCN and their parents is especially limited, and future research is needed.
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Affiliation(s)
- Arpita Parmar
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Kayla Esser
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
| | - Lesley Barreira
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Douglas Miller
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Leora Morinis
- Institute of Health, Policy, Management & Evaluation, Univeristy of California San Francisco, San Francisco, CA 94143, USA;
| | - Yuen-Yu Chong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong 999077, China;
| | - Wanda Smith
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON LS8 4L8, Canada; (D.M.); (W.S.)
| | - Nathalie Major
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON K1H 8L1, Canada;
| | - Paige Church
- Divison of Neonatology, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada;
| | - Eyal Cohen
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Institute of Health, Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M6, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P7, Canada
| | - Julia Orkin
- Department of Paediatrics, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada; (A.P.); (K.E.); (L.B.); (E.C.)
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, ON M5G 1X8, Canada
- Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, ON M5T 1P7, Canada
- Correspondence: ; Tel.: +416-813-7654
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Whiteside SPH, Sim LA, Morrow AS, Farah WH, Hilliker DR, Murad MH, Wang Z. A Meta-analysis to Guide the Enhancement of CBT for Childhood Anxiety: Exposure Over Anxiety Management. Clin Child Fam Psychol Rev 2021; 23:102-121. [PMID: 31628568 DOI: 10.1007/s10567-019-00303-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Cognitive behavior therapy (CBT) is the most empirically supported therapy for childhood anxiety disorders (CADs) but has not reliably outperformed other credible interventions. The current study used meta-analysis to examine the frequency with which the most common treatment components are included in outcome studies and the relation of these components to symptom improvement. Seventy-five studies were identified that included youth with an anxiety disorder treated with CBT or a comparison condition. The protocols for the 111 CBT conditions generally consisted of 12, 1-h sessions delivered to the child with minimal parent inclusion. A greater amount of in-session exposure was related to significantly larger effect sizes between CBT and waitlist control across reporters (- 0.12 to - 0.15; P's < .05) and from pre- to post-treatment for child report (- .06; P < .01). Compared to treatments that omitted relaxation, treatments that included relaxation strategies were associated with significantly smaller pre- to post-treatment effect sizes across reporters (0.38 to 0.80; P's < .05). The current study suggests that CBT protocols for CADs that emphasize in-session exposure and do not include relaxation have the potential to improve the efficacy and effectiveness of therapy. Dismantling studies directly testing these hypotheses are needed.
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Affiliation(s)
- Stephen P H Whiteside
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA.
| | - Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA
| | - Allison S Morrow
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Wigdan H Farah
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Daniel R Hilliker
- Department of Psychiatry and Psychology, Mayo Clinic, Mayo Bldg West 11, 200 First St., SW, Rochester, MN, 55905, USA
| | - M Hassan Murad
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Zhen Wang
- Robert D. and Patricia E. Kern Center for Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
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Byrne G, Ghráda ÁN, O'Mahony T, Brennan E. A systematic review of the use of acceptance and commitment therapy in supporting parents. Psychol Psychother 2021; 94 Suppl 2:378-407. [PMID: 32406169 DOI: 10.1111/papt.12282] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 04/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Acceptance and commitment therapy (ACT) has accrued a growing evidence-base for a wide variety of psychological difficulties. Given that ACT promotes broad and flexible repertoires of behaviour as well as neutralizing the ubiquitous psychological processes theorized to be responsible for much human suffering, such an approach may hold promise. The use of ACT-informed parenting interventions offers another alternative to solely behavioural approaches but it remains relatively understudied and in need of further exploration. DESIGN The current systematic review, which searched four databases, aimed to collate all ACT interventions that included parental therapeutic components in the treatment of various child presenting difficulties. The review also rated the methodological rigour of the ACT evidence-base for this type of treatment format. RESULTS Twenty-seven individual studies covering a broad spectrum of presenting problems were included, comprising of 1,155 participants. A large proportion of studies were within-group designs with a smaller number using randomized controlled trials. The majority of studies reported improvements on either parent report symptoms regarding child physical or psychological functioning as well as parent-reported measures of stress, depression, and anxiety. Similar improvements were noted on a number of ACT mechanisms of change outcomes, including mindfulness, acceptance, and cognitive fusing. These gains were evident for parents of children with neurodevelopmental disorders, chronic pain, and significant physical health difficulties. Maintenance or further treatment gains were often reported at follow-up. These positive findings are tempered by low levels of methodological rigour common in some of the studies included. CONCLUSIONS Despite these limitations, ACT holds promise as a transdiagnostic intervention that can help with the parenting of children with a range of psychological and physical difficulties. PRACTITIONER POINTS ACT has accrued a relatively strong evidence base for a range of psychological difficulties. Despite some methodological shortcomings, ACT shows promise as an intervention to help parents manage stress and difficulties especially in relation to children with autism, chronic pain, and physical health needs. Further research is required in comparing ACT to more established treatments and helping consolidate initial positive findings.
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Affiliation(s)
- Gary Byrne
- Health Service Executive, Dublin, Ireland
| | | | | | - Emma Brennan
- School of Psychology, Trinity College, Dublin, Ireland
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30
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The use of acceptance and commitment therapy (ACT) in addressing family accommodation (FA) for child anxiety. COGNITIVE BEHAVIOUR THERAPIST 2021. [DOI: 10.1017/s1754470x21000064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Abstract
Many parents of children with anxiety tend to engage in varying levels of family accommodation (FA) in order to alleviate anxiety symptoms. This can exacerbate anxiety symptoms and have adverse effects for psychological treatments. A small number of general and specific interventions have been developed for FA but treatment research is at a nascent stage. Acceptance and commitment therapy (ACT) may be an effective treatment for FA. This article reviews the potential advantages and uses of ACT and how ACT’s six core processes can help target particular features of FA. The theoretical support for ACT is reviewed relevant to FA. The article concludes by conjecturing how ACT may be a useful and adaptive treatment in targeting FA.
Key learning aims
(1)
To understand how FA impacts on child anxiety.
(2)
To help provide an overview of how ACT may be a relevant treatment in addressing FA.
(3)
To look at how each of the six core processes may address specific components of FA.
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31
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Chinese adolescents' mindfulness and internalizing symptoms: The mediating role of rumination and acceptance. J Affect Disord 2021; 280:97-104. [PMID: 33207286 DOI: 10.1016/j.jad.2020.11.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/22/2020] [Accepted: 11/07/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND Internalizing problems during adolescence are common psychiatric symptoms. Previous research has demonstrated that mindfulness was significantly and negatively associated with and mindfulness-based interventions would be efficacious for aiming at adolescents' internalizing problems. However, research about how mindfulness could improve internalizing symptoms among Chinese adolescents is sparse and its potential mechanism is still unclear. The present study adopted rumination and acceptance to examine their mediation effects between Chinese adolescents' mindfulness and internalizing symptoms. METHODS A final sample of 1,554 adolescents (aged from 10 to 18 years old, M = 15.58, SD =1.25) were recruited from schools in South China. Participants were asked to complete a package of questionnaires measuring mindfulness, internalizing problems (indicated by generalized anxiety and depression), rumination, and acceptance. RESULTS Structural equation model confirmed our hypothesis and showed that rumination, as well as acceptance, significantly mediated the relationship between Chinese adolescents' mindfulness level and internalizing symptoms (generalized anxiety and depression). LIMITATIONS a) only cross-sectional design was employed in the study; b) most of participants were normal adolescent students, without a diagnosis of any psychiatric disorder; c) all the measures were self-reported by adolescents. CONCLUSIONS Mindfulness not only directly impacted on adolescents' internalizing problems, but also indirectly improved their anxious and depression emotions via the reduction of rumination and the increase of acceptance. Hence, mindfulness training as well as the application of emotion regulation skills may be useful for adolescents exposed to the likelihood of suffering from internalizing problems.
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32
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Harris E, Samuel V. Acceptance and Commitment Therapy: A Systematic Literature Review of Prevention and Intervention Programs for Mental Health Difficulties in Children and Young People. J Cogn Psychother 2020; 34:280-305. [PMID: 33372124 DOI: 10.1891/jcpsy-d-20-00001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Acceptance and commitment therapy (ACT) is increasingly being used to treat mental health difficulties, however there is a paucity of reviews concerning ACT with children. AIM To examine the literature about ACT interventions for child and adolescent mental well-being. METHODS Searches for articles reporting on ACT interventions to prevent/reduce child mental health difficulties were undertaken. Methodological quality was assessed and a narrative synthesis was used to summarize findings about mental health symptoms and psychological flexibility. RESULTS Ten articles were identified focusing on prevention and intervention for anxiety, depression, obsessive compulsive disorder, anorexia nervosa, and trichotillomania. Most studies found that mental health symptoms reduced following an ACT intervention and psychological flexibility increased. However, findings indicate that other active interventions also led to the same changes. CONCLUSIONS ACT is a promising intervention for adolescent mental health, although further research is needed to establish whether reductions in mental health symptoms are due to an increase in psychological flexibility.
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Affiliation(s)
- Emma Harris
- School of Psychology, Cardiff University, Cardiff, UK
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James AC, Reardon T, Soler A, James G, Creswell C. Cognitive behavioural therapy for anxiety disorders in children and adolescents. Cochrane Database Syst Rev 2020; 11:CD013162. [PMID: 33196111 PMCID: PMC8092480 DOI: 10.1002/14651858.cd013162.pub2] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Previous Cochrane Reviews have shown that cognitive behavioural therapy (CBT) is effective in treating childhood anxiety disorders. However, questions remain regarding the following: up-to-date evidence of the relative efficacy and acceptability of CBT compared to waiting lists/no treatment, treatment as usual, attention controls, and alternative treatments; benefits across a range of outcomes; longer-term effects; outcomes for different delivery formats; and amongst children with autism spectrum disorders (ASD) and children with intellectual impairments. OBJECTIVES To examine the effect of CBT for childhood anxiety disorders, in comparison with waitlist/no treatment, treatment as usual (TAU), attention control, alternative treatment, and medication. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (all years to 2016), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO (each to October 2019), international trial registries, and conducted grey literature searches. SELECTION CRITERIA We included randomised controlled trials of CBT that involved direct contact with the child, parent, or both, and included non-CBT comparators (waitlist/no treatment, treatment as usual, attention control, alternative treatment, medication). Participants were younger than age 19, and met diagnostic criteria for an anxiety disorder diagnosis. Primary outcomes were remission of primary anxiety diagnosis post-treatment, and acceptability (number of participants lost to post-treatment assessment), and secondary outcomes included remission of all anxiety diagnoses, reduction in anxiety symptoms, reduction in depressive symptoms, improvement in global functioning, adverse effects, and longer-term effects. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as recommended by Cochrane. We used GRADE to assess the quality of the evidence. MAIN RESULTS We included 87 studies and 5964 participants in quantitative analyses. Compared with waitlist/no treatment, CBT probably increases post-treatment remission of primary anxiety diagnoses (CBT: 49.4%, waitlist/no treatment: 17.8%; OR 5.45, 95% confidence interval (CI) 3.90 to 7.60; n = 2697, 39 studies, moderate quality); NNTB 3 (95% CI 2.25 to 3.57) and all anxiety diagnoses (OR 4.43, 95% CI 2.89 to 6.78; n = 2075, 28 studies, moderate quality). Low-quality evidence did not show a difference between CBT and TAU in post-treatment primary anxiety disorder remission (OR 3.19, 95% CI 0.90 to 11.29; n = 487, 8 studies), but did suggest CBT may increase remission from all anxiety disorders compared to TAU (OR 2.74, 95% CI 1.16 to 6.46; n = 203, 5 studies). Compared with attention control, CBT may increase post-treatment remission of primary anxiety disorders (OR 2.28, 95% CI 1.33 to 3.89; n = 822, 10 studies, low quality) and all anxiety disorders (OR 2.75, 95% CI 1.22 to 6.17; n = 378, 5 studies, low quality). There was insufficient available data to compare CBT to alternative treatments on post-treatment remission of primary anxiety disorders, and low-quality evidence showed there may be little to no difference between these groups on post-treatment remission of all anxiety disorders (OR 0.89, 95% CI 0.35 to 2.23; n = 401, 4 studies) Low-quality evidence did not show a difference for acceptability between CBT and waitlist/no treatment (OR 1.09, 95% CI 0.85 to 1.41; n=3158, 45 studies), treatment as usual (OR 1.37, 95% CI 0.73 to 2.56; n = 441, 8 studies), attention control (OR 1.00, 95% CI 0.68 to 1.49; n = 797, 12 studies) and alternative treatment (OR 1.58, 95% CI 0.61 to 4.13; n=515, 7 studies). No adverse effects were reported across all studies; however, in the small number of studies where any reference was made to adverse effects, it was not clear that these were systematically monitored. Results from the anxiety symptom outcomes, broader outcomes, longer-term outcomes and subgroup analyses are provided in the text. We did not find evidence of consistent differences in outcomes according to delivery formats (e.g. individual versus group; amount of therapist contact time) or amongst samples with and without ASD, and no studies included samples of children with intellectual impairments. AUTHORS' CONCLUSIONS CBT is probably more effective in the short-term than waiting lists/no treatment, and may be more effective than attention control. We found little to no evidence across outcomes that CBT is superior to usual care or alternative treatments, but our confidence in these findings are limited due to concerns about the amount and quality of available evidence, and we still know little about how best to efficiently improve outcomes.
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Affiliation(s)
- Anthony C James
- Department of Psychiatry, University of Oxford, Oxford, UK
- Highfield Unit, Warneford Hospital, Oxford, UK
| | - Tessa Reardon
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
| | | | | | - Cathy Creswell
- Department of Psychiatry, University of Oxford, Oxford, UK
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- School of Psychology & Clinical Language Sciences, University of Reading, Reading, UK
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Creswell C, Waite P, Hudson J. Practitioner Review: Anxiety disorders in children and young people - assessment and treatment. J Child Psychol Psychiatry 2020; 61:628-643. [PMID: 31960440 DOI: 10.1111/jcpp.13186] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 11/18/2019] [Accepted: 12/02/2019] [Indexed: 01/04/2023]
Abstract
Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families.
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Affiliation(s)
- Cathy Creswell
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK
| | - Polly Waite
- Department of Experimental Psychology, University of Oxford, Oxford, UK.,Department of Psychiatry, University of Oxford, Oxford, UK.,School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Jennie Hudson
- Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
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Sigurvinsdóttir AL, Jensínudóttir KB, Baldvinsdóttir KD, Smárason O, Skarphedinsson G. Effectiveness of cognitive behavioral therapy (CBT) for child and adolescent anxiety disorders across different CBT modalities and comparisons: a systematic review and meta-analysis. Nord J Psychiatry 2020; 74:168-180. [PMID: 31738631 DOI: 10.1080/08039488.2019.1686653] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aim: Pediatric Anxiety Disorders (AD) are common. Cognitive behavioral therapy (CBT) is one of two first-line treatments of youth AD and it has previously been shown to be superior to wait-list but not placebo therapy. This study consists of a systematic review and meta-analysis of the literature to assess the efficacy of CBT modalities in comparison to control contingencies for pediatric anxiety disorders.Methods: Studies were included if they were randomized controlled trials, and if CBT was manualized or modular, alone or in combination with medication. CBT was required to include behavioral treatment, exposure treatment, or cognitive elements. Eligible studies included participants aged 18 years or younger.Results: Eighty-one studies were included, with 3386 CBT participants and 2527 control participants. The overall results indicated that CBT is an effective treatment for childhood AD. The results showed that individual-based CBT is superior to wait-list and attention control. Group-based CBT is superior to wait-list control and treatment as usual. Remote-based CBT was superior to attention control and wait-list control. Family-based CBT was superior to treatment as usual, wait-list control, and attention control. Selective serotonin reuptake inhibitors were no more effective than individual-based CBT. Combination treatment was, however, more effective than individual-based CBT.Conclusion: To the best of our knowledge, no meta-analysis has thus far disentangled the effects of CBT modalities across various comparisons. This meta-analysis hence provides an important update to the literature on the efficacy of CBT for treating anxiety disorders in young people.
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Affiliation(s)
| | | | | | - Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland.,Landspitali - the National University Hospital of Iceland, Reykjavik, Iceland
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Fang S, Ding D. The efficacy of group-based acceptance and commitment therapy on psychological capital and school engagement: A pilot study among Chinese adolescents. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Takahashi F, Ishizu K, Matsubara K, Ohtsuki T, Shimoda Y. Acceptance and commitment therapy as a school-based group intervention for adolescents: An open-label trial. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Coto-Lesmes R, Fernández-Rodríguez C, González-Fernández S. Acceptance and Commitment Therapy in group format for anxiety and depression. A systematic review. J Affect Disord 2020; 263:107-120. [PMID: 31818766 DOI: 10.1016/j.jad.2019.11.154] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/30/2019] [Accepted: 11/30/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUND Emotional disorders, such as anxiety and depression, are one of the main causes of disability worldwide. Recent reviews suggest that Acceptance and Commitment Therapy is effective in treating emotional disorders. However, they appraise mainly individual approaches. This review aimed to analyze published studies regarding the usefulness of Acceptance and Commitment Therapy, applied on a group basis, in the treatment of anxiety and depression. METHODS A systematic review of the literature was conducted using the Web of Science, from 2008 to 2019. Fifteen articles fulfilled the inclusion criteria. RESULTS Those patients who received interventions based on Acceptance and Commitment Therapy showed a better emotional state and greater psychological flexibility than patients in control groups without treatment. No differences are found with Cognitive Therapy and Cognitive-Behavioral Therapy. LIMITATIONS the studies reviewed show limitations, principally regarding sample characteristics, study design and manner in which mechanisms responsible for changes are evaluated. CONCLUSION Group-based Acceptance and Commitment Therapy proved to be useful in the psychological treatment of emotional disorders. However, the heterogeneity and limitations of the studies, make it impossible to determine the exact therapeutic elements, and if they are specific to the approach and procedure of this therapy. More research would be necessary to ascertain what patient and/or intervention characteristics might improve results and what the active and specific ingredients of the therapy are. This has clinical relevance because group-based interventions could be more cost-efficient, and it would help facilitate health-care decisions aimed at giving the public access to useful treatments.
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Affiliation(s)
- Rocío Coto-Lesmes
- Department of Psychology, University of Oviedo, Plaza Feijoo, Oviedo, 33003 Asturias, Spain.
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Fang S, Ding D. A meta-analysis of the efficacy of acceptance and commitment therapy for children. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2020. [DOI: 10.1016/j.jcbs.2020.01.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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The Phenomenon of Treatment Dropout, Reasons and Moderators in Acceptance and Commitment Therapy and Other Active Treatments: A Meta-Analytic Review. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i3.33058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Treatment dropout is one of the most crucial issues that a therapist has to face on a daily basis. The negative effects of premature termination impact the client who is usually found to demonstrate poorer treatment outcomes. This meta-analysis reviewed and systematically examined dropout effects of Acceptance and Commitment Therapy (ACT) as compared to other active treatments. The goals of this study were to compare treatment dropout rates and dropout reasons, examine the influence of demographic variables and identify possible therapy moderators associated with dropout.
The current meta-analysis reviewed 76 studies of ACT reporting dropout rates for various psychological and health-related conditions.
Across reviewed studies (N = 76), the overall weighted mean dropout rate was 17.95% (ACT = 17.35% vs. comparison conditions = 18.62%). Type of disorder, recruitment setting and therapists’ experience level were significant moderators of dropout. The most frequently reported reasons for dropout from ACT were lost contact, personal and transportation difficulties, whereas for comparative treatments they were lost contact, therapy factors and time demands.
Given that most moderators of influence are not amenable to direct changes by clinicians, mediation variables should also be explored. Overall, results suggest that ACT appears to present some benefits in dropout rates for specific disorders, settings and therapists.
There was no difference in dropout rate between ACT and control conditions (17.35% vs.18.62%). Significant moderators were client disorder, therapists’ experience level and recruitment and setting.
Comparison condition frequently reported therapy related dropout factors, suggesting that ACT may be a more acceptable option.
There was no difference in dropout rate between ACT and control conditions (17.35% vs.18.62%). Significant moderators were client disorder, therapists’ experience level and recruitment and setting.
Comparison condition frequently reported therapy related dropout factors, suggesting that ACT may be a more acceptable option.
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Mechanisms of the Acceptance and Commitment Therapy: A meta-analytic structural equation model. ACTA PSYCHOLOGICA SINICA 2019. [DOI: 10.3724/sp.j.1041.2019.00662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Enoch MR, Dixon MR. Neuro-Typical Children Outcomes from an Acceptance and Commitment Therapy Summer Camp. Behav Anal Pract 2018; 12:343-352. [PMID: 31976240 DOI: 10.1007/s40617-018-00319-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The current article discusses the practical implications of using acceptance and commitment therapy (ACT) in a community camp setting with children. Previous research demonstrates that ACT curricula for children paired with formal mindfulness- and acceptance-based activities show promise as an intervention for children. ACT may also be an effective intervention with children due to its approachable, acceptable, and easily implemented format of delivery. The current study used a neurotypical sample, and outcomes support the potential for increasing psychological flexibility and mindful awareness between an experimental group and a control group. Scores on the Avoidance and Fusion Questionnaire for Youth (AFQ-Y) and the Child Acceptance and Mindfulness Measure (CAMM) self-report questionnaires were obtained during pre- and postintervention. The results of the AFQ-Y suggest that there was a significant difference between the experimental group (M = 17.13, SD = 2.64) and the control group (M = 27.4, SD = 2.64) at posttest, F(1, 28) = 7.53, p = .01, η p 2 = .212. Similarly, the results of the CAMM suggest that there was a significant difference between the experimental group (M = 29.66, SD = 1.99) and the control group (M = 21.26, SD = 1.99) at posttest, F(1, 28) = 8.89, p = .006, η p 2 = .241. These results indicate that the members of the experimental group, compared to the control group, had significant increases in their overall mindful awareness and psychological flexibility after completing the Mindfulness Camp.
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Affiliation(s)
- Mary Rachel Enoch
- 1Applied Psychology Department, Antioch University New England, 40 Avon Street, Keene, NH 03431 USA
| | - Mark R Dixon
- 2Rehabilitation Institute, Southern Illinois University, 1025 Lincoln Drive, Carbondale, IL 62901 USA
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Abstract
PURPOSE OF REVIEW We review recent research validating cognitive behavioral therapy (CBT) as a first-line intervention for childhood anxiety disorders. We also review recent research aimed at enhancing exposure-based CBT components and adapting CBT to work with specific populations. RECENT FINDINGS Exposure-based CBT is a well-established intervention. Different research groups have found positive evidence to augment CBT by evaluating inhibitory learning principles, the role of parents in child treatment, an individualized case formulation, computer and online forms of CBT, and virtual and augmented reality systems for exposure practice. Specific programs have been developed to meet specific needs of preschoolers, adolescents, and children with comorbid autism spectrum disorder and anxiety. Successful adaptations to CBT exist and the field should continue to improve the generalizability, feasibility, and expected benefit of CBT to improve its effectiveness.
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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: 5.7] [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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Abstract
Acceptance and commitment therapy (ACT) is a modern form of cognitive behavioral therapy based on a distinct philosophy and basic science of cognition. This article reviews the core features of ACT's theoretic model of psychopathology and treatment and its therapeutic approach. It provides a systematic review of randomized controlled trials (RCTs) evaluating ACT for depression and anxiety disorders. Summarizing 36 RCTs, ACT appears to be more efficacious than waitlist conditions and treatment-as-usual, with largely equivalent effects relative to traditional cognitive behavioral therapy. Evidence indicates that ACT treatment outcomes are mediated through increases in psychological flexibility, its theorized process of change.
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Mansell W, McEvoy PM. A test of the core process account of psychopathology in a heterogenous clinical sample of anxiety and depression: A case of the blind men and the elephant? J Anxiety Disord 2017; 46:4-10. [PMID: 27400661 DOI: 10.1016/j.janxdis.2016.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 05/11/2016] [Accepted: 06/23/2016] [Indexed: 11/26/2022]
Abstract
Many cognitive and behavioral processes, such as selective attention to threat, self-focused attention, safety-seeking behaviors, worry and thought suppression, have their foundations in research on anxiety disorders. Yet, they are now known to be transdiagnostic, i.e. shared across a wide range of psychological disorders. A more pertinent clinical and theoretical question is whether these processes are themselves distinct, or whether they reflect a shared 'core' process that maintains psychopathology. The current study utilized a treatment-seeking clinical adult sample of 313 individuals with a range of anxiety disorders and/or depression who had completed self-report measures of widely ranging processes: affect control, rumination, worry, escape/avoidance, and safety-seeking behaviors. We found that only the first factor extracted from a principal components analysis of the items of these measures was associated with symptoms of anxiety and depression. Our findings supported the 'core process' account that had its origins in the field of anxiety disorders, and we discuss the implications for theory, clinical practice and future research across psychological disorders.
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Affiliation(s)
- Warren Mansell
- School of Psychological Sciences, University of Manchester, 2nd Floor, Zochonis Building, Brunswick Street, Manchester, M13 9PL, UK.
| | - Peter M McEvoy
- School of Psychology and Speech Pathology, Curtin University, Perth, Australia; Centre for Clinical Interventions, Perth, Australia
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Changing problematic parent–child interaction in child anxiety disorders: The promise of Acceptance and Commitment Therapy (ACT). JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2016. [DOI: 10.1016/j.jcbs.2015.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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