Disorders - Anxiety Disorders
Weisz, J. R., Kuppens, S., Ng, M. Y., Vaughn-Coaxum, R. A., Ugueto, A. M., Eckshtain, D., Corteselli, K. A.
With the development of empirically supported treatments over the decades, have youth psychotherapies grown stronger? To investigate, we examined changes over time in treatment effects for four frequently treated youth mental-health problems: anxiety, depression, attention-deficit hyperactivity disorder (ADHD), and conduct disorders. We used PubMed and PsycINFO to search for randomized controlled trials (RCTs) that were published between January 1960 and May 2017 involving youths between the ages of 4 and 18 years. We also searched reviews and meta-analyses of youth psychotherapy research, followed reference trails in the reports we identified, and obtained additional studies identified by therapy researchers whom we contacted. We identified 453 RCTs (31,933 participants) spanning 53 years (1963-2016). Effect sizes for the problem-relevant outcome measures were synthesized via multilevel meta-analysis. We tracked temporal trends for each problem domain and then examined multiple study characteristics that might moderate those trends. Mean effect size increased nonsignificantly for anxiety, decreased nonsignificantly for ADHD, and decreased significantly for depression and conduct problems. Moderator analyses involving multiple study subgroups showed only a few exceptions to these surprising patterns. The findings suggest that new approaches to treatment design and intervention science may be needed, especially for depression and conduct problems. We suggest intensifying the search for mechanisms of change, making treatments more transdiagnostic and personalizable, embedding treatments within youth ecosystems, adapting treatments to the social and technological changes that alter youth dysfunction and treatment needs, and resisting old habits that can make treatments unduly skeuomorphic.
Perspectives on Psychological Science : A Journal of the Association for Psychological Science, 14(2) : 216-237
- Year: 2019
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
McMakin, D. L., Ricketts, E. J., Forbes, E. E., Silk, J. S., Ladouceur, C. D., Siegle, G. J., Milbert, M., Trubnick, L., Cousins, J. C., Ryan, N. D., Harvey, A. G., Dahl, R. E.
Sleep disturbance is prevalent in anxious youth and prospectively predicts poor emotional adjustment in adolescence. Study 1 examined whether anxiety treatment improves subjective and objective sleep disturbance in anxious youth. Study 2 examined whether a sleep intervention called Sleeping TIGERS can further improve sleep following anxiety treatment. Study 1 examined 133 youth (ages 9-14; 56% female; 11% ethnic/racial minority) with generalized, social, or separation anxiety over the course of anxiety treatment (cognitive behavioral treatment or client-centered treatment). Sleep-related problems (parent-, child-report) and subjective (diary) and objective (actigraphy) sleep patterns were assessed across treatment in an open trial design. Study 2 included 50 youth (ages 9-14; 68% female; 10% ethnic/racial minority) who continued to report sleep-related problems after anxiety treatment and enrolled in an open trial of Sleeping TIGERS. Pre- and postassessments duplicated Study 1 and included the Focal Interview of Sleep to assess sleep disturbance. Study 1 demonstrated small reductions in sleep problems and improvements in subjective sleep patterns (diary) across anxiety treatment, but outcomes were not deemed clinically significant, and 75% of youth stayed above clinical cutoff. Study 2 showed clinically significant, large reductions in sleep problems and small changes in some subjective sleep patterns (diary). Anxiety treatment improves, but does not resolve, sleep disturbance in peri-pubertal youth, which may portend risk for poor emotional adjustment and mental health. The open trial provides preliminary support that Sleeping TIGERS can improve sleep in anxious youth to a clinically significant degree.
Journal of Clinical Child & Adolescent Psychology, 48(Supplement1) : S284-S297
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Other Psychological Interventions
Zheng, H.
More effective, tolerable interventions for treatment-refractory obsessive-compulsive disorder (OCD) are needed. Preliminary findings encourage optimism that methylphenidate augmentation may be of benefit in the treatment of OCD. To test modulator methylphenidate (MPH) of extended-release formulations (MPH-ER) a safe and effective add-on therapy for refractory OCD, a pilot randomized, placebo-controlled, double-blind trial was conducted at an outpatient, single-center academic setting. Participants included 44 adults with serotonin reuptake inhibitor (SRI) treatment-refractory OCD and receiving a stable fluvoxamine pharmacotherapy with Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores higher than 20. Data were analyzed in the intention-to-treat sample. All subjects were randomized into two parallel groups to receive fluvoxamine (250 mg daily) plus MPH-ER (36 mg daily) or fluvoxamine (250 mg daily) plus identical placebo tablets under double-blind conditions and followed for 8 weeks. Forty-four patients (29 [66%] men), with a mean (SD) age of 24.7 (6) years participated; with a mean (SD) duration of episode 5.7 (3) were randomized and forty-one finished the trial. In the intention-to-treat analysis, the improvement in the Y-BOCS total score and Y-BOCS obsession subscale score was more prominent in the fluvoxamine and MPH-ER group compared with those receiving placebo (P <.001). Additionally, cumulative response rates were higher in the MPH-ER vs placebo groups (59% vs 5%; P <.001). MPH-ER was well tolerated; No subjects dropped out due to side effects. In summary, combined treatment with MPH-ER demonstrated an enhanced clinical rate of response compared to placebo. Further trials should examine MPH-ER efficacy in a larger sample Copyright © 2018 Elsevier Ltd
European Neuropsychopharmacology, 29(3) : 397-404
- Year: 2019
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
, Treatment resistant/treatment refractory
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Antidepressants (any)
, Other biological interventions
Melvin, G. A., Gordon, M. S.
Cognitive-behavioral therapy (CBT) is an evidence-based treatment for school refusal. However, some youth do not respond to CBT. The serious risks associated with school nonattendance call for novel approaches to help those who do not respond to CBT. Because school refusal is commonly associated with anxiety disorders, and the combination of CBT and antidepressant medication enhances outcomes in the treatment of anxiety disorders, combined treatment may be effective for school refusal. This narrative review evaluates the current evidence base for adding antidepressant treatment to CBT for school refusal. Six randomized controlled trials (RCTs), two open trials, six case studies/series, and one observational study were identified and reviewed. There is support for combined CBT and imipramine, but this medication is not typically used due to the risk of concerning side effects. Two recent RCTs failed to provide evidence for the superiority of combined CBT and fluoxetine. Further research in this area is required because the extant studies have a number of methodological limitations. Recommendations are provided for clinicians who consider prescribing antidepressant medication or referring for adjunctive antidepressant treatment for school refusal. Copyright © 2018
Cognitive and Behavioral Practice, 26(1) : 107-118
- Year: 2019
- Problem: Anxiety Disorders (any), Specific Phobia
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention)
, Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Antidepressants (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Beloe, P., Derakshan, N.
Adolescents can be at heightened risk for anxiety and depression, with accumulating research reporting on associations between anxiety and depression and cognitive impairments, implicating working memory and attentional control deficits. Several studies now point to the promise of adaptive working memory training to increase attentional control in depressed and anxious participants and reduce anxiety and depression symptoms, but this has not been explored in a non-clinical adolescent population. The current study explored the effects of adaptive dual n-back working memory training on sub-clinical anxiety and depression symptomology in adolescents. Participants trained on either an online adaptive working memory task or non-adaptive control task for up to 20 days. Primary outcome measures were self-reported anxiety and depression symptomology, before and after intervention, and at 1-month follow-up. Self-reported depression (p = .003) and anxiety (p = .04) decreased after training in the adaptive n-back group relative to the non-adaptive control group in the intention-to-treat sample (n = 120). These effects were sustained at follow-up. Our findings constitute proof of principle evidence that working memory training may help reduce anxiety and depression vulnerability in a non-clinical adolescent population. We discuss the findings' implications for reducing risk of internalising disorders in youth and the need for replication. This article is protected by copyright. All rights reserved.
Developmental Science, : e12831
- Year: 2019
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Calear, A. L.
Objectives: This presentation will test the effectiveness of 2 universal online, self-directed CBT programs in preventing and reducing symptoms of depression and anxiety in an adolescent school-based population. Method(s): Two cluster RCTs were conducted. In the first trial (n = 1477), the MoodGYM program was compared with a wait-list control condition and delivered over 5 weeks to adolescents aged 12-17 years. The second trial (n = 540) was also implemented over 5 weeks to adolescents aged 15-16 years, evaluating SPARX-R against an attention control condition. Both trials measured depressive and anxiety symptom outcomes at preintervention, postintervention, and at 6 months follow-up and were analyzed using mixed-model repeated measure intention-to-treat approaches. Result(s): At postintervention and 6 months follow-up, the MoodGYM program was found to have a significant effect on anxiety for both males and females (Cohen's d = 0.15-0.25) and on depression for males only (d = 0.27-0.43). The SPARX-R program had a significant effect on depression, but not anxiety, at postintervention and at 6 months follow-up (d = 0.13-0.29). Greater adherence to the MoodGYM program was indicative of stronger intervention effects, with improved adherence associated with being in year 9 (ages 14-15 years), living in a rural location, and/or having higher preintervention levels of depressive symptoms or self-esteem. Conclusion(s): Although small to moderate, the effects obtained in the current studies provide support for the use of universal online prevention programs for depression in schools. Future research into methods to increase adherence and engagement with online programs is needed. DDD, TVM, CBT Copyright © 2018
Journal of the American Academy of Child and Adolescent Psychiatry, 57 (10 Supplement) : S35
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Universal prevention
, 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)
Saoji, A. A., Raghavendra, B. R., Madle, K., Manjunath, N. K.
BACKGROUND AND OBJECTIVE: The practice of yoga is associated with enhanced psychological wellbeing. The current study assessed the correlation between the duration of yoga practice with state mindfulness, mind-wandering and state anxiety. Also, we examined if an additional 20 min of yoga breathing with intermittent breath holding (experimental group) for 8 weeks would affect these psychological variables more than regular yoga practice (control group) alone.
METHODS: One hundred sixteen subjects were randomly assigned to experimental (n = 60) and control (n = 56) groups. State mindfulness attention awareness scale (SMAAS), Mind-Wandering Questionnaire (MWQ) and State anxiety inventory were administered at baseline and at the end of 8 weeks.
RESULTS: Baseline assessment revealed a positive correlation between duration of yoga practice with SMAAS scores and negative correlation with MWQ and state anxiety scores. At the end of 8 weeks, both groups demonstrated enhanced psychological functions, but the experimental group receiving additional yoga breathing performed better than the group practicing yoga alone.
CONCLUSION: An additional practice of yoga breathing with intermittent breath holding was found to enhance the psychological functions in young adult yoga practitioners.
Explore: The Journal of Science & Healing, 14(5) : 379-384
- Year: 2018
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Meditation
, Mind-body exercises (e.g. yoga, tai chi, qigong)
Villabo, M.A., Narayanan, M., Compton, S.N., Kendall, P.C., Neumer, S.P.
Objective: To compare the effectiveness of individual cognitive-behavioral therapy (ICBT) and group CBT (GCBT) for referred children with anxiety disorders within community mental health clinics. Method: Children (N = 165; ages 7-13 years) referred to 5 clinics in Norway because of primary separation anxiety disorder (SAD), social anxiety disorder (SOC), or generalized anxiety disorder (GAD) based on Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) criteria participated in a randomized clinical trial. Participants were randomized to ICBT, GCBT, or wait list (WL). WL participants were randomized to 1 of the 2 active treatment conditions following the wait period. Primary outcome was loss of principal anxiety disorder over 12 weeks and 2-year follow-up. Results: Both ICBT and GCBT were superior to WL on all outcomes. In the intent-to-treat analysis, 52% in ICBT, 65% in GCBT, and 14% in WL were treatment responders. Planned pairwise comparisons found no significant differences between ICBT and GCBT. GCBT was superior to ICBT for children diagnosed with SOC. Improvement continued during 2-year follow-up with no significant between-groups differences. Conclusions: Among anxiety disordered children, both individual and group CBT can be effectively delivered in community clinics. Response rates were similar to those reported in efficacy trials. Although GCBT was more effective than ICBT for children with SOC following treatment, both treatments were comparable at 2-year follow-up. Dropout rates were lower in GCBT than in ICBT, suggesting that GCBT may be better tolerated. Response rates continued to improve over the follow-up period, with low rates of relapse. (PsycINFO Database Record (c) 2018 APA, all rights reserved) Impact Statement What is the public health significance of this article?-Findings indicate that both individual and group cognitive-behavioral therapy can be effectively delivered by community mental health practitioners with only a minimal amount of formal training. Outcomes were similar to those reported in more controlled settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Consulting and Clinical Psychology, 86(9) : 751-764
- Year: 2018
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder)
- 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
Bettis, A. H., Forehand, R., Sterba, S. K., Preacher, K. J., Compas, B. E.
The current study examined effects of a preventive intervention on patterns of change in symptoms of anxiety and depression in a sample of children of depressed parents. Parents with a history of depression (N = 180) and their children (N = 242; 50% female; Mage = 11.38; 74% Euro-American) enrolled in an intervention to prevent psychopathology in youth. Families were randomized to a family group cognitive behavioral intervention (FGCB) or a written information (WI) control condition. Parents and youth completed the Child Behavior Checklist and Youth Self Report at baseline, 6-, 12-, 18-, and 24-month follow up. Youth in the FGCB intervention reported significantly greater declines in symptoms of both anxiety and depression at 6, 12, and 18 months compared to youth in the WI condition. Youth with higher baseline levels of each symptom (e.g., anxiety) reported greater declines in the other symptom (e.g., depression) from 0 to 6 months in the FGCB intervention only. Changes in anxiety symptoms from 0 to 6 months predicted different patterns of subsequent changes in depressive symptoms from 6 to 12 months for the two conditions, such that declines in anxiety preceded and predicted greater declines in depression for FGCB youth but lesser increases in depression for WI youth. Findings inform transdiagnostic approaches to preventive interventions for at-risk youth, suggesting that both initial symptom levels and initial magnitude of change in symptoms are important to understand subsequent patterns of change in response to intervention.
Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53, 47(4) : 581-594
- Year: 2018
- 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)
, Psychoeducation, Skills training
Johnstone, J., Nigg, J., Ribbers, A., Atchley, R., Gustafsson, H., Tipsord, J., Oken, B.
Purpose: Given the high degree of stress experienced by many high school students, this study sought to examine whether mindfulness was an acceptable classroom-based stress reduction intervention and whether it offered improvement in mood, anxiety and stress, as measured by self-reports and physiological measures. Result(s): Full data were available from 9 classes (n=202 students). Post-intervention satisfaction for mindfulness withstood baseline expectancy effects (P<.001), while wellness satisfaction was positively correlated with preintervention expectations, r=.33, n=39, P=.03. Post-intervention anxiety scores were significantly lower in students receiving mindfulness compared to usual health class (b=-.07, SE=.03, P=.009); no significant differences were found in other primary outcomes. Fifty-two percent of students (n=35) used the mindfulness app once to practice outside of class; of those 10% used it 10 or more times. Conclusion(s): Wellness satisfaction was influenced by preintervention expectations. Offering mindfulness during the high school day was acceptable to students, but less than 10% met the expectation to use the mindfulness app to practice regularly outside of the classroom. Although anxiety improved, 8 weeks of classroom-based mindfulness, without outside practice, did not appear to be a sufficient ''dose'' to detect significant improvements in mood and stress in self-reports and physiological measures of labinduced stress. These findings address some of the questions about the delivery of mindfulness in a classroom-based situation and suggest lifestyle elements that contribute to an active control for future comparative mindfulness research.
Global Advances in Health and Medicine, 7 : 253
- Year: 2018
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Mindfulness based therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Saleh, D., Camart, N., Sbeira, F., Romo, L.
In our research, we examined the efficacy of an Internet-based stress management program. Our interest in evaluating this type of intervention is based on the increasing accessibility of the Internet today, the growth of Internet-based interventions for various psychopathological problems, and the observation that despite the prevalence of stress among university students, only a fraction of students ever seek professional help. Methodology: "I'm managing my stress" ("Je gere mon stresse"), an Internet-based self-help program composed of four sessions, was examined in this study. The aforementioned program is based on cognitive-behavioral therapy and was inspired by the "Funambule" program in Quebec. Four questionnaires (Perceived Stress Scale, Rosenberg Self-Esteem Scale, Scale of Satisfaction in Studies, and General Health Questionnaire) uploaded online were answered thrice: during "preintervention", "postintervention", and "follow-up" stages, the latter of which occurred three months after the intervention. The sample comprised 128 university students, with the majority being women (81.25%). The subjects were divided randomly into two groups (an experimental group and a control group that did not follow the program). Result(s): The self-esteem scores of the control group were significantly higher than those of the experimental group at the preintervention stage, but this difference disappeared at the postintervention and follow-up stages. There were also significantly lower scores on the General Health Questionnaire subfactors of somatic symptoms and anxiety/insomnia in the experimental group than in the control group during the postintervention stage, though no differences were observed before the intervention. These differences no longer remained after three months. ANOVA revealed significant effects of the intervention over time in the experimental group. Effects were observed at both the postintervention and follow-up stages for self-esteem, perceived stress, satisfaction in studies, and in the somatic symptoms, anxiety and insomnia and severe depression aspects of the General Health Questionnaire (Cohen's d = 0.38 to 4.58). In contrast, no effects were observed in the control group. Conclusion(s): This type of Internet-based program has the ability to reach a large number of students due to its rather short format and accessibility. It has already shown improvements in terms of the levels of perceived stress, psychological distress and satisfaction with studies. The option of online interventions could appeal specifically to students who do not seek professional help. However, even though these results are promising at the postintervention stage, they are limited, as indicated by the lack of significant differences between the two groups after the initial three months of follow-up. We still, specifically, need to improve this intervention program and, generally, need more research to address the methodological problems raised by this type of intervention. Copyright © 2018 Saleh et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PLoS ONE, 13 (9) (no pagination)(e0200997) :
- Year: 2018
- 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)
, Self-help
, Technology, interventions delivered using technology (e.g. online, SMS)
Rosenstock, A., Connolly, M., Weller, R., Hong, M. Y.
Introduction: Brazil nuts are the highest known food source of selenium. Selenium has exhibited a multitude of health benefits including increased antioxidant capacity, improvement of lipid profiles, insulin and glucose responses, and potential elevation of mood. The purpose of the present study was to determine the effects of Brazil nut consumption on postprandial satiety, glucose, insulin, antioxidant activity and anxiety in healthy subjects. Hypothesis: The hypothesis was that consumption of Brazil nuts would increase satiety and antioxidant capacity, improve blood glucose and insulin levels and decrease anxiety compared to an isocaloric (131 kcal) selenium-free carbohydrate snack. Method(s): In a crossover design with two trials, 22 healthy adults (age 25 +/- 1.1y, BMI 22.3 +/-0.7 kg/m2) consumed pretzels (36g) and isocaloric, sodium-matched Brazil nuts (20g), separated by a 48-hour washout period. A visual analogue scale measured satiety at baseline, 20 and 40 minutes after snack consumption, while the modified anxiety scale measured anxiety at baseline and 40 minutes. Blood glucose, insulin and antioxidant levels were measured at baseline and 40 minutes post consumption. Result(s): Both the Brazil nuts and pretzels increased satiety with greater satiety in Brazil nuts compared to pretzels (P<0.05), and decreased anxiety (P=0.020) from baseline to 40 min post consumption with no significant differences between the two trials. Pretzel consumption caused a significant increase in blood glucose and insulin (P<0.001) at 40 min post consumption compared to baseline, while Brazil nut consumption did not significantly increase blood glucose or insulin levels. No significant differences were found between the trials on antioxidant capacity. Conclusion(s): Brazil nut consumption improved postprandial satiety and stabilized glucose and insulin responses which may be beneficial in maintenance and/or prevention of diabetes and reduction in incidence of overweight and obesity. Further studies on long term effects of Brazil nut consumption on reducing overall food intake and preventing cardiovascular disease, diabetes, and weight gain are warranted.
Circulation. Conference, 138(Supplement 1) :
- Year: 2018
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative Interventions (CAM)
, Other complementary & alternative interventions