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Initial research suggests stepped-care approaches to therapy for youth anxiety is associated with reduced therapy time with similar therapeutic outcomes to treatment-as-usual in real-world settings. Research on the acceptability and feasibility of stepped-care approaches in routine practice is very limited. In a secondary analysis of a pilot randomised controlled trial that compared stepped-care to treatment-as-usual in adolescent mental health services, we examine acceptability and feasibility from consumer and clinician perspectives. Fifteen adolescents and ten clinicians provided brief quantitative and qualitative feedback. Some benefits were noted and these related to improved access to treatment; however, major barriers were also noted. Concerns related to the lack of consumer and clinician choice and flexibility in delivery of stepped interventions, challenges engaging adolescents with internet interventions and associated guided telephone calls, and workplace issues. Systemic changes to facilitate consumer preferences, clinician flexibility and staffing are needed for stepped-care to be feasible in routine care. [ABSTRACT FROM AUTHOR]

Background: Evidence about empathy in people high in social anxiety has produced mixed outcomes. The current study aimed to compare cognitive and emotional forms of empathy among university women who were high or low in social anxiety. Methods: Empathy was assessed using both self-report and a directly observable social interaction task. Sixty adult women with either high or low levels of social anxiety completed a self-report measure of empathy and also engaged with a female confederate online. The interpersonal exchange included disclosure of a recent stressful experience by the confederate and participants' responses were coded for indicators of cognitive and emotional empathy. Results were analysed with depression both controlled and not controlled. Results: When depression was statistically controlled, participants who were high in social anxiety demonstrated more robust indicators of empathy on both self-report and the interpersonal exchange for both cognitive and emotional measures of empathy. Results were very similar when depression was not statistically controlled, however the groups no longer differed significantly on the self-report measure of cognitive empathy. Conclusions: The implications for these findings on the interpersonal functioning of socially anxious individuals are discussed. [ABSTRACT FROM AUTHOR]

This study described the psychometric properties of a self-report measure of functional impairment related to anxiety and depression in adolescents, the Adolescent Life Interference Scale for Internalizing symptoms (ALIS-I). A clinical sample of 266 adolescents and a community sample of 63 adolescents, aged 11 to 18 years (Mean = 14.7, SD = 1.71) completed the ALIS-I and additional measures assessing internalizing problems. Exploratory factor analyses indicated four distinct but correlated factors of life interference related to personal withdrawal/avoidance, peer problems, problems with study/work, and somatic symptoms. Reliability and retest reliability (8–12 weeks) of the total score were high and psychometric properties of the subscales were acceptable. The ALIS-I effectively discriminated between clinical and community control groups, and expected correlations were shown between ALIS-I subscales and other related symptom measures. The ALIS-I is a promising instrument for the assessment of functional impairment related to internalizing disorders in youth. [ABSTRACT FROM AUTHOR]

Reliable, valid, and brief measures are important for identifying young people in community contexts who experience mental health problems. This paper reports the development and preliminary validation of the Brief Emotional Distress Scale for Youth (BEDSY), a measure based on anxiety and depression symptoms that load strongly upon the general construct of emotional distress. Participants, aged 11–17 years, included 2663 from a community population and 281 referred anxious youth. From a pool of 20 items, eight were selected for the final scale using methods from classical test theory, followed by item response theory (IRT). The final eight items met the pre-specified criteria for skewness and kurtosis, item-total correlations, IRT characteristics, and discrimination between referred vs. community samples. Exploratory structural equation modeling for a bi-factor model indicated that 81% of total variance was explained by the general emotional distress factor. The 8-item BEDSY showed strong internal consistency, good construct validity, and acceptable sensitivity and specificity in discriminating between a community sample vs anxious youth, and between youth with and without high levels of depressive symptoms. As such the scale has strong potential as a brief screen for identifying emotionally distressed young people in community contexts. • The BEDSY is a new, brief, self-report scale of emotional distress in young people. • It has promise as a brief screen for identifying emotionally distressed youth in community contexts. • It aims to identify youth who are likely to benefit from early intervention. • The scale has strong internal consistency, good construct validity, and discriminant validity. [ABSTRACT FROM AUTHOR]

• Stepped-care has been shown to have clinical and cost efficacy in anxiety disorders. • Stepped-care has not been evaluated in anxious youth in real world settings. • Stepped-care was associated with benefits but also significant challenges. Stepped-care (SC) interventions for treating adolescent anxiety have been shown to reduce therapy time and societal costs with similar therapeutic outcomes to best practice when applied in university clinics. This pilot study examined clinical- and cost-effectiveness of SC in two community mental health services. Fifty-three anxious adolescents (aged 12-18 years) were randomly allocated to SC or treatment as usual (TAU). Adolescent- and clinician-rated symptom severity and quality of life collected over time indicated SC used significantly less therapy time, with similar benefits in clinical effectiveness, waiting time and quality adjusted life years. Significant barriers limited engagement with early therapy steps. [ABSTRACT FROM AUTHOR]

• First study to assess the factor structure of the SARQ in a clinical SAD sample. • One factor solutions demonstrated for the SARQ: Pre-event and SARQ: Post-event. • The SARQ demonstrated good validity and reliability. • The SARQ showed responsivity to treatment and clinical utility. • SARQ assesses rumination in relation to a range of social threat tasks in SAD. Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known as the Thoughts Questionnaire. In particular, we examined the factor structure, internal consistency, test-retest reliability, construct validity, sensitivity to treatment response, clinical cut-off scores (relative to non-clinical participants), and associated test performance indicators of the SARQ. The sample comprised 505 adults with a principal diagnosis of SAD and 130 non-clinical controls. Pre-event and post-event rumination were assessed in relation to a three-minute impromptu speech. Results indicated single factors for the SARQ: Pre-event and SARQ: Post-event scales, along with excellent internal consistency, good test-retest reliability, sound sensitivity to cognitive-behavioural treatment response, and a clear ability to discriminate between individuals with a principal diagnosis of SAD and non-clinical controls. The findings justify the SARQ's use as a robust and reliable measure of state rumination for individuals with SAD that can be used both before and after encountering a social threat. [ABSTRACT FROM AUTHOR]

Anxiety disorders are common, emerge during childhood, and pose a significant burden to society and individuals. Research evaluating the impact of anxiety on functional impairment and quality of life (QoL) is increasing; however, there is yet to be a systematic review and meta-analysis of these relationships in pediatric samples. This systematic review and meta-analysis were conducted to determine the extent of impairments in functioning and QoL that young people with anxiety disorders experience relative to their healthy peers, as well as sociodemographic and clinical moderators of these relationships. Studies were included when they compared young people (mean age range within studies 7–17 years) with a primary clinical anxiety disorder to a healthy comparison group and measured impairment and/or QoL via a validated instrument. A total of 12 studies met criteria for this review (N = 3,129 participants). A majority of studies (K = 9) assessed impairment as an outcome measure, and three assessed QoL outcomes. Meta-analysis of nine studies (N = 1,457 children) showed large relationships between clinical anxiety and life impairment (g = 3.23) with the strongest effects seen for clinician report (g = 5.00), followed by caregiver (g = 2.15) and child (g = 1.58) report. The small number of studies and diversity in methodology prevented quantitative investigation of moderating factors. In the systematic review of QoL outcomes, all three studies reported significantly poorer QoL for youth with anxiety disorders relative to unaffected peers. Findings support the importance of measuring functioning and QoL as outcomes in clinical research and practice among anxious young people. This study is registered with PROSPERO under the identification number CRD42023439040. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Children and adolescents demonstrate diverse patterns of symptom change and disorder remission following cognitive behavioural therapy (CBT) for anxiety disorders. To better understand children who respond sub‐optimally to CBT, this study investigated youths (N = 1,483) who continued to meet criteria for one or more clinical anxiety diagnosis immediately following treatment or at any point during the 12 months following treatment.Data were collected from 10 clinical sites with assessments at pre‐and post‐treatment and at least once more at 3, 6 or 12‐month follow‐up. Participants were assigned to one of three groups based on diagnostic status for youths who: (a) retained an anxiety diagnosis from post to end point (minimal responders); (b) remitted anxiety diagnoses at post but relapsed by end point (relapsed responders); and (c) retained a diagnosis at post but remitted to be diagnosis free at end point (delayed responders). Growth curve models assessed patterns of change over time for the three groups and examined predictors associated with these patterns including demographic, clinical and parental factors, as well as treatment factors.Higher primary disorder severity, being older, having a greater number of anxiety disorders, having social anxiety disorder, as well as higher maternal psychopathology differentiated the minimal responders from the delayed and relapsed responders at the baseline. Results from the growth curve models showed that severity of the primary disorder and treatment modality differentiated patterns of linear change only. Higher severity was associated with significantly less improvement over time for the minimal and relapsed response groups, as was receiving group CBT, when compared to the delayed response group.Sub‐optimal response patterns can be partially differentiated using variables assessed at pre‐treatment. Increased understanding of different patterns of change following treatment may provide direction for clinical decision‐making and for tailoring treatments to specific groups of clinically anxious youth. Future research may benefit from assessing progress during treatment to detect emerging response patterns earlier. [ABSTRACT FROM AUTHOR]

Background and aims Design Setting Participants Intervention and comparator Measurements Comments Alcohol use and anxiety often co‐occur, causing increased severity impairment. This protocol describes a randomized controlled trial (RCT) that aims to test the efficacy and cost‐effectiveness of a web‐based, self‐guided alcohol and anxiety‐focused program, compared with a web‐based brief alcohol‐focused program, for young adults who drink at hazardous levels and experience anxiety. It will also test moderators and mechanisms of change underlying the intervention effects.This RCT will be conducted with a 1:1 parallel group.The study will be a web‐based trial in Australia.Individuals aged 17–30 years who drink alcohol at hazardous or greater levels and experience at least mild anxiety (n = 500) will be recruited through social media, media (TV, print) and community networks.Participants will be randomly allocated to receive a web‐based, integrated alcohol‐anxiety program plus technical and motivational telephone/e‐mail support (intervention) or a web‐based brief alcohol‐feedback program (control).Clinical measures will be assessed at baseline, post‐intervention (2 months), 6 months (primary end‐point), 12 months and 18 months. Co‐primary outcomes are hazardous alcohol consumption and anxiety symptom severity. Secondary outcomes are binge‐drinking frequency; alcohol‐related consequences; depression symptoms; clinical diagnoses of alcohol use or anxiety disorder (at 6 months post‐intervention), health‐care service use, educational and employment outcomes; and quality of life. Mediators and moderators will also be assessed. Efficacy will be tested using mixed models for repeated measures within an intention‐to‐treat framework. The economic evaluation will analyze individual‐level health and societal costs and outcomes of participants between each trial arm, while mediation models will test for mechanisms of change.This will be the first trial to test whether a developmentally targeted, web‐based, integrated alcohol‐anxiety intervention is effective in reducing hazardous alcohol use and anxiety severity among young adults. If successful, the integrated alcohol‐anxiety program will provide an accessible intervention that can be widely disseminated to improve wellbeing of young adults, at minimal cost. [ABSTRACT FROM AUTHOR]

Background: Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participation program in a sample of older adults with depression and/or anxiety. Methods: A total of 172 community-dwelling adults aged 65 years or older with an anxiety and/or depressive disorder will be randomly allocated to either an enhanced CBT plus social participation program (n = 86) or standard CBT (n = 86). Both treatments will be delivered during 12 weekly individual sessions utilising structured manuals and workbooks. Participants will be assessed at pre-treatment, post-treatment, and 12-month follow-up. The primary outcome evaluates mean change in clinician-rated diagnostic severity of anxiety and depressive disorders from baseline to post-treatment (primary endpoint) based on a semi-structured diagnostic interview. Secondary outcomes evaluate changes in symptomatology on self-report anxiety and depression measures, as well as changes in social/community participation, social network, and perceived social support, loneliness, quality of life, and use of health services. Economic benefits will be evaluated using a cost-utility analysis to derive the incremental cost utility ratios for the enhanced CBT program. Discussion: Outcomes from this study will provide support for the establishment of improved psychosocial treatment for older adults with anxiety and/or depression. Study outcomes will also provide health systems with a clear means to reduce the impact of poor emotional health in older age and its associated economic burden. In addition to the empirical validation of a novel treatment, the current study will contribute to the current understanding of the role of social participation in older adult wellbeing. Trial registration: Prospectively registered on the Australian New Zealand Clinical Trials Registry (ID: ACTRN12619000242123; registered 19th February 2019) and the ISRCTN registry (ID: ISRCTN78951376; registered 10th July 2019). [ABSTRACT FROM AUTHOR]

This study assessed the psychometric properties of the Italian version of the Preschool Anxiety Scale-Revised (PAS-R), a parent-reported measure of their preschool child's anxiety symptoms. The participants were mothers of 279 Italian preschoolers (age 2–7 years, M = 4.5 years). According to information criteria derived from a confirmatory factor analysis, the four originally identified factors (generalized anxiety, social anxiety, separation anxiety, specific fears) provided the best fit to the data. Reliability was excellent for the total score and acceptable for the subscales. PAS-R total score showed moderate correlation with internalizing subscales of the Strengths and Difficulties Questionnaire (SDQ) and of the Child Behavior Checklist and weak correlation with the externalizing subscale of the SDQ, demonstrating convergent and concurrent validity, respectively. Test–retest reliability of the PAS-R was good after 1 month. The results suggest good psychometric properties of the Italian PAS-R, although its factor structure needs further investigation with different samples. [ABSTRACT FROM AUTHOR]

The aim of this randomized controlled trial was to evaluate an adapted cognitive behavioural therapy (CBT) programme for treating anxiety in adolescents with acquired brain injury (ABI). Participants with ABI (12–19 years, N = 36) recruited from two sites were randomly allocated into either the intervention receiving 11 sessions of CBT (n = 19) or a wait-list control group (n = 17). The primary outcome was participants' anxiety and secondary outcomes were participants' depression, self-perception, and participation in daily activities, and parental stress, measured at (i) pre-intervention, (ii) immediately post-intervention, (iii) 2 months post-intervention and (iv) 6 months post-intervention. Repeated measures ANOVAs revealed significant treatment effects with the intervention group demonstrating greater improvements in self-reported anxiety, as well as self- and parent-reported depression from pre- to immediately post-treatment, compared to wait-list controls. Little evidence of treatment effects was found for the remaining outcomes (parent-reported anxiety, self-perception, daily participation, and parental stress). Significant improvement in self-reported anxiety found immediately post-treatment was maintained at two- and six-month follow-up. Findings provide support for adapted CBT as an effective means of reducing anxious and depressive symptomatology in adolescents with ABI compared to waitlist controls, and offer support for the use of these techniques to manage anxiety in this population. [ABSTRACT FROM AUTHOR]

This systematic review and meta-analysis aimed to examine the effectiveness of psychological interventions for internalising disorders in youth when delivered in routine settings. Secondary aims were to examine the effectiveness of cognitive behavioural therapy and determine moderators of treatment response. The study was pre-registered (PROSPERO 2020 CRD42020202776). Databases were systematically searched (PsycINFO, Medline, Embase, PubMed, ERIC) in December 2022 and screened according to the PRISMA 2020 statement. Inclusion: School aged participants (4–18 years) with a primary internalising disorder; psychotherapy delivered in a routine setting (e.g. outpatient clinic, school) by setting staff; compared psychotherapy to any control in a randomised controlled trial; reported pre-to-post or pre-to-follow-up comparisons on the primary disorder according to child, parent or independent evaluator report; and was published in English. Risk of bias was assessed using the ROB 2.0 Cochrane tool. Results were synthesised using random effects to pool estimates. Risk ratios were used to analyse dichotomous data and standardised mean differences (SMD) for continuous data. Forty-five studies were included (N = 4901 participants; M = 13 years; range 8–16; SD = 2.5). Nine used waitlist control, 17 treatment as usual, 4 placebo; 15 compared psychotherapy to active control. Psychotherapy was associated with small significant effects pre- to post-treatment compared to non-active controls for anxiety (SMD = − 0.24 to 0.50) and depression (SMD = − 0.19 to 0.34) with effects differing by informant. Psychotherapy led to small significant pre-to-post-benefits in youth internalising disorders in routine settings. Results are limited by reporter type and follow-up. [ABSTRACT FROM AUTHOR]

Loneliness and social isolation are known to be associated with depression, general anxiety, and social anxiety. However, knowledge on the overlapping and unique features of these relationships, while differentiating between social loneliness (perceived absence of an acceptable social network) and emotional loneliness (perceived absence of close connections), is lacking. We constructed a network analysis to examine the relationships between self-reported social loneliness, emotional loneliness, social isolation, depression, general anxiety and social anxiety in a large sample of university students (N = 7314, 67.4 % female, range 16.3–75.8 years, M age = 23.9, SD age = 5.7). Hierarchical regression analyses were used to examine whether depression, general anxiety and social anxiety moderated the relationship between social isolation and loneliness types. As comorbidity between anxiety and depression is high, the role of anxiety as a moderator in the relationship between depression and loneliness types was also examined. The network analysis showed that social loneliness was most strongly explained by social isolation, whereas emotional loneliness was most strongly explained by social anxiety and depression. General anxiety was solely related to loneliness through depression. The regression analyses showed that general and social anxiety and depression did not moderate the relationship between social isolation and loneliness types. Differences found between loneliness types may be influenced by a methodological artifact of the DJGLS. These findings highlight the importance of social anxiety over general anxiety in relation to loneliness. Also, it showed unique relationships for social- and emotional loneliness with psycho-social variables, which has important implications for research- and clinical settings. • Emotional and social loneliness are strongly related. • The network shows the impact of social anxiety over general anxiety on loneliness. • Mental health does not moderate relation between social isolation and loneliness. • Unique relationships for loneliness types may be relevant for clinical practice. [ABSTRACT FROM AUTHOR]

Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. Amongst inhibited preschool children, we aimed to predict each of clinical child anxiety and depressive problems in mid childhood from a broad range of potential risks (demographics, traumatic events and broader recent stressors, parents' well-being, and parenting practices). This study is based on data from a wider population trial of Cool Little Kids that recruited a representative sample of inhibited preschool children enrolled in their year before starting school. In 2011–2012, an inhibition screen was universally distributed to parents of children in their year before school (age 4 years) across eight diverse government areas in Melbourne, Australia. Participants were 545 parents of inhibited preschoolers (78% uptake, 545/703) who were followed to mid childhood (three annual waves 2015–2017, age 7–10 years) with 84% retention (456/545). Parents completed questionnaires spanning child ages 4–10 years, along with diagnostic interviews for child anxiety. Children also completed questionnaires in mid childhood. The questionnaires encompassed a variety of potential risks including sociodemographics, traumatic events, recent life stressors, parent wellbeing and parenting practices. In mid childhood, 57% (246/430) of inhibited preschoolers had a clinical level of anxiety problems while 22% (95/432) had depressive problems (by one or more sources). The aetiology analyses highlighted parent distress and parenting practices (overinvolved/protective, harsh discipline) as key predictors of inhibited preschoolers' internalising problems by mid childhood. Some high-risk families may not have participated. Child depression was not assessed with a diagnostic interview. The measures did not include every possible risk factor. The findings lend support to parenting programs for shy/inhibited young children that aim to prevent the development of anxiety and depression as they grow. [ABSTRACT FROM AUTHOR]

Background : The Minimising Young Children's Anxiety through Schools (MY-CATS) trial is being conducted to determine whether an online evidence-based parent-guided cognitive behavioural therapy intervention in addition to usual school practice is effective and cost-effective compared with usual school practice in reducing anxiety disorders in children aged 4–7 deemed 'at risk' of anxiety disorders. This update article describes the detailed statistical analysis plan for the MY-CATS trial and reports a review of the underpinning sample size assumptions. Methods and design: The MY-CATS study is a two-arm, definitive superiority pragmatic parallel group cluster randomised controlled trial in which schools will be randomised 1:1 to receive either the intervention (in addition to usual school practice) or the usual school practice only. This update to the (published) protocol provides a detailed description of the study methods, the statistical principles, the trial population and the planned statistical analyses, including additional analyses comprising instrumental variable regression and mediation analysis. Trial registration: ISRCTN82398107. Prospectively registered on 14 January 2021 [ABSTRACT FROM AUTHOR]

A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom or diagnostic reduction provides an incomplete picture of clinically meaningful efficacy given that anxiety disorders in this age group are integrally associated with problems in functioning. A systematic review and meta-analysis (N studies = 40, N participants = 3094) evaluating the impacts of psychotherapy for anxiety was conducted on the following outcomes: global functioning, social functioning, academic functioning, and school attendance. Randomised controlled trials with a passive control condition, a child and/or adolescent sample (7–17 years) with a primary anxiety diagnosis, and receiving anxiety-focused psychotherapy were eligible for inclusion if they reported suitable outcome data. Results from the meta-analysis indicated that from pre- to post-treatment, psychotherapy led to significant improvements in global functioning according to clinician (d = 1.55), parent (d = 0.67), and child (d = 0.31) reports and on social functioning according to parent (d = 0.51), but not child (d = 0.31) reports. The qualitative review provided preliminary support psychotherapy's efficacy in increasing family functioning and school attendance, but not so much in enhancing academic performance. These results indicate that psychotherapy improves daily functioning in anxious children and adolescents. The study also highlighted the limited attention paid to measures of functioning in the empirical literature on treatment of childhood anxiety. Trial Registry: This study is registered with PROSPERO under the identification number CRD42021246565. [ABSTRACT FROM AUTHOR]

Background: Peer victimization and anxiety frequently co-occur and result in adverse outcomes in youth. Cognitive behavioural treatment is effective for anxiety and may also decrease children's vulnerability to victimization. Aims: This study aims to examine peer victimization in youth who have presented to clinical services seeking treatment for anxiety. Method: Following a retrospective review of clinical research data collected within a specialized service, peer victimization was examined in 261 children and adolescents (55.6% male, mean age 10.6 years, SD = 2.83, range 6–17 years) with a diagnosed anxiety disorder who presented for cognitive behavioural treatment. Youth and their parents completed assessments of victimization, friendships, anxiety symptoms, and externalizing problems. Results: High levels of victimization in this sample were reported. Children's positive perceptions of their friendships were related to lower risk of relational victimization, while conduct problems were related to an increased risk of verbal and physical victimization. A subsample of these participants (n = 112, 57.1% male, mean age 10.9 years, SD = 2.89, range 6–17 years) had completed group-based cognitive behavioural treatment for their anxiety disorder. Treatment was associated with reductions in both self-reported anxiety and victimization. Results confirm the role of friendships and externalizing symptoms as factors associated with increased risk of victimization in youth with an anxiety disorder in a treatment-seeking sample. Conclusions: Treatment for anxiety, whether in a clinic or school setting, may provide one pathway to care for young people who are victimized, as well as playing a role in preventing or reducing victimization. [ABSTRACT FROM AUTHOR]

Objective: Adolescents experiencing both anxiety and mood disorders show greater life impairment than those with either disorder alone. The aim of this study was to evaluate the efficacy of an online cognitive behavior therapy (CBT) program for these comorbid youth.Methods: Ninety-one adolescents aged 12 to 17 years (M = 14.29, S.D. = 1.62; 66% female) participated if they met DSM-5 criteria for both an anxiety and depressive disorder. Diagnoses were assessed by structured interview and participants also completed measures of symptoms, negative thoughts, and life interference. Participants were randomly allocated to either active treatment (n = 45) or wait (n = 46). Treatment comprised access to an 8-module, online program and was supported by 8, 30-minute telephone sessions with a therapist and the youth, of which the caregiver participated in four.Results: Treated participants showed significantly greater reduction than waiting participants on the primary outcome: total number of disorders and were more likely to remit from all anxiety and mood disorders (43.8% vs 20.9%). Secondary outcomes covering symptoms of anxiety and depression showed similar group by time differences, but there was no significant group by time interaction on life interference.Conclusions: This brief, easily accessible, online intervention that requires relatively low levels of therapist time showed promising impact for a very impaired population.Registration: This trial was registered on the ANZ clinical trials registry-ACTRN12616000139471. [ABSTRACT FROM AUTHOR]

It has been proposed that negative mental imagery plays an important role in the persistence of social fears. Experiencing vivid and distressing 'flashforward' images of a potential social catastrophe appears to be of relevance in speech anxiety. To clarify the role of these images, the current experimental study tested if reducing the vividness and distressing properties of recurring negative flashforward images subsequently reduces anxiety and avoidance tendencies regarding a speech. Methods : Participants were female undergraduates high in speech anxiety (N = 134) who joined our study online. In the experimental condition, we used a visuospatial dual-task to reduce the vividness and distress of flashforward imagery. Primary outcomes were participants' self-reported anxiety and avoidance ratings in anticipation of and during an actual speech. As a secondary outcome, we used observer ratings of participants' anxiety during the speech. Results: Participants reported moderate to high frequency and interference of their vivid and distressing flashforward images in daily life. The dual-task resulted in reductions in image vividness and distress. However, we found no differences between conditions in anxiety and avoidance ratings before and during the speech. Limitations: The imagery manipulation effect was moderate to small. Moreover, we included a subclinical sample. Conclusions: Reducing negative flashforward imagery vividness and distress with a visuospatial dual-task did not directly lead to less anxiety and avoidance tendencies related to a later speech. Thus, findings provided no support for the hypothesis that experiencing highly vivid and distressing flashforward images causally contributes to social fears. • We tested individuals high in speech anxiety with recurring flashforward imagery. • Image vividness and distress were experimentally reduced using a dual-task. • Subsequently, participants delivered a speech and rated anxiety and avoidance. • Anxiety and avoidance were not lower in experimental than in control condition. • No support for causal impact of highly vivid and distressing flashforwards on fear. [ABSTRACT FROM AUTHOR]

Background: Identifying and supporting young children who are at risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prevention and early intervention programmes. Delivering an online intervention through schools to parents of young children who have one or more of these risks could maximise reach. The primary aim of this trial is to evaluate the effectiveness and cost-effectiveness of delivering an online parent-led intervention, compared with usual school provision only, for children (aged 4-7) identified as at risk for anxiety disorders on the basis of at least one risk factor. We also aim to identify the characteristics of children who do and do not benefit from intervention and mechanisms of change from the intervention.Methods: The design will be a parallel group, superiority cluster randomised controlled trial, with schools (clusters) randomised to intervention or usual school practice arms in a 1:1 ratio stratified according to level of deprivation within the school. The study will recruit and randomise at least 60 primary/infant schools in England, and on the basis of recruiting 60 schools, we will recruit 1080 trial participants (540 per arm). Parents of all children (aged 4-7) in sampled Reception, Year 1, and Year 2 classes will be invited to complete screening questionnaires. Children who screen positive on the basis of anxiety symptoms, and/or behavioural inhibition, and/or parent anxiety symptoms will be eligible for the trial. Parents/carers of children in schools allocated to the intervention arm will be offered a brief online intervention; schools in both arms will continue to provide any usual support for children and parents throughout the trial. Assessments will be completed at screening, baseline (before randomisation), 6 weeks, 12 weeks, and 12 months post-randomisation. The primary outcome will be the absence/presence of an anxiety disorder diagnosis at 12 months.Discussion: The trial will determine if delivering an online intervention for parents of young children at risk of anxiety disorders identified through screening in schools is effective and cost-effective.Trial Registration: ISRCTN 82398107 . Prospectively registered on Jan. 14, 2021. [ABSTRACT FROM AUTHOR]

Background: Parenting is a modifiable factor proposed to underpin the transmission of anxiety and depression from parents to children. This study examined the role of parenting in the intergenerational transmission of anxiety and depression across pre‐ and early adolescence. Method: Participants were 531 youth (Mage = 11.18, SD = 0.56; 50.85% boys) and their parent. Child and parent anxiety and depression, and parental rejection, warmth and overprotection were assessed annually over 3 years. Bidirectional relationships between parent and child anxiety and depression, and the mediating role of parenting behaviors, were examined using cross‐lagged panel models. Results: Results suggest bidirectional associations over time between parent and child depression, and parental rejection and child depression. Parental rejection and low warmth were associated with increases in child depression, but did not mediate depression transmission. Parental anxiety was associated with increases in child anxiety and depression, but there was no bidirectional association from child psychopathology to parental anxiety. There was little evidence that parenting predicted changes in child anxiety over time. Child anxiety and depression were associated with subsequent increases in parental depression. Conclusion: Parental depression, rejection and low warmth are independent risk factors for child depression. Parental rejection may also be a consequence of parenting a depressed youth. Parenting did not account for the apparent transmission of parental anxiety to increased child anxiety and depression. Child psychopathology increases risk of parental depression. Parental rejection may be an important modifiable risk factor for youth depression in early adolescence, and may also reduce later risk of parent depression. [ABSTRACT FROM AUTHOR]

Background: The aim was to determine outcomes in the first year of school of a population‐delivered parenting program to prevent internalising problems in temperamentally inhibited preschool children and predictors of engagement in parenting groups. Method: Design: Randomised controlled trial. Setting: 307 preschool services across eight socio‐economically diverse government areas in Melbourne, Australia. Participants: 545 parents of inhibited 4‐year‐old children; 469 (86%) retained at two‐year follow‐up. Intervention: Cool Little Kids program. Primary outcomes were child internalising symptoms and anxiety disorders. Secondary outcomes were parenting, parent well‐being and engagement. Trial registration ISRCTN30996662 http://www.isrctn.com/ISRCTN30996662. Results: In the first year of school (M (SD) age 6.7 (0.4) years), child anxiety symptoms were reduced in the intervention versus control arm (PAS‐R M (SD): total 36.2 (17.2) versus 39.4 (18.5); adjusted difference −3.26, 95% CI −6.46 to −0.05, p =.047; specific fears 9.1 (6.2) versus 10.7 (6.8), adjusted difference −1.53; 95% CI −2.69 to −0.38, p =.009). However, there was little difference in broader child internalising (CMFWQ M (SD): 2.2 (0.5) versus 2.3 (0.6); adjusted difference −0.03, 95% CI −0.13 to 0.06, p =.489) or anxiety disorders (37.6% vs. 42.6%; adjusted OR 0.79, 95% CI 0.53 to 1.18, p =.242). Lower income, younger mothers, less educated and more culturally diverse fathers engaged less with the intervention. Continued skills practice was less frequent for parents of girls and in advantaged neighbourhoods. Conclusions: There were population effects of Cool Little Kids in the first year of school for anxiety symptoms but not disorders. Considering motivation techniques to engage subgroups of families would be helpful in translation research. [ABSTRACT FROM AUTHOR]

Online treatment delivery has the potential to increase access to evidence-based mental health care for children with anxiety disorders. Using a randomized controlled trial design, we evaluated the efficacy of Cool Kids Online, a family-based and therapist supported internet-delivered cognitive behavioral treatment (CBT) designed to target anxiety disorders in children. Ninety-five children aged 7–12 years with a DSM-5 anxiety disorder were randomly allocated to Cool Kids Online or a waitlist control. Children were assessed at baseline, week 11, and 6-months following treatment. Children in waitlist received treatment after week 11 and also completed assessments immediately and six months after treatment, allowing treatment maintenance to be evaluated for all children. Compared to waitlist, Cool Kids Online led to significantly greater remission of anxiety disorders (primary and all anxiety diagnoses) and greater reduction of caregiver-reported anxiety symptoms and interference at week 11. Child-reported anxiety symptoms and interference and child- and caregiver-reported depressive or externalizing symptoms did not differ significantly between conditions. Medium to large within-treatment effects were observed for all children from pre to post treatment with post treatment effects maintained until follow-up. Overall, the findings provide support for the efficacy of the program in treating anxiety. Cool Kids Online compared to waitlist for the remission of anxiety disorders in clinically anxious children; anzctr.org.au ; ACTRN12615000947505. • Online family-based cognitive behaviour therapy reduces child anxiety disorders. • Therapist support during online child anxiety programs may be important for change. • Cool Kids Online is a promising method to improve access to child anxiety treatment. [ABSTRACT FROM AUTHOR]

A considerable body of research in adults has demonstrated that anxiety disorders are characterised by attentional biases to threat. Findings in children have been inconsistent. The present study examined anxiety-related attention biases using eye tracking methodology in 463 preadolescents between 10 and 12 years of age, of whom 92 met criteria for a DSM-5 anxiety disorder and 371 did not. Preadolescent's gaze was recorded while they viewed adolescent face pairs depicting angry-neutral and happy-neutral expressions with each face pair presented for 5000 ms. No group differences were observed across any eye tracking indices including probability of first fixation direction, latency to first fixation, first fixation duration and dwell time. The sample overall showed faster initial attention towards threat cues, followed by a later broadening of attention away from threat. There is a need to identify the types of threats and the developmental period during which visual attention patterns of anxious and non-anxious youth diverge to inform more developmentally sensitive treatments. • Assessed visual attention allocation to peers' emotional face in preadolescents. • No differences between anxious and non-anxious preadolescents were observed. • Regardless of anxiety, time to first fixation was shorter for threat than neutral faces. • Faster initial allocation of attention to threatening peers may be common to all preadolescents. [ABSTRACT FROM AUTHOR]

Social anxiety and depressive symptoms increase markedly during adolescence. Most research examining the emergence of these symptoms has used a variable-centered approach providing little information about how these symptoms group together in individuals over time. A person-centered approach utilizing latent profile and latent transitional analyses was applied to a large adolescent sample (N = 2742, M age =13.65; SD =0.63; 47.9% girls). Subgroups differing in their expressions of social anxiety and depressive symptoms at each of four annual time points were identified and then change in membership of these groups was evaluated. Four subgroups were identified: 1. Low Distress, 2. Socially Anxious, 3. Dysphoric, and 4. Comorbid. The low distress group was the largest and most stable, followed by the socially anxious group, who most commonly transitioned into the comorbid group. In contrast, the dysphoric group were most likely to remit and move to the low distress group. The comorbid group was the smallest and least stable, although once in this group, three quarters of adolescents remained in this group over time. Early intervention is particularly imperative for socially anxious adolescents with or without comorbid depressive symptoms as they are the least likely to improve across the adolescent years. • Four subgroups with varying profiles of social anxiety and depressive symptoms were identified. • For the comorbid group, social anxiety was more likely to precede depression than vice versa. • Transitions between subgroups were driven more by changes in depression than social anxiety. • Those high in social anxiety were the least likely to experience a remission in symptoms over time. [ABSTRACT FROM AUTHOR]