Disorders - Anxiety Disorders
Londono-Tobon, A., Reed, M. O., Taylor, J. H., Bloch, M. H.
Objective: School refusal
is an important pediatric problem with significant negative short- A nd long-term outcomes. Specific psychosocial treatments appear effective in
reducing school refusal, but many children do not respond to these treatments. Although systematic reviews have examined the efficacy of
psychological interventions for school refusal, no systematic reviews on pharmacological interventions exist. Methods: We conducted a comprehensive
literature search of MEDLINE, PsycINFO, Scopus, and Embase for randomized controlled trials (RCTs) or quasi-experimental pharmacologic trials in
children and adolescents with school refusal reported in English or Spanish until July 1, 2017. Two authors screened study titles and abstracts for
eligibility. Data regarding the population, intervention, comparison, and outcomes for each trial were extracted and reported. Effect sizes for
school attendance are presented. Results: The search identified 6 articles, including 7 trials (6 RCTs and 1 open label) and 306 youths.
Pharmacologic treatments investigated for school refusal included antidepressants (imipramine, clomipramine, and fluoxetine) and benzodiazepines
(alprazolam). All pharmacotherapies studied had pretreatment to posttreatment improvements on school refusal, depression, and anxiety symptoms.
However, included trials were severely underpowered and did not demonstrate significant improvement compared to placebo. Conclusions: Data regarding
pharmacological treatments for school refusal are sparse. Most trials in this area were conducted before development of newer antidepressants, were
underpowered, and have significant methodological limitations that are characteristic of the time in which they were conducted. This systematic
review highlights the need for more trials with newer pharmacologic agents, larger sample sizes, and improved systematic assessments of school
refusal and comorbidities. School refusal represents an important functional outcome for many children, especially those with anxiety and depression.
Future pharmacologic studies of anxiety and depression in children may benefit from incorporating specific school refusal measures as secondary
outcomes. Copyright © 2018, Mary Ann Liebert, Inc.
Journal of Child and Adolescent Psychopharmacology, 28(6) : 368-
378
- Year: 2018
- Problem: Anxiety Disorders (any), Specific
Phobia
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants, Antidepressants
(any), Anticonvulsants/mood stabilisers (excl. lithium)
Devoe,
D., Farris, M., Addington, J.
Youth at clinical high risk (CHR) for
psychosis often present with symptoms of depression and anxiety, which can reduce quality of life. Therefore, the aim of this systematic review was
to determine the impact of all interventions on symptoms of depression and anxiety in CHR samples. We systematically searched Embase, EBM, PsycINFO,
CINAHL, and MEDLINE. Studies were selected if they reported changes in depression or anxiety symptoms in youth at CHR and included an intervention.
Data was evaluated using pairwise metaanalyses, stratified by time, and reported as the standardized mean difference (SMD). Twenty-three studies met
our inclusion criteria, including a total of 1,831 CHR participants. The mean age was 19.35 years and 49% were female. Interventions included family
therapy, glycine, antipsychotics, cognitive remediation, however analysis could only be performed on cognitive behavioural therapy (CBT) and omega-3.
CBT did not significantly improve depression at 6-months (SMD = 0.02; 95% CI = -0.25, 0.28), 12-months (SMD = -0.04; 95%CI = -0.23, 0.14), 18-months
(SMD = -0.11; 95%CI = -0.41, 0.20), or at 24-48-month follow-up (SMD = -0.21; 95%CI = -0.50, 0.08). CBT did not significantly improve anxiety at 6-
months (SMD = -0.10; 95% CI = -0.29, 0.08), 12-months (SMD = 0.05; 95%CI = -0.14, 0.23), 18-months (SMD = 0.09; 95%CI = -0.22, 0.39), or at 24-48-
months (SMD = -0.06; 95%CI = -0.55, 0.43). Omega-3 did not significantly improve depression at 6-months (SMD = -0.46; 95CI = -1.15, 0.23) and 12-
months (SMD = -0.29; 95%CI = -1.10, 0.51). In conclusion, no interventions significantly impacted symptoms of depression or anxiety in CHR samples.
However, no trials in this review were designed to target and treat these symptoms and the CBT used was specifically designed to address attenuated
psychotic symptoms.
Early Intervention in Psychiatry, 12 (Supplement
1) : 174
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders, Psychosis Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions, Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Cognitive remediation
therapy, Family therapy, Fish oil (Omega-3 fatty acids), Omega 3 fatty
acids (e.g. fish oil, flax oil)
Eustis, E.H., Hayes-Skelton, S.A., Orsillo, S.M., Roemer, L.
The high rates of anxiety in college students and the many barriers to accessing evidence-based care in communities and on campuses
indicate a clear need to explore ways to increase access to evidence-based treatments. Web-based interventions and preventions are one way to bridge
this gap; they hold the potential to decrease mental health disparities and enhance student functioning. The current RCT examined the acceptability
and efficacy of a 3-session web-based therapist-assisted acceptance-based behavioral intervention targeting anxiety (Surviving and Thriving During
Stress) for college students versus a waitlist (WL) control condition, in a sample of racially and ethnically diverse college students. Overall,
participants rated the program as helpful and acceptable. Mixed-effects regression models (MRMs) were run in SPSS to examine the effects of time,
condition, and Condition x Time on outcomes and hypothesized mechanisms. Significant Condition x Time interactions for general anxiety, depression,
and quality of life (QOL) emerged, suggesting that SATDS participants reported significantly greater changes on these outcomes from pre- to
posttreatment versus WL. However, interaction effects were nonsignificant for anxious arousal and social anxiety. MRMs examining hypothesized
mechanisms revealed significant Condition x Time interactions for experiential avoidance, decentering, and values-based living. However, interaction
effects were nonsignificant for mindfulness. All significant gains were maintained at 1-month follow-up, with the exception of QOL. Results
contribute to the growing literature on the acceptability and efficacy of web-based approaches, and suggest these approaches can be effective for
diverse college students, and may provide a unique platform to increase access to evidence-based care. (PsycINFO Database Record (c) 2018 APA, all
rights reserved)
Behavior Therapy, 49(6) : 889-
903
- Year: 2018
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Acceptance & commitment therapy
(ACT), Technology, interventions delivered using technology (e.g. online, SMS)
Unno, K., Furushima, D., Hamamoto, S., Iguchi, K., Yamada, H., Morita, A., Horie, H., Nakamura, Y.
Theanine, a major amino acid in green tea, exhibits a stress-reducing effect in mice and
humans. Matcha, which is essentially theanine-rich powdered green tea, is abundant in caffeine. Caffeine has a strong antagonistic effect against
theanine. The stress-reducing effect of matcha was examined with an animal experiment and a clinical trial. The stress-reducing effect of matcha
marketed in Japan and abroad was assessed based on its composition. The stress-reducing effect of matcha in mice was evaluated as suppressed adrenal
hypertrophy using territorially-based loaded stress. High contents of theanine and arginine in matcha exhibited a high stress-reducing effect.
However, an effective stress-reducing outcome was only possible when the molar ratio of caffeine and epigallocatechin gallate (EGCG) to theanine and
arginine was less than two. Participants (n = 39) consumed test-matcha, which was expected to have a stress-reducing effect, or placebo-matcha, where
no effect was expected. Anxiety, a reaction to stress, was significantly lower in the test-matcha group than in the placebo group. To predict mental
function of each matcha, both the quantity of theanine and the ratios of caffeine, EGCG, and arginine against theanine need to be verified. Copyright
© 2018 by the authors. Licensee MDPI, Basel, Switzerland.
Nutrients, 10
(10)(1468) :
- Year: 2018
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Universal prevention
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Homeopathic, plant-based medicines
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)
Weisz, J. R., Ugueto, A. M., Herren, J., Marchette, L. K., Bearman, S. K., Lee, E. H., Thomassin, K., Alleyne, A., Cheron, D. M., Tweed, J. L., Hersh, J., Raftery-Helmer, J. N., Weissman, A. S., Jensen-Doss, A.
OBJECTIVE: We assessed sustainability of an empirically supported, transdiagnostic youth psychotherapy program when therapist
supervision was shifted from external experts to internal clinic staff.\rMETHOD: One hundred sixty-eight youths, aged 6-15 years, 59.5% male, 85.1%
Caucasian, were treated for anxiety, depression, traumatic stress, or conduct problems by clinicians employed in community mental health clinics. In
Phase 1 (2.7 years), 1 group of clinicians, the Sustain group, received training in Child STEPs (a modular transdiagnostic treatment + weekly
feedback on youth response) and treated clinic-referred youths, guided by weekly supervision from external STEPs experts. In Phase 2 (2.9 years),
Sustain clinicians treated additional youths but with supervision by clinic staff who had been trained to supervise STEPs. Also in Phase 2, a new
group, External Supervision clinicians, received training and supervision from external STEPs experts and treated referred youths. Phase 2 youths
were randomized to Sustain or External Supervision clinicians. Groups were compared on 3 therapist fidelity measures and 14 clinical outcome
measures.\rRESULTS: Sustain clinicians maintained their previous levels of fidelity and youth outcomes after switching from external to internal
supervision; and in Phase 2, the Sustain and External Supervision groups also did not differ on fidelity or youth outcomes. Whereas all 34 group
comparisons were nonsignificant, trends with the largest effect sizes showed better clinical outcomes for internal than external supervision.
\rCONCLUSIONS: Implementation of empirically supported transdiagnostic treatment may be sustained when supervision is transferred from external
experts to trained clinic staff, potentially enhancing cost-effectiveness and staying power in clinical practice. (PsycINFO Database Record
Journal of Consulting &
Clinical Psychology, 86(9) : 726-737
- Year: 2018
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Other service delivery and improvement
interventions
Bunnell, B. E., Mesa, F., Beidel, D. C.
Selective mutism (SM) is an anxiety disorder marked by withdrawal of speech in particular social situations. Treatment is often
difficult, requiring attention to several characteristics particular to the disorder. Therapeutic tools and activities such as games and mobile
applications (apps) may be particularly advantageous to behavioral therapy for SM. A 2-session hierarchy for shaping successive approximations of
speech in SM was piloted with 15 children, 5 to 17 years old, who were randomly assigned to shaping while using mobile apps, other therapeutic
tools/activities, and reinforcement alone. Very strong treatment gains were observed: 13 of 15 (88.7%) children completed the hierarchy during the
first session and 14 (93.3%) did so during the second session, with the final child completing all but the final step (i.e., to ask and respond to at
least 5 open-ended questions). Moreover, all 15 children spoke to the clinician within 59 minutes of treatment (M = 17 minutes), and 14 (93.3%)
children held five, 5-minute conversations with additional unknown adults during the second session. This occurred regardless of the inclusion of
therapeutic tools/activities, although preliminary patterns of responding were observed such that children shaped while using mobile apps tended to
show less self-reported and physiologically measured anxious distress. The utility of therapeutic activities and mobile apps when treating SM is
discussed as well as areas for future research.
Behavior Therapy, 49(6) : 966-
980
- Year: 2018
- Problem: Anxiety Disorders (any)
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions, 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.
\rMETHODS: 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.
\rRESULTS: 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.\rCONCLUSION: 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)