Disorders - Anxiety Disorders
Waters, A. M., Ford, L. A., Wharton, T. A., Cobham, V. E.
The present study compared the efficacy of a group-based cognitive-behavioural treatment (GCBT) delivered exclusively to
parents of young anxious children (between 4 and 8 years of age) with the same intervention delivered to both children and parents, relative to a
Wait-list Control condition. Parents of children in the Parent Only condition (N = 25) received 10 weekly sessions of GCBT whereas children and
parents in the Parent + Child condition (N = 24) each received 10 weekly sessions of GCBT. Intent-to-treat analyses indicated that both active
treatment conditions were superior to the Wait-list condition (N = 11), with 55.3% of children in the Parent Only condition and 54.8% of children in
the Parent + Child condition no longer meeting criteria for their principal diagnosis at post-treatment. These treatment gains were maintained in
both treatment conditions at six-month and 12-month follow-up assessments. There were no significant differences between the two active conditions on
other outcome measures including parental psychopathology and parenting style. However, an unexpected finding was that parenting satisfaction and to
some extent parenting competence reduced significantly from pre- to post-treatment regardless of the active treatment condition. The present results
suggest that GCBT delivered exclusively to parents of young anxious children may be a viable treatment alternative for improving accessibility to
efficacious treatments for children with anxiety disorders and for reducing costs associated with mental health care delivery. (copyright) 2009
Elsevier Ltd. All rights reserved.
Behaviour Research & Therapy, 47(8) : 654-662
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Wood, J. J., McLeod, B. D., Piacentini, J. C., Sigman, M.
Objective To compare the relative long-term benefit of family-focused cognitive behavioral therapy (FCBT) and
child-focused cognitive behavioral therapy (CCBT) for child anxiety disorders at a 1-year follow-up. Method Thirty-five children (6-13 years old)
randomly assigned to 12-16 sessions of family-focused CBT (FCBT) or child-focused CBT (CCBT) participated in a 1-year follow-up assessment.
Independent evaluators, parents, and children rated anxiety and parental intrusiveness. All were blind to treatment condition and study hypotheses.
Results Children assigned to FCBT had lower anxiety scores than children assigned to CCBT on follow-up diagnostician- and parent-report scores, but
not child-report scores. Exploratory analyses suggested the advantage of FCBT over CCBT may have been evident more for early adolescents than for
younger children and that reductions in parental intrusiveness may have mediated the treatment effect. Conclusion FCBT may yield a stronger treatment
effect than CCBT that lasts for at least 1 year, although the lack of consistency across informants necessitates a circumspect view of the findings.
The potential moderating and mediating effects considered in this study offer interesting avenues for further study.
Child Psychiatry & Human Development, 40(2) : 301-316
- Year: 2009
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Specific
Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Salemink, E., VanDenHout, M., Kindt, M.
Over the
past 20 years evidence has accumulated that individuals suffering from anxiety tend to interpret ambiguous information as threatening. Considering
the causal role of this interpretive bias in anxiety, it was recently established that modifying interpretive biases influences anxiety. This
suggests that anxiety can be clinically treated by directly targeting this interpretive bias. The present study was designed to modify a negative
interpretive bias in highly anxious individuals, and subsequently assess the hypothesized beneficial effects on clinical measures. High trait-anxious
participants were randomly assigned to one of two conditions: a positive interpretational Cognitive Bias Modification (CBM-I) or a control condition
(n = 2 null 17). The program was offered online for eight consecutive days. Upon completing the program, participants who had followed positive CBM-I
were less state and trait-anxious compared to the control group. Additionally, positively trained participants scored lower on a measure of general
psychopathology (SCL-90). No effects were observed on social anxiety and stress vulnerability. The mixed pattern of findings renders them rather
inconclusive, leaving interpretations of the potential therapeutic merits of CBM-I open for future research. (copyright) 2009 Elsevier Ltd. All
rights reserved.
Journal of Anxiety
Disorders, 23(5) : 676-683
- Year: 2009
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Sheehan, David V., Kamijima, Kunitoshi
Sertraline is a selective serotonin reuptake inhibitor that has been used and studied extensively throughout the
world and found to be safe and well tolerated in numerous patient populations, including those with either psychiatric and/or medical comorbidities.
Randomized clinical trials have shown that it is an effective treatment for depressive and anxiety disorders and its efficacy is unaffected by
psychiatric comorbidity. In non-comorbid patients, sertraline is effective for the acute treatment of major depressive disorders and prevention of
relapse or recurrence. It is effective for acute treatment and longer-term management of social anxiety disorder, posttraumatic stress disorder,panic
disorder, and generalized anxiety disorder. In adults and in pediatric patients, it is an effective short-term and long-term treatment for obsessive
compulsive disorder.Sertraline has a good tolerability profile and has low fatal toxicity. In summary, sertraline is as effective as other
antidepressants over a wide range of indications but may offer tolerability benefits as well as efficacy in patients with psychiatric and/or medical
comorbidities and certain subtypes of depression.
International Clinical Psychopharmacology, 24(2) : 43-60
- Year: 2009
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Smits, J. A. J., Berry, A. C., Rosenfield, D., Powers, M. B., Behar, E., Otto, M. W.
Background: Exercise interventions repeatedly have been shown to be efficacious for
the treatment of depression, and initial studies indicate similar efficacy for the treatment of anxiety conditions. To further study the potential
beneficial role of prescriptive exercise for anxiety-related conditions, we examined the role of exercise in reducing fears of anxiety-related
sensations (anxiety sensitivity). Methods: We randomly assigned 60 participants with elevated levels of anxiety sensitivity to a 2-week exercise
intervention, a 2-week exercise plus cognitive restructuring intervention, or a waitlist control condition. Assessment of outcome was completed at
pretreatment, midtreatment, 1-week posttreatment, and 3-week follow-up. Results: We found that both exercise conditions led to clinically significant
changes in anxiety sensitivity that were superior to the waitlist condition, representing a forge controlled effect size (d = 2.15). Adding a
cognitive component did not facilitate the effects of the exercise intervention. Consistent with hypotheses, changes in anxiety sensitivity mediated
the beneficial effects of exercise on anxious and depressed mood. Conclusions: We discuss these findings in terms of the potential role of exercise
as an additional psychosocial intervention for conditions such as panic disorder, where anxiety sensitivity is a prominent component of pathology.
copyright 2008 Wiley-Liss, Inc.
Depression &
Anxiety, 25(8) : 689-699
- Year: 2008
- 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, Physical activity, exercise
Silverman, W. K., Pina, A. A., &
Viswesvaran, C.
The article reviews psychosocial treatments for phobic
and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In
addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's
(1998) criteria. Findings from a series of meta-analyses of the studies that used waitlists also are reported. In accordance with Nathan and Gorman,
the majority of the studies were either methodologically robust or fairly rigorous. In accordance with Chambless and colleagues, although no
treatment was well-established, Individual Cognitive Behavior Therapy, Group Cognitive Behavior Therapy (GCBT), GCBT with Parents, GCBT for social
phobia (SOP), and Social Effectiveness Training for children with SOP each met criteria for probably efficacious. The other treatments were either
possibly efficacious or experimental. Meta-analytic results revealed no significant differences between individual and group treatments on diagnostic
recovery rates and anxiety symptom reductions, as well as other youth symptoms (i.e., fear, depression, internalizing and externalizing problems).
Parental involvement was similarly efficacious as parental noninvolvement in individual and group treatment formats. The article also provides a
summary of the studies that have investigated mediators, moderators, and predictors of treatment outcome. The article concludes with a discussion of
the clinical representativeness and generalizability of treatments, practice guidelines, and future research directions.
Journal of Clinical Child & Adolescent
Psychology, 37(1) : 105-130
- Year: 2008
- Problem: Anxiety Disorders (any), Social phobia (social anxiety disorder), Specific
Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Walkup, J. T., Albano, A.
M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J.
T., Ginsburg, G. S., et-al
Background: Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral
therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined
efficacy. Methods: In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of
separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a
dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We
administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4, 8, and 12. Results: The percentages
of children who were rated as very much or much improved on the Clinician Global Impression-Improvement scale were 80.7% for combination therapy
(P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%).
Combination therapy was superior to both monotherapies (P<0.001). Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and
pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all
therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in
the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral
therapy than with sertraline. Conclusions: Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety
disorders; a combination of the two therapies had a superior response rate. (ClinicalTrials.gov number, NCT00052078.) Copyright (copyright) 2008
Massachusetts Medical Society.
New England Journal of Medicine, 359(26) : 2753-
2766
- Year: 2008
- Problem: Anxiety Disorders (any), Social phobia (social anxiety disorder)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Parslow, Ruth, Morgan, Amy J., Allen, Nicholas B., Jorm, Anthony F., O'Donnell, Colin
P., Purcell, Rosemary
OBJECTIVE: To review the evidence for the effectiveness of complementary and self-help treatments for anxiety disorders and situational
anxiety in children and adolescents. DATA SOURCES: Systematic literature search using PubMed, PsycINFO and the Cochrane Library for 111 treatments up
to February 2006. STUDY SELECTION: There were 11 treatments for which intervention studies had been undertaken and reported. DATA EXTRACTION: Studies
on each treatment were reviewed by one author and checked by a second. A consensus was reached for level of evidence. DATA SYNTHESIS: Relevant
evidence was available for bibliotherapy, dance and movement therapy, distraction techniques, humour, massage, melatonin, relaxation training,
autogenic training, avoiding marijuana, a mineral-vitamin supplement (EMPower +) and music therapy. Findings from case-control studies, individual
cohort studies or low quality randomised controlled trials indicated that several treatments may have potential to reduce anxiety, including
bibliotherapy, massage, melatonin, and relaxation training. CONCLUSIONS: Although some complementary and self-help treatments might be useful for
children and adolescents with anxiety, they need to be tested adequately through randomised controlled trials before they could be recommended.
[References: 40]
Medical Journal of
Australia, 188(6) : 355-9
- Year: 2008
- 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), Psychological Interventions
(any), Self-help
Liber, J. M., VanWidenfelt, B. M., Utens, E.
M. W. J., Ferdinand, R. F., VanDerLeeden, A. J. M., Gastel, W. V., Treffers, P. D. A.
Background: The present study compares an individual versus a group format in the delivery of
manualised cognitive-behavioural therapy (FRIENDS) for children with anxiety disorders. Clinically referred children (aged 8 to 12) diagnosed with
Separation Anxiety Disorder (n = 52), Generalised Anxiety Disorder (n = 37), Social Phobia (n = 22) or Specific Phobia (n = 16) were randomly
assigned to individual (n = 65) or group (n = 62) treatment. Method: Analyses were conducted separately for the intent-to-treat sample and the sample
of children who completed treatment. Analyses included chi-square comparisons and regression analyses with treatment format as a predictor. Results:
Forty-eight percent of the children in the individual versus 41% in the group treatment were free of any anxiety disorder at post-treatment; 62%
versus 54% were free of their primary anxiety disorder. Regression analyses showed no significant difference in outcome between individual and group
treatment. Conclusions: Children improved in both conditions. Choice between treatments could be based on pragmatic considerations such as
therapeutic resources, referral rates, and the preference of the parents and the child. copyright 2008 The Authors.
Journal of Child Psychology & Psychiatry & Allied
Disciplines., 49(8) : 886-893
- Year: 2008
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Specific
Phobia
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Kendall, P. C., Hudson, J. L., Gosch, E., Flannery-Schroeder, E., Suveg, C.
This randomized clinical trial compared the
relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based
education/support/attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85%
Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized
anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at
posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also
conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were
superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports
of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder.
Implications for treatment and suggestions for research are discussed. copyright 2008 American Psychological Association.
Journal of Consulting &
Clinical Psychology., 76(2) : 282-297
- Year: 2008
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Mostert, J., Loxton, H.
The prevalence of anxiety symptoms among South African children is reported to be significantly higher than in other
parts of the world. The need for an effective anxiety prevention and early intervention program for use with South African children is urgently
needed. The aim of the present study was therefore to determine whether the Australian FRIENDS program could effectively reduce the anxiety symptoms,
as measured by the Spence Children's Anxiety scale (SCAS), among a sample of South African children from low socioeconomic background. The program
evaluation employed a quasi-experimental, nonequivalent control group design that followed participants (N = 46) over a course of 10 months. Within
group effects and between group effects revealed that the FRIENDS program had little statistically significant post intervention effect on the
anxiety symptoms of this sample, but had significant effects in the longer term, at 4 months and 6 months follow-up. The implications of these
results for the South African context are discussed.
Behaviour Change., 25(2) : 85-
96
- Year: 2008
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Broman-Fulks, J. J., Storey, K.
M.
Anxiety sensitivity, or the belief that anxiety-related sensations can have
negative consequences, has been shown to play an important role in the etiology and maintenance of panic disorder and other anxiety-related
pathology. Aerobic exercise involves exposure to physiological cues similar to those experienced during anxiety reactions. The present study sought
to investigate the efficacy of a brief aerobic exercise intervention for high anxiety sensitivity. Accordingly, 24 participants with high anxiety
sensitivity scores (Anxiety Sensitivity Index-Revised scores 28) were randomly assigned to complete either six 20-minute sessions of aerobic exercise
or a no-exercise control condition. The results indicated that individuals assigned to the aerobic exercise condition reported significantly less
anxiety sensitivity subsequent to exercise, whereas anxiety sensitivity scores among non-exercisers did not significantly change. The clinical
research and public health implications of these findings are discussed, and several potential directions for additional research are
recommended.
Anxiety, Stress &
Coping, 21(2) : 117-128
- Year: 2008
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Physical activity, exercise