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Lawrence PJ, Harvey K, Williams C, Creswell C. Barriers and facilitators to targeted anxiety prevention programmes in families at risk: a qualitative interview study. Eur Child Adolesc Psychiatry 2022; 31:565-575. [PMID: 33346882 PMCID: PMC9034995 DOI: 10.1007/s00787-020-01703-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 12/07/2020] [Indexed: 12/24/2022]
Abstract
Anxiety disorders are the most common psychiatric disorder in children and young people. They can be prevented in those at risk, but families do not always take up opportunities to participate in prevention programmes. This qualitative study aimed to understand what families with children who were at prospective risk of anxiety disorders perceived to be the barriers to access to targeted anxiety prevention programmes, and to explore what would help facilitate access. We used Information Power to determine our sample size, and individually interviewed seven young people (14-17 years) who had anxiety disorders and their mothers, each of whom had pre-natal anxiety disorders. We transcribed all interviews and thematically analyzed them to identify perceived barriers and facilitators to targeted anxiety prevention programmes. Perceived potential barriers to access included possible negative consequences of anxiety prevention, difficulties in identifying anxiety as a problem and concerns about how professions would respond to raising concerns about anxiety. Possible facilitators included promoting awareness of anxiety prevention programmes and involvement of schools in promotion and delivery of prevention. Our findings illustrate that implementation of targeted anxiety prevention could be improved through (i) the provision of tools for parents to recognize anxiety in their children as a problem, (ii) promotion of awareness, as well as delivery, of anxiety prevention via schools and (iii) the involvement of parents and possibly adolescents in the intervention programme, but not younger children.
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Affiliation(s)
- P J Lawrence
- School of Psychology, University of Southampton, Southampton, UK.
| | - K Harvey
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - C Williams
- Department of Experimental Psychology , University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
| | - C Creswell
- Department of Experimental Psychology , University of Oxford, Oxford, UK
- Department of Psychiatry, University of Oxford, Oxford, UK
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Porritt J, Rodd H, Morgan A, Williams C, Gupta E, Kirby J, Creswell C, Newton T, Stevens K, Baker S, Prasad S, Marshman Z. Development and Testing of a Cognitive Behavioral Therapy Resource for Children's Dental Anxiety. JDR Clin Trans Res 2016; 2:23-37. [PMID: 28879243 DOI: 10.1177/2380084416673798] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cognitive Behavioral Therapy (CBT) is an evidence-based treatment for dental anxiety; however, access to therapy is limited. The current study aimed to develop a self-help CBT resource for reducing dental anxiety in children, and to assess the feasibility of conducting a trial to evaluate the treatment efficacy and cost-effectiveness of such an intervention. A mixed methods design was employed. Within phase 1, a qualitative "person-based" approach informed the development of the self-help CBT resource. This also employed guidelines for the development and evaluation of complex interventions. Within phase 2, children, aged between 9 and 16 y, who had elevated self-reported dental anxiety and were attending a community dental service or dental hospital, were invited to use the CBT resource. Children completed questionnaires, which assessed their dental anxiety and health-related quality of life (HRQoL) prior to and following their use of the resource. Recruitment and completion rates were recorded. Acceptability of the CBT resource was explored using interviews and focus groups with children, parents/carers and dental professionals. For this analysis, the authors adhered to the Mixed Methods Appraisal Tool criteria. There were 24 families and 25 dental professionals participating in the development and qualitative evaluation of the CBT resource for children with dental anxiety. A total of 56 children agreed to trial the CBT resource (66% response rate) and 48 of these children completed the study (86% completion rate). There was a significant reduction in dental anxiety (mean score difference = 7.7, t = 7.9, df = 45, P < 0.001, Cohen's d ES = 1.2) and an increase in HRQoL following the use of the CBT resource (mean score difference = -0.03, t = 2.14, df = 46, P < 0.05, Cohen's d ES = 0.3). The self-help approach had high levels of acceptability to stakeholders. These findings provide preliminary evidence for the effectiveness and acceptability of the resource in reducing dental anxiety in children and support the further evaluation of this approach in a randomized control trial. Knowledge Transfer Statement: This study details the development of a guided self-help Cognitive Behavioral Therapy resource for the management of dental anxiety in children and provides preliminary evidence for the feasibility and acceptability of this approach with children aged between 9 and 16 y. The results of this study will inform the design of a definitive trial to examine the treatment- and cost-effectiveness of the resource for reducing dental anxiety in children.
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Affiliation(s)
- J Porritt
- Department of Psychology, Sociology, and Politics, Sheffield Hallam University, Collegiate Crescent, Sheffield, UK
| | - H Rodd
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - A Morgan
- Paediatric Dentistry Department, Charles Clifford Dental Hospital, Sheffield, UK
| | - C Williams
- Institute of Health and Wellbeing, Mental Health and Wellbeing, University of Glasgow, Administration Building, Gartnavel Royal Hospital, Glasgow, UK
| | - E Gupta
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - J Kirby
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - C Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Whiteknights, Reading, Berkshire, UK
| | - T Newton
- Oral Health Services Research & Dental Public Health, King's College London, Denmark Hill Campus, Caldecot Road, London, UK
| | - K Stevens
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, Sheffield, UK
| | - S Baker
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
| | - S Prasad
- Derbyshire Community Health Services, Long Eaton Dental Clinic, UK
| | - Z Marshman
- School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield, UK
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Roberts S, Lester KJ, Hudson JL, Rapee RM, Creswell C, Cooper PJ, Thirlwall KJ, Coleman JRI, Breen G, Wong CCY, Eley TC. Serotonin transporter [corrected] methylation and response to cognitive behaviour therapy in children with anxiety disorders. Transl Psychiatry 2014; 4:e444. [PMID: 25226553 PMCID: PMC4203012 DOI: 10.1038/tp.2014.83] [Citation(s) in RCA: 73] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 07/26/2014] [Indexed: 01/19/2023] Open
Abstract
Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35-45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT.
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Affiliation(s)
- S Roberts
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - K J Lester
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - J L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - R M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - C Creswell
- Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - P J Cooper
- Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK,Department of Psychology, Stellenbosch University, Western Cape, South Africa
| | - K J Thirlwall
- Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - J R I Coleman
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - G Breen
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - C C Y Wong
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK
| | - T C Eley
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, King's College London, London UK,MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Kings College London, Box PO80, SGDP Centre, 16 De Crespigny Park, London SE5 8AF, UK. E-mail:
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Eley TC, Hudson JL, Creswell C, Tropeano M, Lester KJ, Cooper P, Farmer A, Lewis CM, Lyneham HJ, Rapee RM, Uher R, Zavos HMS, Collier DA. Therapygenetics: the 5HTTLPR and response to psychological therapy. Mol Psychiatry 2012; 17:236-7. [PMID: 22024766 PMCID: PMC3272476 DOI: 10.1038/mp.2011.132] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Abstract
We present an integrative review of the development of child anxiety, drawing on a number of strands of research. Family aggregation and genetic studies indicate raised vulnerability to anxiety in offspring of adults with the disorder (e.g. the temperamental style of behavioural inhibition, or information processing biases). Environmental factors are also important; these include adverse life events and exposure to negative information or modelling. Parents are likely to be key, although not unique, sources of such influences, particularly if they are anxious themselves. Some parenting behaviours associated with child anxiety, such as overprotection, may be elicited by child characteristics, especially in the context of parental anxiety, and these may serve to maintain child disorder. Emerging evidence emphasizes the importance of taking the nature of child and parental anxiety into account, of constructing assessments and interventions that are both disorder specific, and of considering bidirectional influences.
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Affiliation(s)
- L Murray
- Winnicott Research Unit, School of Psychology, University of Reading, Reading, UK.
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Abstract
OBJECTIVE The cognitive-behavioral model of chronic fatigue syndrome (CFS) proposes that rigidly held beliefs act to defend individuals against low self-esteem. This study is the first to investigate the prevalence of a potential mechanism, the Defensive High Anxious coping style, among individuals with CFS. METHODS The study comprised 68 participants (24 CFS; 24 healthy volunteers; 20 chronic illness volunteers). Participants completed the Bendig short form of the Taylor Manifest Anxiety Scale (B-MAS) and the Marlowe-Crowne Social Desirability Scale (MC) in order to ascertain the distribution of participants in each group within the four coping styles defined by Weinberger et al. [J. Abnorm. Psychol. 88 (1979) 369]. RESULTS A greater number of participants in the CFS group (46%) were classified as Defensive High Anxious compared to the two comparison groups [chi(2)(2)=8.84, P=.012]. CONCLUSION This study provides support for the existence of defensive coping mechanisms as described by the cognitive-behavioral model of CFS. Furthermore, it has been suggested that this particular coping style may impinge directly on physical well being through similar mechanisms as identified in CFS, and further research linking these areas of research is warranted.
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Affiliation(s)
- C Creswell
- Sub-Department of Clinical Health Psychology, University College London, Gower Street, WC1E 6BT, London, UK.
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Bishop DV, Aamodt-Leeper G, Creswell C, McGurk R, Skuse DH. Individual differences in cognitive planning on the Tower of Hanoi task: neuropsychological maturity or measurement error? J Child Psychol Psychiatry 2001; 42:551-6. [PMID: 11383971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The Tower of Hanoi (ToH) task was given to 238 children aged from 7 to 15 years, and 20 adults. Individual variation within an age band was substantial. ToH score did not correlate significantly with Verbal IQ, nor with ability to inhibit a prepotent response. We readministered the ToH to 45 children after 30 to 40 days. The test-retest correlation of .5 is low in relation to accepted psychometric standards, though at least as high as reliability of the related Tower of London (ToL) in adults. The reasons for low reliability remain unclear: task novelty did not seem to be involved, as children did not improve on retest. We conclude that it is not safe to use this test to index integrity or maturation of underlying neurological systems in children. We compared our results with three published studies using the ToL with children, and found similar levels of performance on problems involving the same number of moves. Another study using automated ToL obtained much poorer scores, suggesting that computerised presentation may impair children's performance.
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Affiliation(s)
- D V Bishop
- Department of Experimental Psychology, University of Oxford, UK.
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Skuse DH, James RS, Bishop DV, Coppin B, Dalton P, Aamodt-Leeper G, Bacarese-Hamilton M, Creswell C, McGurk R, Jacobs PA. Evidence from Turner's syndrome of an imprinted X-linked locus affecting cognitive function. Nature 1997; 387:705-8. [PMID: 9192895 DOI: 10.1038/42706] [Citation(s) in RCA: 523] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Turner's syndrome is a sporadic disorder of human females in which all or part of one X chromosome is deleted. Intelligence is usually normal but social adjustment problems are common. Here we report a study of 80 females with Turner's syndrome and a single X chromosome, in 55 of which the X was maternally derived (45,X[m]) and in 25 it was of paternal origin (45,X[p]). Members of the 45,X[p] group were significantly better adjusted, with superior verbal and higher-order executive function skills, which mediate social interactions. Our observations suggest that there is a genetic locus for social cognition, which is imprinted and is not expressed from the maternally derived X chromosome. Neuropsychological and molecular investigations of eight females with partial deletions of the short arm of the X chromosome indicate that the putative imprinted locus escapes X-inactivation, and probably lies on Xq or close to the centromere on Xp. If expressed only from the X chromosome of paternal origin, the existence of this locus could explain why 46,XY males (whose single X chromosome is maternal) are more vulnerable to developmental disorders of language and social cognition, such as autism, than are 46,XX females.
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Affiliation(s)
- D H Skuse
- Behavioural Sciences Unit, Institute of Child Health, London, UK.
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Abstract
Analyzing the results of the first 110 interviews from the Rehabilitation Engineering Research Center on Aging's Consumer Assessments Project, this study examined subjects' responses to the question, "Can you think of a device you would like to have that you haven't been able to find--a device that may not have yet been developed?" Each response was compared to the results of a Hyper-ABLEDATA search for similar existing products. When asked to propose a new device, 43 subjects (39% of the sample) responded with suggestions. In all instances, however, the respondents suggested devices that are already available. These findings indicate that subjects did not have up-to-date or complete information on the assistive devices that could improve their quality of life.
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Affiliation(s)
- W C Mann
- Rehabilitation Engineering Research Center on Aging, University at Buffalo, NY 14214, USA
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Bertozzi W, Hynes M, Sargent C, Creswell C, Dunn P, Hirsch A, Leitch M, Norum B, Rad F, Sasanuma T. Focal plane instrumentation: A very high resolution MWPC system for inclined tracks. ACTA ACUST UNITED AC 1977. [DOI: 10.1016/0029-554x(77)90639-5] [Citation(s) in RCA: 130] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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