Disorders - Anxiety Disorders
Werner-Seidler, A., Spanos, S., Calear, A. L., Perry, Y., Torok, M., O'Dea, B., Christensen, H., Newby, J. M.
Depression and anxiety are often first experienced during childhood and adolescence, and interest in the
prevention of these disorders is growing. The focus of this review was to assess the effectiveness of psychological prevention programs delivered in
schools, and to provide an update to our previous review from five years ago (Werner-Seidler, Perry, Calear, Newby, & Christensen, 2017). Three
electronic databases were systematically searched for published articles of randomised controlled trials (RCTs) evaluating the efficacy of school-
based prevention programs until October 2020. There were 130 articles that met inclusion criteria, representing 118 unique trials and 45,924
participants. Small between-group effect sizes for depression (g = 0.21) and anxiety (g = 0.18) were detected immediately post-intervention. Subgroup
analyses suggested that targeted prevention programs (for young people with risk factors or symptoms) were associated with significantly greater
effect sizes relative to universal programs for depression, which was confirmed by meta-regression. There was also some evidence that external
providers conferred some benefit over school-staff delivered programs. Overall, study quality was moderate and no association between risk of bias
and effect size was detected. School-delivered psychological prevention programs have small effects in reducing symptoms of depression and anxiety.
Refinement of these programs, and knowledge about how they can be sustainably delivered in schools beyond the trial period is now needed for
population-level preventive effects. Systematic Review Registration Number: PROPSERO - CRD42020188323.
Clinical Psychology
Review, 89 : 102079
- Year: 2021
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Weerdmeester, J., van-Rooij, M. M., Maciejewski, D. F. Engels, R. C., Granic, I.
This
study assessed the efficacy of a virtual reality biofeedback video game (DEEP) in reducing anxiety symptoms. In addition, changes in engagement and
cognitive appraisals including self-efficacy, locus of control, and threat-challenge appraisals were measured and it was explored how these factors
related to anxiety regulation. Undergraduates with elevated anxiety symptoms (N = 112) were randomly assigned to four training sessions with DEEP or
a smartphone-guided breathing application. Trait anxiety was measured at screening, pretest, posttest, and 3 months later. State anxiety was assessed
before and after each session. In addition, engagement and appraisals were assessed in each session. Participants in both conditions showed a
significant decrease in trait anxiety symptoms from pre- to posttest and this decrease remained stable at follow-up. Furthermore, all participants
decreased in state anxiety from pre- to postsession, except for DEEP sessions that included exposure. DEEP users increased in self-efficacy and
observed resources to cope throughout the training. In addition, DEEP users felt more engaged in initial sessions than those who used the control
application, but their engagement decreased toward the final session. In contrast, participants in the control group showed no change in appraisals
nor engagement. Taken together, results demonstrate the potential of digital interventions such as biofeedback games and guided relaxation
applications as anxiety regulation tools and show that self-efficacy and threat-challenge appraisals in particular are potential mechanisms of change
in biofeedback interventions. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
Technology, Mind, and Behavior, 2(2) : No Pagination
Specified
- Year: 2021
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Service Delivery & Improvement, Psychological Interventions
(any), Biofeedback, neurofeedback, audio/video feedback, Relaxation, Technology, interventions delivered using technology (e.g. online, SMS)
Urao, Y., Ohira, I., Koshiba, T., Ishikawa, S. I., Sato, Y., Shimizu, E.
Background: In Japan,
'Journey of the Brave', a cognitive behavioural therapy (CBT)-based anxiety preventive education programme, was previously developed and its
effectiveness examined in two small-scale controlled trials. These studies had some limitations, including a small number of participants and not
having regular classroom teachers as programme facilitators. Therefore, we conducted a large-scale controlled trial, with teachers as programme
implementers. Method(s): Twenty-seven elementary schools participated: 1622 and 1123 children were allocated to the intervention and control groups,
respectively. The intervention group received a programme comprising ten 45-min sessions, while the control group underwent the regular school
curriculum. Anxiety symptoms among participants were assessed using the Spence Children's Anxiety Scale (SCAS) at three stages (pre-intervention,
post-intervention, and follow-up). Result(s): Following primary analysis, estimated mean changes in SCAS from baseline to follow-up were - 4.91 (95%
CI - 5.91, - 3.90) in the intervention group and - 2.53 (95% CI - 3.52, - 1.54) in the control group; the group difference was 2.37 (95% CI 1.42,
3.33, p < 0.0001). Children in the intervention group showed significant reduction in their anxiety score versus children in the control group.
Conclusion(s): The results showed a statistically significant anxiety score reduction in the intervention group, thus verifying the programme's
effectiveness. Trial registration The University Hospital Medical Information Network (UMIN): UMIN000032517. Registered 10 May 2018-Retrospectively
registered, https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000037083 Copyright © 2021, The Author(s).
Child and Adolescent Psychiatry and Mental
Health, 15(1) :
- Year: 2021
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Tsui, T. Y. L., DeFrance, K., Khalid-Khan, S., Granic, I., Hollenstein, T.
Objective: Anxiety disorders are the most prevalent form of psychopathology among youth. Because demand for treatment far exceeds
availability, there is a need for alternative approaches that are accessible, engaging, and incorporate practice to reach as many youth as possible.
MindLight is a novel videogame intervention that combines evidence-based anxiety reduction techniques with neurofeedback mechanics that has been
shown to reduce anxiety symptoms in youth. This study examined the effectiveness of MindLight compared with online cognitive behavioral therapy (CBT)
to replicate and extend those findings by testing the reduction of reactivity to anxiety-eliciting laboratory stressors. Materials and
Methods: A randomized controlled trial was conducted with laboratory assessments at pre-intervention, post-intervention, and 3-month follow-up.
Participants were 117 anxious youth (66.7% female, 33.3% male; age range: 8.05-15.93 years) who were randomized into MindLight (n = 56) and CBT (n =
60) conditions. Both interventions were completed in five 1-hour sessions within a 3-week period. At each time point, anxiety symptoms were assessed
through self-report, and state anxiety and anxious arousal were measured during laboratory stress tasks. Results: All measures of anxiety
significantly decreased over time in both conditions (P < 0.05). Moreover, youth in the MindLight condition showed greater pre-to-post reductions in
anxiety symptoms compared with youth in the CBT condition (P < 0.05). Conclusion: Findings demonstrate that the effects of MindLight and
online CBT are not only associated with reductions in anxiety symptoms, but also impact how youth react to laboratory stressors in the moment.
ClinicalTrials.gov Identifier: NCT02326545.
Games for Health Journal, 10(5) : 330-338
- Year: 2021
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention, Attention/cognitive bias
modification, Biofeedback, neurofeedback, audio/video feedback, Technology, interventions delivered using technology (e.g. online, SMS)
Tsai, C. L., Lin, Y. W., Hsu, H. C., Lou, M. L., Lane, H. Y., Tu, C. H., Ma, W. F.
Background: Increasing health awareness in
health promotion is considered as one of the less stigmatized interventions for improving help-seeking behaviors and total well-being. This study
aimed to explore the short-term and long-term effectiveness of the health-awareness-strengthening lifestyle (HASL) program on Taiwanese young adults
with at-risk mental state. Method(s): A pre-and post-test randomized trial was conducted on 92 young adults with at-risk mental state. The HASL
program was provided to the experimental group as intervention, and it was only provided to the control group passively by request after the post-
test for ethical reasons. The program was conducted once every six weeks, 60-90 min per session, for a total of three times. Mental health risk,
anxiety level, health promotion lifestyles, quality of life, physiological index, and physical exercises were assessed one week before and after the
program for both groups and followed up to 6 and 12 months for experimental group only. Result(s): Compared to the control group, those in the
experimental group showed significant improvements regarding anxiety level, health promotion lifestyles, and quality of life one week after
participating in the program. Furthermore, the experimental group also showed an additional long-term positive effect on mental risk, physical
exercises, and physical health after the follow-ups. Conclusion(s): The outcomes highlighted the interventions of the HASL program leading to more
positive health effects on young adults with at-risk mental state. The implementation of similar clinical service is recommended for young adults
with at-risk mental state. Copyright © 2021 by the authors. Licensee MDPI, Basel, Switzerland.
International Journal of Environmental Research and Public Health, 18(4) : 1-
13
- Year: 2021
- 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, Dietary advice, dietary change, Physical activity, exercise, Other complementary & alternative
interventions
Thomas, J. G., Sharp, P. B., Niznikiewicz, M. A., Heller, W.
Objective: A novel brief intervention was used to investigate how empathic support and expectation can
induce changes in mood, anxiety, and perceived stress. Method(s): Seventy-six undergraduates with high negative affect were assigned to three
conditions of a program involving tasks with no known therapeutic benefit. In Group 1: Expectation Only, participants were given a deceptive
description of the benefits of the program to quantify the magnitude of symptom change due to expectation alone. In Group 2: Empathic Support
+Expectation, participants were also instructed to write about past and current sources of distress and provided with supportive notes each week to
quantify the role of empathic support plus expectation. In Group 3: Control, participants were told they were \"norming\" the instruments. Result(s):
Participants in Groups 1 and 2 demonstrated decreases in depression, anxiety, and rumination, with significant medium effect reductions found in the
empathic support plus expectation condition. Conclusion(s): Evidence suggests that empathic support and expectation cause reduction of symptoms
spanning depression and anxiety.
Psychotherapy research : journal of the Society for Psychotherapy Research, : 1-
11
- Year: 2021
- 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, Biofeedback, neurofeedback, audio/video feedback, Creative expression: music, dance, drama, art
Teesson, M., Newton, N., Slade, T., Chapman, C., Birrell, L., Mewton, L., Mather, M., Hides, L., McBride, N., Allsop, S., Andrews, G.
Introduction and Aims: Mental health and
substance use disorders are leading causes of disability among young people globally [1]. Research has highlighted the comorbidity of these disorders
[2], yet few existing prevention programs concurrently target these issues. Furthermore, many programs are hampered by poor implementation fidelity.
The Climate Schools Combined (CSC) Study was the first trial to test the effectiveness of an online prevention model targeting both mental health and
substance use disorders among adolescents. Design and Methods: A four-arm cluster RCT involving 6386 students from 71 schools was conducted from
2014-2016. Schools were randomised to one of the following conditions; 1) \"Control,\" 2) \"Climate Schools-Substance Use,\" 3) \"Climate Schools-
Mental Health,\" or 4) the \"CSC\" intervention. Result(s): Compared to Controls, the Combined intervention increased knowledge related to alcohol
and cannabis at 12, 24 and 30 months (30 months: alcohol SMD 0.26, 95% CI 0.14 - 0.39, cannabis SMD 0.17, 95% CI 0.06 - 0.28), increased knowledge
related to mental health at 24 months (SMD 0.17, 95% CI 0.08 - 0.27), less growth in their odds of drinking and heavy episodic drinking at 12, 24 and
30 months (30 months: drinking OR 0.25, 95% CI 0.12 - 0.51, heavy episodic drinking OR 0.15, 95% CI 0.04 - 0.58), and reduced increases in anxiety
symptoms at 12 and 30 months (30 months: SMD -0.12, 95% CI -0.22 - -0*01). No difference was found in symptoms or probable diagnosis of depression.
The Combined intervention also showed evidence of improvement on some outcomes compared to the Substance Use and Mental Health interventions.
Discussions and Conclusion(s): For the first time, there is evidence of the effectiveness of a universal school-based preventive intervention
concurrently targeting substance use, depression and anxiety. It provides educators with an easy to implement and scalable approach to prevention.
Disclosure of Interest Statement: MT and NN are developers of the Climate Schools programs, as well as the Directors of Climate Schools Pty Ltd,
which distributes the Climate Schools programs on a not-for-profit basis.
Alcoholism: Clinical and Experimental Research, 45
(SUPPL 1) : 75A
- Year: 2021
- Problem: Anxiety Disorders (any), Depressive Disorders, Substance Use Disorders (any), Alcohol
Use, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Strohm, M., Siegesleitner, M., Kunze, A. E., Werner, G. G., Ehring,
T., Wittekind, C. E.
Background: Imagery Rescripting (ImRs) is a promising intervention to reduce symptoms associated with aversive
memories, but little is known about its working mechanisms. The present study investigates whether ImRs increases perceived mastery and attenuates
emotional reactivity to memory retrieval on a subjective and physiological level. Method(s): Seventy-nine individuals reporting memories of
distressing real-life events were randomly allocated to ImRs, positive imagery (PI), or no-intervention control (NIC). The memory was reactivated
before the intervention and at 1-week follow-up to assess subjective measures and physiological reactivity (heart rate [HR], skin conductance level
[SCL], and facial electromyography activity [EMG]) during memory retrieval. Result(s): ImRs was superior to PI and NIC on subjective memory distress
and helplessness, but not on other emotions. ImRs did not exceed PI and NIC in reducing state stress symptoms or increasing perceived mastery.
Physiological reactivity (HR, EMG) decreased from pre-intervention to follow-up with no differences between groups. Conclusion(s): Positive effects
of ImRs on helplessness and distress were found. Null findings regarding mastery might result from timing of its assessment or the fact that rather
high-functioning participants were included. The lack of between group differences on physiological responses indicates that ImRs did not exceed
habituation effects in the present sample. Copyright © 2021, The Author(s).
Cognitive Therapy and Research., :
- Year: 2021
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Other Psychological Interventions
Stewart, K. E., Antony, M. M., Koerner, N.
Context: The Attention Training Technique (ATT, Wells, 1990) is an intervention guiding
individuals to focus, shift, and divide their attention in response to sounds presented in an audiorecording. The ATT has long been recommended for
generalized anxiety disorder (GAD); however, there is insufficient research on its effects on excessive worry and related processes. Objectives: This
experiment examined whether the ATT is more efficacious than a control intervention at reducing worry and modifying worry-related processes (e.g.,
attention control, negative metacognitive beliefs, attention bias, mindfulness). Participants: 78 adults with probable GAD. Design: Participants
completed measures of worry and worry-related processes at the lab. They then monitored worry and attention daily for a week. Following this
baseline, participants recompleted the lab measures and were randomly assigned to ATT or control. Participants listened to their assigned recording
once/day for a week while again monitoring worry and attention daily. Participants then recompleted the lab measures. Results: The ATT did not
perform better than the control condition on any measure. A variety of improvements were seen over the intervention period in both conditions.
Conclusions: ATT may not have meaningful effects on excessive worry and worry-related processes. Explanations for null findings are offered.
(PsycInfo Database Record (c) 2021 APA, all rights reserved)
Behaviour Research and Therapy Vol 141 2021, ArtID
103863, 141 :
- Year: 2021
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification
Steains, S. Y., Malouff, J. M., Schutte, N. S.
BACKGROUND: Selective mutism is a rare childhood anxiety disorder characterized by a consistent failure to speak in certain social
situations where speech is expected, despite fluent speech in other situations. The purpose of this meta-analysis was to investigate the efficacy of
psychological interventions for selective mutism in randomized controlled trials (RCTs).\rMETHODS: Five RCTs with a total of 233 participants were
analysed using a random-effects model. A quality assessment of the included studies revealed that psychometrically sound measures and treatment
manuals were used across all studies.\rRESULTS: The results of the analyses showed psychological interventions to be more effective than no
treatment, with the overall weighted effect size of g = 0.87, indicating a large mean treatment effect. This effect did not significantly differ with
whether only selective mutism specific or nonselective mutism specific measures were included in the analysis.\rCONCLUSIONS: These findings provide
support for the efficacy of psychological treatment for selective mutism. Future research could examine the effects of the successful treatments
identified in this meta-analysis when compared with a psychological placebo or another bona fide treatment.
Child: Care, Health & Development, 47(6) : 771-781
- Year: 2021
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any)
Stapinski, L. A., Prior, K., Newton, N. C., Biswas, R. K., Kelly, E., Deady, M., Lees, B., Teesson, M., Baillie, A. J.
Background: Anxiety and alcohol use disorders are common and disabling conditions that people typically endure for many years
before accessing treatment. The link between anxiety and alcohol use is well-established, with these issues commonly emerging and/or escalating
during emerging adulthood. This randomized controlled trial evaluated a psychologist-supported, web-based intervention, designed with and for
emerging adults, that aims to promote adaptive coping strategies, and prevent anxiety and alcohol use from progressing to chronic, mutually-
reinforcing disorders. Method(s): Between December 2017 and September 2018, 123 emerging adults (aged 17-24) reporting anxiety symptoms and hazardous
alcohol use were randomized to receive the Inroads or control (assessment plus alcohol information) intervention. The Inroads program combined five
web-based cognitive behavioral therapy modules with weekly psychologist support via email/phone. Primary outcomes were alcohol consumption, severity
of alcohol-related consequences, and general anxiety symptoms, assessed at baseline, 2 and 6-months post-baseline. Secondary outcomes included
hazardous alcohol use and social anxiety. Trial Registration: Prospectively registered in the Australian New Zealand Clinical Trials Registry,
ACTRN12617001609347. Finding(s): Alcohol consumption and associated consequences reduced in both groups, with the Inroads group reporting greater
alcohol reductions by 6-month follow-up (mean difference -0.74, 95% CI: -1.47 to -0.01, d = 0.24). Relative to controls, hazardous alcohol use
reduced among Inroads participants at both follow-ups (2-month mean difference -2.14, 95% CI: -4.06 to -0.22). Inroads participants also reported
reduced symptoms of general (mean difference -3.06, 95% CI: -4.97 to -1.15, d = 0.88) and social anxiety (mean difference -3.21, 95% CI: -6.34 to -
0.07, d = 0.32) at 2-month follow-up, with improvements in social anxiety sustained at 6-months. Interpretation(s): The Inroads program demonstrated
beneficial effects on alcohol consumption, hazardous alcohol use, and anxiety symptoms. The web-based format is aligned with youth treatment
preferences and can be delivered at scale to achieve wide dissemination and reduce the significant burden associated with these chronic, mutually
reinforcing conditions. Funding(s): Australian Rotary Health, Australian National Health and Medical Research Council. Copyright © 2021 The
Authors
, 39 (no
pagination) :
- Year: 2021
- Problem: Anxiety Disorders (any), Alcohol
Use
- 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)
Springfield, C. R., Isa, R. S., Bass, E. L., Vanneste, S., Pinkham, A. E.
OBJECTIVES: Paranoia manifests
similarly in subclinical and clinical populations and is related to distress and impairment. Previous work links paranoia to amygdala hyperactivity
and reduced activation of the ventrolateral prefrontal cortex (VLPFC), a region thought to regulate amygdala activity. METHOD(S): This study aimed to
reduce subclinical paranoia in 40 undergraduates by increasing activity of the VLPFC via single-session transcranial Direct Current Stimulation
(tDCS). A double-blind, crossover (active vs. sham stimulation) design was used. RESULT(S): Paranoia significantly decreased after active stimulation
(dz = 0.51) but not sham (dz = 0.19), suggesting that tDCS of VLPFC was associated with mean-level reductions in paranoia. CONCLUSION(S): These
findings demonstrate preliminary support for the role of single-session active stimulation to the VLPFC for reducing subclinical paranoia in healthy
individuals. PRACTITIONER POINTS: In both clinical and subclinical populations, paranoia is related to distress and poorer functional outcomes.
Paranoia has been linked to overactivation of the amygdala, a brain region responsible for detecting salience and threat, and reduced activation of
the ventrolateral prefrontal cortex (VLPFC), a region thought to modulate and regulate amygdala activity. In this study, transcranial direct current
stimulation (tDCS) of the VLPFC reduced self-reported paranoia in healthy undergraduate students. tDCS may be a promising intervention for reducing
paranoia in subclinical and clinical populations. Effects were relatively small and require replication with larger subclinical samples and with
clinical samples. Copyright © 2021 The British Psychological Society.
The British journal of clinical
psychology., 29 :
- Year: 2021
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions