Disorders - Anxiety Disorders
Sun, M., Rith-Najarian, L. R., Williamson, T. J., Chorpita, B. F.
Our aim was to investigate whether four treatment features (i.e., the inclusion of parental involvement, goal-setting strategies, maintenance/relapse prevention sessions, the addition of booster sessions) were associated with posttreatment and follow-up effect size of youth cognitive behavioral therapies (yCBTs) for anxiety, depression, posttraumatic stress disorder, and obsessive-compulsive disorder in age groups spanning young children to adolescents. We conducted a random-effects meta-analysis of 106 yCBTs tested in 76 randomized clinical trials from the PracticeWise Database to examine average effects of yCBTs posttreatment and at a later follow-up assessment. We coded the use of parental involvement, goal setting, booster sessions, and maintenance/relapse prevention in each yCBT and conducted random-effects meta-regression analyses to investigate whether these treatment features were associated with yCBT effects at posttreatment as well as at follow-up. Overall, yCBTs produced large pre- to posttreatment effects (d = 1.05), 95% confidence interval [0.94, 1.15], and larger pre- to follow-up effects (d = 1.29), 95% confidence interval [1.18, 1.40]. Metaregression results indicated that parental involvement was significantly associated with larger pre- to posttreatment effect sizes as well as pre- to follow-up effect sizes. Booster sessions, goal setting, and maintenance/relapse prevention were not significantly related to effect sizes at posttreatment or follow-up. Parental involvement may be helpful for maximizing long-term effectiveness of yCBT. Future studies should investigate for whom and under what conditions inclusion of yCBT treatment features is related to the durability of treatment gains.
Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 48(Supplement1) : S269-S283
- Year: 2019
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
, Relapse prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other service delivery and improvement interventions
Crane, M. F., Boga, D., Karin, E., Gucciardi, D. F., Sinclair, L.
Objective: This group-randomized control trial examined the efficacy of guided coping and emotion regulatory self-reflection as a means to strengthen resilience by testing the effects of the training on anxiety and depression symptoms and perceived stressor frequency after an intensive stressor period. Method(s): The sample was 226 officer cadets training at the Royal Military College, Australia. Cadets were randomized by platoon to the self-reflection (n = 130) or coping skills training (n = 96). Surveys occurred at 3 time points: Baseline, immediately following the final reflective session (4-weeks postbaseline), and longer-term follow-up (3-months postinitial follow-up). Result(s): There were no significant baseline differences in demographic or outcome variables between the intervention groups. On average, cadets commenced the resilience training with mild depression and anxiety symptoms. Analyses were conducted at the individual-level after exploring group-level effects. No between-groups differences were observed at initial follow-up. At longer-term follow-up, improvements in mental health outcomes were observed for the self-reflection group, compared with the coping skills group, on depression (Cohen's d = 0.55; 95% CI [0.24, 0.86]), anxiety symptoms (Cohen's d = 0.69; 95% CI [0.37, 1.00]), and perceived stressor frequency (Cohen's d = 0.46; 95% CI [0.15, 0.77]). Longitudinal models demonstrated a time by condition interaction for depression and anxiety, but there was only an effect of condition for perceived stressor frequency. Mediation analyses supported an indirect effect of the intervention on both anxiety and depression via perceived stressor frequency. Conclusion(s): Findings provide initial support for the use of guided self-reflection as an alternative to coping skills approaches to resilience training. Copyright © 2019 American Psychological Association.
Journal of Consulting and Clinical Psychology, 87(2) : 125-140
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Skills training, Other Psychological Interventions
Wolpert, M., Dalzell, K., Ullman, R., Garland, L., Cortina, M., Hayes, D., Patalay, P., Law, D.
This Review reports on a scoping review followed by a systematic review to consider interventions designed to address or manage depression or anxiety in children and young people up to the age of 25 years without the need to involve mental health professionals. The scoping review identified 132 approaches, 103 of which referred to children or young people (younger than 25 years). These approaches included social interaction, engagement with nature, relaxation, distraction, sensory stimulation, physical activity, altering perceptions, engaging in hobbies, self-expression, and exploration. A systematic review of effectiveness studies from the literature identified in the scoping review found only 38 studies on seven types of intervention that met the inclusion criteria. 16 studies were based on cognitive or behavioural principles (15 on digital interventions and one on bibliotherapy), ten focused on physical exercise, five on light therapy, three on dietary supplements, two on massage therapy, one on online peer support, and one on contact with a dog. Most studies focused on adolescents or young adults. Evidence suggested that light therapy could be effective for season depression and that digital interventions based on attention bias modification are ineffective for anxiety. Mixed evidence was available on the effectiveness of computerised cognitive behavioural therapy for depression and anxiety, and of physical exercise for depression. All other studies had insufficient certainty to obtain even tentative conclusions about effectiveness. These results highlight the disparity between the extensive range of approaches identified in the scoping review and the restricted number and focus found in the systematic review of effectiveness of these approaches. We call for an expanded research agenda that brings evaluation rigour to a wide range of self or community approaches. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
The Lancet Psychiatry, 6(1) : 46-60
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Service Delivery & Improvement, Psychological Interventions (any)
, Other complementary & alternative interventions
, Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement interventions
Davenport, C., Arentz, S., Sekyere, E., Steel, A.
Higher education students are at increased risk of stress. Self-care and clinical prescription of vitamin supplements is common. B-Vitamins are often indicated due to their co-enzymatic roles in glucose metabolism and maintenance of healthy nervous system function. Activated-B-Vitamins are a new generation of B-Vitamins with theoretical advantages. However, there's limited evidence comparing the effects of Standard-B-Vitamins with Activated-B-Vitamins. This RCT compared the effectiveness of Activated-B-Vitamins against Standard-B-Vitamins over three-weeks on stress, anxiety, fatigue and depression in students. Interventions were supplied by Herbs-of-Gold and 133-tertiary-students were randomised to Standard-B-Complex "Mega-B-Complex" or Activated-B-Complex "Activated-B-Complex". Primary outcome was stress according to Depression-Anxiety-Stress-Scale (DASS21). Secondary outcomes were anxiety, depression and fatigue according to the DASS21 and Fatigue-Severity-Scale (FSS). Feasibility was evaluated through recruitment from Endeavour's Sydney Campus, retention and acceptability. Participants were randomised to one of two parallel groups. There were no differences between groups at baseline for student demographics, course/year-of-study, dietetics or mean scores for stress, anxiety, fatigue and depression. At three-weeks, a significant difference between groups was found for the primary outcome of stress (p = 0.005) favouring Standard-B-Vitamin. The mean score of the Standard-B-Group was 11.6 +/- 6.7 compared to 15.3 +/- 7.9 in the Activated-B-Group. No difference between groups was found for anxiety, fatigue or depression. However, both groups reported improvement over time with a higher proportion of participants moving into the 'normal' category for anxiety and depression. There were four adverse reactions, however no serious or unresolved adverse effects. This trial provides evidence for the superior effectiveness of Standard-B-Vitamins compared to Activated-B-Vitamins for reducing stress in students. Copyright © 2019
Advances in Integrative Medicine, 6 (Supplement 1) : S121
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Vitamins and supplements
Brown, J. S., Blackshaw, E., Stahl, D., Fennelly, L., McKeague, L., Sclare, I., Michelson, Daniel
Introduction: Schools may provide a convenient intervention setting for young people with mental health problems generally, as well as for those who are unwilling or unable to access traditional clinic-based mental health services. However, few studies focus on older adolescents, or those from ethnic minority groups. This study aims to assess the feasibility of a brief school-based psychological intervention for self-referred adolescents aged 16-19 years. Methods: A two-arm cluster randomised controlled trial was conducted in 10 inner-city schools with block randomisation of schools. The intervention comprised a one-day CBT Stress management programme with telephone follow-up (DISCOVER) delivered by 3 psychology (2 clinical and 1 assistant) staff. The control was a waitlist condition. Primary outcomes were depression (Mood and Feelings Questionnaire; MFQ) and anxiety (Revised Child Anxiety and Depression Scale; RCADS-anxiety subscale). Data were analysed descriptively and quantitatively to assess feasibility. Results: 155 students were enrolled and 142 (91.6%) followed up after 3 months. Participants were predominantly female (81%) and the mean age was 17.3 years, with equal numbers enrolled from Year 12 and Year 13. Over half (55%) of students were from ethnic minority groups. Intraclass correlations were low. Variance estimates were calculated to estimate the sample size for a full RCT. Preliminary outcomes were encouraging, with reductions in depression (d = 0.27 CI-0.49 to -0.04, p = 0.021) and anxiety (d = 0.25, CI-0.46 to -0.04, p = 0.018) at follow-up. Conclusions: Results support the feasibility of a school-based, self-referral intervention with older adolescents in a definitive future full-scale trial (Trial no. ISRCTN88636606). (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Adolescence, 71 : 150-161
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Dunning, D. L., Griffiths, K., Kuyken, W., Crane, C., Foulkes, L., Parker, J., Dalgleish, T.
BACKGROUND: Mindfulness based interventions (MBIs) are an increasingly popular way of attempting to improve the behavioural, cognitive and mental health outcomes of children and adolescents, though there is a suggestion that enthusiasm has moved ahead of the evidence base. Most evaluations of MBIs are either uncontrolled or nonrandomized trials. This meta-analysis aims to establish the efficacy of MBIs for children and adolescents in studies that have adopted a randomized, controlled trial (RCT) design. METHOD(S): A systematic literature search of RCTs of MBIs was conducted up to October 2017. Thirty-three independent studies including 3,666 children and adolescents were included in random effects meta-analyses with outcome measures categorized into cognitive, behavioural and emotional factors. Separate random effects meta-analyses were completed for the seventeen studies (n = 1,762) that used an RCT design with an active control condition. RESULT(S): Across all RCTs we found significant positive effects of MBIs, relative to controls, for the outcome categories of Mindfulness, Executive Functioning, Attention, Depression, Anxiety/Stress and Negative Behaviours, with small effect sizes (Cohen's d), ranging from .16 to .30. However, when considering only those RCTs with active control groups, significant benefits of an MBI were restricted to the outcomes of Mindfulness (d = .42), Depression (d = .47) and Anxiety/Stress (d = .18) only. CONCLUSION(S): This meta-analysis reinforces the efficacy of using MBIs for improving the mental health and wellbeing of youth as assessed using the gold standard RCT methodology. Future RCT evaluations should incorporate scaled-up definitive trial designs to further evaluate the robustness of MBIs in youth, with an embedded focus on mechanisms of action. Copyright © 2018 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
Journal of child psychology and psychiatry, and allied disciplines, 60(3) : 244-258
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Mindfulness based therapy
Albanese, B. J., Bauer, B. W., Raudales, A. M., Capron, D. W., Schmidt, N. B.
Background: Anxiety sensitivity cognitive concerns (ASCC), or fear of cognitive dyscontrol sensations, confers risk for anxiety and mood psychopathology. Recent work demonstrated that novel perceptual challenges generated by a head mounted display can elicit fear among those with elevated ASCC. This suggests that interoceptive exposure to perceptual challenges may offer a means to mitigate ASCC. This study was designed to evaluate whether repeated exposure to novel perceptual challenges can reduce ASCC, and if these effects are stronger among those experiencing greater negative emotionality as a proxy for individuals likely to present for treatment. Method(s): Participants with elevated ASCC (N = 57) were randomized to one of three experimental conditions utilizing a head-mounted display. In the rotations condition (n = 20), participants viewed themselves spinning in a circle. In the opposite directions condition (n = 20), participants turned their head while the camera moved in the opposite direction creating dissonance in their visual field. In the control condition (n = 17), participants completed a series of simple arithmetic problems. Result(s): Participants in the rotation condition, relative to control, reported significant reductions in ASCC from pre- to post-exposure and these effects were strongest for those with elevated negative affect. The main effect of the opposite directions exposure on post-treatment ASCC was non-significant, but follow-up analyses revealed that reductions in ASCC were observed among those with elevated negative affectivity. Discussion(s): Perceptual illusion challenges appear to have utility for reducing ASCC through repeated exposure. There was evidence for the perceptual illusion exercises, particularly the rotations condition, specifically reducing ASCC, making this challenge the first we are aware of that specifically targets ASCC-related concerns. Limitation(s): As a proof-of-concept study, the present sample was not recruited for clinically-significant psychopathology, and only a brief follow-up was utilized. Future research should utilize a longer follow-up and test if these exposures mitigate ASCC-relevant psychopathology among clinical samples. Copyright © 2019
Behavior Therapy., 56 : 1173-1184
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Fergus, T. A., Limbers, C. A.
Researchers have called for the examination of test anxiety interventions that extend beyond the delivery of individual services by a trained professional. Following from conceptual models and research findings underscoring the importance of metacognitive beliefs to test anxiety, a controlled pilot study examined whether a group format delivery of the attention training technique (ATT) component of metacognitive therapy reduces test anxiety among eighth-grade students. Students completed baseline study measures and were allocated based upon class period to five sessions of ATT (n = 39) or a music listening control (n = 34) delivered within a group format during a school week. Students completed postintervention study measures on the final day of the intervention and completed follow-up study measures approximately 3 weeks following the intervention. As predicted, students receiving ATT reported less postintervention test anxiety than the control when they held stronger baseline metacognitive beliefs about worry. The patterns of findings held at the follow-up and when specifically examining the cognitive (i.e., worry) dimension of test anxiety. Study results suggest that ATT may be a viable test anxiety intervention for students holding heightened metacognitive beliefs about worry. Future directions are discussed. Copyright © 2018
Behavior Therapy, 50(4) : 803-816
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Deng, F.
To explore the effect of Ideological and political education on the recovery of hippocampal neuron damage in college students. One hundred students suffering from anxiety disorder were randomly divided into two groups, the observation group and the control group, 50 cases in each group. The two groups of patients were treated with the same combination of traditional Chinese and Western medicine anti-anxiety treatment. The control group was given routine nursing during the experiment. The observation group was given ideological and Political Education on the basis of the control group. Hamilton Anxiety Scale (HAMA) and Depression Scale (HAMD) were used to evaluate the efficacy of the two groups of patients. The total effective rate of the observation group (98.2 %) was significantly higher than that of the control group (62.3 %, p<0.05). The scores of somatization, depression, anxiety, interpersonal sensitivity and psychosis in the observation group were significantly lower than those in the control group (p<0.05). Ideological and political education is conducive to improve college students' awareness of anxiety disorders, enhance their ability of self-regulation, improve bad mood, and improve the treatment effect.
Indian Journal of Pharmaceutical Sciences, 81 (1 Supplement 1) : 54
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Waite, P., Marshall, T., Creswell, C.
Background: Computerized treatments have been shown to be effective in young people with anxiety disorders within research settings. The aims of this study were to evaluate a self-completed, therapist-supported online treatment for adolescent anxiety disorders in a routine clinical care setting and examine whether additional sessions for parents improved treatment outcome. Method(s): Sixty adolescents (13-18 years) referred by primary and secondary care services for treatment of an anxiety disorder and their parent(s) were randomly allocated to begin treatment immediately or after a 16-week waitlist. Half the parents (receiving treatment immediately or after a waitlist) were allocated to receive sessions themselves. Assessments were conducted pre- and posttreatment and at 6-month follow-up. Result(s): There was no significant difference posttreatment between the immediate treatment and waitlist groups in remission of primary anxiety disorder (Odds Ratio (OR) = 2.19, 95% CI: 0.72-6.70). Parent sessions did not significantly improve adolescent outcomes immediately or at 6-month follow-up (OR = 0.75, 95% CI: 0.26-2.15; OR = 1.14, 95% CI: 0.42-3.15). Conclusion(s): Within a routine clinical care setting, a therapist-supported online treatment failed to deliver significantly better outcomes for adolescents with anxiety disorders than a waitlist. Further research is needed to develop more effective treatments for this population. Copyright © 2019 Association for Child and Adolescent Mental Health
Child and Adolescent Mental Health., 24(3) : 242-250
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS), Other service delivery and improvement interventions
Pettit, J. W., Bechor, M., Rey, Y., Vasey, M. W., Abend, R., Pine, D. S., Bar-Haim, Y., Jaccard, J., Silverman, W. K.
OBJECTIVE: Randomized clinical trials of augmentation strategies for youth with treatment-resistant anxiety disorders do not exist. We present findings from an efficacy trial of attention bias modification treatment (ABMT) as an augment for this population, in comparison with attention control training (ACT). METHOD(S): Sixty-four youths (34 boys; M age=11.7 years) who continued to meet for anxiety diagnoses after completing cognitive behavior therapy (CBT) were randomized to either ABMT or ACT. ABMT and ACT consisted of dot-probe attention training trials presenting angry and neutral faces; probes appeared in the location of neutral faces on 100% of trials in ABMT and 50% of trials in ACT. Independent evaluators, youths, and parents completed ratings of youth anxiety severity, and youths completed measures of attention bias to threat and attention control at pretreatment, posttreatment, and two-month follow-up. RESULT(S): Both arms produced significant reductions in anxiety severity, with no differences between arms. Specifically, across informants, anxiety severity was significantly reduced at posttreatment and reductions were maintained at follow-up. Primary anxiety disorder diagnostic recovery combined across arms was 50% at posttreatment and 58% at follow-up. Attention control, but not attention bias to threat, was significantly improved at posttreatment in both arms. CONCLUSION(S): This is the first study to show anxiety can be reduced in youth who did not respond to CBT, and that anxiety-reducing effect is found using both attention training contingency schedules. These findings, along with increases in attention control in both arms, raise intriguing questions about mechanisms of anxiety reduction in treatment-resistant youth with attention training that require further research. Copyright © 2019. Published by Elsevier Inc.
Journal of the American Academy of Child and Adolescent Psychiatry., 59(1) : 157-165
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Treatment resistant/treatment refractory
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Kennedy, S. M., Bilek, E. L., Ehrenreich-May, J.
The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) is an intervention for children aged 7 to 13 targeting high negative emotion, emotional reactivity, and emotion regulation deficits common across emotional disorders. Our objective was to collect pilot randomized controlled trial (RCT) data on the efficacy of the UP-C, comparing UP-C with an active, anxiety-focused intervention. Participants were 47 children with at least one primary anxiety disorder; approximately one half had elevated depression symptoms. Participants received either UP-C or the anxiety-focused control treatment. No condition-related differences were found with respect to diagnostic remission and anxiety symptoms. However, differences in favor of UP-C were observed with respect to treatment response at follow-up, depression symptoms, sadness dysregulation, and cognitive reappraisal. Results provide preliminary evidence that the UP-C may be at least as efficacious in treating anxiety as well-supported anxiety-specific treatment protocols and may produce greater gains in certain emotion reactivity and regulation variables.
Behavior Modification, 43(3) : 330-360
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions