Disorders - Anxiety Disorders
Ginsburg, G. S., Drake, K. L., Tein, J-Y, Teetsel, R., Riddle, M. A.
Objective: The authors examined the efficacy of a family-based intervention to prevent the onset of anxiety disorders in offspring of anxious parents. Method: Participants were 136 families with a parent meeting DSM-IV criteria for an anxiety disorder and one child 6-13 years of age without an anxiety disorder. Families were randomly assigned to the family-based intervention (N = 70) or to an information-monitoring control condition (N = 66). All families were expected to complete assessments, administered by blind interviewers, at baseline, at the end of the intervention (or 8 weeks after randomization) and at 6- and 12-month follow-ups. Onset of any anxiety disorder and anxiety symptom severity (assessed using the Anxiety Disorders Interview Schedule for Children) at 12 months were the primary and secondary outcome measures, respectively. Results: The incidence of child anxiety disorders was 31% in the control group and 5% in the intervention group (odds ratio = 8.54, 95% CI = 2.27, 32.06). At the 1-year follow-up, youths in the control group also had higher anxiety symptoms ratings than those in the intervention group. Effect sizes were medium to large (0.81 at 6 months and 0.57 at 12 months for anxiety symptoms), and the number needed to treat was 3.9 at 12 months. Significant moderators included baseline levels of child anxiety; significant mediators were parental distress and modeling of anxiety. Child maladaptive cognitions and parental anxiety did not mediate outcomes. Conclusions: A brief psychosocial prevention program holds promise for reducing the 1-year incidence of anxiety disorders among offspring of anxious parents. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).
The American Journal of Psychiatry, 172(12) : 1207-1214
- Year: 2015
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
Kosters, M. P., Chinapaw, M. J., Zwaanswijk, M., van-der-Wal, M. F., Koot, H. M.
OBJECTIVES: We investigated whether intervention effects of FRIENDS for Life, a school-based prevention program for children with anxiety or depression symptoms, were maintained over a period of 12 months after the intervention in a naturalistic setting.
METHODS: We used a quasi-experimental design, with 339 children in the intervention group and 157 in the control group (aged 8-13 years) in schools in Amsterdam, the Netherlands. We collected self-, teacher, and peer reports of anxiety and depression scores before and after intervention, and 6 and 12 months after intervention, from 2010 to 2012.
RESULTS: Intervention-group children reported a continuing and significant decrease in anxiety and depression scores compared with the control group. Twelve months after the intervention, participants' anxiety and depression levels were comparable to those of the general population. Girls reported a stronger decrease in anxiety scores than did boys. Teacher reports suggested no effects. Although classmates reported increased internalizing problems in intervention-group children immediately after intervention, these effects disappeared over time.
CONCLUSIONS: FRIENDS for Life, an indicated prevention program, yielded long-lasting and continuing reduction in anxiety and depression problems when implemented in daily school practice.
American Journal of Public Health, 105(10) : 2005-2013
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Other Psychological Interventions
James, A. C., James, G., Cowdrey, F. A., Soler, A., Choke, A.
Background: A previous Cochrane review (James 2005) showed that cognitive behavioural therapy (CBT) was effective in treating childhood anxiety disorders; however, questions remain regarding (1) the relative efficacy of CBT versus non-CBT active treatments; (2) the relative efficacy of CBT versus medication and the combination of CBT and medication versus placebo; and (3) the long-term effects of CBT. ; Objectives: To examine (1) whether CBT is an effective treatment for childhood and adolescent anxiety disorders in comparison with (a) wait-list controls; (b) active non-CBT treatments (i.e. psychological placebo, bibliotherapy and treatment as usual (TAU)); and (c) medication and the combination of medication and CBT versus placebo; and (2) the long-term effects of CBT.; Search Methods: Searches for this review included the Cochrane Central Register of Controlled Trials (CENTRAL) and the Cochrane Depression, Anxiety and Neurosis Group Register, which consists of relevant randomised controlled trials from the bibliographic databases-The Cochrane Library (1970 to July 2012), EMBASE, (1970 to July 2012) MEDLINE (1970 to July 2012) and PsycINFO (1970 to July 2012).; Selection Criteria: All randomised controlled trials (RCTs) of CBT versus waiting list, active control conditions, TAU or medication were reviewed. All participants must have met the criteria of the Diagnostic and Statistical Manual (DSM) or the International Classification of Diseases (ICD) for an anxiety diagnosis, excluding simple phobia, obsessive-compulsive disorder, post-traumatic stress disorder and elective mutism.; Data Collection and Analysis: The methodological quality of included trials was assessed by three reviewers independently. For the dichotomous outcome of remission of anxiety diagnosis, the odds ratio (OR) with 95% confidence interval (CI) based on the random-effects model, with pooling of data via the inverse variance method of weighting, was used. Significance was set at P < 0.05. Continuous data on each child's anxiety symptoms were pooled using the standardised mean difference (SMD).; Main Results: Forty-one studies consisting of 1806 participants were included in the analyses. The studies involved children and adolescents with anxiety of mild to moderate severity in university and community clinics and school settings. For the primary outcome of remission of any anxiety diagnosis for CBT versus waiting list controls, intention-to-treat (ITT) analyses with 26 studies and 1350 participants showed an OR of 7.85 (95% CI 5.31 to 11.60, Z = 10.26, P < 0.0001), but with evidence of moderate heterogeneity (P = 0.04, I² = 33%). The number needed to treat (NNT) was 6.0 (95% CI 7.5 to 4.6). No difference in outcome was noted between individual, group and family/parental formats. ITT analyses revealed that CBT was no more effective than non-CBT active control treatments (six studies, 426 participants) or TAU in reducing anxiety diagnoses (two studies, 88 participants). The few controlled follow-up studies (n = 4) indicate that treatment gains in the remission of anxiety diagnosis are not statistically significant.; Authors' Conclusions: Cognitive behavioural therapy is an effective treatment for childhood and adolescent anxiety disorders; however, the evidence suggesting that CBT is more effective than active controls or TAU or medication at follow-up, is limited and inconclusive.;
Cochrane Database of Systematic Reviews, (2) : CD004690
- Year: 2015
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Kallapiran, K., Koo, S., Kirubakaran, R., Hancock, K.
Background: Mindfulness-based interventions (MBIs) are increasingly used in the management of various mental health disorders in children and adolescents. However, there is limited evidence about the efficacy of various interventions used. Method: A systematic review was performed to examine the effects of different MBIs on mental health symptoms and quality of life in both clinical and nonclinical samples of children and adolescents using data from only randomized control trials. The studies were also assessed for quality. Based on the type of MBI, study population, and control arm we had three comparisons for meta-analyses. Results: Fifteen studies were included in the qualitative analysis but only 11 trials with comparable interventions and controls were included for meta-analyses. Mindfulness-based stress reduction/mindfulness-based cognitive therapy arm was more effective than nonactive control in the nonclinical populations. Acceptance commitment therapy was comparable to active treatments in patients in the clinical range. Other MBIs were also effective improving anxiety and stress but not depression in nonclinical populations compared to nonactive control. Conclusions: Mindfulness-based interventions can be effective in children and adolescents with mental health symptoms. As there were significant limitations these results must be interpreted with caution.
Child & Adolescent Mental Health, 20(4) : 182-194
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders
- 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
Gilomen, S. A., Lee, C. W.
Background and Objectives: Emotional Freedom Techniques (EFT) is a type of therapy involving the stimulation of acupuncture points while using a spoken affirmation to target a psychological issue. While some studies cite data indicating EFT is highly efficacious, findings in other studies are unconvincing. The aim of this meta-analysis was to examine the effect of EFT, particular acupoint stimulation, in the treatment of psychological distress.; Method: A systematic review of the literature identified 18 randomised control trials published in peer reviewed journals involving a total of 921 participants.; Results: A moderate effect size (Hedge's g = -0.66: 95% CI: -0.99 to -0.33) and significantly high heterogeneity (I(2) = 80.78) across studies was found using a random effects model indicating that EFT, even after removing outliers (decreases in I(2) = 72.32 and Hedge's g = -0.51:95% CI:-0.78 to -0.23), appears to produce an effect. The analysis involved 12 studies comparing EFT with waitlist controls, 5 with adjuncts and only 1 comparison with an alternate treatment. Meta-regression and subgroup analyses were conducted to examine the effect of moderators on effect size of symptom change following EFT.; Conclusions: Due to methodological shortcomings, it was not possible to determine if the effect is due to acupoint stimulation or simply due to treatment elements common with other therapies.; Copyright © 2015 Elsevier Ltd. All rights reserved.
Journal of Behavior Therapy & Experimental Psychiatry, 48 : 140-148
- Year: 2015
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Acupuncture, acupressure
Lee, H-J., Goetz, A. R., Turkel, J. E., Siwiec, S. G.
Background and Objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. Conclusions: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Anxiety, Stress & Coping, 28(2) : 226-237
- Year: 2015
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Attention/cognitive bias modification
, Technology, interventions delivered using technology (e.g. online, SMS)
Langley, A. K., Gonzalez, A., Sugar, C. A., Solis, D., Jaycox, L.
Objective: To evaluate the feasibility and acceptability of a school-based intervention for diverse children exposed to a range of traumatic events, and to examine its effectiveness in improving symptoms of posttraumatic stress, depression, and anxiety. Method: Participants were 74 schoolchildren (Grades 1-5) and their primary caregivers. All participating students endorsed clinically significant posttraumatic stress symptoms. School clinicians were trained to deliver Bounce Back, a 10-session cognitive-behavioral group intervention. Children were randomized to immediate or delayed (3-month waitlist) intervention. Parent-and child-report of posttraumatic stress and depression, and child report of anxiety symptoms, were assessed at baseline, 3 months, and 6 months. Results: Bounce Back was implemented with excellent clinician fidelity. Compared with children in the delayed condition, children who received Bounce Back immediately demonstrated significantly greater improvements in parent-and child-reported posttraumatic stress and child-reported anxiety symptoms over the 3-month intervention. Upon receipt of the intervention, the delayed intervention group demonstrated significant improvements in parent-and child-reported posttraumatic stress, depression, and anxiety symptoms. The immediate treatment group maintained or showed continued gains in all symptom domains over the 3-month follow-up period (6-month assessment). Conclusions: Findings support the feasibility, acceptability, and effectiveness of the Bounce Back intervention as delivered by school-based clinicians for children with traumatic stress. Implications are discussed.
Journal of Consulting & Clinical Psychology, 83(5) : 853-865
- Year: 2015
- Problem: Anxiety Disorders (any), Post Traumatic Stress Disorder, Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Korte, K. J., Schmidt, N. B.
Anxiety sensitivity (AS), the fear of anxiety and its potential consequences, places individuals at an increased risk for the development of anxiety disorders. While elevated AS is correctable, often through very brief interventions, individuals high in AS may be unaware of the risks associated with this risk factor and, therefore, may be unaware or unmotivated to address this potential risk. The purpose of the present investigation was to examine the use of motivation enhancement therapy (MET) to enhance motivation to utilize a preventive intervention in a non-intervention seeking population with elevated levels of AS. We examined this issue in a randomized controlled pilot study. Participants (N = 23) were randomized to one of two groups: (1) a MET group (n = 12) group or (2) a control group focused on healthy behaviors (n = 11). Those in the MET group received MET focused on enhancing motivation to reduce AS, whereas those in the control group received psychoeducation about health and general well being. At the end of the study, all of the participants were given the option to receive a computerized intervention previously found to be effective at reducing AS. Results revealed that the MET group had significant changes in motivation to change anxiety and motivation to attend the AS preventative intervention. Moreover, 50 % of individuals in the MET group completed the preventative intervention in comparison to 0 % in the control group. Implications of the findings are discussed.
Cognitive Therapy & Research, 39(4) : 520-530
- Year: 2015
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Motivational interviewing, includes Motivational Enhancing Therapy, Psychoeducation
Klein, A. M., Rapee, R. M., Hudson, J. L., Schniering, C. A., Wuthrich, V. M., Kangas, M., Lyneham, H. J., Souren, P. M., Rinck, M.
The present study was designed to examine the effects of training in positive interpretations in clinically anxious children. A total of 87 children between 7 and 12 years of age were randomly assigned to either a positive cognitive bias modification training for interpretation (CMB-I) or a neutral training. Training included 15 sessions in a two-week period. Children with an interpretation bias prior to training in the positive training group showed a significant reduction in interpretation bias on the social threat scenarios after training, but not children in the neutral training group. No effects on interpretation biases were found for the general threat scenarios or the non-threat scenarios. Furthermore, children in the positive training did not self-report lower anxiety than children in the neutral training group. However, mothers and fathers reported a significant reduction in social anxiety in their children after positive training, but not after neutral training. This study demonstrated that clinically anxious children with a prior interpretation bias can be trained away from negative social interpretation biases and there is some evidence that this corresponds to reductions in social anxiety. This study also highlights the importance of using specific training stimuli. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).
Behaviour Research & Therapy, 75 : 78-84
- Year: 2015
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Leventhal, K. S., Gillham, J., DeMaria, L., Andrew, G., Peabody, J., Leventhal, S.
We conducted a randomized controlled trial of a 5-month resilience-based program (Girls First Resilience Curriculum or RC) among 2308 rural adolescent girls at 57 government schools in Bihar, India. Local women with at least a 10th grade education served as group facilitators. Girls receiving RC improved more (vs. controls) on emotional resilience, self-efficacy, social-emotional assets, psychological wellbeing, and social wellbeing. Effects were not detected on depression. There was a small, statistically significant negative effect on anxiety (though not likely clinically significant). Results suggest psychosocial assets and wellbeing can be improved for girls in high-poverty, rural schools through a brief school-day program. To our knowledge, this is one of the largest developing country trials of a resilience-based school-day curriculum for adolescents.
Journal of Adolescence, 45 : 284-295
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Skills training, Other Psychological Interventions, Positive psychology
Nehmy, T. J., Wade, T. D.
Objective: The aim of the current study was to evaluate a prevention program targeting unhelpful perfectionism and self-compassion, designed to prevent growth of negative affect (NA). Method: Four schools participated in the research, where grade levels were allocated to either the intervention (". Healthy Minds") or the control condition (N=688 individuals; mean age 14.90 years), and assessments occurred at baseline, post-intervention, and 6- and 12-month follow-up. Results: There were no significant between group differences at post-intervention but at 6-month follow-up the intervention group had significantly lower unhelpful perfectionism, self-criticism and NA than the controls. Only significant between-group differences in unhelpful perfectionism were retained at 12-month follow-up (Cohen's d=.24). Examination of the sub-group lower in NA at baseline showed the intervention group was significantly less likely to have elevated NA at 6-month follow-up than controls, indicating a prevention effect. Discussion: The effects obtained in the current study provide support for the utility of a perfectionism intervention for reducing transdiagnostic outcomes, including unhelpful perfectionism, self-judgment, and NA, and preventing the growth of NA. Ways of producing longer terms effects for NA need to be further investigated, as does the impact of the intervention on different types of psychopathology. Trial registration: ACTRN12614000650695.
Behaviour Research & Therapy, 67 : 55-63
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders, Eating Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Psychoeducation, Other Psychological Interventions
Millings, A., Morris, J., Rowe, A., Easton, S., Martin, J. K., Majoe, D., Mohr, C.
Background: Internet interventions for mental health concerns are known to be effective, but how can developing technology be utilised to improve engagement and augment the effectiveness of these programs? One option might be to incorporate feedback about the user's physiological state into the program, via wearable sensors. Objectives: This mixed-methods pilot study sought to examine whether the effectiveness of an online intervention for stress in students could be augmented by the use of prototype wearable sensors. Methods: Students who were stressed, but not depressed, were allocated to a stress management program alone (n = 34), with sensors (n = 29), or to no intervention (n = 35). Interventions lasted 4 weeks. Outcome measures included measures of stress, anxious, and depressive symptoms, and were measured immediately after the interventions and 4 weeks later. Participants in the two program groups were interviewed to gain feedback about the program and the sensors. Results: Significant pre-post reductions in stress (p = .019) were observed for those in the program alone group. Significant reductions in depressive symptoms were observed among postgraduates (p = .006), but not undergraduates, in the program only group. The program plus sensors group had a broadly similar, but weaker set of results, indicating that the sensors impeded, rather than augmented, the effectiveness of the program. Qualitative data explicate this finding, highlighting participation burden as a key issue. Participants provided detailed feedback about the program, the sensors, and biofeedback exercises, which are summarised and discussed with reference to the quantitative findings. Conclusions: The newly developed stress management program could be an effective way to improve student mental health. Wearable sensor technology, particularly biofeedback exercises, may be a useful contribution for the next generation of e-therapies, but further development of the prototypes is needed and their reliability and usability will likely affect user responses to them.
Internet Interventions, 2(3) : 330-339
- Year: 2015
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Biofeedback, neurofeedback, audio/video feedback, Technology, comparing delivery mode (e.g. online vs. face-to-face)