Disorders - Anxiety Disorders
Dwyer, J., Telang, S., Reed, M., Bloch, M.
Background: Selective serotonin reuptake inhibitors (SSRIs) are the first line pharmacologic for anxiety, OCD and depressive disorders in the pediatric population. Many clinicians report that many children prescribed SSRI medication experience a Pediatric Behavioral Activation Syndrome, which exists along a spectrum from mild activation, increased energy, insomnia or irritability up through agitation, hyperactivity, and possibly even manic behavior. However, evidence of Pediatric Behavioral Activation Syndrome from randomized, placebo-controlled trials of SSRI medications remains sparse. Efforts to quantify the degree of risk have been hampered by inconsistent reporting across clinical trials, and the range of behaviors which might constitute an activation syndrome. Here we have undertaken a meta-analysis of pediatric SSRI clinical trials in an effort to better define the risk of symptoms of the behavioral activation syndromes in pediatric populations. Methods: PubMed was searched for randomized, placebocontrolled trials of SSRIs in pediatric populations (less than 18 years of age). The reference list from previous metaanalyses examining the efficacy of antidepressant medications in pediatric populations was searched for further eligible trials. We extracted the rates of several adverse event outcomes associated with the behavioral activation syndrome in children (insomnia, irritability, agitation, hyperactivity, anxiety/nervousness and akathisia/restlessness) as well as mania (manic behavior). Comprehensive Meta-Analysis version 3.0 was used to examine the risk ratio of adverse events on SSRI medications compared to placebo. Results: A minority of studies reported adverse event rates for the outcome of interest, especially manic behavior. SSRI use was associated with a significantly increased risk of insomnia, irritability, agitation and hyperactivity in children compared to placebo. There was no evidence of publication bias or significant heterogeneity among included trials. We plan to additionally examine the FDA database of medication trials as well as industry trial databases to identify additional data on side-effects from trials that may not have reported these outcomes in peer-reviewed publications. Conclusions: Peer-reviewed published reports of pediatric SSRI trials appear to support that symptoms of Pediatric Behavioral Activation Syndrome are more common with these medications as compared to placebo. Caution is warranted as these spontaneously reported adverse events may have issues with reporting and measurement bias that may have affected the suicidality literature with these same medications. Additionally, although we did not detect publication or reporting bias in the included trials, there exists a strong possibility that the risk of adverse events reported in peer-reviewed publication may systematically differ from those not published.
Neuropsychopharmacology, 43 (Supplement 1) : S133
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs)
Wright, B., Tindall, L., Littlewood, E., Allgar, V., Abeles, P., Trepel, D., Ali, S.
OBJECTIVES: Computer-administered cognitive-behavioural therapy (CCBT) may be a promising treatment for adolescents with depression, particularly due to its increased availability and accessibility. The feasibility of delivering a randomised controlled trial (RCT) comparing a CCBT program (Stressbusters) with an attention control (self-help websites) for adolescent depression was evaluated.
DESIGN: Single centre RCT feasibility study.
SETTING: The trial was run within community and clinical settings in York, UK.
PARTICIPANTS: Adolescents (aged 12-18) with low mood/depression were assessed for eligibility, 91 of whom met the inclusion criteria and were consented and randomised to Stressbusters (n=45) or websites (n=46) using remote computerised single allocation. Those with comorbid physical illness were included but those with psychosis, active suicidality or postnatal depression were not.
INTERVENTIONS: An eight-session CCBT program (Stressbusters) designed for use with adolescents with low mood/depression was compared with an attention control (accessing low mood self-help websites).
PRIMARY AND SECONDARY OUTCOME MEASURES: Participants completed mood and quality of life measures and a service Use Questionnaire throughout completion of the trial and 4 months post intervention. Measures included the Beck Depression Inventory (BDI) (primary outcome measure), Mood and Feelings Questionnaire (MFQ), Spence Children's Anxiety Scale (SCAS), the EuroQol five dimensions questionnaire (youth) (EQ-5D-Y) and Health Utility Index Mark 2 (HUI-2). Changes in self-reported measures and completion rates were assessed by treatment group.
RESULTS: From baseline to 4 months post intervention, BDI scores and MFQ scores decreased for the Stressbusters group but increased in the website group. Quality of life, as measured by the EQ-5D-Y, increased for both groups while costs at 4 months were similar to baseline. Good feasibility outcomes were found, suggesting the trial process to be feasible and acceptable for adolescents with depression.
CONCLUSIONS: With modifications, a fully powered RCT is achievable to investigate a promising treatment for adolescent depression in a climate where child mental health service resources are limited.
Trial registration number: isrctn31219579.
BMJ Open, 7(1) : e012834
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Xu, L., Liu, H.
This study tested the efficacy of an 8-weeks Rational Emotive Behavior Therapy (REBT) programme on adjusted irrational beliefs and mental symptoms. The sample of 60 female college students was randomly assigned to a REBT (n = 25) and non-REBT group (n = 35). We expected increase mental symptoms in the non-REBT group, but not in the REBT group, due to the REBT programme intervention. According to our data, adjusted irrational beliefs increased in the REBT group but remained unchanged in the non-REBT group. Even a REBT programme intervention of 8-sessions can protect female college students from an increase in mental symptoms during the university period. Copyright © 2018, Anka Publishers. All rights reserved.
NeuroQuantology, 15(4) : 156-161
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Topper, M., Emmelkamp, P. M., Watkins, E., Ehring, T.
BACKGROUND: This randomized controlled trial evaluated the efficacy of a preventive intervention for anxiety disorders and depression by targeting excessive levels of repetitive negative thinking (RNT; worry and rumination) in adolescents and young adults.
METHODS: Participants (N = 251, 83.7% female) showing elevated levels of RNT were randomly allocated to a 6-week cognitive-behavioral training delivered in a group, via the internet, or to a waitlist control condition. Self-report measures were collected at pre-intervention, post-intervention, 3 m and 12 m follow-up.
RESULTS: Both versions of the preventive intervention significantly reduced RNT (d = 0.53 to 0.89), and symptom levels of anxiety and depression (d = 0.36 to 0.72). Effects were maintained until 12 m follow-up. The interventions resulted in a significantly lower 12 m prevalence rate of depression (group intervention: 15.3%, internet intervention: 14.7%) and generalized anxiety disorder (group intervention: 18.0%, internet intervention: 16.0%), compared to the waitlist (32.4% and 42.2%, respectively). Mediation analyses demonstrated that reductions in RNT mediated the effect of the interventions on the prevalence of depression and generalized anxiety disorder.
CONCLUSIONS: Results provide evidence for the efficacy of this preventive intervention targeting RNT and support a selective prevention approach that specifically targets a known risk factor to prevent multiple disorders.
Behaviour Research & Therapy, 90 : 123-136
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Vaclavik, D., Buitron, V., Rey, Y., Marin, C. E., Silverman, W. K., Pettit, J.W.
Cognitive-behavioral therapies (CBTs) are efficacious treatments for anxiety disorders in Latino youth. However, there is a gap in knowledge about moderators of CBT outcomes in Latino youth. This study addresses this gap by examining parental acculturation as a moderator of youth anxiety outcomes in a randomized controlled trial (RCT) of parent-involved CBT (CBT/P) and peer-involved group CBT (GCBT) in 139 Latino youth (ages 6 to 16 years; mean age = 9.68 years). Comparable youth anxiety reduction effects were found for CBT/P and GCBT. Parental acculturation to majority United States culture, but not identification with country of origin, significantly moderated youth anxiety outcomes: at low levels of parental acculturation to majority United States culture, youth posttreatment anxiety scores were lower in GCBT than CBT/P; at high levels of parental acculturation to majority United States culture, youth posttreatment anxiety scores were lower in CBT/P than GCBT. These findings provide further evidence for the efficacy of CBTs for anxiety disorders in Latino youth and also provide guidance for moving toward personalization of CBTs' selection depending on parental acculturation levels. (PsycINFO Database Record (c) 2019 APA, all rights reserved) Abstract (French) Las terapias cognitivo-conductuales (CBT) son tratamientos eficaces para los trastornos de ansiedad en jovenes Latinos. Sin embargo, existe una limitacion en el conocimiento sobre los moderadores de los resultados de CBT en jovenes Latinos. El presente estudio aborda esta limitacion al examinar el nivel de aculturacion de los padres como moderador de resultados de CBT para la ansiedad en un estudio clinico controlado aleatorizado de CBT con participacion de los padres (CBT/P) y CBT con pares en formato de grupo (GCBT) en 139 jovenes Latinos (de 6 a los 16 anos; edad promedio = 9.68 anos). Se encontraron efectos comparables en la reduccion de la ansiedad de los jovenes entre CBT/P y GCBT. El nivel de aculturacion de los padres modero significativamente los resultados de la ansiedad de los jovenes: a niveles bajos de aculturacion de los padres, las puntuaciones de ansiedad de los jovenes de postratamiento fueron mas bajas en GCBT que en CBT/P; a niveles altos de aculturacion de los padres, las puntuaciones de ansiedad de los jovenes de postratamiento fueron mas bajas en CBT/P que en GCBT. Estos resultados sugieren evidencia sobre la eficacia de las CBTs para los trastornos de ansiedad en jovenes Latinos y tambien ofrecen una guia hacia la personalizacion de la seleccion de las CBTs segun el nivel de aculturacion de los padres. (PsycINFO Database Record (c) 2019 APA, all rights reserved)
Journal of Latina/o Psychology, 5(4) : 261-274
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Perry, J. E., Ross, M., Weinstock, J., Weaver, T.
Research has supported mindfulness as a predictor of athletic success. This study used a parallel trial design to examine the benefit of a brief one-session mindfulness training for performance on an individual, nonpacing, closed skill athletic task (i.e., golf putting). All participants (N = 65) answered questionnaires and engaged in two trials of the putting task. Participants were randomly assigned to an intervention or control group using a simple randomization strategy. Between trials, the intervention group received a mindfulness intervention. Mindfulness intervention included psychoeducation, reflection upon previous sport experiences, an experiential exercise, and putting applications. Repeated-measures ANOVAs demonstrated that the intervention group exhibited more successful outcomes on objective putting performance, flow state experience, and state anxiety (p < .05). Results suggest mindfulness may prevent performance deterioration and could produce psychological benefits after a brief training session. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
The Sport Psychologist, 31(4) : 410-421
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Mindfulness based therapy
Sekizaki, R., Nemoto, T., Tsujino, N., Takano, C., Yoshida, C., Yamaguchi, T., Katagiri, N., Ono, Y., Mizuno, M.
Aim: Preventive intervention and treatment using internet-based cognitive behaviour therapy (iCBT) can be easily administered to school students, as they are quite familiar with internet tools. This study aims to investigate the effectiveness and contribution of iCBT to mental healthcare in a school setting. Methods: Eighty Japanese high school boys who were participating in a sports specialist course were enrolled in this study. The participants were randomly assigned to either the iCBT intervention group or the control group. Both programmes were administered for 4 weeks. To evaluate the effects, physical and mental health problems and self-efficacy were assessed. Results: The mean number of times that the iCBT website was accessed during the intervention period was 16.9, and the mean access frequency (percentage of the number of times the website was accessed during the intervention period) was 40.1% in the iCBT group. A statistically significant interaction between group and time in favour of the iCBT group was observed based on the Kessler-6 (K6) scale for depression and anxiety. Conclusions: The results suggest that a school mental healthcare programme using iCBT is suitable for students and useful for coping with stress and reducing depressed mood and anxiety in young people, especially athletes, who are regarded as needing special mental health support. Copyright © 2017 Wiley Publishing Asia Pty Ltd.
Early Intervention in Psychiatry., :
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Technology, interventions delivered using technology (e.g. online, SMS)
Sampl, J., Maran, T., Furtner, M. R.
The present randomized pilot intervention study examines the effects of a mindfulness-based self-leadership training (MBSLT) specifically developed for academic achievement situations. Both mindfulness and self-leadership have a strong self-regulatory focus and are helpful in terms of stress resilience and performance enhancements. Based on several theoretical points of contact and a specific interplay between mindfulness and self-leadership, the authors developed an innovative intervention program that improves mood as well as performance in a real academic setting. The intervention was conducted as a randomized controlled study over 10 weeks. The purpose was to analyze the effects on perceived stress, test anxiety, academic self-efficacy, and the performance of students by comparing an intervention and control group (n = 109). Findings demonstrated significant effects on mindfulness, self-leadership, academic self-efficacy, and academic performance improvements in the intervention group. Results showed that the intervention group reached significantly better grade point averages than the control group. Moreover, the MBSLT over time led to a reduction of test anxiety in the intervention group compared to the control group. Furthermore, while participants of the control group showed an increase in stress over time, participants of the intervention group maintained constant stress levels over time. The combination of mindfulness and self-leadership addressed both positive effects on moods and on objective academic performance. The effects demonstrate the great potential of combining mindfulness with self-leadership to develop a healthy self-regulatory way of attaining achievement-related goals and succeeding in high-stress academic environments. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Mindfulness, 8(5) : 1393-1407
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Mindfulness based therapy
Rapee, R. M., Lyneham, H. J., Wuthrich, V., Chatterton, M. L., Hudson, J. L., Kangas, M., Mihalopoulos, C.
Objective Stepped care is embraced as an ideal model of service delivery but is minimally evaluated. The aim of this study was to evaluate the efficacy of cognitive-behavioral therapy (CBT) for child anxiety delivered via a stepped-care framework compared against a single, empirically validated program. Method A total of 281 youth with anxiety disorders (6-17 years of age) were randomly allocated to receive either empirically validated treatment or stepped care involving the following: (1) low intensity; (2) standard CBT; and (3) individually tailored treatment. Therapist qualifications increased at each step. Results Interventions did not differ significantly on any outcome measures. Total therapist time per child was significantly shorter to deliver stepped care (774 minutes) compared with best practice (897 minutes). Within stepped care, the first 2 steps returned the strongest treatment gains. Conclusion Stepped care and a single empirically validated program for youth with anxiety produced similar efficacy, but stepped care required slightly less therapist time. Restricting stepped care to only steps 1 and 2 would have led to considerable time saving with modest loss in efficacy. Clinical trial registration information-A Randomised Controlled Trial of Standard Care Versus Stepped Care for Children and Adolescents With Anxiety Disorders; http://anzctr.org.au/; ACTRN12612000351819. Copyright © 2017 American Academy of Child and Adolescent Psychiatry
Journal of the American Academy of Child and Adolescent Psychiatry, 56(10) : 841-848
- Year: 2017
- 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)
, Other service delivery and improvement interventions
Rosenblum, K. L., Muzik, M., Morelen, D. M., Alfafara, E. A., Miller, N. M., Waddell, R. M., Schuster, M. M., Ribaudo, J.
We conducted a study to evaluate the effectiveness of Mom Power, a multifamily parenting intervention to improve mental health and parenting among high-risk mothers with young children in a community-based randomized controlled trial (CB-RCT) design. Participants (N = 122) were high-risk mothers (e.g., interpersonal trauma histories, mental health problems, poverty) and their young children (age <6 years), randomized either to Mom Power, a parenting intervention (treatment condition), or weekly mailings of parenting information (control condition). In this study, the 13-session intervention was delivered by community clinicians trained to fidelity. Pre- and post-trial assessments included mothers' mental health symptoms, parenting stress and helplessness, and connection to care. Mom Power was delivered in the community with fidelity and had good uptake (>65%) despite the risk nature of the sample. Overall, we found improvements in mental health and parenting stress for Mom Power participants but not for controls; in contrast, control mothers increased in parent-child role reversal across the trial period. The benefits of Mom Power treatment (vs. control) were accentuated for mothers with interpersonal trauma histories. Results of this CB-RCT confirm the effectiveness of Mom Power for improving mental health and parenting outcomes for high-risk, trauma-exposed women with young children. ClinicalTrials.gov Identifier: NCT01554215. Copyright © 2017, Springer-Verlag Wien.
Archives of Women's Mental Health, 20(5) : 673-686
- Year: 2017
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Other service delivery and improvement interventions
Saelid, G. A., Nordahl, H. M.
Rational emotive behaviour therapy (REBT) is effective in reducing distress in several target groups. No other study has tested the mental health effects on adolescents in a high school setting while expanding a Cognitive Behaviour-based therapy, REBT, into the concept of mental health literacy. The format of the ABC model, which is an important element of REBT, functioned as a working manual in and between three sessions. This study tested whether knowledge and practical use of the ABC model increased self-esteem and hope, and reduced symptoms of anxiety and depression, and dysfunctional thinking. Sixty-two high school students with subclinical levels of anxiety and depression were randomly allocated into three groups; three individual REBT sessions, or three individual attentional placebo (ATP) sessions or no sessions (control). However, dysfunctional thinking, self-esteem and hope were not measured in the control group. Repeated measures with ANOVA and t-tests were conducted. Both REBT and ATP significantly reduced symptoms of anxiety and depression, but only REBT was significantly different from the control group at the six-month follow-up. Only REBT significantly reduced dysfunctional thinking, and both REBT and ATP significantly increased self-esteem and hope. REBT had both an immediate and a long-term effect. The findings show the potential positive effects of educating well-documented psychological techniques as ordinary education in school. Further research might contribute to decide whether or not to change the school system by enclosing mental health literacy classes for all students.
Cognitive Behaviour Therapy, 46(3) : 196-210
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
McEvoy, P. M., Graville, R., Hayes, S., Kane, R. T., Foster, J. K.
The first aim of this study was to compare attention manipulation techniques deriving from metacognitive therapy (the Attention Training Technique; ATT) and mindfulness-based approaches (Mindfulness-Based Progressive Muscle Relaxation, MB-PMR) to a thought wandering control (TWC) condition, in terms of their impact on anxiety and four mechanisms: distancing, present-focused attention, uncontrollability and dangerousness, metacognitive beliefs, and cognitive flexibility (Stroop task). The second aim was to test indirect effects of the techniques on anxiety via the mechanism measures. High trait anxious participants (N = 81, Mage = 23.60, SDage = 7.66, 80% female) were randomized to receive ATT, MB-PMR, or the TWC condition. Measures of cognitive and somatic anxiety, distancing, present-focused attention, metacognitive beliefs, and cognitive flexibility were administered before or after the attention manipulation task. Compared to the TWC group, ATT and MB-PMR were associated with greater changes on cognitive (but not somatic) anxiety, present-focused attention, metacognitive beliefs, and uncorrected errors for threat-related words on the Stroop task. The pattern of means was similar for distancing, but this did not reach statistical significance, and Stroop speed increased equally for all conditions. Indirect effects models revealed significant effects of condition on state anxiety via distancing, metacognitive beliefs, and present-focused attention, but not via Stroop errors. ATT and MB-PMR were associated with changes on anxiety and the mechanism measures, suggesting that the mechanisms of change may be more similar than different across these techniques. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Behavior Therapy, 48(5) : 678-694
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Psychological Interventions (any)
, Other Psychological Interventions, Mindfulness based therapy, Relaxation