Search

Previous research has identified factors related to outcome in child anxiety treatment and parent training programs for child behavior problems. However, it is unclear what factors predict outcomes in interventions delivered online to parents of young children at risk of anxiety. This study investigated predictors of child anxiety outcomes among 433 families with young children (3-6 years) who participated in a randomized controlled trial of Cool Little Kids Online, an eight-module early intervention program for child anxiety based on cognitive-behavioral therapy (CBT). Potential predictors included baseline demographic factors, child and parent mental health factors, and indicators of program use, including number of online modules completed and frequency of homework practice. Results showed that only access to a printer moderated intervention effectiveness. Printer access predicted lower child anxiety in the Cool Little Kids Online group, but had no effect on outcomes in the wait-list group. In both groups, higher levels of child anxiety symptoms, child-inhibited temperament, and poorer parent mental health at baseline predicted higher levels of child anxiety symptoms at 6-month follow-up. The amount of online program use was not related to improvements in child anxiety symptoms. However, parents who reported practicing the program skills more frequently showed greater reductions in child anxiety, and access to a printer was related to frequency of program skills practice. These findings provide empirical support for the important role of skills practice in online CBT interventions, and suggest that practicing program skills may be more important than completing the online modules. [ABSTRACT FROM AUTHOR]

Abstract: Anxiety and depression are commonly comorbid in older adults and are associated with worse physical and mental health outcomes and poorer response to psychological and pharmacological treatments. However, little research has examined the effectiveness of psychological programs to treat comorbid anxiety and depression in older adults. Sixty-two community dwelling adults aged over 60 years with comorbid anxiety and depression were randomly allocated to group cognitive behavioural therapy or a waitlist condition and were assessed immediately following and three months after treatment. After controlling for cognitive ability at pre-treatment, cognitive behaviour therapy resulted in significantly greater reductions, than waitlist, on symptoms of anxiety and depression based on a semi-structured diagnostic interview rated by clinicians unaware of treatment condition. Significant time by treatment interactions were also found for self-report measures of anxiety and depression and these gains were maintained at the three month follow up period. In contrast no significant differences were found between groups on measures of worry and well-being. In conclusion, group cognitive behavioural therapy is efficacious in reducing comorbid anxiety and depression in geriatric populations and gains maintain for at least three months. [Copyright &y& Elsevier]

Abstract: This study investigated the time-course of attentional bias in socially phobic (SP) and non-phobic (NP) adults. Participants viewed angry and happy faces paired with neutral faces (i.e., face-face pairs) and angry, happy and neutral faces paired with household objects (i.e., face-object pairs) for 5000ms. Eye movement (EM) was measured throughout to assess biases in early and sustained attention. Attentional bias occurred only for face-face pairs. SP adults were vigilant for angry faces relative to neutral faces in the first 500ms of the 5000ms exposure, relative to NP adults. SP adults were also vigilant for happy faces over 500ms, although there were no group-based differences in attention to happy-neutral face pairs. There were no group differences in attention to faces throughout the remainder of the exposure. Results suggest that social phobia is characterised by early vigilance for social cues with no bias in subsequent processing. [Copyright &y& Elsevier]

The article focuses on a study which examines the efficacy of early parenting intervention for preschool-aged children with anxiety and behavioral inhibition disorders. The study demonstrates the high levels of inhibition of selected children of parents with a current anxiety disorder. Methods of the study include the controlled trials which examine the early intervention with strategies on graded exposure, contingency management, parent training, and parent anxiety management to help reduce the risk of anxiety in preschool-aged children. Results of the study emphasize that children with parent intervention show a significant reduction in the severity of anxiety disorders.

Abstract: In the past few years, the field of psychology has seen a dramatic increase in interest in the prevention of mental disorder and emotional difficulties. This special series provides some excellent examples of the promises held by a- variety of prevention programs. At the same time, the papers in this volume highlight several important issues to consider and barriers to the implementation of prevention programs. This discussion paper explores the themes and issues raised by these papers and considers some of the lessons to be extracted for research into and implementation of prevention programs across mental health. [Copyright &y& Elsevier]

Objective: To evaluate a school-based early intervention program for the reduction of anxious symptoms in at-risk children from low socioeconomic status neighborhoods. Method: A total of 425 children (8-11 years old) from nine schools in low socioeconomic status areas were screened to identify children with high-level anxious symptoms. Ninety-one children were selected, and schools were assigned to either an eight-session active intervention or a waitlist control. Active intervention was conducted in small groups during school time by both school and health personnel. Parents of children in active intervention were offered two information sessions. Results: Demographic data indicated a low socioeconomic status for the sample. Children assigned to active intervention demonstrated a significant reduction in symptoms of anxiety relative to children assigned to waitlist and differences were maintained 4 months after treatment according to both self-report (F287 = 6.73, p < 0.005, partial η² = 0.134) and teacher report (F2,87 = 7.99, p = .001, partial η² = 0.155). Parents did not return sufficient data for meaningful statistical analysis. Conclusions: School-based early intervention appears to offer an effective means of reducing anxious symptomatology in economically disadvantaged populations. The school environment offers promise as a means of extending the reach of efficacious interventions for mental health to underserviced populations. [ABSTRACT FROM AUTHOR]

Self-help and psychoeducation have been identified as effective methods for delivering treatment, yet not everyone benefits from these brief interventions. Therefore it is clinically and economically useful to identify who is likely to require more intensive assistance. This paper develops a prognostic scale which predicts who will recover from panic attacks and who will require more assistance.Method: Random regression models were used to evaluate the relationship between predictive variables, baseline severity, and the rate of improvement in 117 people with DSMIV panic attacks who participated in a trial of a psycho-educational booklet, a self-help workbook, and brief group CBT over a 9-month period. ROC analysis was used to choose cut-off points on a scale made up of significant predictors.Results: Panic disorder and agoraphobia symptom measures were predicted by baseline social anxiety, and general mental health. There was no significant effect on the outcome for baseline depression or anxiety sensitivity. While general mental health (SF12 Mental Component scores) was predicted by the age at first panic attack, neuroticism, panic disorder and/or agoraphobia symptoms and a positive screen for alcohol use disorders. A prognostic scale based on simple additive scoring was equivalent to standard scores and significantly better than chance at predicting who would recover and who required face-to-face therapy.Conclusions: The prognostic scale may be used to guide the choice of psychoeducation, self-help or face-to-face therapy as the first step in stepped care. [Copyright &y& Elsevier]

Despite growing recognition of childhood anxiety as a common and often debilitating clinical concern, we have limited knowledge of the particular ways in which anxiety interferes with daily life for young children who have not yet entered formal schooling. The present study evaluated the psychometric properties of the Child Anxiety Life Interference Scale – Preschool Version (CALIS-PV). The CALIS-PV is a brief (18 item) parent-report measure of the impacts of a young child’s anxiety on their own life and that of her or his parent. Participants were 784 parents of a child aged 3–7 years, who completed the CALIS-PV as a part of the follow-up assessment battery for two anxiety prevention trials targeted at preschool children with temperamental inhibition. Confirmatory factor analysis supported three CALIS-PV factors reflecting anxiety-related life interference at home, outside home and on parent life. The three factors showed good internal consistency and good convergent and divergent validity, and successfully differentiated children with and without an anxiety diagnosis. Findings provide initial support for the CALIS-PV as a reliable and valid measure of the daily life impacts of childhood anxiety for preschool-aged children and their parents. [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]

Abstract: Transdiagnostic interventions present pragmatic benefits in treatment dissemination and training of mental health professionals when faced with emotional disorders such as anxiety and depression. Excessive worry is a common feature across emotional disorders and represents an ideal candidate target for transdiagnostic intervention. The current pilot trial examined the efficacy of a behavioural activation treatment for worry (BAW) in a community population. 49 individuals experiencing excessive worry were randomised to waitlist or BAW receiving an 8 week group based intervention. Results demonstrated that BAW was successful in reducing excessive worry, depressive symptoms, cognitive avoidance, Intolerance of Uncertainty and improving problem solving orientation. Twice as many individuals showed clinically significant reductions in excessive worry after treatment compared to the waitlist control. Despite limitations to sample size and power, this study presents promising support for BAW as a practical transdiagnostic treatment for worry. [Copyright &y& Elsevier]

Abstract: Cognitive Behavioural Group Therapy (CBGT) for social phobia has been shown to be efficacious within research units and effective within a variety of real world clinical settings. However, most effectiveness studies of CBGT for social phobia have (a) used protocols without demonstrated efficacy, (b) not included direct comparison groups, and/or (c) contained features of efficacy trials. This study addressed these limitations by using a benchmarking strategy to compare outcomes from the same CBGT protocol used in both a research unit and a community clinic. Research (N = 71) and community (N = 94) patients completed the same 12-session protocol, which resulted in significant reductions in social anxiety and life interference at post-treatment. Compared to research unit patients, community patients had more severe symptoms and life interference at pre-treatment, and were more likely to be male, use medication, have comorbid disorders, and have lower educational attainment. Importantly, degree of improvement on social anxiety symptoms and life interference did not differ across the treatment settings for either completer or intention-to-treat analyses. There was some evidence that being younger, single, and having a depression diagnosis were associated with dropout. Pre-treatment symptoms and number of diagnoses predicted post-treatment symptoms. Consistent with previous uncontrolled trials, it is concluded that CBGT is effective within community mental health clinics. [Copyright &y& Elsevier]

With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system. A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention. This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings. Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850). [ABSTRACT FROM AUTHOR]

• Adolescent males are often reluctant to seek help for symptoms of anxiety disorders. • Mental health literacy is associated with help-seeking attitudes in adolescent males. • Alignment with norms of hegemonic masculinity moderated this relationship. • Mental health initiatives may benefit from incorporating themes of masculinity. Poor mental health literacy and greater alignment with norms of hegemonic masculinity are established barriers to mental health help-seeking in men. However, little is known about how these variables influence adolescent male help-seeking and in particular, help-seeking for anxiety disorders. This study investigated the relationship between i) anxiety mental health literacy, ii) alignment with traditional masculinity norms and iii) help-seeking attitudes, intentions and behaviour in a sample of adolescent males. 1732 adolescent males (aged 12–18 years) participated online whilst at school. Participant attitudes towards formal help-seeking, intentions to seek help from a family member and from an online source were found to predict professional help-seeking behaviour by the adolescent and/or by their parents on the adolescents' behalf. In adolescents with a low or average personal alignment with norms of hegemonic masculinity, greater anxiety mental health literacy was positively associated with more favourable attitudes towards formal and informal help-seeking. However, this relationship was not found in adolescent males with a greater alignment with norms of hegemonic masculinity. The study had a correlational research design and used self-report measures. Mental health initiatives which consider the impact of masculinity and gender stereotypes have the potential to significantly improve help-seeking in this population. [ABSTRACT FROM AUTHOR]

Background: Despite considerable evidence on parenting risk and protective factors for child anxiety and depressive disorders, the development of interventions based on this evidence is still lagging behind. To address this gap, the web-based Parenting Resilient Kids (PaRK) program was developed to target these risk and protective factors. This study evaluated the effects of the program at 12-month follow-up.Methods: A randomized controlled trial was conducted with a community sample of 355 parents and 342 children (Mchild age = 9.79). Parents randomized into the web-based PaRK intervention condition received a personalized feedback report about their parenting and were recommended a tailored course of up to 12 interactive modules. Parents in the control condition received a standard set of web-based educational factsheets.Results: Parents in the intervention group demonstrated significantly greater improvement in self-reported parenting compared to control group parents from baseline to 12-month follow-up, d = 0.24, 95% CI [0.03, 0.45]. Both groups showed reductions in child anxiety and depressive symptoms, parental psychological control and unhealthy family functioning; and improvements in parental acceptance, child- and parent- health-related quality of life.Limitations: The PaRK intervention was tailored based on the parents' own report of their parenting behaviors. There was an over-representation of highly-educated mothers and only one parent-child dyad was included per family.Conclusions: PaRK improved parenting for up to 12 months, but had no superior effect on children's mental health outcomes compared with an educational-factsheet intervention. Further follow-up is needed to assess longer-term effects. [ABSTRACT FROM AUTHOR]

Background: Cultural factors influence both the expression of social anxiety and the interpretation and functioning of social anxiety measures. This study aimed to test the measurement equivalence of two commonly used social anxiety measures across two sociocultural contexts using individuals with social anxiety disorder (SAD) from Australia and Japan.Methods: Scores on the straightforwardly-worded Social Interaction Anxiety Scale (S-SIAS) and the Social Phobia Scale (SPS) from two archival datasets of individual with SAD, one from Australia (n = 201) and one from Japan (n = 295), were analysed for measurement equivalence using a multigroup confirmatory factor analysis (CFA) framework.Results: The best-fitting factor models for the S-SIAS and SPS were not found to be measurement equivalent across the Australian and Japanese samples. Instead, only a subset of items was invariant. When this subset of invariant items was used to compare social anxiety symptoms across the Australian and Japanese samples, Japanese participants reported lower levels of fear of attracting attention, and similar levels of fear of overt evaluation, and social interaction anxiety, relative to Australian participants.Limitations: We only analysed the measurement equivalence of two social anxiety measures using a specific operationalisation of culture. Future studies will need to examine the measurement equivalence of other measures of social anxiety across other operationalisations of culture.Conclusions: When comparing social anxiety symptoms across Australian and Japanese cultures, only scores from measurement equivalent items of social anxiety measures should be used. Our study highlights the importance of culturally-informed assessment in SAD. [ABSTRACT FROM AUTHOR]