Melnyk, B. M., Amaya, M., Szalacha, L. A., Hoying, J., Taylor, T., Bowersox, K.

Feasibility, Acceptability, and Preliminary Effects of the COPE Online Cognitive-Behavioral Skill-Building Program on Mental Health Outcomes and Academic Performance in Freshmen College Students: A Randomized Controlled Pilot Study

PROBLEM: Despite the increasing prevalence of mental health disorders in university students, few receive needed evidence-based treatment. OBJECTIVE: The purpose of this study was to assess the feasibility and preliminary effects of a seven-session online cognitive-behavioral skill-building intervention (i.e., COPE, Creating Opportunities for Personal Empowerment) versus a comparison group on their anxiety, depressive symptoms, and grade performance. METHODS: A randomized controlled pilot study was conducted from September 2012 to May 2013 with 121 college freshmen enrolled in a required one credit survey course. FINDINGS: Although there were no significant differences in anxiety and depressive symptoms between the groups, only COPE students with an elevated level of anxiety at baseline had a significant decline in symptoms. Grade point average was higher in COPE versus comparison students. Evaluations indicated that COPE was a positive experience for students. CONCLUSIONS: COPE is a promising brief intervention that can be integrated effectively into a required freshman course. Copyright © 2015 Wiley Periodicals, Inc.

Journal of child and adolescent psychiatric nursing : official publication of the Association of Child and Adolescent Psychiatric Nurses, Inc, 28(3) : 147-154

Nguyen-Feng, V. N., Frazier, P. A., Greer, C. S., Howard, K. G., Paulsen, J. A., Meredith, L., Kim, S.

A randomized controlled trial of a web-based intervention to reduce distress among students with a history of interpersonal violence

Psychology of Violence, 5(4) : 444

Hintz, S., Frazier, P.A., Meredith, L.

Evaluating an online stress management intervention for college students

Journal of Counseling Psychology, 62(2) : 137

Frazier, P., Meredith, L. Greer, C., Paulsen, J.A., Howard, K., Dietz, L. R., Qin, K.

Randomized controlled trial evaluating the effectiveness of a web-based stress management program among community college students

BACKGROUND AND OBJECTIVES:\rThis study evaluated the effectiveness of a web-based stress management program among community college students that focused on increasing perceived control over stressful events.\r\rDESIGN:\rStudents (N = 257) were randomly assigned to a Present Control Intervention or a Stress-information only comparison group.\r\rMETHODS:\rPrimary outcomes were perceived stress and stress symptoms; secondary outcomes were depression and anxiety. Self- report measures were completed online at preintervention, postintervention, and three-week follow-up. Intervention effects were estimated using linear mixed models. Seventy-five percent of the sample (n = 194) completed the pretest and comprised the intent-to-treat sample.\r\rRESULTS: \rParticipants in the intervention group reported significant increases in present control, and significant decreases in all four primary and secondary outcome measures from baseline to postintervention and follow-up. Within-group effect sizes were small to medium at postintervention (mean d = -.34) and follow-up (mean d = -.49). The mean between-group effect size on the four outcome measures was d = .35 at postintervention but d = .12 at follow-up, due to unexpected decreases in distress in the comparison group.\r\rCONCLUSIONS:\rOur online program is a cost-effective mental health program for college students. Limitations and future direction are discussed.\r\rKEYWORDS:\rcollege students; community college; emotional distress; online intervention; perceived control; stress management

Anxiety, Stress, & Coping, 28(5) : 576- 586

Chandler, G. E., Roberts, S. J., Chiodo, L.

Resilience Intervention for Young Adults With Adverse Childhood Experiences

CONCLUSIONS: An increase in health behavior is theoretically consistent with this strengths-based intervention. Evaluating this intervention with a larger sample is important. Interrupting the ACE to illness trajectory is complex. This short-term empower resilience intervention, however, holds promise as an opportunity to reconsider the negative effects of the trauma of the past and build on strengths to develop a preferred future. BACKGROUND: Adverse childhood experiences (ACEs) are correlated with risk behaviors of smoking, disordered eating, and alcohol and substance abuse. Such behaviors can lead to significant public health problems of chronic obstructive pulmonary disease, obesity, liver disease, and hypertension, yet some individuals do not appear to suffer negative consequences but rather bounce back. OBJECTIVE: To pilot the feasibility and potential efficacy of the Empower Resilience Intervention to build capacity by increasing resilience and health behaviors and decreasing symptoms and negative health behaviors with young adults in an educational setting who have had ACEs. DESIGN: A two-group pre-post repeated measures design to compare symptoms, health behaviors, and resilience and written participant responses. RESULTS: There was a statistically significant cohort by time interaction for physical activity in the intervention group. There was no significant change in risk behaviors or resilience score by cohort. Young adults in the intervention group reported building strengths, reframing resilience, and creating support connections. Copyright © The Author(s) 2015.

Journal of the American Psychiatric Nurses Association, 21(6) : 406- 416

Bennett, K., Manassis, K., Duda, S., Bagnell, A., Bernstein, G. A., Garland, E. J., Miller, L. D., Newton, A., Thabane, L., Wilansky, P.

Preventing child and adolescent anxiety disorders: Overview of systematic reviews

Overviews of systematic reviews (OSRs) provide rapid access to high quality, consolidated research evidence about prevention intervention options, supporting evidence-informed decision-making, and the identification of fruitful areas of new research. This OSR addressed three questions about prevention strategies for child and adolescent anxiety: (1) Does the intervention prevent anxiety diagnosis and/or reduce anxiety symptoms compared to passive controls? (2) Is the intervention equal to or more effective than active controls? (3) What is the evidence quality (EQ) for the intervention? Prespecified inclusion criteria identified systematic reviews and meta-analyses (2000-2014) with an AMSTAR quality score = 3/5. EQ was rated using Oxford evidence levels EQ1 (highest) to EQ5 (lowest). Three reviews met inclusion criteria. One narrative systematic review concluded school-based interventions reduce anxiety symptoms. One meta-analysis pooled 65 randomized controlled trials (RCTs; any intervention) and reported a small, statistically significant reduction in anxiety symptoms and diagnosis incidence. Neither review provided pooled effect size estimates for specific intervention options defined by type (i.e., universal/selective/indicated), intervention content, or comparison group (i.e., passive/active control), thus precluding EQ ratings. One meta-analysis pooled trials of vigorous exercise and reported small, nonstatistically significant reductions in anxiety symptoms for comparisons against passive and active controls (EQ1). Better use of primary studies in meta-analyses, including program-specific pooled effect size estimates and network meta-analysis is needed to guide evidence-informed anxiety prevention program choices. RCTs of innovative community/primary care based interventions and web-based strategies can fill knowledge gaps.

Depression & Anxiety, 32(12) : 909- 918

Ahlen, J., Lenhard, F., Ghaderi, A.

Universal prevention for anxiety and depressive symptoms in children: A meta-analysis of randomized and cluster-randomized trials

Although under- diagnosed, anxiety and depression are among the most prevalent psychiatric disorders in children and adolescents, leading to severe impairment, increased risk of future psychiatric problems, and a high economic burden to society. Universal prevention may be a potent way to address these widespread problems. There are several benefits to universal relative to targeted interventions because there is limited knowledge as to how to screen for anxiety and depression in the general population. Earlier meta-analyses of the prevention of depression and anxiety symptoms among children suffer from methodological inadequacies such as combining universal, selective, and indicated interventions in the same analyses, and comparing cluster-randomized trials with randomized trials without any correction for clustering effects. The present meta-analysis attempted to determine the effectiveness of universal interventions to prevent anxiety and depressive symptoms after correcting for clustering effects. A systematic search of randomized studies in PsycINFO, Cochrane Library, and Google Scholar resulted in 30 eligible studies meeting inclusion criteria, namely peer-reviewed, randomized or cluster-randomized trials of universal interventions for anxiety and depressive symptoms in school-aged children. Sixty-three percent of the studies reported outcome data regarding anxiety and 87 % reported outcome data regarding depression. Seventy percent of the studies used randomization at the cluster level. There were small but significant effects regarding anxiety (.13) and depressive (.11) symptoms as measured at immediate posttest. At follow-up, which ranged from 3 to 48 months, effects were significantly larger than zero regarding depressive (.07) but not anxiety (.11) symptoms. There was no significant moderation effect of the following pre-selected variables: the primary aim of the intervention (anxiety or depression), deliverer of the intervention, gender distribution, children's age, and length of the intervention. Despite small effects, we argue for the possible clinical and practical significance of these programs. Future evaluations should carefully investigate the moderators and mediators of program effects to identify active program components. (PsycINFO Database Record (c) 2016 APA, all rights reserved)

Journal of Primary Prevention, 36(6) : 387-403

Braden, A. M., Osborne, M. S., Wilson, S. J.

Psychological intervention reduces self-reported performance anxiety in high school music students

Music performance anxiety (MPA) can be distressing for many young people studying music, and may negatively impact upon their ability to cope with the demands and stressors of music education. It can also lead young people to give up music or to develop unhealthy coping habits in their adult music careers. Minimal research has examined the effectiveness of psychological programs to address MPA in young musicians. Sixty-two adolescents were pseudo- randomized to a cognitive behavioral (CB) group-delivered intervention or a waitlist condition. The intervention consisted of psychoeducation, cognitive restructuring and relaxation techniques, identification of strengths, goal-setting, imagery and visualization techniques to support three solo performances in front of judges. Significant reductions in self-rated MPA were found in both groups following the intervention and compared to their baseline MPA. This reduction was maintained at 2-months follow-up. There appeared to be inconsistent effects of the intervention upon judge- rated MPA, however the presence of floor effects precluded meaningful reductions in MPA. There appeared to be no effect of the intervention upon judge-rated performance quality. This study highlights the potential for group-based CB programs to be delivered within school music curricula to help young musicians develop skills to overcome the often debilitating effects of MPA. (PsycINFO Database Record (c) 2015 APA, all rights reserved) (journal abstract).

Frontiers in Psychology, 6(195) :

Chu, I. H., Lin, Y. J., Wu, W. L., Chang, Y. K., Lin, I. M.

Effects of yoga on heart rate variability and mood in women: A randomized controlled trial

Objective: To examine the effects of an 8-week yoga program on heart rate variability and mood in generally healthy women. Design: Randomized controlled trial. Participants: Fifty-two healthy women were randomly assigned to a yoga group or a control group. Interventions: Participants in the yoga group completed an 8-week yoga program, which comprised a 60-minute session twice a week. Each session consisted of breathing exercises, yoga pose practice, and supine meditation/relaxation. The control group was instructed not to engage in any yoga practice and to maintain their usual level of physical activity during the study. Outcome measures: Participants' heart rate variability, perceived stress, depressive symptoms, and state and trait anxiety were assessed at baseline (week 0) and after the intervention (week 9). Results: No measures of heart rate variability changed significantly in either the yoga or control group after intervention. State anxiety was reduced significantly in the yoga group but not in the control group. No significant changes were noted in perceived stress, depression, or trait anxiety in either group. Conclusions: An 8-week yoga program was not sufficient to improve heart rate variability. However, such a program appears to be effective in reducing state anxiety in generally healthy women. Future research should involve longer periods of yoga training, include heart rate variability measures both at rest and during yoga practice, and enroll women with higher levels of stress and trait anxiety.

Journal of Alternative & Complementary Medicine, 21(12) : 789-795

de-Oliveira, I. J., de-Souza, V. V., Motta, V., Da-Silva, S. L.

Effects of Oral Vitamin C Supplementation on Anxiety in Students: A Double-Blind, Randomized, Placebo-Controlled Trial

Vitamin C ascorbic acid) is a well-known antioxidant that is involved in anxiety, stress, depression, fatigue and mood state in humans. Studies have suggested that oxidative stress may trigger neuropsychological disorders. Antioxidants may play an important therapeutic role in combating the damage caused by oxidative stress in individuals that suffer from anxiety. In this context, it was hypothesized that oral vitamin C supplementation would reduce anxiety. However, few up to date studies have evaluated the consequences of oral vitamin C supplementation on anxiety in humans. The present study examined the effects of oral vitamin C supplements in 42 high school students, in a randomized, double-blind, placebo-controlled trial. The students were given either vitamin C (500 mg day(-1)) or placebo. Plasma concentrations of vitamin C and blood pressure were measured before the intervention and then one day after the intervention. Anxiety levels were evaluated for each student before and after 14 days following supplementation with the Beck Anxiety Inventory. Results showed that vitamin C reduced anxiety levels and led to higher plasma vitamin C concentration compared to the placebo. The mean heart rates were also significantly different between vitamin C group and placebo control group. Present study results not only provide evidence that vitamin C plays an important therapeutic role for anxiety but also point a possible use for antioxidants in the prevention or reduction of anxiety. This suggests that a diet rich in vitamin C may be an effective adjunct to medical and psychological treatment of anxiety and improve academic performance.

Pakistan Journal of Biological Sciences, 18(1) : 11-18

Compas, B. E., Forehand, R., Thigpen, J., Hardcastle, E., Garai, E., McKee, L., Keller, G., Dunbar, J. P., Watson, K. H., Rakow, A., Bettis, A., Reising, M., Cole, D., Sterba, S.

Efficacy and moderators of a family group cognitive-behavioral preventive intervention for children of parents with depression

Objective: Building on an earlier study (Compas, Forehand, Thigpen, et al., 2011), tests of main effects and potential moderators of a family group cognitive-behavioral (FGCB) preventive intervention for children of parents with a history of depression are reported. Method: Assessed a sample of 180 families (242 children ages 9-15 years) in a randomized controlled trial assessed at 2, 6, 12, 18 and 24 months after baseline. Results: Significant effects favoring the FGCB intervention over a written information comparison condition were found on measures of children's symptoms of depression, mixed anxiety/depression, internalizing problems, and externalizing problems, with multiple effects maintained at 18 and 24 months, and on incidence of child episodes of major depressive disorder over the 24 months. Effects were stronger for child self-reports than for parent reports. Minimal evidence was found for child age, child gender, parental education, parental depressive symptoms, or presence of a current parental depressive episode at baseline as moderators of the FGCB intervention. Conclusions: The findings provide support for sustained and robust effects of this preventive intervention. (PsycINFO Database Record (c) 2016 APA, all rights reserved) (journal abstract).

Journal of Consulting & Clinical Psychology, 83(3) : 541- 553

Creswell, C., Cruddace, S., Gerry, S., Gitau, R., McIntosh, E., Mollison, J., Murray, L., Shafran, R., Stein, A., Violato, M., Voysey, M., Willetts, L., Williams, N., Yu, L. M., Cooper, P. J.

Treatment of childhood anxiety disorder in the context of maternal anxiety disorder: A randomised controlled trial and economic analysis

Background: Cognitive - behavioural therapy (CBT) for childhood anxiety disorders is associated with modest outcomes in the context of parental anxiety disorder. Objectives: This study evaluated whether or not the outcome of CBT for children with anxiety disorders in the context of maternal anxiety disorders is improved by the addition of (i) treatment of maternal anxiety disorders, or (ii) treatment focused on maternal responses. The incremental cost-effectiveness of the additional treatments was also evaluated. Design: Participants were randomised to receive (i) child cognitive - behavioural therapy (CCBT); (ii) CCBT with CBT to target maternal anxiety disorders [CCBT + maternal cognitive - behavioural therapy (MCBT)]; or (iii) CCBT with an intervention to target mother - child interactions (MCIs) (CCBT + MCI). Setting: A NHS university clinic in Berkshire, UK. Participants: Two hundred and eleven children with a primary anxiety disorder, whose mothers also had an anxiety disorder. Interventions: All families received eight sessions of individual CCBT. Mothers in the CCBT + MCBT arm also received eight sessions of CBT targeting their own anxiety disorders. Mothers in the MCI arm received 10 sessions targeting maternal parenting cognitions and behaviours. Non-specific interventions were delivered to balance groups for therapist contact. Main outcome measures: Primary clinical outcomes were the child's primary anxiety disorder status and degree of improvement at the end of treatment. Follow-up assessments were conducted at 6 and 12 months. Outcomes in the economic analyses were identified and measured using estimated quality-adjusted life-years (QALYs). QALYS were combined with treatment, health and social care costs and presented within an incremental cost - utility analysis framework with associated uncertainty. Results: MCBT was associated with significant short-term improvement in maternal anxiety; however, after children had received CCBT, group differences were no longer apparent. CCBT + MCI was associated with a reduction in maternal overinvolvement and more confident expectations of the child. However, neither CCBT + MCBT nor CCBT + MCI conferred a significant post-treatment benefit over CCBT in terms of child anxiety disorder diagnoses [adjusted risk ratio (RR) 1.18, 95% confidence interval (CI) 0.87 to 1.62, p = 0.29; adjusted RR CCBT + MCI vs. control: adjusted RR 1.22, 95% CI 0.90 to 1.67, p = 0.20, respectively] or global improvement ratings (adjusted RR 1.25, 95% CI 1.00 to 1.59, p = 0.05; adjusted RR 1.20, 95% CI 0.95 to 1.53, p = 0.13). CCBT + MCI outperformed CCBT on some secondary outcome measures. Furthermore, primary economic analyses suggested that, at commonly accepted thresholds of cost-effectiveness, the probability that CCBT + MCI will be cost-effective in comparison with CCBT (plus non-specific interventions) is about 75%. Conclusions: Good outcomes were achieved for children and their mothers across treatment conditions. There was no evidence of a benefit to child outcome of supplementing CCBT with either intervention focusing on maternal anxiety disorder or maternal cognitions and behaviours. However, supplementing CCBT with treatment that targeted maternal cognitions and behaviours represented a cost-effective use of resources, although the high percentage of missing data on some economic variables is a shortcoming. Future work should consider whether or not effects of the adjunct interventions are enhanced in particular contexts. The economic findings highlight the utility of considering the use of a broad range of services when evaluating interventions with this client group.

Health Technology Assessment, 19(38) : 1- 218