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Xian J, Zhang Y, Jiang B. Psychological interventions for social anxiety disorder in children and adolescents: A systematic review and network meta-analysis. J Affect Disord 2024; 365:614-627. [PMID: 39173929 DOI: 10.1016/j.jad.2024.08.097] [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: 11/29/2023] [Revised: 08/16/2024] [Accepted: 08/17/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Social anxiety disorder (SAD) is a high-prevalence mental disorder among children and adolescents. The aim of this study is to compare and rank the effectiveness of several psychotherapies for SAD among children and adolescents. METHODS Only randomized controlled trials (RCTs) were utilized by searching PubMed, Embase, Cochrane Library, and Web of Science. We used network meta-analysis in the Bayesian framework to analyze the data. This study is registered with PROSPERO, number CRD42023476829. RESULTS In total, 30 RCTs with 1547 individuals were included, and nine psychotherapies with three control conditions were compared and ranked in this study. The findings revealed that internet-delivered cognitive behavioural therapy (surface under the cumulative ranking curve [SUCRA: 71.2 %]), group cognitive behavioural therapy (SUCRA: 68.4 %), and individual cognitive behavioural therapy (SUCRA: 66.0 %) significantly reduced social anxiety symptoms; internet-delivered cognitive behavioural therapy also significantly decreased depression symptoms in these patients (SUCRA: 92.2 %). In addition, group cognitive behavioural therapy can enhance functioning in these patients (SUCRA: 89.6 %). CONCLUSION These results suggest that internet-delivered cognitive behavioural therapy is the optimal type of psychotherapy for reducing social anxiety and depression symptoms in children and adolescents with SAD, internet-delivered parent-child interaction therapy and cognitive bias modification of interpretation have relatively poor treatment effects on social anxiety symptoms in children than other psychological interventions, and group cognitive behavioural therapy has better benefits in enhancing the functioning among children and adolescents with SAD. Further studies are needed to ascertain these results due to the limited number of included studies.
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Affiliation(s)
- Jinhua Xian
- School of Education Science, Jiangsu Second Normal University, Nanjing, China
| | - Yan Zhang
- School of Education Science, Jiangsu Second Normal University, Nanjing, China
| | - Bo Jiang
- School of Education Science, Jiangsu Second Normal University, Nanjing, China.
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2
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Farley R, de Diaz NAN, Emerson LM, Simcock G, Donovan C, Farrell LJ. Mindful Parenting Group Intervention for Parents of Children with Anxiety Disorders. Child Psychiatry Hum Dev 2024; 55:1342-1353. [PMID: 36689038 PMCID: PMC9869845 DOI: 10.1007/s10578-023-01492-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/24/2023]
Abstract
Parenting behaviour and rearing style contribute to the intergenerational relationship between parental and child anxiety. Current psychological interventions for child anxiety typically do not adequately address parental mental health, parenting behaviours or the parent-child relationship. The current pilot study examines the effectiveness of a mindful parenting intervention (MPI) for parents of young children with clinical anxiety. It was hypothesised that the intervention would be associated with improvements in parental stress, mental health, and mindfulness, and a reduction in child clinical anxiety symptoms. Twenty-one parents of children aged 3-7 years diagnosed with anxiety disorders participated in an 8-week group MPI program that aimed to increase their intentional moment to moment awareness of the parent-child relationship. Parental (anxiety, depression, hostility, stress, burden, mindfulness, mindful parenting) and child (anxiety diagnoses, anxiety severity, comorbidities) outcomes were assessed at pre- and post-intervention, and at 3-month follow-up. Parents reported a significant increase in mindful parenting and a significant reduction in parent-child dysfunctional interaction, but no change in mental health symptoms. There was a significant reduction in parent-rated child anxiety symptoms, severity of child anxiety diagnosis and number of comorbid diagnoses at post and 3-month follow-up. Limitations include a lack of waitlist control, small sample size, and participants were largely mothers, from intact families and highly educated. There was attrition of 43% and outcomes were predominantly self-report. MPIs offer a novel and potentially effective method of increasing mindful parenting, decreasing dysfunctional parent-child interactions, reducing parenting stress and might also be an effective early intervention for indirectly decreasing young children's clinical anxiety symptoms. Larger-scale controlled trials of MPIs are needed.
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Affiliation(s)
- Robyn Farley
- Griffith University, Gold Coast, Australia.
- School of Applied Psychology, Health Building (G40), Parklands Drive, Southport, QLD, 4222, Australia.
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Takahashi T, Ishikawa SI, Aiboshi T, Miyauchi M. Evaluating the long-term effects of cognitive behavioural therapy as an early intervention for at-risk anxiety disorders among preschool children in Asia. Clin Child Psychol Psychiatry 2024; 29:994-1010. [PMID: 37578134 DOI: 10.1177/13591045231194104] [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] [Indexed: 08/15/2023]
Abstract
There are few evaluations of early intervention for the prevention of anxiety disorders in East Asia, and those that exist generally evaluate outcomes to a maximum of 6-12 months. The current study evaluated the long-term effect (5 years) of an anxiety prevention program presented to preschool children and their parents in Japan. Participants for the study were 10 inhibited children 5-6 years old and their parents. The parent's and children's program comprised group sessions of a cognitive-behavioural program. Parents and teachers completed the anxious/depressed, withdrawn and behavioural inhibition at pre-post-intervention and 3-month follow-up. Five years after starting the intervention, participants were invited to a diagnostic interview, Anxiety Disorders Interview Schedule (ADIS) to examine a long-term preventive effect of the intervention. The majority of children showed a reduction in anxious/depressed, behavioral inhibition, and approximately half showed reliable change according to parents' and teachers' reports. Moreover, the results indicated that 9 of the 10 children did not met the diagnostic criteria for anxiety disorders. These results suggested that the early intervention had preventive effects because the diagnostic criteria for anxiety disorders were not met in the follow-up assessment conducted five years later.
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Affiliation(s)
| | | | | | - Mai Miyauchi
- Hanagashima Clinic, Social Welfare Corporation Canvasnokai, Miyazaki, Japan
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Zhang B, Wang J, Abdullah AB. The effects of art therapy interventions on anxiety in children and adolescents: A meta-analysis. Clinics (Sao Paulo) 2024; 79:100404. [PMID: 38936289 PMCID: PMC11260852 DOI: 10.1016/j.clinsp.2024.100404] [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: 02/08/2024] [Accepted: 05/18/2024] [Indexed: 06/29/2024] Open
Abstract
OBJECTIVE This study aimed to assess the effects of art therapy on anxiety among children and adolescents. METHODS We searched several databases, including PubMed, Web of Science, Embase (via Ovid), PsychINFO (through EBSCO), and The Cochrane Library, comprising the Cochrane Database of Systematic Reviews and the Cochrane Central Register of Controlled Trials. Additionally, Chinese databases such as CNKI (China National Knowledge Infrastructure) and Wan Fang Data were explored from their beginnings until October 22, 2023. Studies that investigated the impact of art therapy on anxiety compared to a control group were included. The methodological quality of these randomized controlled trials was evaluated using the Cochrane Handbook's risk of bias instrument. RESULTS Six studies involving 422 participants were included. The findings indicated a notable decrease in anxiety symptoms due to art therapy, with a Standardized Mean Difference (SMD) of -1.42, 95% Confidence Interval (95%CI -2.33, -0.51), p < 0.002. Notably, there was pronounced heterogeneity, as evidenced by Tau2 = 1.41, Chi2 = 101.19, df = 6, and I² = 94%, with Z = 3.06. CONCLUSION Art therapy significantly improved the anxiety symptoms of children and adolescents, positioning it as an effective means of treating anxiety.
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Affiliation(s)
- Bo Zhang
- Guizhou Equipment Manufacturing Polytechnic, Guizhou, China; Universiti Utara Malaysia, Malaysia.
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Lee SJ, Jeong EJ, Choi JI, Park MS. Social intelligence and pathological gaming: a longitudinal study of the associations among negative emotions, social intelligence, aggression, and pathological gaming in adolescents. Front Psychiatry 2024; 15:1353969. [PMID: 38903650 PMCID: PMC11187769 DOI: 10.3389/fpsyt.2024.1353969] [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: 12/12/2023] [Accepted: 05/13/2024] [Indexed: 06/22/2024] Open
Abstract
Introduction Pathological gaming continues to be highlighted as one of the most critical issues concerning adolescents. Numerous studies have aimed to elucidate the relationships between adolescents' negative emotions (e.g., peer stress, anxiety, loneliness) and social factors (e.g., social skills and relationships) with pathological gaming. Despite the recognition of social intelligence as a crucial factor related to social factors in adolescents, there is a paucity of research examining pathological gaming and social intelligence through longitudinal analyses. Method This study focuses on exploring the factors that induce or inhibit pathological gaming among adolescents by analysing three-year longitudinal data from Korean adolescent gamers (N=968). Using a structural equation model, the study examines the relationships between adolescents' negative emotions (e.g., peer stress, anxiety, loneliness), social intelligence, and pathological gaming to elucidate their associations. Results The results indicate that negative emotions can potentially reduce levels of social intelligence and increase aggression. Increased aggression, in turn, appears to be associated with higher levels of pathological gaming. Social intelligence was found to impact pathological gaming potentially negatively and may exert a significantly stronger influence on aggression compared to negative emotions. Discussion The study's findings suggest that bolstering adolescents' social aptitude and addressing mental health concerns could serve as beneficial interventions in tackling issues associated with excessive media engagement among youth. These findings suggest that, within the context of adolescent pathological gaming, social intelligence could significantly affect aggression and emerge as a key variable that may lead to pathological gaming.
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Affiliation(s)
- Sung Je Lee
- Department of Digital Culture and Contents, Konkuk University, Seoul, Republic of Korea
| | - Eui Jun Jeong
- Department of Digital Culture and Contents, Konkuk University, Seoul, Republic of Korea
| | - Jae In Choi
- Department of Digital Culture and Contents, Konkuk University, Seoul, Republic of Korea
| | - Man Su Park
- Department of Media and Communication, Hanyang University, Seoul, Republic of Korea
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6
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Zerrouk M, Ravigopal T, Bell MA. Assessing anxiety problems in a community sample during toddlerhood: The impact of child temperament and maternal intrusiveness. Infant Behav Dev 2024; 75:101932. [PMID: 38492253 PMCID: PMC11162957 DOI: 10.1016/j.infbeh.2024.101932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 01/22/2024] [Accepted: 02/25/2024] [Indexed: 03/18/2024]
Abstract
Previous research indicates that child temperament and maternal behaviors are related to internalizing behaviors in children. We assessed whether maternal intrusiveness (MI) observed at 10-months would moderate the impact of temperamental fear and the impact of inhibitory control (IC) at 24 months on anxiety problems at 36 months. A mother-child interaction task was coded for MI. Behavioral tasks were given to assess children's IC. Parents completed questionnaires about their children's temperamental fear and anxiety problems. Results showed that greater temperamental fear reported at 24 months predicted greater anxiety problems reported at 36 months, regardless of MI levels. Lower levels of IC at 24 months predicted more anxiety problems reported at 36 months when children experienced greater MI. These findings illustrate the importance of examining both intrinsic and extrinsic factors, independently and interactively, that contribute to children's anxiety problems in toddlerhood.
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Klein AM, Hagen A, Mobach L, Zimmermann R, Baartmans JMD, Rahemenia J, de Gier E, Schneider S, Ollendick TH. The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology. Clin Child Fam Psychol Rev 2024; 27:602-625. [PMID: 38616213 PMCID: PMC11222243 DOI: 10.1007/s10567-024-00476-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043-1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303-311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138-144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616-629, 2013; Kendall et al. Cogn Behav Pract 12:136-148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34-43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.
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Affiliation(s)
- Anke M Klein
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands.
| | - Annelieke Hagen
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | - Lynn Mobach
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Pro Persona Institute for Integrated Mental Health Care, Wolfheze, The Netherlands
| | - Robin Zimmermann
- Mental Health Research and Treatment Center (FBZ), Ruhr University, Bochum, Germany
| | | | - Jasmin Rahemenia
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | | | - Silvia Schneider
- Mental Health Research and Treatment Center (FBZ), Ruhr University, Bochum, Germany
| | - Thomas H Ollendick
- Department of Psychology, Child Study Center, Virginia Tech, Blacksburg, USA
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Dumont É, Parent S, Castellanos-Ryan N, Jacques S, Freeston MH, Zelazo PD, Séguin JR. The Role of Executive Function at 6 Years in the Association between Behavioral Inhibition at 5 Years and Anxiety at 7 Years. Res Child Adolesc Psychopathol 2024; 52:919-931. [PMID: 38329683 DOI: 10.1007/s10802-024-01175-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/09/2024]
Abstract
EF skills play a central role in the etiology and maintenance of anxiety, but it is unclear whether they act as moderators or mediators in the relation between early behavioral inhibition (BI) and later anxiety. The current study tested two models by examining whether two executive functions (EF) skills (cognitive flexibility and working memory) assessed at age 6 acted as moderators or mediators in the relation between BI at 5 years and anxiety symptoms at 7 years. The sample consisted of 422 children from the Quebec Longitudinal Study of Child Development. We tested the moderation model, main and interaction effects using hierarchical multiple regression analyses and the mediation model with the product of coefficients test. Results showed that higher BI at 5 years predicted high anxiety at 7 years only at low levels of cognitive flexibility or working memory at 6 years. This suggests that high levels of cognitive flexibility or working memory at 6 years may act as protective factors. In contrast, neither cognitive flexibility nor working memory at age 6 acted as mediators in the association between BI at 5 years and anxiety at 7 years. Results support the hypothesis that goal-driven cognitive control processes act as moderators and promote adaptive functioning by dampening the effect of early BI on later anxiety.
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Affiliation(s)
- Émilie Dumont
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
- CHU Ste-Justine Research Center, Bureau B17.107; 3175 chemin Côte Ste-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Sophie Parent
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
- CHU Ste-Justine Research Center, Bureau B17.107; 3175 chemin Côte Ste-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Natalie Castellanos-Ryan
- School of Psychoeducation, Université de Montréal, Montréal, Québec, Canada
- CHU Ste-Justine Research Center, Bureau B17.107; 3175 chemin Côte Ste-Catherine, Montréal, Québec, H3T 1C5, Canada
| | - Sophie Jacques
- Department of Psychology and Neuroscience, Dalhousie University, Nova Scotia, Canada
| | - Mark H Freeston
- School of Psychology and Affiliated to the Institute of Neuroscience, Newcastle University, Newcastle, UK
| | - Philip David Zelazo
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - Jean R Séguin
- CHU Ste-Justine Research Center, Bureau B17.107; 3175 chemin Côte Ste-Catherine, Montréal, Québec, H3T 1C5, Canada.
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Québec, Canada.
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9
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Kong Q, Han B. Pharmacotherapy and cognitive bias modification for the treatment of anxiety disorders. Expert Rev Neurother 2024; 24:517-525. [PMID: 38557434 DOI: 10.1080/14737175.2024.2334847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 03/21/2024] [Indexed: 04/04/2024]
Abstract
INTRODUCTION Anxiety disorders are characterized by widespread and persistent anxiety or recurrent panic attacks. As a result of their high prevalence, chronicity, and comorbidity, patients' quality of life and functioning are severely compromised. However, several patients do not receive treatment. AREAS COVERED This review discusses the effectiveness, safety, and limitations of major medications and cognitive bias modification (CBM) for treating anxiety disorders. The possibility of combined treatment is also discussed in the literature. Furthermore, drawing on Chinese cultural perspectives, the authors suggest that anxiety can be recognized, measured, and coped with at three levels of skill (), vision (), and Tao (). EXPERT OPINION The combination of pharmacotherapy and CBM is possibly more effective in treating anxiety disorders than either treatment alone. However, clinicians and patients should participate in the joint decision-making process and consider comprehensive factors. Moderate anxiety has adaptive significance. In the coming years, by combining the downward analytical system of western culture with the upward integrative system of Chinese culture, a comprehensive understanding of anxiety and anxiety disorders should be established, rather than focusing only on their treatment.
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Affiliation(s)
- Qingyan Kong
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Buxin Han
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
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10
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Baartmans JMD, van Steensel BFJA, Kossakowski JJ, Klein AM, Bögels SM. Intergenerational relations in childhood anxiety: A network approach. Scand J Psychol 2024; 65:346-358. [PMID: 37966048 DOI: 10.1111/sjop.12983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 10/18/2023] [Accepted: 10/29/2023] [Indexed: 11/16/2023]
Abstract
OBJECTIVE Family factors are assumed to play a central role in the development of childhood anxiety disorders. How child and parental anxiety symptoms are intertwined on a symptom and family level has not yet been examined. Such knowledge may lead to a more detailed understanding of the intergenerational relation in anxiety problems. The current study investigated the relation between anxiety in children and their parents at a symptom level using a network approach. METHOD Parents of 1,452 clinically referred children in the Netherlands completed questionnaires on anxiety about their children and themselves. We examined relations on a symptom level both within persons and between parents and children. In addition, we also compared the relations between parental and child anxiety symptoms in families with children with an anxiety disorder (n = 350) versus families with children who displayed other psychiatric diagnoses (n = 1,102). RESULTS Anxiety symptom relations within persons were more intertwined than the symptom relations between family members. Between-person relations were found among similar anxiety symptoms, suggesting specific intergenerational relations. The feeling of being fearful was found to be a central and connecting symptom in all family members (fathers, mothers, and children). The relations between parental and child anxiety symptoms were more specific (i.e., among similar symptoms) in families with children with an anxiety disorder than in families with children with other types of psychopathologies. CONCLUSIONS This study found that anxiety symptom associations are present within the family on a detailed (symptom) level. This stresses the importance of future studies to examine factors responsible for this family-anxiety transmission.
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Affiliation(s)
- Jeanine M D Baartmans
- UvA Minds, Academic Treatment Centre, Amsterdam, The Netherlands
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | | | | | - Anke M Klein
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | - Susan M Bögels
- Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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11
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Ramos ML, Zhou AM, Lytle MN, Myruski S, Pérez-Edgar K, Buss KA. Interactions among stress, behavioral inhibition, and delta-beta coupling predict adolescent anxiety during the COVID-19 pandemic. Dev Psychobiol 2024; 66:e22485. [PMID: 38483054 PMCID: PMC11000197 DOI: 10.1002/dev.22485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 09/27/2023] [Accepted: 02/26/2024] [Indexed: 04/10/2024]
Abstract
The COVID-19 pandemic brought about unprecedented changes and uncertainty to the daily lives of youth. The range of adjustment in light of a near-universal experience of COVID restrictions highlights the importance of identifying factors that may render some individuals more susceptible to heightened levels of anxiety during stressful life events than others. Two risk factors to consider are temperamental behavioral inhibition (BI) and difficulties in emotion regulation (ER). As such, the current paper focused on BI examined prior to COVID, because of its developmental link to anxiety and ER, as difficulties may be associated with differences in anxiety. We examined a neurocognitive marker of ER processes, delta-beta coupling (DBC). The current paper had two goals: (1) to examine BI in relation to COVID-related worry and social anxiety experienced during the pandemic, and (2) to explore the role of individual differences in early DBC in the relationship between BI and anxiety outcomes 6 months apart during COVID-19 (n = 86; T1 Mage = 15.95, SD = 1.73; T6 Mage = 16.43, SD = 1.73). We found support for the moderating role of DBC in the relationship between BI levels and social anxiety disorder (SAD) symptom severity during the pandemic. Here, high BI was predictive of increased SAD symptom levels in adolescents with stronger DBC.
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Affiliation(s)
- Michelle L Ramos
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Anna M Zhou
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Marisa N Lytle
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Sarah Myruski
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Koraly Pérez-Edgar
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Kristin A Buss
- Department of Psychology, The Pennsylvania State University, University Park, Pennsylvania, USA
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12
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Wiemer J, Leimeister F, Gamer M, Pauli P. The ventromedial prefrontal cortex in response to threat omission is associated with subsequent explicit safety memory. Sci Rep 2024; 14:7378. [PMID: 38548770 PMCID: PMC10979006 DOI: 10.1038/s41598-024-57432-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
In order to memorize and discriminate threatening and safe stimuli, the processing of the actual absence of threat seems crucial. Here, we measured brain activity with fMRI in response to both threat conditioned stimuli and their outcomes by combining threat learning with a subsequent memory paradigm. Participants (N = 38) repeatedly saw a variety of faces, half of which (CS+) were associated with an aversive unconditioned stimulus (US) and half of which were not (CS-). When an association was later remembered, the hippocampus had been more active (than when forgotten). However, the ventromedial prefrontal cortex predicted subsequent memory specifically during safe associations (CS- and US omission responses) and the left dorsolateral prefrontal cortex during outcomes in general (US and US omissions). In exploratory analyses of the theoretically important US omission, we found extended involvement of the medial prefrontal cortex and an enhanced functional connectivity to visual and somatosensory cortices, suggesting a possible function in sustaining sensory information for an integration with semantic memory. Activity in visual and somatosensory cortices together with the inferior frontal gyrus also predicted memory performance one week after learning. The findings imply the importance of a close interplay between prefrontal and sensory areas during the processing of safe outcomes-or 'nothing'-to establish declarative safety memory.
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Affiliation(s)
- Julian Wiemer
- Institute of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany.
| | - Franziska Leimeister
- Institute of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Matthias Gamer
- Institute of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
| | - Paul Pauli
- Institute of Psychology (Biological Psychology, Clinical Psychology, and Psychotherapy), University of Würzburg, Würzburg, Germany
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13
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Salter D, Neelakandan A, Wuthrich VM. Anxiety and Teacher-Student Relationships in Secondary School: A Systematic Literature Review. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01665-7. [PMID: 38446364 DOI: 10.1007/s10578-024-01665-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 03/07/2024]
Abstract
Anxiety disorders are the most prevalent mental disorders experienced by adolescents. As students spend a significant amount of time within a school environment, it is not surprising that factors in the school environment have been linked to student mental health. Positive teacher-student relationships (TSRs) in children have been found to improve student mental health outcomes, with supportive TSRs associated with reduced student anxiety, and in turn, student anxiety has also been associated with reduced poorer TSR quality. The findings in adolescents are less clear. This review aimed to systematically evaluate the impact of TSRs on anxiety in secondary school students, and vice-versa using PRISMA guidelines. Searches were conducted in five databases and studies screened against inclusion and exclusion criteria, and rated for study quality by two independent researchers. Twenty-six studies across 12 countries were included. Most studies reported higher quality TSRs (e.g., those that are perceived as more supportive, caring, and warm) was associated with decreased anxiety. Conversely, TSRs that were characterised by dependence, motivational support, conflict, or harassment, were associated with increased anxiety. Most studies used a cross-sectional design and as such conclusions regarding causality as well as the direction of the effects cannot be made. However, early evidence from a limited number of longitudinal studies indicated that positive TSRs reduced anxiety over time. Future research is warranted to investigate whether anxiety affects TSRs, as well as exploring specific strategies and approaches teachers can use to establish positive relationships with their students.
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Affiliation(s)
- Darby Salter
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Aswathi Neelakandan
- School of Psychological Sciences, Macquarie University, Sydney, Australia
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- School of Psychological Sciences, Macquarie University, Sydney, Australia.
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney, Australia.
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14
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LoParo D, Fonseca AC, Matos APM, Craighead WE. Anxiety and Depression from Childhood to Young Adulthood: Trajectories and Risk Factors. Child Psychiatry Hum Dev 2024; 55:127-136. [PMID: 35763175 DOI: 10.1007/s10578-022-01391-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/03/2022]
Abstract
This study aimed to (1) evaluate how population levels of anxiety and depression grow and correlate from middle childhood through early adulthood, and (2) determine whether sex, family socioeconomic status, parental education, academic achievement, learning disabilities, or externalizing symptoms predict anxiety and/or depression levels and growth trajectory. We used two longitudinal samples (N = 445, 448) of Portuguese children. Mean depression levels increased from mid-childhood through adolescence before stabilizing in early adulthood and were most strongly predicted by academic achievement and learning disabilities. Mean anxiety levels increased until adolescence before decreasing across early adulthood and were most strongly predicted by academic achievement, learning disabilities, and externalizing symptoms. Quadratic models of growth fit best for both depression and anxiety, and depression and anxiety growth trajectories were strongly correlated. Though anxiety and depression trajectories differ in pattern and predictors, the two are highly interrelated and pathways to comorbid anxiety and depression should be characterized.
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Affiliation(s)
- Devon LoParo
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, 2nd Floor, Atlanta, GA, 30329, USA.
| | | | | | - W Edward Craighead
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 12 Executive Park Drive NE, 2nd Floor, Atlanta, GA, 30329, USA
- Department of Psychology, Emory University, Atlanta, GA, USA
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15
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Pishdar S, Kalantari S, Kalantari S, Sheikhi HR, Kuchaki Z. Impact of the Integrated Program of Transdiagnostic Treatment and Parent Education on the Social Anxiety of Female Students. Cureus 2024; 16:e55299. [PMID: 38562264 PMCID: PMC10982126 DOI: 10.7759/cureus.55299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/29/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE The objective of this study was to assess the efficacy of the combined program of transdiagnostic treatment and parent education in reducing social anxiety among female students. METHODOLOGY This descriptive cross-sectional study was conducted among all female elementary school students in Bandar Abbas, Iran, during the academic year 2022-2023. The social phobia questionnaire was given to all female students in grades three to six to assess individuals in terms of the social anxiety disorder (SAD) variable. We used the social anxiety scale developed by Leibovitz as the questionnaire in this investigation. This self-assessment questionnaire was designed for individuals aged 18 and above. It consists of 24 statements, divided into two subscales: performance anxiety (13 statements) and social settings (11 statements). Each item is individually assessed for fear intensity on a scale of 0 to 3, ranging from no to extreme. Similarly, avoidance behavior is evaluated on a scale of 0 to 3, representing the frequency ranging from never to always. RESULTS The mean general anxiety levels among both groups (students vs. parents) during the pre-test were similar (48.06 ± 4.39 vs. 48.06± 4.1). However, in the post-test, the mean of the experimental groups was lower than that of the pre-test (32.13 ± 3.77 vs. 47.2 ± 3.6). The normality assumption for the pre-test and post-test variables of generalized anxiety was verified with a significance level over 0.05 (p ≥ 0.05). CONCLUSION The findings demonstrated that the integrated meta-diagnostic treatment program for parents had a more pronounced effect on alleviating their social anxiety in comparison to students. These findings imply that if parents possess a comprehensive understanding of the factors contributing to their children's anxiety, it will significantly enhance their ability to mitigate their child's social anxiety.
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Affiliation(s)
- Sedigheh Pishdar
- Clinical Psychology, Islamic Azad University of Bandar Abbas, Bandar Abbas, IRN
| | - Solaleh Kalantari
- Personality Psychology, Islamic Azad University Sari Branch Campus, Mazandaran, IRN
| | - Sara Kalantari
- Family Therapy, University of Science and Culture, Tehran, IRN
| | - Hamid Reza Sheikhi
- Department of Nursing, Islamic Azad University, Qaenat Branch, Qaenat, IRN
| | - Zeinab Kuchaki
- Department of Nursing, Ilam University of Medical Sciences, Ilam, IRN
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16
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Lee S, Bernstein R, Ip KI, Olson SL. Developmental cascade models linking contextual risks, parenting, and internalizing symptoms: A 17-year longitudinal study from early childhood to emerging adulthood. Dev Psychopathol 2024; 36:144-160. [PMID: 36453121 PMCID: PMC10232681 DOI: 10.1017/s0954579422001043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Although internalizing problems are the most common forms of psychological distress among adolescents and young adults, they have precursors in multiple risk domains established during childhood. This study examined cascading risk pathways leading to depression and anxiety symptoms in emerging adulthood by integrating broad contextual (i.e., multiple contextual risks), parental (i.e., negative parenting), and child (i.e., internalizing behaviors) characteristics in early and middle childhood. We also compared common and differential pathways to depression and anxiety symptoms depending on the conceptualization of symptom outcomes (traditional symptom dimension vs. bifactor dimensional model). Participants were 235 children (109 girls) and their families. Data were collected at 3, 6, 10, and 19 years of child age, using multiple informants and contexts. Results from a symptom dimension approach indicated mediation pathways from early childhood risk factors to depression and anxiety symptoms in emerging adulthood, suggesting common and distinct risk processes between the two disorders. Results from a bifactor modeling approach indicated several indirect pathways leading to a general internalizing latent factor, but not to symptom-specific (i.e., depression, anxiety) latent factors. Our findings highlighted comparative analytic approaches to examining transactional processes associated with later internalizing symptoms and shed light on issues of early identification and prevention.
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Affiliation(s)
- Sujin Lee
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Rachel Bernstein
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
| | - Ka I Ip
- Department of Psychology, Yale University, New Haven, CT, USA
| | - Sheryl L Olson
- Department of Psychology, University of Michigan, Ann Arbor, MI, USA
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17
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Qiu SY, Yin XN, Yang Y, Li T, Lu D, Li JM, Yang WK, Wen GM, Zhang JY, Zhang Y, Lei HY, Wang X, Wu JB. Relationship between bedtime, nighttime sleep duration, and anxiety symptoms in preschoolers in China. Front Psychol 2024; 15:1290310. [PMID: 38298521 PMCID: PMC10827991 DOI: 10.3389/fpsyg.2024.1290310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/08/2024] [Indexed: 02/02/2024] Open
Abstract
Background Sleep problems in preschoolers are becoming increasingly prominent, and the association between sleep status and anxiety symptoms has attracted growing attention. However, studies investigating the relationship between bedtime and nighttime sleep duration in preschoolers and their anxiety symptoms remain scant. We used the large sample data from the Longhua Cohort Study of Children in Shenzhen, China (LCCS) to analyze the association between bedtime and sleep in preschoolers and their anxiety symptoms. Methods A cross-sectional study of 69,138 preschoolers in Longhua District, Shenzhen, China was conducted in 2022. Data on sociodemographic characteristics of families, bedtime, nighttime sleep duration of preschoolers, and their anxiety symptoms (measured by the Spence Preschool Children Anxiety Scale) were collected through a structured questionnaire completed by the parents. Using binary logistic regression models, the relationship between bedtime, nighttime sleep duration, and childhood anxiety symptoms was examined. Results The bedtimes of preschoolers were concentrated between 21:01-22:00 (52.41%). Among the preschoolers, 38.70% had bedtimes later than 22:00, and 75.49% had insufficient nighttime sleep duration. The positive screening rate for anxiety symptoms among preschoolers was 3.50%. After adjusting for confounding factors using binary logistic regression models, compared with preschoolers with bedtime ≤21:00, The OR (95%CI) values of anxiety in preschoolers with bedtime ≥23:01, 22:01-23:00 and 21:01-22:00 were 2.86 (2.21-3.69), 1.51 (1.27-1.79) and 1.48 (1.26-1.76), respectively. Compared with those with sufficient nighttime sleep duration, the OR (95%CI) of children with nighttime sleep duration less than 9 h was 1.36 (1.23-1.51). Conclusion An association exists between bedtime and nighttime sleep duration in preschoolers and their anxiety symptoms. Preschoolers with 21:00 for bedtime and a nighttime sleep duration of 10 h may have lower anxiety symptoms. These findings support the importance of adequate sleep for preventing anxiety symptoms in children.
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Affiliation(s)
- Shuang-Yan Qiu
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Xiao-Na Yin
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yanni Yang
- Xinhe Experimental School, Shenzhen, China
| | - Ting Li
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Dali Lu
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Jie-Min Li
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Wei-Kang Yang
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Guo-Ming Wen
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Jing-Yu Zhang
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Yan Zhang
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Hai-Yan Lei
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
| | - Xin Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, Institute for Brain Research and Rehabilitation, Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Jian-Bo Wu
- Shenzhen Longhua Maternity and Child Healthcare Hospital, Shenzhen, China
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18
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McLellan LF, Woon S, Hudson JL, Lyneham HJ, Karin E, Rapee RM. Treating child anxiety using family-based internet delivered cognitive behavior therapy with brief therapist guidance: A randomized controlled trial. J Anxiety Disord 2024; 101:102802. [PMID: 38071870 DOI: 10.1016/j.janxdis.2023.102802] [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: 03/08/2023] [Revised: 11/04/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
Online treatment delivery has the potential to increase access to evidence-based mental health care for children with anxiety disorders. Using a randomized controlled trial design, we evaluated the efficacy of Cool Kids Online, a family-based and therapist supported internet-delivered cognitive behavioral treatment (CBT) designed to target anxiety disorders in children. Ninety-five children aged 7-12 years with a DSM-5 anxiety disorder were randomly allocated to Cool Kids Online or a waitlist control. Children were assessed at baseline, week 11, and 6-months following treatment. Children in waitlist received treatment after week 11 and also completed assessments immediately and six months after treatment, allowing treatment maintenance to be evaluated for all children. Compared to waitlist, Cool Kids Online led to significantly greater remission of anxiety disorders (primary and all anxiety diagnoses) and greater reduction of caregiver-reported anxiety symptoms and interference at week 11. Child-reported anxiety symptoms and interference and child- and caregiver-reported depressive or externalizing symptoms did not differ significantly between conditions. Medium to large within-treatment effects were observed for all children from pre to post treatment with post treatment effects maintained until follow-up. Overall, the findings provide support for the efficacy of the program in treating anxiety. Cool Kids Online compared to waitlist for the remission of anxiety disorders in clinically anxious children; anzctr.org.au; ACTRN12615000947505.
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Affiliation(s)
- Lauren F McLellan
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Samantha Woon
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia; School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Jennifer L Hudson
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia; School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Heidi J Lyneham
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
| | - Eyal Karin
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Ronald M Rapee
- Lifespan Health and Wellbeing Research Centre, Faculty of Medicine, Health and Human Sciences, School of Psychological Sciences, Macquarie University, Sydney, NSW, 2109, Australia
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19
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Weijs ML, Daum MM, Lenggenhager B. Cardiac interoception in infants: Behavioral and neurophysiological measures in various emotional and self-related contexts. Psychophysiology 2023; 60:e14386. [PMID: 37421217 DOI: 10.1111/psyp.14386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 06/02/2023] [Accepted: 06/24/2023] [Indexed: 07/10/2023]
Abstract
Interoception, the perception of internal bodily signals, is fundamental to our sense of self. Even though theoretical accounts suggest an important role for interoception in the development of the self, empirical investigations are limited, particularly in infancy. Previous studies used preferential-looking paradigms to assess the detection of sensorimotor and multisensory contingencies in infancy, usually related to proprioception and touch. So far, only one recent study reported that infants discriminated between audiovisual stimuli presented synchronously or asynchronously with their heartbeat. This discrimination was related to the amplitude of the infant's heartbeat evoked potentials (HEP), a neural correlate of interoception. In the current study, we measured looking preferences between synchronous and asynchronous visuocardiac (bimodal), and audiovisuocardiac (trimodal) stimuli as well as the HEP in conditions of different emotional contexts and with different degrees of self-relatedness in a mirror-like setup. While the infants preferred trimodal to bimodal stimuli, we did not observe the predicted differences between synchronous and asynchronous stimulation. Furthermore, the HEP was not modulated by emotional context or self-relatedness. These findings do not support previously published results and highlight the need for further studies on the early development of interoception in relation to the development of the self.
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Affiliation(s)
- Marieke L Weijs
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Moritz M Daum
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Jacobs Center for Productive Youth Development, University of Zurich, Zurich, Switzerland
| | - Bigna Lenggenhager
- Department of Psychology, University of Zurich, Zurich, Switzerland
- Department of Psychology, University of Konstanz, Constance, Germany
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20
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Ahadianfard P, Gharraee B, Aghebati A, Asgarabad MH. Effectiveness of unified protocol for trans diagnostic treatment in children with anxiety disorders: A randomized control trial. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:387. [PMID: 38333174 PMCID: PMC10852158 DOI: 10.4103/jehp.jehp_1578_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 12/24/2022] [Indexed: 02/10/2024]
Abstract
BACKGROUND The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) is a theory-derived approach that can target the common underlying processes, such as the cognitive, emotional, and behavioral processes in emotional disorders in children aged 8-12 years. This study aimed to investigate UP-C's efficacy in treating children's anxiety disorders compared to cognitive behavior therapy (CBT). MATERIALS AND METHODS In this randomized control trial (RCT), with pre-test, post-test, and follow-up, 34 participants aged 8-12 with anxiety disorders were selected through the restricted randomization method and allocated to intervention (UP-C) or control (CBT) groups by random allocation rule. UP-C group consisted of 15 weekly individual sessions, and CBT included 16 weekly individual sessions. The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) and The Screen for Child Anxiety Related Disorders (SCARED-71) were completed in the pre-test, post-test, and three-month follow-up stages. The data of participants were analyzed using the repeated measure analysis of variance. A P- value under. 05 was regarded as significant. RESULTS Based on the repeated measures ANOVA, UP-C, and CBT significantly reduced anxiety symptoms (P = .002) and emotional suppression (P = .032). Moreover, UP-C and CBT significantly increased emotion regulation (P = .000) and cognitive reappraisal (P = .000). CONCLUSION The individual UP-C can be effective as anxiety-oriented CBT in treating anxiety disorders. Also, in the three months follow-up, the UP-C's effects were more stable and progressive than the CBT.
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Affiliation(s)
- Pantea Ahadianfard
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Banafsheh Gharraee
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Asma Aghebati
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
| | - Mojtaba Habibi Asgarabad
- Health Promotion Research Center, Iran University of Medical Sciences, Tehran, Iran
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Health Psychology, School of Behavioral Sciences and Mental Health (Tehran Institute of Psychiatry), Iran University of Medical Sciences, Tehran, Iran
- Positive Youth Development Lab, Human Development and Family Sciences, Texas Tech University, Texas, U.S.A
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21
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Zimmermann KS, Richardson R, Baker KD. Developmental changes in functional connectivity between the prefrontal cortex and amygdala following fear extinction. Neurobiol Learn Mem 2023; 205:107847. [PMID: 37865263 DOI: 10.1016/j.nlm.2023.107847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/13/2023] [Accepted: 10/18/2023] [Indexed: 10/23/2023]
Abstract
The amygdala and prefrontal cortex (PFC) undergo dramatic changes in structure, function, and regional connectivity in early life, ultimately stabilizing in early adulthood. Pathways between these two structures underlie many forms of emotional learning, including the extinction of conditioned fear. Here we sought to characterize changes in extinction-related medial PFC (mPFC) → amygdala functional connectivity across development that might explain adolescent impairments in extinction. The retrograde tracer Fluorogold was infused into the amygdala of postnatal day (P)22-23 (juvenile), P31-32 (adolescent), or ≥ P69 (adult) rats, which were then exposed to fear conditioning and extinction training. Brains were collected following extinction or context exposure and processed for expression of pMAPK (as a marker of learning-dependent plasticity) in prelimbic (PL) and infralimbic (IL) amygdala-projecting neurons. Consistent with previous findings, amygdala-projecting mPFC neurons were located primarily in layers (L)II/III and V of the mPFC. We noted that mPFC LII/III projected predominantly to the ipsilateral basolateral amygdala, whereas LV projected bilaterally and targeted multiple amygdalar nuclei. Extinction was not associated with changes in extinction-related plasticity in the PL-amygdala pathways in any age group. No changes were seen in LII/III of the IL, but extinction-related plasticity in LV amygdala-projecting IL neurons decreased linearly across development. These findings suggest that extinction-related functional connectivity between the IL and the amygdala undergoes fundamental changes across development that may contribute to alterations in fear suppression across development.
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Affiliation(s)
- K S Zimmermann
- School of Psychology, UNSW Sydney, New South Wales 2052, Australia
| | - R Richardson
- School of Psychology, UNSW Sydney, New South Wales 2052, Australia
| | - K D Baker
- School of Psychology, UNSW Sydney, New South Wales 2052, Australia.
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22
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Moscovitch DA, Moscovitch M, Sheldon S. Neurocognitive Model of Schema-Congruent and -Incongruent Learning in Clinical Disorders: Application to Social Anxiety and Beyond. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2023; 18:1412-1435. [PMID: 36795637 PMCID: PMC10623626 DOI: 10.1177/17456916221141351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Negative schemas lie at the core of many common and debilitating mental disorders. Thus, intervention scientists and clinicians have long recognized the importance of designing effective interventions that target schema change. Here, we suggest that the optimal development and administration of such interventions can benefit from a framework outlining how schema change occurs in the brain. Guided by basic neuroscientific findings, we provide a memory-based neurocognitive framework for conceptualizing how schemas emerge and change over time and how they can be modified during psychological treatment of clinical disorders. We highlight the critical roles of the hippocampus, ventromedial prefrontal cortex, amygdala, and posterior neocortex in directing schema-congruent and -incongruent learning (SCIL) in the interactive neural network that comprises the autobiographical memory system. We then use this framework, which we call the SCIL model, to derive new insights about the optimal design features of clinical interventions that aim to strengthen or weaken schema-based knowledge through the core processes of episodic mental simulation and prediction error. Finally, we examine clinical applications of the SCIL model to schema-change interventions in psychotherapy and provide cognitive-behavior therapy for social anxiety disorder as an illustrative example.
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Affiliation(s)
- David A. Moscovitch
- Department of Psychology and Centre for Mental Health Research & Treatment, University of Waterloo
| | - Morris Moscovitch
- Rotman Research Institute and Department of Psychology, Baycrest Centre for Geriatric Care
- Department of Psychology, University of Toronto
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23
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Brookman R, Bird F, Harris CB, Grant KA. Social Anxiety Disorder: Associations with Peer-Liking, Discrimination, and Prejudicial Feelings in Early Adolescent Girls. Child Psychiatry Hum Dev 2023; 54:1231-1241. [PMID: 35195808 PMCID: PMC8863903 DOI: 10.1007/s10578-022-01336-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2022] [Indexed: 01/01/2023]
Abstract
Social anxiety can have an adverse effect on social connections, educational achievement, and wellbeing. However, the extent to which students stigmatize their peers with social anxiety disorder (SAD) in female educational settings remains unknown. This study investigated the relationship between SAD, peer-liking and stigma in a cohort of early adolescent girls. The sample was 103 sixth and seventh graders attending three girls' schools in Australia. The students, aged between 10- and 13-years, were randomly allocated to either a control (n = 52) or experimental (n = 51) group. Participants completed an online survey while at school to examine their responses to one of two age-and-gender matched vignettes: a hypothetical peer with SAD (experimental condition), or without SAD (control condition). Contrary to expectations, group comparisons revealed that students with the SAD vignette liked their peer more than students with the non-SAD vignette. Also, students endorsed higher levels of pity, lower levels of fear, but similar levels of anger when considering their SAD (versus non-SAD) peer. In the SAD group, higher levels of pity were associated with greater peer-liking. The opposite pattern was evident in response to the non-SAD peer. Importantly, students discriminated less (preferred less social distance) in response to their peer with SAD. This points to the potential benefit of adolescent peer programs that aim to promote positive peer-relationships as a protective factor for students with SAD. Future research may examine gender and socio-economically diverse students to increase the confidence with which findings can be generalized to other educational settings.
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Affiliation(s)
- Ruth Brookman
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Fay Bird
- KYDS Youth Development Service, 265 Pacific Hwy, Lindfield, NSW, 2070, Australia
| | - Celia B Harris
- The MARCS Institute for Brain, Behaviour and Development, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Kerry-Ann Grant
- Health Education and Training Institute, Locked Bag 7118, Parramatta BC, NSW, 2124, Australia
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24
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Wergeland GJH, Haaland ÅT, Fjermestad KW, Öst LG, Gjestad R, Bjaastad JF, Hoffart A, Husabo E, Raknes S, Haugland BSM. Predictors of school-based cognitive behavior therapy outcome for youth with anxiety. Behav Res Ther 2023; 169:104400. [PMID: 37690362 DOI: 10.1016/j.brat.2023.104400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents' credibility and expectancy of interventions should be targeted to optimize school-based CBT.
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Affiliation(s)
- Gro Janne H Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Åshild T Haaland
- Department of Child and Adolescence Mental Health, Sørlandet Hospital, Kristiansand, Norway
| | | | | | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Elisabeth Husabo
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway
| | | | - Bente S M Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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25
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Li Y, Zhou Z, Zhang Y, Ai H, Liu M, Liu J, Wang L, Qiu J, Rachel Han Z, Zhang Z, Luo YJ, Xu P. Brain development mediates the relationship between self-reported poor parental monitoring and adolescent anxiety. Neuroimage Clin 2023; 40:103514. [PMID: 37778196 PMCID: PMC10542017 DOI: 10.1016/j.nicl.2023.103514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Adolescence is the peak period for the onset of generalized anxiety disorder (GAD). Brain networks of cognitive and affective control in adolescents are not well developed when their exposure to external stimuli suddenly increases.Reasonable parental monitoring is especially important during this period.To examine the role of parental monitoring in the development of functional brain networks of GAD, we conducted a cross-validation-based predictive study based on the functional brain networks of 192 participants. We found that a set of functional brain networks, especially the default mode network and its connectivity with the frontoparietal network, could predict the ages of adolescents, which was replicated in three independent samples.Importantly, the difference between predicted age and chronological age significantly mediated the relationship between parental monitoring and anxiety levels. These findings suggest that inadequate parental monitoring plays a crucial role in the delayed development of specific brain networks associated with GAD in adolescents. Our work highlights the important role of parental monitoring in adolescent development.
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Affiliation(s)
- Yiman Li
- School of Psychology, Shenzhen University, Shenzhen, China; Institute for Neuropsychological Rehabilitation, University of Health and Rehabilitation Sciences, Qingdao, China
| | - Zheyi Zhou
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China; Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Yuqi Zhang
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Hui Ai
- Institute of Applied Psychology, Tianjin University, Tianjin, China; Academy of Medical Engineering and Translational Medicine, Tianjin University, Tianjin, China
| | - Mingfang Liu
- Community Health Service Center, Beijing Normal University, Beijing, China
| | - Jing Liu
- The China Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Li Wang
- College of Electronic Information and Automation, Civil Aviation University of China, Tianjin, China
| | - Jiang Qiu
- School of Psychology, Southwest University (SWU), Chongqing, China
| | - Zhuo Rachel Han
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing, China
| | - Zhanjun Zhang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China
| | - Yue-Jia Luo
- School of Psychology, Shenzhen University, Shenzhen, China; Institute for Neuropsychological Rehabilitation, University of Health and Rehabilitation Sciences, Qingdao, China; State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal University, Beijing, China.
| | - Pengfei Xu
- Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education (BNU), Faculty of Psychology, Beijing Normal University, Beijing, China; Center for Emotion and Brain, Shenzhen Institute of Neuroscience, Shenzhen, China.
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Zeevi-Cousin A, Lavenda O. The Mediating Role of Parenting Style in the Relationship between Parents' Openness to Different Ways of Thinking and Child Anxiety. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1564. [PMID: 37761525 PMCID: PMC10528896 DOI: 10.3390/children10091564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/14/2023] [Accepted: 09/15/2023] [Indexed: 09/29/2023]
Abstract
The quality of parent-child relationships plays a significant role in the development of child anxiety, especially regarding aspects of parental control, intrusive behavior, and a lack of warmth. Nevertheless, the underlying mechanisms of these parenting behaviors that are associated with the risk of child anxiety have yet to be revealed. The present study aims to examine the contribution of a cognitive aspect of parenting, i.e., openness to different ways of thinking, to the development of child anxiety through its impact on parenting style. A sample of 300 Israeli parents (72% women) over the age of 18 (M = 38.8, SD = 6.2), with at least one child over the age of 6 (M = 13.3, SD = 5.5 of oldest child), was recruited through social media platforms. Participants provided demographic information and filled out self-reported questionnaires dealing with child anxiety (using the Child Behavior Checklist), openness to different ways of thinking (using the Interpersonal Reactivity Index), and parenting style (using the Parental Behavior Inventory). The analysis confirmed the mediation role of hostile/coercive parenting style in the association between parental openness to different ways of thinking and child anxiety. However, the association between supportive/engaged parenting and child anxiety was non-significant. Apparently, openness to different ways of thinking allows for parents to consolidate parenting that does not resort to coercive and hostile behaviors, control, obedience, and severe strictness. As a result, the child develops self-regulation and coping mechanisms that reduce the risk for developing anxiety.
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Affiliation(s)
| | - Osnat Lavenda
- School of Social Work, Ariel University, Ariel 40700, Israel
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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: 7] [Impact Index Per Article: 7.0] [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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Byrne S, Cobham V, Richardson M, Imuta K. Do Parents Enhance Cognitive Behavior Therapy for Youth Anxiety? An Overview of Systematic Reviews Over Time. Clin Child Fam Psychol Rev 2023; 26:773-788. [PMID: 37217646 PMCID: PMC10465628 DOI: 10.1007/s10567-023-00436-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2023] [Indexed: 05/24/2023]
Abstract
The last 20 years has seen debate regarding the merits of involving parents in cognitive behavior therapy (CBT) for youth anxiety played out across systematic reviews which have high impact. These reviews examined varying treatment formats in relation to parent involvement, including youth only CBT (Y-CBT), parent only CBT (P-CBT) and family CBT (youth and parent; F-CBT). This is a novel overview of systematic reviews examining evidence for parental involvement in CBT for youth anxiety over the period this was studied. Two independent coders systematically searched for studies in medical and psychological databases using the categories "Review", "Youth", "Anxiety", "Cognitive Behavior Therapy" and "Parent/Family". Of the 2,189 unique articles identified, there were 25 systematic reviews since 2005 which compared the effects of CBT for youth anxiety with varying parent involvement. Despite systematically studying the same phenomenon, the reviews were heterogeneous in outcome, design, inclusion criteria and often had methodological limitations. Of the 25 reviews, 21 found no difference between formats and 22 reviews were considered inconclusive. Yet while there were typically no statistical differences, consistent patterns in the direction of effects were detected over time. P-CBT was less effective than other formats, suggesting the importance of directly treating anxious youths. Early reviews favored F-CBT over Y-CBT, however, later reviews did not show this trend. We consider the effects of moderators including exposure therapy, long-term outcomes and the child's age. We consider how to manage heterogeneity in primary studies and reviews to better detect treatment differences where they exist.Trial registration This protocol is registered with the Open Science Framework: osf.io/2u58t.
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Affiliation(s)
- S Byrne
- School of Psychology, University of Queensland, Brisbane, QLD, Australia.
| | - V Cobham
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- Parenting and Family Support Centre, University of Queensland, Brisbane, QLD, Australia
| | - M Richardson
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, QLD, Australia
| | - K Imuta
- School of Psychology, University of Queensland, Brisbane, QLD, Australia
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Liu R, Bell MA. Fearful temperament in middle childhood predicts adolescent attention bias and anxiety symptoms: The moderating role of frontal EEG asymmetry. Dev Psychopathol 2023; 35:1335-1345. [PMID: 34895372 PMCID: PMC9189245 DOI: 10.1017/s0954579421001231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The current study provided first analyses of the moderating effect of baseline-to-task frontal EEG asymmetry on the associations between 9-year fearful temperament and adolescent attention bias to threat as well as anxiety symptoms. Participants include a community sample of 122 children (60 boys, 62 girls; Mage = 14.66 years; Range = 11.82-18.13 years). Baseline-to-task frontal EEG asymmetry at age 9 moderated the relation between fearful temperament at age 9 and adolescent anxiety symptoms. Specifically, fearful temperament predicted adolescent anxiety symptoms when children showed greater right activation from baseline to an executive function task, but not greater left activation. Baseline-to-task frontal EEG asymmetry moderated the association between fearful temperament and sustained (i.e., stimulus onset asynchrony is 1250 ms) but not automatic attention bias (i.e., stimulus onset asynchrony is 500 ms). Children with greater left frontal activation from baseline to task more efficiently direct attention away from threat. Adolescent automatic attention bias to threat was related to concurrent anxiety symptoms. These findings illustrate the importance of considering frontal EEG asymmetry to shape how fearful children process threat and to influence their behavioral problems.
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Affiliation(s)
- Ran Liu
- The Division of Child and Adolescent Psychiatry, Department of Psychiatry, Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, USA
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Stiede JT, Trent ES, Viana AG, Guzick AG, Storch EA, Hershfield J. Cognitive Behavioral Therapy for Children and Adolescents with Anxiety Disorders. Child Adolesc Psychiatr Clin N Am 2023; 32:543-558. [PMID: 37201966 PMCID: PMC11177010 DOI: 10.1016/j.chc.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
Anxiety disorders are the most common class of psychiatric conditions among children and adolescents. The cognitive behavioral model of childhood anxiety has a strong theoretic and empirical foundation that provides the basis for effective treatment. Cognitive behavioral therapy (CBT), with an emphasis on exposure therapy, is the gold standard treatment for childhood anxiety disorders, with strong empirical support. A case vignette demonstrating CBT for childhood anxiety disorders in practice, as well as recommendations for clinicians, are also provided.
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Affiliation(s)
- Jordan T Stiede
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA.
| | - Erika S Trent
- University of Houston, 4849 Calhoun Road, Room 373, Houston, TX 77204, USA
| | - Andres G Viana
- University of Houston, 4849 Calhoun Road, Room 373, Houston, TX 77204, USA
| | - Andrew G Guzick
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
| | - Eric A Storch
- Baylor College of Medicine, One Baylor Plaza, MS:350, Houston, TX 77030, USA
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31
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Byrne S, Richardson M, Riba M, Imuta K. Parent Versus Individual Cognitive Behavioral Therapy for Youth Anxiety: Protocol for an Overview of Systematic Reviews Over Time. JMIR Res Protoc 2023; 12:e48077. [PMID: 37384370 PMCID: PMC10365617 DOI: 10.2196/48077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) has shown to be highly effective for treating youth anxiety; yet, there is ongoing debate as to whether involving parents improves outcomes. For example, parents who attend may learn CBT skills to help their child in an ongoing way; yet, they could also distract their child from treatment depending on how they interact. As evidence has accumulated, reviews and meta-analyses have attempted to examine the most effective treatment format. These reviews often have high impact in the field; however, they use varied methodologies and draw on different primary studies. Different formats of CBT for youth anxiety have been developed in relation to parental involvement, including youth-only CBT (Y-CBT; where the youth alone attends treatment), youth and parent or family CBT (F-CBT; where youths and their parents attend together), and, most recently, parent-only CBT (P-CBT; where the parent alone attends). OBJECTIVE This protocol describes an overview of systematic reviews comparing the relative efficacy of different formats of CBT for youth anxiety (Y-CBT, F-CBT, and P-CBT) over the study period. The protocol will also examine the moderating effects of variables on the efficacy of different formats; for example, youths' age and long-term outcomes. METHODS We will analyze the results of systematic reviews that compare different levels and types of parental involvement in CBT for youth anxiety over the study period. A systematic review of medical and psychological databases (PsycINFO, PubMed, SCOPUS, Web of Science, Cochrane Library, and Embase) will identify reviews comparing the efficacy of different formats of parent involvement in CBT for youth anxiety. Data extraction will include (1) author names (and year of publication), (2) review design, (3) age range, (4) analysis type, (5) conclusions, and (6) moderators. This overview will present the relative efficacy of formats chronologically in a table and then describe the main results longitudinally in a narrative summary. A Measurement Tool to Assess Systematic Reviews, 2nd Edition (AMSTAR 2), quality rating will be given to each review, and the amount of primary study overlap across reviews will be quantified. RESULTS The last search was conducted on July 1, 2022. The reviews were published between 2005 and 2022. We found a total of 3529 articles, of which we identified 25 for the final analysis. CONCLUSIONS This overview will compare and report the relative efficacy of Y-CBT, P-CBT, and F-CBT for youth anxiety over the study period, describe the heterogeneity across reviews and primary studies, and consider the moderating effect of relevant variables. It will describe the limitations of an overview, including the potential for nuance in the data to be lost, and provide conclusions and recommendations for conducting systematic reviews regarding parental involvement for CBT for youth anxiety. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/48077.
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Affiliation(s)
- Simon Byrne
- School of Psychology, University of Queensland, Brisbane, Australia
| | - Meg Richardson
- School of Psychology, University of Queensland, Brisbane, Australia
- School of Psychology and Wellbeing, University of Southern Queensland, Ipswich, Australia
| | - Marcos Riba
- University of Queensland Library, Brisbane, Australia
| | - Kana Imuta
- School of Psychology, University of Queensland, Brisbane, Australia
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32
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Revisiting uncertainty as a felt sense of unsafety: The somatic error theory of intolerance of uncertainty. J Behav Ther Exp Psychiatry 2023; 79:101827. [PMID: 36512913 DOI: 10.1016/j.jbtep.2022.101827] [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] [Received: 08/01/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
Intolerance of uncertainty (IU) has gained widespread interest as a construct of broad interest from both transdiagnostic and trans-situational perspectives. We have approached this article inspired by the curiosity, clinical observation, consideration of different theoretical perspectives, speculation, optimism and indeed fun that can be seen in S. J. Rachman's work. We address some of what we know about IU before considering one way of conceptualizing IU from the standpoint of a felt sense or embodied experience. In the first part, we start with Woody and Rachman's (1994) observations of people with GAD. Second, we consider some key findings from the literature. Third, we consider two important perspectives on uncertainty, namely, Brosschot et al.'s (2016, 2018) influential Generalized Unsafety Theory of Stress and uncertainty as an emotion. In the second part, backing our clinical hunch about the importance of the felt sense of uncertainty, we consider IU from the perspective of interoception and the somatic error theory of anxiety (Khalsa & Feinstein, 2018). We propose the somatic error theory of intolerance of uncertainty, which places the experience of uncertainty at the heart of our understanding of intolerance of uncertainty. This is followed by predictions, unresolved questions, and potential clinical implications. Finally, we revisit Woody and Rachman's (1994) suggestions for treatment as internalizing "a sense of safety in a range of circumstances (p. 750)" and update this from the perspective of the felt sense of uncertainty. We finish by suggesting that uncertainty can be tolerated, perhaps accepted, and even embraced.
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Schniering CA, Forbes MK, Rapee RM, Wuthrich VM, Queen AH, Ehrenreich-May J. Assessing Functional Impairment in Youth: Development of the Adolescent Life Interference Scale for Internalizing Symptoms (ALIS-I). Child Psychiatry Hum Dev 2023; 54:508-519. [PMID: 34655359 DOI: 10.1007/s10578-021-01241-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2021] [Indexed: 12/31/2022]
Abstract
This study described the psychometric properties of a self-report measure of functional impairment related to anxiety and depression in adolescents, the Adolescent Life Interference Scale for Internalizing symptoms (ALIS-I). A clinical sample of 266 adolescents and a community sample of 63 adolescents, aged 11 to 18 years (Mean = 14.7, SD = 1.71) completed the ALIS-I and additional measures assessing internalizing problems. Exploratory factor analyses indicated four distinct but correlated factors of life interference related to personal withdrawal/avoidance, peer problems, problems with study/work, and somatic symptoms. Reliability and retest reliability (8-12 weeks) of the total score were high and psychometric properties of the subscales were acceptable. The ALIS-I effectively discriminated between clinical and community control groups, and expected correlations were shown between ALIS-I subscales and other related symptom measures. The ALIS-I is a promising instrument for the assessment of functional impairment related to internalizing disorders in youth.
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Affiliation(s)
- Carolyn A Schniering
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia. .,Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA.
| | - Miriam K Forbes
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Viviana M Wuthrich
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia
| | - Alexander H Queen
- Department of Psychology, Tufts University, 490 Boston Avenue, Medford, MA, USA
| | - Jill Ehrenreich-May
- Department of Psychology, University of Miami, 5665 Ponce de Leon Blvd, Coral Gables, FL, 33146, USA
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Morandini JS, Kelly A, de Graaf NM, Malouf P, Guerin E, Dar-Nimrod I, Carmichael P. Is Social Gender Transition Associated with Mental Health Status in Children and Adolescents with Gender Dysphoria? ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1045-1060. [PMID: 37014582 PMCID: PMC10101898 DOI: 10.1007/s10508-023-02588-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 03/11/2023] [Accepted: 03/13/2023] [Indexed: 05/11/2023]
Abstract
Social gender transition is an increasingly accepted intervention for gender variant children and adolescents. To date, there is scant literature comparing the mental health of children and adolescents diagnosed with gender dysphoria who have socially transitioned versus those who are still living in their birth-assigned gender. We examined the mental health of children and adolescents referred to the Gender Identity Development Service (GIDS), a specialist clinic in London, UK, who had socially transitioned (i.e., were living in their affirmed gender and/or had changed their name) versus those who had not socially transitioned. Referrals to the GIDS were aged 4-17 years. We assessed mental health correlates of living in one's affirmed gender among 288 children and adolescents (208 birth-assigned female; 210 socially transitioned) and of name change in 357 children and adolescents (253 birth-assigned female; 214 name change). The presence or absence of mood and anxiety difficulties and past suicide attempts were clinician rated. Living in role and name change were more prevalent in birth-assigned females versus birth-assigned males. Overall, there were no significant effects of social transition or name change on mental health status. These findings identify the need for more research to understand how social transition influences mental health, including longitudinal studies that allow for more confident inferences to be made regarding the relationship between social transition and mental health in young people with gender dysphoria.
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Affiliation(s)
- James S Morandini
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Aidan Kelly
- Gender Service Organization, Kelly Psychology, London, UK
| | - Nastasja M de Graaf
- Center of Expertise on Gender Dyphoria, VU University Medical Center, Amsterdam, The Netherlands
| | - Pia Malouf
- King Street Psychology Clinic, Newtown, Australia
| | - Evan Guerin
- School of Behavioural and Health Sciences, Australian Catholic University, Sydney, Australia
| | - Ilan Dar-Nimrod
- School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia
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Wise S, Huang-Pollock C, Pérez-Edgar K. Frontal alpha asymmetry in anxious school-aged children during completion of a threat identification task. Biol Psychol 2023; 179:108550. [PMID: 37003420 PMCID: PMC10175183 DOI: 10.1016/j.biopsycho.2023.108550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 03/09/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
Asymmetry of EEG alpha power in the frontal lobe has been extensively studied over the past 30 years as a potential marker of emotion and motivational state. However, most studies rely on time consuming manipulations in which participants are placed in anxiety-provoking situations. Relatively fewer studies have examined alpha asymmetry in response to briefly presented emotionally evocative stimuli. If alpha asymmetry can be evoked in those situations, it would open up greater methodological possibilities for examining task-driven changes in neural activation. Seventy-seven children, aged 8-12 years old (36 of whom were high anxious), completed three different threat identification tasks (faces, images, and words) while EEG signal was recorded. Alpha power was segmented and compared across trials in which participants viewed threatening vs. neutral stimuli. Threatening images and faces, but not words, induced lower right vs. left alpha power (greater right asymmetry) that was not present when viewing neutral images or faces. Mixed results are reported for the effect of anxiety symptomatology on asymmetry. In a similar manner to studies of state- and trait-level withdrawal in adults, frontal neural asymmetry can be induced in school-aged children using presentation of brief emotional stimuli.
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Affiliation(s)
- Shane Wise
- The Pennsylvania State University, Department of Psychology, USA.
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36
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Hudson JL, McLellan LF, Eapen V, Rapee RM, Wuthrich V, Lyneham HJ. Combining CBT and sertraline does not enhance outcomes for anxious youth: a double-blind randomised controlled trial. Psychol Med 2023; 53:1741-1749. [PMID: 34463234 PMCID: PMC10106296 DOI: 10.1017/s0033291721003329] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/15/2021] [Accepted: 07/21/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Anxiety disorders are the most prevalent mental disorder in children and young people. Developing effective therapy for these children is critical to reduce mental disorders across the lifespan. The study aimed to evaluate the efficacy of combining cognitive behavioural therapy (CBT) and sertraline (SERT) in the treatment of anxiety in youth, using a double-blind randomised control trial design. METHODS Ninety-nine youth (ages 7-15 years) with an anxiety disorder were randomly allocated to either individual (CBT) and SERT or individual CBT and pill placebo and assessed again immediately and 6 months after treatment. RESULTS There were no significant differences between conditions in remission of primary anxiety disorder or all anxiety disorders. Furthermore, there were no significant differences in rates of change in diagnostic severity, parent-reported anxiety symptoms, child-reported anxiety symptoms or life interference due to anxiety. CONCLUSIONS The efficacy of CBT for children and adolescents with anxiety disorders is not significantly enhanced by combination with a short-term course of anti-depressants over and above the combined effects of pill placebo.
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Affiliation(s)
- Jennifer L. Hudson
- Black Dog Institute, University of New South Wales, Randwick, NSW 2031, Australia
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Lauren F. McLellan
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Valsamma Eapen
- Academic Unit of Infant Child and Adolescent Psychiatry South West Sydney (AUCS), University of New South Wales, Sydney, NSW 2052, Australia
| | - Ronald M. Rapee
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Viviana Wuthrich
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Heidi J. Lyneham
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW 2109, Australia
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37
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Bayer JK, Prendergast LA, Brown A, Bretherton L, Hiscock H, Nelson-Lowe M, Gilbertson T, Noone K, Bischof N, Beechey C, Muliadi F, Mihalopoulos C, Rapee RM. Prediction of clinical anxious and depressive problems in mid childhood amongst temperamentally inhibited preschool children: a population study. Eur Child Adolesc Psychiatry 2023; 32:267-281. [PMID: 34368891 DOI: 10.1007/s00787-021-01857-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/31/2021] [Indexed: 11/30/2022]
Abstract
Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. Amongst inhibited preschool children, we aimed to predict each of clinical child anxiety and depressive problems in mid childhood from a broad range of potential risks (demographics, traumatic events and broader recent stressors, parents' well-being, and parenting practices). This study is based on data from a wider population trial of Cool Little Kids that recruited a representative sample of inhibited preschool children enrolled in their year before starting school. In 2011-2012, an inhibition screen was universally distributed to parents of children in their year before school (age 4 years) across eight diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited preschoolers (78% uptake, 545/703) who were followed to mid childhood (three annual waves 2015-2017, age 7-10 years) with 84% retention (456/545). Parents completed questionnaires spanning child ages 4-10 years, along with diagnostic interviews for child anxiety. Children also completed questionnaires in mid childhood. The questionnaires encompassed a variety of potential risks including sociodemographics, traumatic events, recent life stressors, parent wellbeing and parenting practices. In mid childhood, 57% (246/430) of inhibited preschoolers had a clinical level of anxiety problems while 22% (95/432) had depressive problems (by one or more sources). The aetiology analyses highlighted parent distress and parenting practices (overinvolved/protective, harsh discipline) as key predictors of inhibited preschoolers' internalising problems by mid childhood. Some high-risk families may not have participated. Child depression was not assessed with a diagnostic interview. The measures did not include every possible risk factor. The findings lend support to parenting programs for shy/inhibited young children that aim to prevent the development of anxiety and depression as they grow.
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Affiliation(s)
- Jordana K Bayer
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia.
- Murdoch Children's Research Institute, Melbourne, Australia.
- Department of Paediatrics, University of Melbourne, Melbourne, Australia.
| | - Luke A Prendergast
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Australia
| | - Amy Brown
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Lesley Bretherton
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Royal Children's Hospital, Melbourne, Australia
| | - Margaret Nelson-Lowe
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Tamsyn Gilbertson
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Kate Noone
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Natalie Bischof
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Cassima Beechey
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Fenny Muliadi
- School of Psychology and Public Health, La Trobe University (Melbourne Campus), Melbourne, VIC, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics, School of Health and Social Development, Deakin University, Melbourne, Australia
| | - Ronald M Rapee
- Centre for Emotional Health, Macquarie University, Sydney, Australia
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Becker-Haimes EM, Wislocki K, Schriger SH, Kratz HE, Sanchez AL, Clapp D, Frank HE. Preliminary Implementation Outcomes of a Free Online Toolkit to Support Exposure Therapy Implementation for Youth. CHILD & YOUTH CARE FORUM 2023; 52:1-18. [PMID: 36711198 PMCID: PMC9854404 DOI: 10.1007/s10566-023-09732-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 12/19/2022] [Accepted: 01/07/2023] [Indexed: 01/21/2023]
Abstract
Background Exposure therapy ("exposure") for youth anxiety is highly underutilized in clinical practice. Asynchronous, online implementation strategies such as online toolkits hold promise as pragmatic approaches for extending the sustainability of evidence-based interventions, but their long-term usage, perceived utility, and impact are rarely studied. Objective This study presents three-year preliminary implementation outcomes for a free, online toolkit to support exposure therapy use with youth: the Resource for Exposure for Anxiety Disordered Youth (READY; www.bravepracticeforkids.com). Implementation outcomes of interest included READY usage statistics, adoption, perceived utility, and clinician exposure use. Methods Web analytics characterized usage patterns. A survey of READY users (N = 49; M age = 34.2, 82.9% female, 71% White) assessed adoption, perceived utility, clinician exposure use, and persistent barriers to exposure use. Results In its first three years, READY had 13,543 page views across 1,731 unique users; 442 (25.6%) registered as a site user to access specialized content. Survey data suggested variability in usage and perceived utility across toolkit components. Qualitative analyses highlighted persistent exposure barriers that pointed to potential READY refinements. Conculsions Overall, READY has been accessed by hundreds of clinicians, but its impact was limited by low return to the site. This study highlights strengths and limitations of standalone online implementation supports and identifies additional steps needed to optimally support clinicians to deliver exposure to youth in need.
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Affiliation(s)
- Emily M. Becker-Haimes
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
| | - Katherine Wislocki
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Department of Psychological Science, University of California Irvine, Irvine, USA
| | | | - Hilary E. Kratz
- Department of Psychology, La Salle University, Philadelphia, USA
| | - Amanda L. Sanchez
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, 3535 Market Street, 3rd floor, 19104 Philadelphia, PA USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
- Department of Psychology, George Mason University, Fairfax, VA USA
| | - Douglas Clapp
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, USA
- Department of Psychology, La Salle University, Philadelphia, USA
| | - Hannah E. Frank
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University, Providence, USA
- Bradley Hospital, Lifespan Health System, Providence, USA
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Quagliato LA, de Matos UMA, Nardi AE. Lifetime psychopathology in the offspring of parents with anxiety disorders: A systematic review. J Affect Disord 2022; 319:618-626. [PMID: 36174782 DOI: 10.1016/j.jad.2022.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/25/2022] [Accepted: 09/20/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The offspring of parents with Anxiety Disorders (AD) are at high risk for different types of psychopathology, including AD. However, little is known about how parental anxiety during pregnancy and/or the postnatal period might result in alterations in behavior or neurodevelopmental changes in offspring. To examine the effect of parental AD on offspring behavior and neurodevelopment, we conducted a systematic review. METHODS Following PRISMA guidelines, we searched the Web of Science, PubMed, and PsycINFO databases. RESULTS Forty-seven articles met the inclusion criteria for the systematic review. Prenatal maternal anxiety is related to negative temperament, increased attention to fearful vocalizations, decreased alertness, and impaired psychomotor and cognitive development in early and middle childhood. AD during the postnatal period is associated with greater negative temperament, internalizing symptoms, and anxiety symptoms in early childhood, middle childhood, and adolescence. CONCLUSION Our review is the first to demonstrate that prenatal and postnatal AD symptoms impact offspring. Future research should explore the mediating and moderating factors leading to the development of psychopathology in the offspring of parents with AD.
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Affiliation(s)
- Laiana A Quagliato
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Voluntários da Pátria 190 s. 722, 22270-010, Brazil.
| | - Ursula M A de Matos
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Voluntários da Pátria 190 s. 722, 22270-010, Brazil
| | - Antonio E Nardi
- Laboratory of Panic & Respiration, Institute of Psychiatry, Federal University of Rio de Janeiro, Rua Voluntários da Pátria 190 s. 722, 22270-010, Brazil
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Pizzo A, Sandstrom A, Drobinin V, Propper L, Uher R, Pavlova B. Parental Overprotection and Sleep Problems in Young Children. Child Psychiatry Hum Dev 2022; 53:1340-1348. [PMID: 34191190 DOI: 10.1007/s10578-021-01199-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2021] [Indexed: 12/26/2022]
Abstract
Poor sleep in children predicts mental and physical disorders later in life. Identifying and changing modifiable factors associated with sleep problems in young children may improve their health trajectory. Our aim was to establish whether overprotective parenting was associated with problems sleeping in children. Parents of children aged 2-6 years completed questionnaires about their own anxiety, parenting style, and about their children's sleep. We obtained 307 reports on 197 children from 240 parents. Using mixed-effects linear regression, we found that maternal (beta = 0.26, 95% CI 0.11 to 0.41, p = 0.001) and paternal (beta = 0.35, 95% CI 0.17 to 0.53, p < 0.001) overprotection were associated with impaired sleep in children. This relationship remained unchanged when controlling for parental anxiety. Decreasing parents' overprotection may improve children's sleep, and reduce the risk of physical and mental disorders later in their life.
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Affiliation(s)
- Alex Pizzo
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Andrea Sandstrom
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Vladislav Drobinin
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Lukas Propper
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- IWK Health Centre, Halifax, NS, Canada
| | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
- Nova Scotia Health Authority, Halifax, NS, Canada
| | - Barbara Pavlova
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada.
- Nova Scotia Health Authority, Halifax, NS, Canada.
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Urao Y, Yoshida M, Sato Y, Shimizu E. School-based cognitive behavioural intervention programme for addressing anxiety in 10- to 11-year-olds using short classroom activities in Japan: a quasi-experimental study. BMC Psychiatry 2022; 22:658. [PMID: 36284274 PMCID: PMC9594947 DOI: 10.1186/s12888-022-04326-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 10/20/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although several school-based cognitive behavioural intervention programmes have been developed in Japan to prevent and improve children's anxiety disorders, the substantial time required for their completion remains a problem. METHODS A brief version of the cognitive behavioural programme called 'Journey of the Brave', developed for Japanese children was conducted among 90 children aged 10‒11 years using 20-min short classroom activities, and its effectiveness was examined. The children were divided into two groups: the intervention (n = 31) and control groups (n = 59). The control group did not attend any programme sessions and followed regular school curriculum. We conducted 14 weekly programme sessions and assessed children at pre-intervention, post-intervention, and 2-month follow-up (6 months after the beginning). The primary and secondary outcome measures were the Spence Children's Anxiety Scale (SCAS) to assess children's anxiety symptoms and the Strengths and Difficulties Questionnaire (SDQ) to measure behaviour problems, respectively. RESULTS A statistically significant reduction in the SCAS score in the intervention group was found at 2-month follow-up compared with the control group. A significant reduction was also observed in the SDQ score. CONCLUSIONS Our findings suggested that the 'Journey of the Brave' programme, which requires only 5 h of short classroom activities, demonstrates promising results compared with previous programmes. A larger randomised control trial would be desirable. TRIAL REGISTRATION UMIN, UMIN000009021, Registered 10 March 2012.
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Affiliation(s)
- Yuko Urao
- Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670, Japan.
| | - Michiko Yoshida
- grid.136304.30000 0004 0370 1101Department of Cognitive Behavioural Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
| | - Yasunori Sato
- grid.26091.3c0000 0004 1936 9959Department of Preventive Medicine and Public Health, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Eiji Shimizu
- grid.136304.30000 0004 0370 1101Research Centre for Child Mental Development, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan ,grid.136304.30000 0004 0370 1101Department of Cognitive Behavioural Physiology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8670 Japan
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Chen Y, Xiong W, Zhang Y, Bai X, Cheng G, Zhang Y, Chen R, Guo Y, Kong H, Zhang Y, Qu H, Zhao Y. Carbon Dots Derived from Os Draconis and Their Anxiolytic Effect. Int J Nanomedicine 2022; 17:4975-4988. [PMID: 36275482 PMCID: PMC9583237 DOI: 10.2147/ijn.s382112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background At present, people are susceptible to developing depression and anxiety disorders in response to stress. However, there is no specific medicine for anxiety. Os Draconis (OD, named "Long gu" in Chinese) are fossilized bones that have been used in traditional Chinese medicine to treat neurological diseases for thousands of years. Thus, we conducted this study to determine the biological basis for the anxiolytic effect of OD. Methods In this study, novel carbon dots (OD-CDs) from OD decoctions were discovered and separated. OD-CDs were anatomized using nanomaterials characterization methods to characterize the morphological structure, optical properties, and functional group properties. Four behavioural tests were conducted to observe the behavioural activities of mice, including the open field test (OFT), light/dark box test (LDT), elevated plus maze test (EPMT), and novelty-suppressed feeding test (NSFT), to determine its anxiolytic effects. Moreover, we assessed the possible mechanisms of the OD-CDs by detecting hormones associated with the hypothalamic-pituitary-adrenal (HPA) axis. Results OD-CDs were spherical and monodispersed with a narrow size distribution between 1 and 5 nm and had a yield of 3.67%. OD-CDs increased the activity time of mice in the central zone in the OFT. The mice in the experimental group showed more frequent activity in the light compartment and the open arms, in LDT and EPMT, respectively. In addition, OD-CDs shortened the feeding latency in the NSFT. Furthermore, the results after OD-CDs intervention showed a significant increase in serum serotonin (5-HT) and norepinephrine (NE). In addition, the concentrations of corticotropin-releasing hormone (CRH), adrenocorticotropic hormone (ATCH), and corticosterone (CORT) were decreased. Conclusion These results demonstrate a definite anxiolytic effect of OD-CDs and reveal the possible mechanism of action of OD-CDs' anxiolytic effect, which supports the research of OD for neurological disorders and a promising new trend of therapeutic approach and drug development.
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Affiliation(s)
- Yumin Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Wei Xiong
- School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
- Institutes of Health Research, Mayinglong Pharmaceutical Group Co., Ltd, Wuhan, Hubei, People’s Republic of China
| | - Ying Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Xue Bai
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Guoliang Cheng
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Yifan Zhang
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Rui Chen
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Yinghui Guo
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Hui Kong
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Yue Zhang
- School of Life Sciences, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Huihua Qu
- Centre of Scientific Experiment, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
| | - Yan Zhao
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, People’s Republic of China
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Landoni M, Silverio SA, Ionio C, Giordano F. Managing Children's Fears during the COVID-19 Pandemic: Strategies Adopted by Italian Caregivers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11699. [PMID: 36141968 PMCID: PMC9517545 DOI: 10.3390/ijerph191811699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Life-threatening events, such as the COVID-19 pandemic, may generate feelings of insecurity and fear in the affected population, particularly children. Parents' ability to help children cope with negative emotions is essential during challenging periods. The current study aims to analyse the coping strategies adopted by Italian caregivers concerning their children's fears about COVID-19. METHOD An online survey was administered during the Italian lockdown to 649 parents of at least one child aged 5 to 17 years old. Respondents completed the survey for themselves and their children. In addition, a qualitative content analysis of the data from the open-ended question was conducted (N = 569; 87.9% women; MAge = 45 years). RESULTS Several themes were identified. Firstly, families' primary approach was 'communication and meaning-making'. Secondly, another essential strategy was 'the importance of safe space', enabled by keeping routine in place and creating a loving and caring environment. Thirdly, other factors relevant to managing children's fears were 'adaptation', 'religion', 'a positive attitude', and 'humour and hope'. Finally, the last two strategies significant and valuable for Italian families were 'flexibility' and 'maintaining virtual contacts. CONCLUSION During the pandemic COVID-19, parents may have used various strategies to protect their children from stress. Future research could investigate single parents' coping strategies explicitly developed during the COVID-19 lockdown.
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Affiliation(s)
- Marta Landoni
- CriDee Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Sergio A. Silverio
- Department of Women & Children’s Health, King’s College London, London SE1 7EH, UK
| | - Chiara Ionio
- CriDee Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
| | - Francesca Giordano
- RiRes Department of Psychology, Università Cattolica del Sacro Cuore, 20123 Milan, Italy
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Weitz N, Opre A. Combining Dance/Movement Therapy with Cognitive Behavioral Therapy in Treatment of Children with Anxiety Disorders: Factors Explaining Therapists' Attitudes. AMERICAN JOURNAL OF DANCE THERAPY 2022; 44:186-209. [PMID: 36124161 PMCID: PMC9472729 DOI: 10.1007/s10465-022-09369-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 12/04/2022]
Abstract
Anxiety disorders (ADs) are among the most common psychiatric disorders and they may appear as early on as in childhood. The current study addressed the combination of two treatments approaches for ADs: Dance/movement therapy (DMT) and cognitive behavioral therapy (CBT), focusing on factors that explain the therapists' attitudes towards actually combining the two therapies. The study utilized a quantitative design, with a perceptions survey administered via an online questionnaire. Ninety-nine therapists participated in the study (DMT-only n = 35, CBT-only n = 42, and DMT + CBT, n = 22). Following preliminary analysis (comparison between the groups, correlations and factor analysis), the structural equation model (SEM, confirmatory factor analysis) revealed a good fit between the theoretical model and the empirical data. First, it was found that the reported actual use of the combined approaches (DMT + CBT) in treatment of children with ADs, was significantly explained by therapists who had experience practicing DMT but not CBT perceiving this combination as efficient. Second, the therapists' use of the combined therapy (DMT + CBT) approaches was not related to their sense of efficacy as therapists of children with ADs. The model represents concordance between the components of the therapists' attitudes: Affective—belief that it is efficient, cognitive—perception of it as effective, and behavioral—their actual use.
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Jewell C, Wittkowski A, Pratt D. The impact of parent-only interventions on child anxiety: A systematic review and meta-analysis. J Affect Disord 2022; 309:324-349. [PMID: 35460744 DOI: 10.1016/j.jad.2022.04.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 02/28/2022] [Accepted: 04/13/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Parent-only interventions for childhood anxiety may be an important alternative to resource and time intensive child-focused cognitive behavioural therapy (CBT). This systematic review and meta-analysis aimed to investigate the efficacy of parent-only interventions in reducing symptoms of anxiety disorders in school-aged children. METHODS A systematic search of five databases (inception to March 2021) identified 29 eligible studies. A range of study designs were captured, including randomised controlled trials (RCTs) and case series. A narrative synthesis was conducted. Random effects meta-analyses were performed on parent- and child-reported outcomes and pre-test post-test effect sizes were calculated for uncontrolled studies. RESULTS Findings indicated a significant treatment effect for parent-only interventions compared to waitlist controls. No significant differences were found when comparing parent-only interventions with other active interventions; anxiety symptoms reduced in both conditions. No significant treatment effects were found for child-rated outcomes. Calculated effect sizes for uncontrolled studies were typically large, although sample sizes were small. No clear evidence was found for a superior type, duration or format of intervention. LIMITATIONS The methodological quality of many studies in this review (19/29) was rated 'weak'. Only English language papers were included. CONCLUSIONS To date, this is the first systematic review and meta-analysis of the efficacy of parent-only interventions for reducing symptoms of child anxiety disorders. Our results suggest that parent-only interventions may be effective in reducing child anxiety. These findings are important for clinical practice because they suggest that efficient, low intensity interventions delivered to parents may lead to positive outcomes for children.
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Affiliation(s)
- C Jewell
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK
| | - A Wittkowski
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health Foundation Trust, Manchester, UK.
| | - D Pratt
- Centre for New Treatments and Understanding in Mental Health, School of Health Sciences, The University of Manchester, UK; Manchester Academic Health Science Centre, Manchester, UK; Greater Manchester Mental Health Foundation Trust, Manchester, UK
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46
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Baartmans JMD, van Steensel FJA, Klein AM, Wiers RWHJ, Bögels SM. The role of parental anxiety symptoms in the treatment of childhood social anxiety disorder. Behav Res Ther 2022; 156:104157. [PMID: 35863242 DOI: 10.1016/j.brat.2022.104157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 06/17/2022] [Accepted: 06/29/2022] [Indexed: 11/28/2022]
Abstract
The study investigated the role of parental anxiety symptoms in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. Participants were 152 children between 7 and 18 years and their parents (146 mothers, 123 fathers). Anxiety was assessed pretreatment, posttreatment, and at three months and one year follow ups. There were no baseline differences in parental anxiety symptoms between the two groups. In both groups parental anxiety symptoms decreased from pretreatment to posttreatment, and only mothers' anxiety symptoms decreased further from posttreatment to the one year follow up. Parental anxiety symptoms before the treatment were not related to the being free of all anxiety diagnoses in the children at posttreatment. However, some indications were found for greater improvements during treatment when parents had higher anxiety symptoms before treatment. Changes in parental anxiety symptoms were found to be related to changes in child anxiety symptoms. This was not found for the total clinical severity of all inclusion anxiety disorders. This relation was visible independently in fathers or mothers, or in groups of children with a primary social anxiety disorder or with another primary anxiety disorder. In conclusion, we did not find clear indications that parental anxiety symptoms explain the differences in treatment outcomes for children with a primary social anxiety disorder compared to children with other primary anxiety disorders. More research with larger samples is needed to draw stronger conclusions.
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Affiliation(s)
- J M D Baartmans
- UvA Minds, Academic Treatment Centre, the Netherlands; Developmental Psychology, University of Amsterdam, the Netherlands.
| | - F J A van Steensel
- Child Development and Education, University of Amsterdam, the Netherlands
| | - A M Klein
- UvA Minds, Academic Treatment Centre, the Netherlands
| | - R W H J Wiers
- Developmental Psychology, University of Amsterdam, the Netherlands
| | - S M Bögels
- Child Development and Education, University of Amsterdam, the Netherlands
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Nissinen NM, Sarkola T, Autti-Rämö I, Gissler M, Kahila H, Koponen AM. Mood and neurotic disorders among youth with prenatal substance exposure: A longitudinal register-based cohort study. J Affect Disord 2022; 308:328-336. [PMID: 35439464 DOI: 10.1016/j.jad.2022.04.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 03/16/2022] [Accepted: 04/09/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prenatal substance exposure is associated with mood and neurotic disorders but this association is complex and understudied. This study investigated the recorded use of specialised healthcare services for mood and neurotic disorders among youth with prenatal substance exposure in comparison with an unexposed matched cohort. Furthermore, the influence of adverse maternal characteristics and out-of-home care (OHC) is investigated. METHODS This longitudinal register-based matched cohort study included 594 exposed and 1735 unexposed youth. Cox proportional hazard regression models were applied to study the first episode of mood and neurotic disorders in specialised healthcare from 13 years of age, and the influence of adverse maternal characteristics and OHC. Mediation analysis was applied to study the mediating effect of OHC on the association between prenatal substance exposure and the disorders. RESULTS The exposed cohort had a two-fold higher likelihood of being treated at specialised healthcare for mood and neurotic disorders compared with the unexposed cohort (HR 2.34, 95% CI 1.86-2.95), but this difference was attenuated to non-significant levels (AHR 1.29, 95% CI 0.92-1.81) following adjustments with adverse maternal characteristics and OHC. OHC mediated 61% (95% CI 0.41-0.94) of the association between prenatal substance exposure and youth's mood and neurotic disorders. LIMITATIONS Register data likely include more severe cases of disorders, and as an observational study, causality cannot be assessed. CONCLUSION Mood and neurotic disorders are more common following prenatal exposure to substances and interlinked with significant adversities in the postnatal caregiving environment and OHC.
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Affiliation(s)
- Niina-Maria Nissinen
- Folkhälsan Research Center, Helsinki, Finland; Tampere University, Faculty of Social Sciences, Health Sciences Unit, Tampere, Finland.
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki, Helsinki University Hospital, Helsinki, Finland; Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Ilona Autti-Rämö
- University of Helsinki, Children's Hospital, Division of Child Neurology, Helsinki, Finland
| | - Mika Gissler
- THL Finnish Institute for Health and Welfare, Information Services Department, Helsinki, Finland; Karolinska Institute, Department of Molecular Medicine and Surgery, Stockholm, Sweden and Region Stockholm, Academic Primary Health Care Centre, Stockholm, Sweden; University of Turku, Research Centre for Child Psychiatry, Turku, Finland
| | - Hanna Kahila
- Department of Obstetrics and Gynaecology, University of Helsinki, Helsinki University Central Hospital, Helsinki, Finland
| | - Anne M Koponen
- Folkhälsan Research Center, Helsinki, Finland; University of Helsinki, Department of Public Health, Helsinki, Finland
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48
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Méndez FJ, Orgilés M, Espada JP, García-Fernández JM, Essau CA. Editorial: Anxiety Disorders in Childhood and Adolescence: Psychopathology, Assessment, and Treatment. Front Psychol 2022; 13:930299. [PMID: 35795416 PMCID: PMC9252446 DOI: 10.3389/fpsyg.2022.930299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 12/05/2022] Open
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49
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Ooi J, Dodd HF, Meiser-Stedman R, Hudson JL, Bridges J, Pass L. The efficacy of interventions for behaviourally inhibited preschool-aged children: A meta-analysis. J Anxiety Disord 2022; 88:102559. [PMID: 35366584 DOI: 10.1016/j.janxdis.2022.102559] [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: 05/17/2021] [Revised: 03/01/2022] [Accepted: 03/19/2022] [Indexed: 10/18/2022]
Abstract
The current systematic review and meta-analyses examined the efficacy of psychological interventions targeting behavioural inhibition and anxiety in preschool-aged children, evaluated within randomised controlled trials. Web of Science, MEDLINE, PsycINFO and CINAHL were systematically searched from inception to March 2021. Ten studies (N = 1475 children, aged 3 - 7 years) were included in the current review. Separate analyses were conducted for behavioural inhibition, anxiety symptoms, and anxiety diagnosis as reported by parents, teachers, and observer-ratings. Pooled outcomes ranged from post-intervention to 12-month follow-up due to the limited number of studies. Meta-analyses revealed that intervention did not reduce behavioural inhibition as assessed by independent observers (SMD = -0.13, 95% CI = -0.63 to.38), but did reduce behavioural inhibition as reported by parents (SMC = -0.64, 95% CI = -1.00 to -0.27) and teachers (SMD = -0.69, 95% CI = -1.02 to -0.36). Additionally, intervention appeared to reduce the risk of anxiety disorders (RR =0.75, 95% CI =0.62 to.90), and parent-report anxiety symptoms (SMC = -0.47, 95% CI = -0.83 to -0.12) in preschool-aged children. Intervention may be efficacious in reducing anxiety in preschool-aged behaviourally inhibited children. It is less clear whether intervention leads to change in BI.
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Affiliation(s)
- Jinnie Ooi
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK; Department of Clinical Psychology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, UK.
| | - Helen F Dodd
- College of Medicine and Health, St Luke's Campus, Heavitree Road, University of Exeter, Exeter EX1 2LU, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Jennifer L Hudson
- Black Dog Institute, University of New South Wales, Hospital Road, Randwick, NSW 2031, Australia
| | - Jessica Bridges
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - Laura Pass
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
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50
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Cao C, Yang S, Sun K, Gu J. Hypothalamic-pituitary-adrenal Axis Multilocus Genetic Variation, Childhood Parenting and Adolescent Anxiety Symptoms: Evidence of Cumulative Polygenic Plasticity. J Youth Adolesc 2022; 51:1597-1610. [PMID: 35474403 DOI: 10.1007/s10964-022-01610-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/27/2022] [Indexed: 11/29/2022]
Abstract
Research suggests that genetic variants that regulate the hypothalamic-pituitary-adrenal (HPA) axis function moderate the association between parenting and anxiety symptoms, but these studies have primarily focused on (i) individual genes with very small and unreliable effect and (ii) the role of mothers as opposed to fathers. Using a multilocus genetic profile score approach, the current study is the first to examine the moderation effect of HPA-axis multilocus genetic variants on the associations of both maternal and paternal parenting with adolescent anxiety symptoms. In a sample of Chinese Han adolescents (N = 772; 50.1% girls; Mage = 16.48 ± 1.40 years, range: 15-20 years), a theory-driven multilocus genetic profile score was computed by counting the numbers of alleles that were previously linked to heightened stress reactivity in six HPA-axis related genes. This HPA-axis related multilocus genetic profile score equivalently interacted with both maternal and paternal parenting in the prediction of adolescent anxiety symptoms. Consistent with cumulative polygenic plasticity hypothesis of differential susceptibility model, adolescents with more versus low alleles linked to heightened stress reactivity not only suffered more from poor maternal or paternal parenting quality, but also benefited more from high maternal or paternal parenting quality. However, none of the individual HPA-axis genes within this multilocus genetic profile score yielded a significant gene-by-environment (G × E) interaction when examined in isolation. The findings survived after internal replication analysis and a novel, valid influence statistic DFBETAS analysis, demonstrating the robustness of the results. The current study highlights the potential value of using a multilocus approach to understand G × E effects underlying anxiety symptoms and emphasizes the role of both mothers and fathers in such gene-parenting interactions, especially in Chinese families.
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Affiliation(s)
- Cong Cao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China.
| | - Shan Yang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Kexin Sun
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Junlian Gu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China
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