Disorders - Anxiety Disorders
Wolff, J., Esposito-Smythers, C., Frazier, E., Stout, R., Gomez, J., Massing-Schaffer, M., Nestor, B., Cheek, S., Graves, H., Yen, S., Hunt, J., Spirito, A.
The current study conducted a preliminary test of whether community mental health clinic staff
could implement a multicomponent cognitive behavioral treatment, developed for adolescents with substance misuse (alcohol and/or marijuana) and
comorbid psychiatric symptoms. We randomized a total of 111 families, with an adolescent 12-18 years old, referred to a home-based services program
for youth with co-occurring substance use and mental health problems, to receive treatment from either masters-level therapists who received
intensive cognitive behavioral therapy (I-CBT) training or from masters-level therapists who took part in a typical brief continuing education-style
CBT workshop (treatment as usual, or TAU). Each family's therapist and insurance company determined the frequency and intensity of treatment. We
administered follow-up assessments at 3, 6, and 12 months. There was a small, but not statistically significant, reduction in the percent days of
heavy drinking and marijuana use over time for both conditions, with the overall effect across the three follow-up points favoring the I-CBT
condition. There were no differences on alcohol use days or other drug use. There was also a small, but nonsignificant, positive effect over time on
externalizing symptoms, depressed mood, and anxiety, favoring the I-CBT condition. Youth in the I-CBT condition relative to TAU had significantly
fewer juvenile justice contacts, while the pattern of costly service use varied, with higher rates at 6-month and lower rates at 12-month follow-ups.
If therapists pay greater attention to parent training and provide more parent-adolescent communication sessions, outcomes may improve above standard
community care. Training enhancements, to better meet the needs of community therapists and their clinic settings, may also produce better overall
results for parents and adolescents. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Journal of Substance Abuse Treatment Vol 116 2020, ArtID
108055, 116 :
- Year: 2020
- Problem: Anxiety Disorders (any), Depressive Disorders, Alcohol
Use, Cannabis Use
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder), At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Whiteside, S. P. H., Brennan, E., Biggs, B. K., Vickers, K., Hathaway, J., Seifert, S.
J., Kramer, K. M., Hofschulte, D. R.
With exposure emerging as a key ingredient in anxiety treatment for childhood anxiety disorders (CADs), expansion of exposure techniques
is a promising avenue for improving treatment efficacy. The present study examined use of imaginal exposure (IE), a technique understudied in the
treatment of CADs. Specifically, the study tested whether two forms of exposure to worries (verbal IE and virtual reality exposure therapy, VRET)
would be effective and acceptable forms of exposure with youth. Twenty youth with fears of academic failure completed both types of worry exposure,
presented in randomized order. Regardless of order of presentation, both verbal IE and VRET elicited moderate anxiety that decreased to mild over the
span of the exposures. Both were found to be acceptable by youth and neither was associated with negative side effects. Youth found VRET to be
slightly more interesting and novel, but noted that verbal IE was more realistic and individualized. The present study supports the use of standalone
worry exposure as an effective and acceptable treatment for general worries in youth and suggests VRET could be more effective with improved realism.
Copyright © 2020 Elsevier Ltd
, 76 (no
pagination) :
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Exposure therapy, Exposure
and response prevention, Narrative exposure therapy (NET), Technology, interventions delivered using technology (e.g. online, SMS), Technology, comparing delivery mode (e.g. online vs. face-to-face)
Weineck, F., Schultchen,
D., Hauke, G., Messner, M., Pollatos, O.
Background Previous research has shown that anxiety syndromes are highly prevalent
among university students. Effective treatments are needed to reduce the burden of anxiety in this population. Powerful postures have been found to
impact affective states, as well as interoception (i.e. the ability to perceive inner bodily signals). However, no previous study has compared the
effects of powerful- and neutral postures in regards to anxiety and interoceptive ability. Methods The first part of the study measured the single-
session effect of adopting powerful- vs. neutral postures on students' (n = 57) interoceptive ability and state anxiety. The second part of the
study measured the effect of adopting powerful or neutral postures twice daily for two weeks, on individuals' interoceptive ability and trait
anxiety. Results State anxiety decreased in both conditions whereas interoceptive accuracy only increased in the power posing condition after a
single session. Interoceptive accuracy increased in both groups after two weeks of training. Limitations The study included no comparison to a
condition where individuals adopted their natural (i.e. usual) bodily posture. Conclusions Embodiment interventions that include elements of adopting
an open or expansive bodily posture whilst maintaining a self-focus, can help to reduce state anxiety and improve interoceptive accuracy in student
populations. Power posing does not seem to be superior to holding a neutral posture to improve interoceptive accuracy or anxiety. One reason
therefore could be that both conditions include the manipulation of self-focus and a postural change that diverges from individuals' normal posture.
Copyright © 2020 Weineck 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, 15(12 December) :
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Other complementary & alternative
interventions
Versluis, A., Verkuil, B., Spinhoven,
P., Brosschot, J. F.
Worry is an important mediator in the relation between stressors and
health. This pilot study examined whether a smartphone-based in time worry-reduction training was feasible and improved physiological health (i.e.
increased heart rate variability [HRV]). A total of 26 high-worriers were randomised to an experimental or active-control condition (EC and CC
respectively). Participants in both conditions registered emotions 5 times daily for a month. The EC additionally received worry-reduction training
with mindfulness exercises. Primary outcomes were feasibility and HRV measured at baseline, after 2 weeks (halfway), and at 4 weeks (post-
intervention). Both training conditions were feasible and well received. HRV increased in the EC and CC, but this increase did not differ between
conditions. Preliminary findings suggest that both training conditions are feasible and might improve HRV, which is an important predictor of
cardiovascular disease. This pilot study only provided preliminary evidence, but it laid the groundwork for future randomised controlled trials that
ought to include more participants and a waitlist control group in order to get more definitive evidence of the effectiveness of the intervention.
(PsycInfo Database Record (c) 2021 APA, all rights reserved)
British Journal of Guidance & Counselling, 48(2) : 227-
239
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled 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)
Throuvala, M. A., Griffiths, M. D., Rennoldson, M., Kuss, D. J.
Evidence suggests a growing call for the prevention of excessive smartphone and social media use and the ensuing
distraction that arises affecting academic achievement and productivity. A ten-day online randomized controlled trial with the use of smartphone
apps, engaging participants in mindfulness exercises, self-monitoring and mood tracking, was implemented amongst UK university students (n = 143).
Participants were asked to complete online pre-and post-intervention assessments. Results indicated high effect sizes in reduction of smartphone
distraction and improvement scores on a number of self-reported secondary psychological outcomes. The intervention was not effective in reducing
habitual behaviours, nomophobia, or time spent on social media. Mediation analyses demonstrated that: (i) emotional self-awareness but not mindful
attention mediated the relationship between intervention effects and smartphone distraction, and (ii) online vigilance mediated the relationship
between smartphone distraction and problematic social media use. The present study provides preliminary evidence of the efficacy of an intervention
for decreased smartphone distraction and highlights psychological processes involved in this emergent phenomenon in the smartphone literature. Online
interventions may serve as complementary strategies to reduce distraction levels and promote insight into online engagement. More research is
required to elucidate the mechanisms of digital distraction and assess its implications in problematic use. Copyright © 2020 by the authors.
International Journal of Environmental Research and Public Health, 17(13) : 1-
30
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Mindfulness based
therapy, Technology, interventions delivered using technology (e.g. online, SMS)
Strawn, J.
R., Mills, J. A., Schroeder, H., Mossman, S. A., Varney, S. T., Ramsey, L. B., Poweleit, E. A., Desta, Z., Cecil, K., DelBello, M. P.
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are commonly used to treat pediatric anxiety disorders,
including generalized anxiety disorder (GAD); however, their efficacy and tolerability are difficult to predict. This study evaluated the efficacy
and tolerability of escitalopram in adolescents with GAD (DSM-IV-TR) and the impact of variants in HTR2A and serotonin transporter (SLC6A4) genes and
cytochrome P450 2C19 (CYP2C19) phenotypes on response as well as CYP2C19 phenotype on escitalopram pharmacokinetics from February 2015 through
November 2018. METHOD(S): Patients were treated with escitalopram (forced titration to 15 mg/d, then flexible titration to 20 mg/d) (n = 26, mean +/-
SD age: 14.8 +/- 1.7 years) or placebo (n = 25, mean +/- SD age: 14.9 +/- 1.6 years) for 8 weeks. Outcomes were the change in scores on the Pediatric
Anxiety Rating Scale (PARS) and Clinical Global Impressions (CGI) scales as well as vital signs and adverse events. Plasma escitalopram and
desmethylcitalopram area under the curve during 24 hours (AUC0-24) and maximum concentration (Cmax) were determined and compared across CYP2C19
phenotypes. RESULT(S): Escitalopram was superior to placebo for mean +/- SD baseline-to-endpoint change in PARS (-8.65 +/- 1.3 vs -3.52 +/- 1.1, P =
.005) and CGI scores, and increasing CYP2C19 metabolism was associated with decreases in escitalopram Cmax (P = .07) and AUC0-24 (P < .05). Vital
signs, corrected QT interval, and adverse events were similar in patients who received escitalopram and placebo. CONCLUSION(S): Escitalopram reduces
anxiety symptoms, and pharmacogenetics variables influence the trajectory and magnitude of improvement. Variation in CYP2C19 metabolism accounts for
significant differences in escitalopram pharmacokinetics, raising the possibility that CYP2C19 phenotype should be considered when prescribing
escitalopram. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02818751. © Copyright 2020 Physicians Postgraduate Press, Inc.
The
Journal of clinical psychiatry, 81(5) :
- Year: 2020
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any)
Strawn, J. R.
Objectives: This
presentation aims to summarize recent findings from the Child/Adolescent Anxiety Multimodal Study (CAMS), RCTs, and meta-analyses of SSRIs and SNRIs
in pediatric anxiety disorders. It also aims to review data that will allow clinicians to tailor pharmacotherapy for anxious youth. Method(s): First,
a literature review was conducted to identify SSRI and SNRI treatment studies of youth with generalized, social, and separation anxiety disorders.
Second, side effects from double-blind, placebo-controlled trials of SSRIs and SNRIs (16 SSRI and 4 SNRI trials) in youth with anxiety disorders were
examined with Bayesian hierarchical models. Third, key secondary analyses from CAMS related to SSRI tolerability and differential predictors of
treatment response and placebo response were summarized. Result(s): In anxious youth, antidepressant-related improvement occurs early in the course
of treatment, and SSRIs are associated with more rapid and greater improvement compared to SNRIs. In general, SSRIs are well-tolerated; however,
compared to placebo, SSRIs have greater adverse event-related discontinuation (p = 0.0003), activation (p = 0.003), sedation (p = 0.002), insomnia (p
= 0.001), abdominal pain (p = 0.005), and headache (p = 0.04). Activation is more common with SSRIs (vs SNRIs, p = 0.007) and may be related to
medication exposure (ie, area under the curve and Cmax). Youth with social anxiety disorder do best with treatments that include an SSRI
(vs CBT monotherapy or placebo), and responses to CBT monotherapy are similar to placebo in youth with a primary diagnosis of social anxiety
disorder, so treatment should include an SSRI. Finally, in patients with a primary diagnosis of generalized anxiety disorder (GAD), treatments that
included CBT were associated with better outcomes compared to sertraline monotherapy, although the latter was superior to a placebo. Conclusion(s):
SSRIs and SNRIs are effective in the treatment of pediatric anxiety disorders; however, SSRIs may be associated with poorer tolerability (vs placebo)
compared to SNRIs. Primary diagnosis is an important predictor of treatment response but not medication tolerability. These findings raise the
possibility that clinicians should use differential tolerability and efficacy data to predict response trajectory and when to use combination
treatment vs monotherapy. ADP, AD, AXX Copyright © 2020
Journal of the
American Academy of Child and Adolescent Psychiatry, 59 (10 Supplement) : S276
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors
(SNRIs), Antidepressants
(any)
Sood, M., Newman-Taylor, K.
Background: Paranoia, in
both clinical and non-clinical groups, is characterised by unfounded interpersonal threat beliefs. Secure attachment imagery attenuates paranoia, but
little is known about the mechanisms of change. Cognitive fusion describes the extent to which we can 'step back' from compelling beliefs, to
observe these as mental events, and is implicated in psychopathology cross-diagnostically. Aim(s): This study extends previous research demonstrating
the impact of attachment imagery on paranoia and anxiety to determine whether cognitive fusion mediates these relationships. Method(s): We utilised a
randomized experimental design and recruited an analogue sample with high levels of non-clinical paranoia to test the impact of imagery and the role
of cognitive fusion. Result(s): Secure attachment imagery resulted in reduced paranoia and anxiety compared to threat/insecure imagery. Cognitive
fusion mediated the relationships between imagery and paranoia, and imagery and anxiety. Conclusion(s): Secure attachment imagery is effective in
reducing paranoia and anxiety and operates via cognitive fusion. In clinical practice, these interventions should seek to facilitate the ability to
'step back' from compelling threat beliefs, in order to be most beneficial. Copyright © 2020, The Author(s).
Cognitive
Therapy and Research, 44(6) : 1150-1161
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Sinyor, M., Hawes, D., Rector, N. A., Cheung, A. H., Williams, M., Cheung, C., Goldstein, B. I., Fefergrad, M., Levitt, A. J., Schaffer,
A.
Objectives: A number of school-based interventions for preventing and attenuating symptoms of anxiety and depression in youth
have been developed worldwide but evidence of their effectiveness is mixed. None of these curricula stem from existing children's literature,
however, the Harry Potter (HP) series has been identified as potentially imparting Cognitive Behavioural Therapy concepts. Methods: This study aimed
to broadly capture, at an interim stage, the feasibility of a pilot HP curriculum aimed at imparting CBT skills to middle-schoolers in order to
inform full development of the curriculum. The study design further included a non-randomized, Group (HP; Control) by Time (Baseline, Post-
Intervention, Followup) mixed factorial approach retrospectively examining change in scores on a \"Well-Being and Resiliency Survey\" (WBRS) which
assessed multiple symptomatic and social domains. Results: In total, 232 grade seven and eight students participated in the curriculum over two years
with no dropouts. Compared to 362 controls, there were no significant differences in WBRS scores between groups at post or one-year follow-up.
Conclusions: This pilot study demonstrated the feasibility of rapid and broad implementation of the intervention. Preliminary analyses showed no
indication of effectiveness which may be the product of the intervention being in an interim stage during the study period and/or the retrospective
design and limitations in data quality. Specifically, these results suggest that the WBRS may be a suboptimal instrument for measuring the
effectiveness of this intervention. A prospective trial of the complete, revised curriculum with validated measures is required to provide an
adequately assessment of its impact. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (French) Objectifs: Un certain nombre
d'interventions en milieu scolaire visant a prevenir et a attenuer les symptomes d'anxiete et de depression chez les adolescents ont ete mises au
point dans le monde, mais les donnees probantes de leur efficacite sont partagees. Aucun de ces programmes d'etudes n'est issu de la litterature
pour enfants existante, pourtant, la serie des Harry Potter (HP) a ete reconnue transmettre potentiellement des concepts de la therapie cognitivo-
comportementale (TCC). Methodes: La presente etude visait a apprehender largement, a un stade preliminaire, la faisabilite d'un programme pilote HP
destine a transmettre des competences de TCC aux eleves de premier cycle du secondaire afin d'eclairer l'elaboration complete du programme. La
methode de l'etude comprenait en outre un groupe non randomise (HP, temoin) une chronologie (ligne de depart, post-intervention, suivi), une
approche factorielle mixte examinant retrospectivement le changement des scores a un << Sondage sur le bien-etre et la resilience (SBER) qui evaluait
les multiples domaines symptomatiques et sociaux. Resultats: En tout, 232 eleves de 7e et de 8e annee ont participe au programme durant deux ans sans
abandons. Comparativement aux 362 temoins, il n'y avait pas de differences significatives des scores de SBER entre les groupes au suivi d'un an ou
apres. Conclusions: Cette etude pilote a demontre la faisabilite de la mise en oeuvre rapide et elargie de l'intervention. Les analyses
preliminaires n'ont indique aucune efficacite qui puisse etre le produit du stade preliminaire de l'intervention durant la periode de l'etude
et/ou de la methode retrospective et des limitations de la qualite des donnees. Specifiquement, ces resultats suggerent que le SBER peut etre un
instrument sous-optimal pour mesurer l'efficacite de cette intervention. Un essai prospectif du programme complet revise avec des mesures validees
est necessaire pour obtenir une evaluation adequate de son effet. (PsycInfo Database Record (c) 2021 APA, all rights reserved)
Journal of the Canadian Academy of Child and Adolescent Psychiatry / Journal de l'Academie canadienne de psychiatrie de l'enfant
et de l'adolescent, 29(2) : 66-75
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Universal prevention
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Siegel, M. P., Conklin, S. M.
Background: The gut microbiome communicates bidirectionally
with the brain, linking the gut to psychological phenomena such as stress, depression, and anxiety. Probiotics, or ingestible supplements containing
billions of mutualistic bacteria, have demonstrated the mechanistic potential to influence mood; however, few studies have experimentally examined
the acute effects of these compounds on individuals not recruited for psychopathology or gut dysfunction. The present study hypothesized reductions
in stress, anxiety and depression symptoms following an acute, one week dosing period of B. longum intake. Method(s): The efficacy of a one-week
period of orally administered B. longum was tested utilizing a double-blind experimental design. Participants were randomly assigned to either
placebo or probiotic capsules under double blinded conditions and completed the Perceived Stress Scale (PSS), the Center for Epidemiological Studies
Depression scale (CES-D), and the State-Trait Anxiety Inventory (STAI Y2 form) to assess for differences before and after one-week intervention.
Result(s): No significant reduction in symptoms between groups over the one-week period was found. Conclusion(s): These findings suggest that 7-days
of B. longum does not reduce stress, depressive symptoms, or anxiety in generally healthy young adults. Copyright © 2020 The Author(s)
Brain, Behavior, and Immunity - Health, 2 (no pagination) :
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Shetty, R., Kongasseri, S., Rai, S.
This study examined the efficacy of mindfulness based cognitive therapy on children (MBCT-C) with
anxiety. Two hundred and forty children were screened, of which 52 (25 boys and 27 girls) with anxiety were randomly allocated to either MBCT-C or
group therapy (GT including cognitive behavioral principles). Both groups were rated on the Spence Children's Anxiety Scale and Emotion Regulation
Questionnaire-Child and Adolescent, pre- and 12 weeks post-interventions. MBCT-C was found to be more effective than GT in improving anxiety among
children (between-group effect size Cohen's d 1.05) and as effective as GT in reducing emotion suppression for effective emotion regulation. This
study provides support for MBCT-C as an effective group intervention for children with anxiety. © Copyright 2020 Springer Publishing Company,
LLC.
Journal of Cognitive
Psychotherapy, 34(4) : 306-318
- Year: 2020
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Mindfulness based
therapy
Shelemy, L., Harvey, K., Waite, P.
A large proportion
of emotional problems begin in adolescence and negatively impact quality of life into adulthood. There have been multiple teacher-delivered,
classroom-based programs created to reduce internalizing problems amongst young people. This meta-analysis and systematic review aims to examine the
effectiveness of teacher-delivered interventions for depression, anxiety, post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder
(OCD) symptoms in adolescents, and a range of factors that may impact outcomes. Database searches were conducted from PsycInfo, Medline (PubMed),
Scopus, Cochrane Library and the British Educational Index (database inception to January 2020). Quality assessment of studies used the EPHPP Quality
Assessment Tool. Fifty-two studies were identified that quantitatively assessed, via controlled design, intervention effects on internalizing
disorder symptoms. Three meta-analyses found teacher-delivered interventions were significantly better than control conditions at improving
depression (g = -0.12), anxiety (g = -0.13) and PTSD symptoms (g = -0.66) in students. Improvements were only maintained at follow-up for anxiety
symptoms and no effect sizes reached a 'small' threshold. However, the effect sizes were 'moderate' within the context of universal prevention
programs for young people. No interventions measured OCD outcomes. Improved outcomes were associated with interventions that lasted up to 16 weeks,
had 45-90 minute long sessions and included two or more days of teacher training. Future studies should report number of sessions taught, quality of
teacher training and fidelity of intervention. Analysis of outcomes for participants with high versus low baseline mental health scores would enable
a better understanding of for whom interventions are most effective. (PsycInfo Database Record (c) 2023 APA, all rights reserved)
Mental Health and Prevention Vol 19 2020, ArtID 200182, 19 :
- Year: 2020
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions
(any), Skills training, Mindfulness based
therapy