Disorders - Anxiety Disorders
Schleider, J. L., Weisz, J.
R.
Objective Despite progress in the development of evidence-based interventions for youth psychiatric problems, up to 75% of youths
with mental health needs never receive services, and early dropout is common among those who do. If effective, then single-session interventions
(SSIs) for youth psychiatric problems could increase the accessibility, scalability, completion rates, and cost-effectiveness of youth mental health
services. This study assessed the effects of SSIs for youth psychiatric problems. Method Using robust variance estimation to address effect size (ES)
dependency, findings from 50 randomized-controlled trials (10,508 youths) were synthesized. Results Mean postintervention ES showed a Hedges g value
equal to 0.32; the probability that a youth receiving SSI would fare better than a control-group youth was 58%. Effects varied by several moderators,
including target problem: ESs were largest for anxiety (0.56) and conduct problems (0.54) and weakest for substance abuse (0.08; targeted in >33% of
studies). Other problems yielded numerically promising but nonsignificant ESs (e.g., 0.21 for depression), potentially from low representation across
trials. ESs differed across control conditions, with larger ESs for studies with no treatment (0.41) versus active controls (0.14); developmental
periods, with greater ESs for children (0.42) than adolescents (0.19); intervention types, with largest ESs for youth-focused cognitive-behavioral
approaches (0.74); and follow-up lengths, with smaller ESs for follow-ups exceeding 13 weeks. ESs did not differ for self- versus therapist-
administered interventions or for youths with diagnosable versus subclinical problems. Conclusion Findings support the promise of SSIs for certain
youth psychiatric problems and the need to clarify how, to what degree, and for whom SSIs effect lasting change. Copyright © 2016 American Academy of
Child and Adolescent Psychiatry
Journal of the American Academy of Child & Adolescent Psychiatry, 56(2) : 107-
115
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders, Substance Use Disorders (any)
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any)
Carthy, T., Benaroya-Milshtein, N., Valevski, A., Apter, A.
Objective: Emotional dysregulation is an important element in the pathophysiology of childhood anxiety
disorders and can distinguish anxious subjects from controls. Treatment with selective serotonin inhibitors (SSRIs) has been found to lessen anxiety,
but its effects on emotional reactivity and regulation are less documented. The aim of the study was to prospectively assess changes in emotional
reactivity and regulation in response to citalopram in children and adolescents with anxiety disorders, with special focus on the mechanism of
reappraisal. Methods: The sample included 70 children and adolescents (38 boys, 32 girls) 10-17 years of age, divided into three groups: Those with
anxiety disorder treated with citalopram for 8 weeks (n = 35); untreated subjects with anxiety disorder on the waiting list for cognitive behavioral
therapy (CBT) (n = 15); and subjects without anxiety disorder (controls) (n = 20). Emotional reactivity and regulation (i.e., reappraisal), were
assessed at baseline and after 8 weeks (follow-up) with validated computer-based instruments, Reactivity and Regulation-Situations (REAR-S) and
Reactivity and Regulation-Images (REAR-I). Results: Citalopram-treated subjects showed significantly greater improvement in reappraisal ability than
CBT-waitlisted subjects. Improvement in the ability to reappraise threatening images correlated significantly with the decrease in anxiety. There was
a decrease in negative emotional reactivity between assessments, which was positively correlated with clinical improvement. Higher intensity of
baseline reactivity (on the REAR-S) predicted more severe symptoms at follow-up. Conclusions: Citalopram therapy improves reappraisal ability in
children and adolescents with anxiety. However, the improvement in other examined emotional reactivity indices occurred in both medicated and
waitlisted groups. It is possible that these findings may have implications for understanding the pathophysiology of anxiety in children and
adolescents. © Copyright 2017, Mary Ann Liebert, Inc. 2017.
Journal of Child and Adolescent Psychopharmacology, 27(1) : 43-
51
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Ahmadi, A., Mustaffa, M. S., Haghdoost, A. A., Mansor, S. M. S.
Introduction: Anxiety disorders in primary school-aged children negatively affect their mental health and psychological
development. Available non-medical treatments for these conditions are time-consuming and expensive. In this context, eclectic therapy is a
therapeutic approach that incorporates some therapeutic techniques and philosophies to create the ideal treatment. In this study, eclectic therapy
consisted of art therapy and cognitive-behavioral therapy designed for children suffering from high level of anxiety in their middle childhood years.
The therapy also included group guidance sessions for their mothers. The effectiveness of this intervention was examined in the study. Methods: 61
students aged 9-12 years with high levels of anxiety participated in the study. Intervention A (n = 20) consisted of 9-hour eclectic therapy for
children with 3-hour group guidance sessions for their mothers. Intervention B (n = 20) consisted of 9-hour eclectic therapy for children. There was
also a control group (n = 21). Results: Teacher ratings of children's mental health difficulties and self-report ratings of anxiety disorders
indicated a significant difference from pretest to posttest, revealing a large effect size between the two interventions. Higher levels of pretest
scores significantly predicted higher posttest scores for all domains of anxiety and mental health difficulties. Furthermore, age, gender, mothers
working a 15-hour day, mother's educational level, parental divorce rates, parental death, and family monthly income predicted therapy outcomes.
Conclusion: Results provide support for the effectiveness of eclectic art and CBT to improve children's mental health and reduce anxiety through
changing thoughts, beliefs, emotions, and behaviors that may cause fear and anxiety. Copyright © 2017, Sociedade de Psiquiatria do Rio Grande do Sul.
All rights reserved.
Trends in Psychiatry and
Psychotherapy, 39(2) : 88-97
- Year: 2017
- 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), Cognitive & behavioural therapies (CBT), Creative expression: music, dance, drama, art, Other service delivery and improvement
interventions
Twohig, M. P., Levin, M. E.
Acceptance and commitment therapy (ACT) is a modern form of cognitive
behavioral therapy based on a distinct philosophy and basic science of cognition. This article reviews the core features of ACT's theoretic model of
psychopathology and treatment and its therapeutic approach. It provides a systematic review of randomized controlled trials (RCTs) evaluating ACT for
depression and anxiety disorders. Summarizing 36 RCTs, ACT appears to be more efficacious than waitlist conditions and treatment-as-usual, with
largely equivalent effects relative to traditional cognitive behavioral therapy. Evidence indicates that ACT treatment outcomes are mediated through
increases in psychological flexibility, its theorized process of change.
Psychiatric Clinics of North
America, 40(4) : 751-770
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Acceptance & commitment therapy
(ACT)
Weersing, V. R., Brent, D. A., Rozenman, M. S., Gonzalez, A., Jeffreys, M., Dickerson, J. F., Lynch, F. L., Porta, G., Iyengar, S.
Importance: Anxiety and depression affect 30% of youth but
are markedly undertreated compared with other mental disorders, especially in Hispanic populations.\rObjective: To examine whether a pediatrics-based
behavioral intervention targeting anxiety and depression improves clinical outcome compared with referral to outpatient community mental health
care.\rDesign, Setting, and Participants: This 2-center randomized clinical trial with masked outcome assessment conducted between brief behavioral
therapy (BBT) and assisted referral to care (ARC) studied 185 youths (aged 8.0-16.9 years) from 9 pediatric clinics in San Diego, California, and
Pittsburgh, Pennsylvania, recruited from October 6, 2010, through December 5, 2014. Youths who met DSM-IV criteria for full or probable diagnoses of
separation anxiety disorder, generalized anxiety disorder, social phobia, major depression, dysthymic disorder, and/or minor depression; lived with a
consenting legal guardian for at least 6 months; and spoke English were included in the study. Exclusions included receipt of alternate treatment for
anxiety or depression, presence of a suicidal plan, bipolar disorder, psychosis, posttraumatic stress disorder, substance dependence, current abuse,
intellectual disability, or unstable serious physical illness.\rInterventions: The BBT consisted of 8 to 12 weekly 45-minute sessions of behavioral
therapy delivered in pediatric clinics by master's-level clinicians. The ARC families received personalized referrals to mental health care and
check-in calls to support accessing care from master's-level coordinators.\rMain Outcomes and Measures: The primary outcome was clinically
significant improvement on the Clinical Global Impression-Improvement scale (score <=2). Secondary outcomes included the Pediatric Anxiety Rating
Scale, Children's Depression Rating Scale-Revised, and functioning.\rResults: A total of 185 patients were enrolled in the study (mean [SD] age,
11.3 [2.6] years; 107 [57.8%] female; 144 [77.8%] white; and 38 [20.7%] Hispanic). Youths in the BBT group (n=95), compared with those in the ARC
group (n=90), had significantly higher rates of clinical improvement (56.8% vs 28.2%; chi21=13.09, P<.001; number needed to treat, 4), greater
reductions in symptoms (F2,146=5.72; P=.004; Cohen f=0.28), and better functioning (mean [SD], 68.5 [10.7] vs 61.9 [11.9]; t156=3.64; P<.001; Cohen
d=0.58). Ethnicity moderated outcomes, with Hispanic youth having substantially stronger response to BBT (76.5%) than ARC (7.1%) (chi21=14.90;
P<.001; number needed to treat, 2). Effects were robust across sites.\rConclusions and Relevance: A pediatric-based brief behavioral intervention for
anxiety and depression is associated with benefits superior to those of assisted referral to outpatient mental health care. Effects were especially
strong for Hispanic participants, suggesting that the protocol may be a useful tool in addressing ethnic disparities in care.\rTrial Registration:
clinicaltrials.gov Identifier: NCT01147614.
JAMA Psychiatry, 74(6) : 571-
578
- Year: 2017
- Problem: Anxiety Disorders (any), Generalized Anxiety Disorder, Social phobia (social anxiety disorder), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other Psychological Interventions
Ost, L.
G., Ollendick, T. H.
Anxiety disorders are among the most common disorders affecting youths in the general population, with up to 10% of children and 20%
of adolescents meeting criteria for an anxiety disorder at any one point in time. Cognitive-behavior therapies (CBT), varying between 9 and 18 weeks
of treatment, are considered evidence-based for the treatment of anxiety disorders in youth. During the last two decades treatments that are brief,
intensive, or concentrated (BIC) have been developed and this meta-analysis includes 23 RCTs of these new approaches across the anxiety disorders.
BIC yielded a lower attrition (2.3%) than standard CBT (6.5%). The effect sizes (ES) for comparison of BIC with waiting-list (1.47) and placebo
(0.91) were significant, whereas that with standard CBT (0.01) was not. Regarding remission at post/recovery at follow-up BIC (54%/64%) and standard
CBT (57%/63%) were comparable and both were significantly higher than placebo (26%/35%), which was higher than WLC (7%/9%). Within-group ES at post
and follow-up were 1.50 and 1.53 for BIC, and 0.98 and 1.05 for standard CBT, indicating maintenance of the effects up to 12 months after therapy.
Advantages and disadvantages of BIC are discussed and we suggest that BIC-interventions represent a paradigm shift in the delivery of services for
youth with anxiety disorders. Copyright © 2017 Elsevier Ltd
Behaviour Research and Therapy, 97 : 134-145
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Midgley,
N., OKeeffe, S., French, L., Kennedy, E.
While
the evidence base for psychodynamic therapy with adults is now quite substantial, there is still a lack of research evaluating the effectiveness of
psychodynamic therapies with children and young people. Those studies that have been carried out are also not widely known in the field. To help
address the second point, in 2011, we carried out a review of the evidence base for psychodynamic psychotherapy for children and adolescents, which
identified 35 studies which together provided some preliminary evidence for this treatment for a range of childhood disorders. The present study is
an updated review, focusing on research published between March 2011 and November 2016. During this period, 23 additional studies were published, of
which 5 were reports on randomised controlled trials, 3 were quasi-experimental controlled studies and 15 were observational studies. Although most
studies covered children with mixed diagnoses, there were a number of studies examining specific diagnostic groups, including children with
depression, anxiety and disruptive disorders. whilst the quality of studies was mixed, some were well-designed and reported, and overall indicated
promising findings. Nevertheless, further high-quality research is needed in order to better understand the effectiveness of psychodynamic
psychotherapy across a range of different disorders, and to ensure that services can provide a range of evidence-based treatments for children and
young people. Copyright © 2017 Association of Child Psychotherapists.
Journal of
Child Psychotherapy, 43(3) : 307-329
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders, Suicide or self-harm behaviours (excluding non-suicidal self-harm)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Psychodynamic/Psychoanalysis
McConville, J., McAleer, R., Hahne, A.
BACKGROUND: High levels of
stress have been identified in medical students and increasingly in other health profession student population groups. As stress can affect
psychological well-being and interfere with learning and clinical performance, there is a clear argument for universities to include health
professional student well-being as an outcome in core curriculum. Mindfulness training is a potential construct to manage stress and enhance academic
success.\rOBJECTIVES: The aims of this systematic review were to assess the effectiveness of mindfulness training in medical and other health
professional student population groups and to compare the effectiveness of the different mindfulness-based programs.\rDATA SOURCES: A literature
search was completed using The Cochrane library, Medline, Cinahl, Embase, Psychinfo, and ERIC (proquest) electronic databases from inception to June
2016. Randomized and non-randomized controlled trials were included. Of the potential 5355 articles, 19 met the inclusion criteria.\rSTUDY SELECTION
PARTICIPANTS AND INTERVENTIONS: Studies focused on medical (n = 10), nursing (n = 4), social work (n = 1), psychology (n = 1), and medical plus other
health (n = 3) students. Interventions were based on mindfulness.\rDATA EXTRACTION: The 19 studies included 1815 participants. Meta-analysis was
performed evaluating the effect of mindfulness training on mindfulness, anxiety, depression, stress, mood, self-efficacy, and empathy. The effect of
mindfulness on academic performance was discussed.\rDATA SYNTHESIS AND CONCLUSIONS: Mindfulness-based interventions decrease stress, anxiety, and
depression and improve mindfulness, mood, self-efficacy, and empathy in health profession students. Due to the range of presentation options,
mindfulness training can be relatively easily adapted and integrated into health professional training programs.
Explore: The Journal of Science & Healing, 13(1) : 26-
45
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention, At risk (indicated or selected prevention)
-
Treatment and intervention: Complementary & Alternative
Interventions (CAM), Psychological Interventions
(any), Mindfulness based
therapy, Meditation, Mind-body exercises (e.g. yoga, tai chi, qigong)
Locher, C., Koechlin,
H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I., Kessler, R. C., Kossowsky, J.
IMPORTANCE: Depressive disorders (DDs), anxiety disorders (ADs), obsessive-compulsive disorder
(OCD), and posttraumatic stress disorder (PTSD) are common mental disorders in children and adolescents. OBJECTIVE: To examine the relative efficacy
and safety of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and placebo for the treatment of
DD, AD, OCD, and PTSD in children and adolescents. DATA SOURCES: PubMed, EMBASE, PsycINFO, Web of Science, and Cochrane Database from inception
through August 7, 2016. STUDY SELECTION: Published and unpublished randomized clinical trials of SSRIs or SNRIs in youths with DD, AD, OCD, or PTSD
were included. Trials using other antidepressants (eg, tricyclic antidepressants, monoamine oxidase inhibitors) were excluded. DATA EXTRACTION AND
SYNTHESIS: Effect sizes, calculated as standardized mean differences (Hedges g) and risk ratios (RRs) for adverse events, were assessed in a random-
effects model. MAIN OUTCOMES AND MEASURES: Primary outcomes, as defined by authors on preintervention and postintervention data, mean change data,
and adverse event data, were extracted independently by multiple observers following PRISMA guidelines. RESULTS: Thirty-six trials were eligible,
including 6778 participants (3484 [51.4%] female; mean [SD] age, 12.9 [5.1] years); 17 studies for DD, 10 for AD, 8 for OCD, and 1 for PTSD. Analysis
showed that SSRIs and SNRIs were significantly more beneficial compared with placebo, yielding a small effect size (g = 0.32; 95% CI, 0.25-0.40; P <
.001). Anxiety disorder (g = 0.56; 95% CI, 0.40-0.72; P < .001) showed significantly larger between-group effect sizes than DD (g = 0.20; 95% CI,
0.13-0.27; P < .001). This difference was driven primarily by the placebo response: patients with DD exhibited significantly larger placebo responses
(g = 1.57; 95% CI, 1.36-1.78; P < .001) compared with those with AD (g = 1.03; 95% CI, 0.84-1.21; P < .001). The SSRIs produced a relatively large
effect size for ADs (g = 0.71; 95% CI, 0.45-0.97; P < .001). Compared with participants receiving placebo, patients receiving an antidepressant
reported significantly more treatment-emergent adverse events (RR, 1.07; 95% CI, 1.01-1.12; P = .01 or RR, 1.49; 95% CI, 1.22-1.82; P < .001,
depending on the reporting method), severe adverse events (RR, 1.76; 95% CI, 1.34-2.32; P < .001), and study discontinuation due to adverse events
(RR, 1.79; 95% CI, 1.38-2.32; P < .001). CONCLUSIONS AND RELEVANCE: Compared with placebo, SSRIs and SNRIs are more beneficial than placebo in
children and adolescents; however, the benefit is small and disorder specific, yielding a larger drug-placebo difference for AD than for other
conditions. Response to placebo is large, especially in DD. Severe adverse events are significantly more common with SSRIs and SNRIs than placebo.
Copyright © 2017 American Medical Association. All rights reserved.
JAMA Psychiatry, 74(10) : 1011-
1020
- Year: 2017
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- 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)
Zemestani, M., Imani, M., Ottaviani, C.
High rates of comorbid depression and anxiety often complicate psychological
interventions. The current preliminary study was designed to examine the efficacy of a unified and transdiagnostic model based on emotion regulation
skills for patients with comorbid depression and anxiety. Forty-three participants with a diagnosis of major depression and varying levels of
comorbid anxiety symptoms were randomly assigned to either a unified and transdiagnostic treatment group (UP; n = 20) or a wait-list control group (n
= 23). The treatment group received 14 weekly UP sessions. Scores on the Beck Depression Inventory-II, Beck Anxiety Inventory, and Emotion Regulation
Questionnaire were used as outcome measures. Data provided preliminary evidence that UP can be effective in reducing depressive and anxiety symptoms
and in improving the use of effective emotion regulation strategies up to 3 months. Present results support the implementation of UP as a beneficial
group treatment for patients with comorbid depressive and anxiety symptoms. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
International
Journal of Cognitive Therapy, 10(2) : 175-185
- Year: 2017
- Problem: Anxiety Disorders (any), Depressive Disorders
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Gibby, B. A., Casline, E. P., Ginsburg, G. S.
Pediatric anxiety disorders are common, disabling, and chronic conditions. Efforts over the past two decades have focused on
developing and testing effective treatments. Short-term efficacy of both Cognitive Behavioral Therapy (CBT) and selective serotonin reuptake
inhibitors has been established. Data are emerging on the long-term (i.e., 2 years or longer) effectiveness of these treatments, but this literature
has yet to be adequately synthesized. This study presents a systematic and critical qualitative review of published long-term follow-up (LTFU)
studies of youth treated for an anxiety disorder. A comprehensive search of several databases identified 21 published reports (representing 15 LTFU
cohorts of treated youth) meeting specified inclusion criteria. LTFU assessments occurred a mean of 5.85 years after initial treatment (range 2-19
years). Diagnostic rates at LTFU and predictors (e.g., demographic, baseline child clinical variables, treatment type) of outcomes at LTFU were also
examined. A discussion of the limitations of this literature is provided to qualify interpretations of findings and to inform future studies.
Findings can aid clinicians and families in making treatment decisions and setting reasonable expectations for the long-term prognosis after
treatment for anxiety.
Clinical Child & Family Psychology Review, 20(2) : 201-
225
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Jones, E. B., Sharpe, L.
BACKGROUND: Cognitive bias modification (CBM) is a novel, but controversial intervention with considerable divergence amongst conclusions
in individual studies and reviews. This systematic review synthesizes meta-analyses of CBM to determine whether CBM is effective, and what parameters
most reliably evoke the process of CBM.\rMETHODS: A systematic literature search resulted in twelve meta-analyses in total, from which the published
effect sizes were extracted.\rRESULTS: Attention bias modification (ABM) shifted targeted biases in adults (ES = 0.24-1.16), was effective as a
buffer to stressor vulnerability (ES = 0.33-0.77) and in symptom control (ES = 0.16-0.41). Cognitive bias modification for interpretation (CBM-I)
modified targeted biases (ES = 0.52-0.81) but did not reliably reduce stressor vulnerability (ES = 0.01-0.24, p > .05). CBM consistently reduced
anxiety symptoms, but effects on depressive symptomatology were less compelling. The long-term efficacy of CBM was only supported in addiction
studies.\rLIMITATIONS: The review included a single CBM-I only meta-analysis, and two meta-analyses with pooled reporting on ABM and CBM-I outcomes.
\rCONCLUSIONS: Overall, this synthesis shows CBM is effective in the short-term for anxiety in adults, and highlights some conditions under which CBM
is most efficacious. Rather than debating the efficacy of CBM, future research should focus on developing procedures that more reliably induce bias
modification and determining the most efficacious clinical applications.
Journal of Affective Disorders, 223 : 175-183
- Year: 2017
- Problem: Anxiety Disorders (any)
- Type: Systematic reviews
-
Stage: At risk (indicated or selected prevention), Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Attention/cognitive bias
modification