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In light of concerning evidence that many young people with mental disorders are not receiving appropriate mental health intervention, school-based mental health screening has been advocated as one way to improve identification of at-risk youth. Despite having much promise, universal screening in schools remains a relatively uncommon practice internationally. Various barriers that deter school psychologists and counsellors from screening have been identified, including lack of resourcing to implement screening, lack of knowledge about the mechanics of how to carry out a screening program, and concern about how to manage the anticipated increased workload generated by following up identified students. In this practice-based paper we discuss a four-stage process that guides school psychologists and counsellors in the establishment of a school-based screening program, with specific reference to overcoming perceived barriers.
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.
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.
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.
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.
Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior to verbally-based CBT (VB-CBT) on pre-registered outcomes.
A randomized controlled trial of IE-CBT v. VB-CBT for social anxiety was completed in a community mental health clinic setting. Participants were randomized to IE (n = 53) or VB (n = 54) CBT, with 1-month (primary end point) and 6-month follow-up assessments. Participants completed 12, 2-hour, weekly sessions of IE-CBT or VB-CBT plus 1-month follow-up.
Intention to treat analyses showed very large within-treatment effect sizes on the social interaction anxiety at all time points (ds = 2.09–2.62), with no between-treatment differences on this outcome or clinician-rated severity [1-month OR = 1.45 (0.45, 4.62), p = 0.53; 6-month OR = 1.31 (0.42, 4.08), p = 0.65], SAD remission (1-month: IE = 61.04%, VB = 55.09%, p = 0.59); 6-month: IE = 58.73%, VB = 61.89%, p = 0.77), or secondary outcomes. Three adverse events were noted (substance abuse, n = 1 in IE-CBT; temporary increase in suicide risk, n = 1 in each condition, with one being withdrawn at 1-month follow-up).
Group IE-CBT and VB-CBT were safe and there were no significant differences in outcomes. Both treatments were associated with very large within-group effect sizes and the majority of patients remitted following treatment.
Modifiable factors associated with increased risk of cognitive decline include emotional (anxiety, depression), cognitive (low social and mental stimulation), and health factors (smoking, alcohol use, sedentary lifestyle, obesity). Older adults with anxiety and depression may be at heightened risk due to direct and indirect impacts of emotional distress on cognitive decline.
Randomized controlled trial
Community sample attending a university clinic. Participants: 27 participants (female = 20) aged over 65 years (M = 72.56, SD = 6.74) with an anxiety and/or mood disorder. Interventions: two cognitive behavioral therapy (CBT) interventions (face-to-face or low intensity) that targeted emotional, health, and cognitive risks for cognitive decline.
Participants completed diagnostic interviews; self-report measures of anxiety, depression, quality of life, and lifestyle factors at baseline; post-treatment; and 3-month follow-up.
Both interventions resulted in significant and sustained improvements in depression, anxiety, quality of life, and physical and social activity. At post-treatment, face-to-face CBT demonstrated significantly greater improvements in emotional symptoms, alcohol use, and memory (exercise approached significance). At 3-month follow-up, gains were maintained and there were significantly greater increases in mental activity for face-to-face CBT, with social activity approaching significance. Conclusions: This study demonstrates the feasibility of CBT interventions to reduce emotional as well as lifestyle risk factors associated with cognitive decline in at-risk older participants. Large studies are needed to evaluate the long-term impact on cognitive decline. The trial was registered with the Australian and New Zealand Clinical Trials Registry (Trial Registration No. ACTRN12618000939291).
Objective: This pilot study explored the feasibility and preliminary efficacy of a therapist-facilitated telecare cognitive behavioural anxiety program delivered through schools to children within rural communities. Method: Sixteen children aged 9–12 years (82.5% male), with a principal diagnosis of an anxiety disorder, and their mothers participated in the pilot study. The treatment program was an adaption of the Cool Kids Child and Adolescent Anxiety Management Program. Treatment was delivered by clinical psychologists and involved 10 weekly sessions with children via an interactive, real-time videoconferencing online platform at their school. Parents also received 4 phone calls during the treatment program. Outcome measures included clinician-rated diagnostic status and child- and parent-reported symptoms and interference. Results: According to combined parent and child reports, 62.5% of children no longer met diagnostic criteria for their primary anxiety disorder, and 31.25% did not meet diagnostic criteria for any anxiety disorder post-treatment. Results indicated that the severity of anxiety symptoms, functional impact of anxiety symptoms, externalising difficulties, and depressive symptoms in children decreased significantly post-treatment, as reported by both parents and children. Conclusions: A telecare model of therapy could be a feasible and effective way of delivering evidence-based intervention to children in rural communities.
This study examined factors influencing parent willingness to use D-Cycloserine (DCS) for treating child anxiety. N = 222 parents were given information about using DCS to treat anxiety. They were then asked to rate their willingness to allow their child to take DCS/antibiotics for mild anxiety, severe anxiety, or an infection. The associations between willingness to use DCS and parental trait anxiety, demographics, as well as specific concerns regarding the medication, were examined. Parents could also provide written responses regarding their attitudes to DCS, which were analysed for themes. Parents reported concerns regarding potential side-effects from DCS. More severe anxiety was associated with more willingness to consent; however, parents were more willing to use antibiotics to treat an infection than DCS to treat their child's anxiety. The degree of perceived benefit from DCS was most strongly associated with parents’ willingness to use it. Overall, parents expressed mixed views, reporting they would consider using DCS to treat their child; however, they had significant concerns about it. Results suggest providing parents with information explaining how DCS works, its risks and potential benefits may increase its acceptability.
Anxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent.
To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980).
Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up.
No variants passed a genome-wide significance threshold (P=5×10–8) in either analysis. Four variants met criteria for suggestive significance (P<5×10–6) in association with response post-treatment, and three variants in the 6-month follow-up analysis.
This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.
We previously reported an association between 5HTTLPR genotype and
outcome following cognitive–behavioural therapy (CBT) in child anxiety
(Cohort 1). Children homozygous for the low-expression short-allele
showed more positive outcomes. Other similar studies have produced mixed
results, with most reporting no association between genotype and CBT
To replicate the association between 5HTTLPR and CBT outcome in child
anxiety from the Genes for Treatment study (GxT Cohort 2,
n = 829).
Logistic and linear mixed effects models were used to examine the
relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both
cohorts were performed.
There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2.
Mega-analyses identified a significant association between 5HTTLPR and
remission from all anxiety disorders at follow-up (odds ratio 0.45,
P = 0.014), but not primary anxiety disorder
The association between 5HTTLPR genotype and CBT outcome did not
replicate. Short-allele homozygotes showed more positive treatment
outcomes, but with small, non-significant effects. Future studies would
benefit from utilising whole genome approaches and large, homogenous
Positive reappraisal is an important cognitive strategy for older adults associated with wide-ranging improvements in psychological well-being. However, little is known about the relationship between positive reappraisal and positive and negative emotion, anxiety and depression, and whether positive reappraisal is associated with continued increases in positive emotion over time.
In the first study, 61 participants aged 62 to 88 years (M = 72, SD = 5.8) completed current measures of cognitive emotion regulation, positive emotion, negative emotion, anxiety and depression regarding their most distressing aging-related adverse life event, and rated (retrospectively) positive reappraisal use at the time of the stressor. Utilizing a longitudinal design, in a second study 60 participants aged 62 to 88 years (M = 71.2, SD = 5.7) completed the same measures for a recent adverse life event and repeated the measures 3 and 6 months later.
In the first study, positive reappraisal reported for both time periods was significantly correlated with current positive emotion, but not negative emotion with mixed findings for anxiety and depression, and positive reappraisal use increased with time since stressor onset. In the second study, positive reappraisal was significantly correlated with positive emotion and significantly predicted positive emotion from 3-month to 6-month follow-up, and was related to anxiety and depression but not general negative emotion.
These findings indicate that positive reappraisal is related to positive emotion but not consistently with negative emotion, and continues to be beneficial over time in older adults who have experienced a stressor.
Cognitive processes are considered integral to the conceptualisation of emotional disorders and distress. Contemporary models have emphasised the importance of individual differences in the interpretation of internal events, including emotions. Maladaptive beliefs about emotional experience may motivate unhelpful control strategies, and impact negatively on psychological wellbeing. Building on existing measures of emotion, an integrative scale was developed to assess a range of maladaptive beliefs about the experience of negative emotions. Psychometric evaluation provided preliminary support for the reliability and validity of the Affect Intolerance Scale (AIS). Furthermore, the scale demonstrated a unique relationship with clinical symptomatology (i.e., depression, anxiety, stress and worry) above and beyond existing measures assessing dimensions of emotional experience. Potential utility of the measure for clinical practice and avenues for future research are discussed.
The purpose of this study was to test whether children and adolescents with anxiety disorders exhibit selective processing of threatening facial expressions in a pictorial version of the emotional Stroop paradigm. Participants named the colours of filters covering images of adults and children displaying either a neutral facial expression or one displaying the emotions of anger, disgust, or happiness. A delay in naming the colour of a filter implies attentional capture by the facial expression. Anxious participants, relative to control participants, exhibited slower colour naming overall, implying greater proneness to distraction by social cues. Children exhibited longer colour-naming latencies as compared to adolescents, perhaps because young children have a limited ability to inhibit attention to distracting stimuli. Adult faces were associated with slower colour naming than were child faces, irrespective of facial expressions in both groups, possibly because adults provide especially salient cues for children and adolescents. Inconsistent with prediction, participants with anxiety disorders were not slower than healthy controls at naming the colours of filters covering threatening expressions (i.e., anger and disgust) relative to filters covering faces depicting happy or neutral expressions.
Self-help for social phobia has not received controlled empirical evaluation.
To evaluate the efficacy of pure self-help through written materials for severe social phobia and self-help augmented by five group sessions with a therapist. These conditions were compared with a waiting-list control and standard, therapist-led group therapy.
Participants with severe generalised social phobia (n=224) were randomised to one of four conditions. Assessment included diagnoses, symptoms and life interference at pretreatment, 12 weeks and at 24 weeks.
A larger percentage of patients no longer had a diagnosis of social phobia at post-intervention in the pure self-help group than in the waiting-list group, although this percentage decreased slightly over the next 3 months. Symptoms of social anxiety and life interference did not differ significantly between these groups. Augmented self-help was better than waiting list on all measures and did not differ significantly from group treatment.
Self-help augmented by therapist assistance shows promise as a less resource-intensive method for the management of social phobia. Pure self-help shows limited efficacy for this disorder.
This study assessed the relative merits of sociodemographic variables and psychological variables in understanding women's fear of rape. A comprehensive understanding of the factors involved in women's fear of rape may allow for more effective interventions with women. Four hundred and eleven women, aged 18 years or older participated in the study, which surveyed their fear of rape and experience of rape. In agreement with previous findings, sociodemographic variables contributed significantly but relatively little (13%) to the variance in women's fear of rape. In contrast, psychological factors (perceived likelihood of being raped and perceived severity of consequences) predicted an additional 29% of the variance to this fear. Greater perceived likelihood of being raped functioned as a partial mediating variable between sociodemographic factors of age and relationship status and women's fear of rape. These results are encouraging as psychological models provide more avenues for restructuring such fear and modifying concordant, dysfunctional behaviours. Consequently, these results provide direction to intervention and education programs aimed at reducing women's fear of rape.
There is evidence suggesting that obsessive–compulsive disorder (OCD) in adults may be associated with an impaired ability to recognise the facial expression of disgust (Sprengelmeyer et al., 1997a; Woody, Corcoran, & Tolin, in press). It has been suggested that this impairment begins in childhood when the recognition of emotional expressions is being learnt (see Spengelmeyer et al., 1997a). This study compared the recognition of facial affect in children aged around 11 years with a diagnosis of obsessive–compulsive disorder (OCD; n = 11), other anxiety disorders (n = 20), and nonclinical children (n = 19), adapting the methodology of Sprengelmeyer et al. Disgust was most commonly misclassified as anger by children in all three groups. However, children with OCD did not show any evidence of a recognition deficit for disgust in comparison to either control group. Unexpectedly, however, children with OCD recognised expressions of surprise more accurately than nonclinical children. Recognition of disgust or any other emotion was not related to child self-reported anxiety symptoms. Given the observed differences in some studies with adults, future research may benefit by examining older adolescents and young adults to determine when these effects may first be noticed.
Despite the popular belief that chocolate adversely affects young children's behaviour, there have been no direct investigations into the behavioural response to chocolate consumption. This study investigated the effect of chocolate ingestion on the behaviour of 26 preschool children. Dried fruit was consumed in a separate condition to control for nonspecific factors, such as excitement and novelty, associated with the effects of receiving positive substances. Children were observed while they listened to a short story, immediately before and 30 minutes after they ate chocolate or fruit. The children's behaviours were videotaped and scored by two blind raters who coded their behaviours according to six objective and two subjective measures. There were no significant behavioural changes due to consumption of either chocolate or fruit on subjective and objective ratings. These findings raise questions about the popular perception that chocolate promotes poor attention and increased activity in preschool children.
Parents of children with anxiety disorders (n = 45) and parents of nonclinical children (n = 33) were interviewed regarding the rearing of two children in their family. The purpose of the study was to determine whether overprotective parenting, according to parent report, occurs specifically in the context of relationships with the anxiety-disordered child or whether parents also perceive themselves to be overprotective of the anxious child's sibling. Self-reports of overprotection by parents of anxious children were also compared to self-reports of overprotection by parents of nonclinical children. Mothers in the clinical group were more likely to report that they were more protective of the anxious child than they were to report being either more protective of the sibling or equally protective of both children. Both mothers and fathers in the clinical group were no more likely than nonclinical parents to perceive themselves as being more protective overall than other parents.