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Background Children with a social anxiety disorder have worse treatment outcomes after Cognitive Behavior Therapy (CBT) than children with other anxiety disorders. Anxiety disorders and mood disorders are strongly related and especially social anxiety is related to high comorbidity rates with mood disorders. The aim of the study was to investigate how comorbid mood disorders are related to treatment outcomes after CBT and whether this can explain the worse outcomes for childhood social anxiety. Methods Participants were 152 referred clinically children (7–18 years) with either a social anxiety disorder (n = 52) or another anxiety disorder (n = 100) of whom 24.3% (n = 37) had a comorbid mood disorder. Child anxiety, internalizing symptoms, and quality of life were measured pre-treatment, post-treatment, 3 months and 1 year after treatment, using child and both parents’ report. Results Children with a primary social anxiety disorder more often had a comorbid mood disorder than children with another primary anxiety disorder. Children with a mood disorder had more severe anxiety problems before treatment. Comorbid mood disorders were related to greater anxiety reductions after treatment. The worse outcomes for children with a primary social anxiety disorder remained after controlling for comorbid mood disorders. Conclusions Findings stress the importance of future studies examining why the presence of a comorbid mood disorder is associated with greater anxiety reductions, and other factors that explain the worse treatment outcomes found for childhood social anxiety disorder.

Objective: To investigate whether mindfulness-based childbirth and parenting (MBCP) or enhanced care as usual (ECAU) for expectant couples decreases fear of childbirth (FOC) and nonurgent obstetric interventions during labor and improves newborn outcomes. Design: Randomized controlled trial. Setting: Midwifery settings, the Netherlands, April 2014-July 2017. Population: Pregnant women with high FOC (n = 141) and partners. Methods: Allocation to MBCP or ECAU. Hierarchical multilevel and intention-to-treat (ITT) and per-protocol (PP) analyses. Main outcome measures: Primary: pre-/postintervention FOC, labor anxiety disorder, labor pain (catastrophizing and acceptance), and preferences for nonurgent obstetric interventions. Secondary: rates of epidural analgesia (EA), self-requested cesarean birth (sCB), unmedicated childbirth, and 1- and 5-minute newborn's Apgar scores. Results: MBCP was significantly superior to ECAU in decreasing FOC, catastrophizing of labor pain, preference for nonurgent obstetric interventions, and increasing acceptance of labor pain. MBCP participants were 36% less likely to undergo EA (RR 0.64, 95% CI [0.43-0.96]), 51% less likely to undergo sCB (RR 0.49, 95% CI [0.36-0.67]), and twice as likely to have unmedicated childbirth relative to ECAU (RR 2.00, 95% CI [1.23-3.20]). Newborn's 1-minute Apgar scores were higher in MBCP (DM −0.39, 95% CI [−0.74 to −0.03]). After correction for multiple testing, results remained significant in ITT and PP analyses, except EA in ITT analyses and 1-minute Apgar. Conclusions: MBCP for pregnant couples reduces mothers’ fear of childbirth, nonurgent obstetric interventions during childbirth and may improve childbirth outcomes. MBCP adapted for pregnant women with high FOC and their partners appears an acceptable and effective intervention for midwifery care.

Many children referred to mental health services have neurodevelopmental problems, which are not always recognized because the resulting emotional and behavioral problems dominate diagnosis and treatment. BOAM (Basic needs, Order, Autonomy and Meaning) is a new diagnostic system consisting of imaginative models that explain the complexity of symptoms and underlying neuropsychological problems in a simple way. It is designed to be used in a transparent, collaborative process with families, so that family members can better understand the nature of mental health problems, thus increasing self-knowledge and mutual understanding. In this study, the feasibility of the BOAM diagnostic trajectory and subsequent treatment informed by this trajectory are evaluated clinically in 34 children who have not responded to or relapsed after treatment as usual (TAU). Parents completed questionnaires pre-test, post-test and at a 3-month follow-up. The treatment drop-out rate was 2.9%. Post-test, parents rated the BOAM trajectory positively. The questionnaires (measuring child psychopathology, attention, executive functioning, family functioning, partner relationships and parenting stress) demonstrated sensitivity to change, and therefore, seems appropriate for a future effectiveness study. A limitation was the high percentage of missing measurements both post-test (41%) and at the follow-up (41%). The BOAM diagnostic trajectory and subsequent treatment may be a feasible alternative for children who do not respond to or relapse after TAU.

Objectives We evaluated the effects of the family mindfulness-based intervention (MBI) “MYmind” for children with ADHD and their parents, and examined child and parent predictors of child outcome. Methods Using a pragmatic quasi-experimental waitlist design, children aged 7–19 years (n = 167), clinically referred with a DSM-IV ADHD diagnosis, and both their parents completed waitlist (average waiting time was 8 weeks), pre-test, post-test, 8-week, and 1-year follow-up measurements. MYmind consisted of eight weekly 1.5-h mindfulness-based group sessions for children and parallel for parents, and a follow-up session. We assessed children’s and both parents’ ADHD symptoms and other psychopathology, child executive function, parental stress, parental overreactivity, and mindful parenting. Results Multilevel analyses revealed medium-to-large effect-sized reduced child ADHD symptoms between pre- and post-test, becoming stronger at follow-ups, while no waitlist effects occurred. Parents above the ADHD threshold improved on adult ADHD symptoms with similar sized effects. Children’s and parents’ other psychopathology, child executive function, parental overreactivity, and mindful parenting improved, whereas parental stress only improved at 1-year follow-up. Child age, child gender, ADHD medication, parental ADHD, and parent participation did not predict child outcome. Parent gender however interacted with parental ADHD to predict child outcome; children of fathers (but not mothers) above the ADHD threshold improved more than children of fathers below the ADHD threshold at post-test and at 8-week follow-up. Reduced paternal ADHD from pre- to post-test mediated this effect. Conclusions Family MBI (MYmind) may reduce childhood ADHD and improve parental functioning. Fathers with ADHD symptoms appear important in helping offspring with ADHD.

Objectives Adolescents with autism often experience comorbid internalizing disorders such as anxiety disorders or depression but the available evidence-based treatments to support the mental health of adolescents with autism are limited. The aim of this study was to investigate if and how MYmind, a mindfulness-based program (MBP) for youth with autism, could benefit adolescents with comorbid internalizing disorder(s). Methods A person-centered approach with a multiple baseline design was used to investigate the effects of MYmind. Five adolescents with autism and an internalizing disorder took part in the 9-week MYmind program. The adolescents and their parents completed a daily questionnaire on their personal goals during a baseline phase, the intervention, a 2-month follow-up phase, and a 1-year follow-up phase. We analyzed the effects on their personal goals using visual inspection and statistical analysis for single-case designs. Also, we investigated potential processes of change by analyzing how changes were related over time. Results Findings indicated that most, but not all, adolescents benefitted from the MBP. Four out of five adolescents showed medium-sized improvement in some of their personal goals. However, one adolescent reported a deterioration during the intervention and 2-month follow-up phase. Decreased worry preceded behavioral improvements in two adolescents, whereas other potential mechanisms of change showed inconclusive results. Conclusion The findings indicated that most of the adolescents with autism and a comorbid internalizing disorder partially benefitted from the MBP.

Objectives Childhood psoriasis and eczema negatively impact the well-being of children and their parents. Identifying variables that protect against, or reduce, the negative impact of these skin conditions could greatly improve the lives of children with these skin conditions and their parents. We therefore aimed to investigate whether higher levels of parental dispositional mindfulness are associated with lower levels of psychological distress and better quality of life in children with psoriasis or eczema and their parents. Methods Children with psoriasis or eczema (n = 180, M age = 10.22, females = 108) and their parents (n = 210, M age = 39.97, females = 183) were recruited from social media and NHS dermatology clinics in the UK. Parents completed questionnaires assessing dispositional mindfulness, parental stress, psychological distress (depression, anxiety, general stress), and quality of life related to their child’s skin condition. Children completed questionnaires assessing quality of life related to their skin condition and pruritus (itch intensity). Results Parental dispositional mindfulness explained significant amounts of variance in parental stress, parent depression, parent anxiety, parent general stress, and both parent and child quality of life. These relationships were not moderated by skin condition. Conclusion Parental dispositional mindfulness is associated with better well-being in parents of children with psoriasis or eczema, and their children. Mindfulness-based interventions for parents may be beneficial for improving well-being in both children with skin conditions and their parents. Trial Registration: https://aspredicted.org/xf429.pdf (see Supplementary Materials A).

Objective: Self-focused attention is a maintaining factor for social anxiety disorder. It was shown that self-focused attention correlates with trait mindfulness, but not with attention control. This study examined the reliability and validity of the Japanese version of the self-focused attention (J-SFA) scale. Method: Students (N = 502) completed a set of questionnaires, measuring self-focused attention, social anxiety symptoms, trait mindfulness, and attention control. Results: A confirmatory factor analysis indicated that the J-SFA scale has a bi-factor structure. The Cronbach's α coefficient was high. Correlation analysis showed that each factor of the J-SFA scale was significantly weakly to moderately correlated with social anxiety symptoms and trait mindfulness, and the J-SFA scale's factors were significantly or non-significantly very weakly correlated with attentional control functions. Conclusion: The findings indicate that the J-SFA demonstrated satisfactory reliability and validity for our sample and provide impetus for future research into the measure for clinical and nonclinical samples in Japan.

Contains fulltext : 248841.pdf (Publisher’s version ) (Open Access) BACKGROUND: Family mindfulness-based intervention (MBI) for child attention-deficit/hyperactivity disorder (ADHD) targets child self-control, parenting and parental mental health, but its effectiveness is still unclear. METHODS: MindChamp is a pre-registered randomised controlled trial comparing an 8-week family MBI (called 'MYmind') in addition to care-as-usual (CAU) (n = 55) with CAU-only (n = 48). Children aged 8-16 years with remaining ADHD symptoms after CAU were enrolled together with a parent. Primary outcome was post-treatment parent-rated child self-control deficits (BRIEF); post hoc, Reliable Change Indexes were explored. Secondary child outcomes included ADHD symptoms (parent/teacher-rated Conners' and SWAN; teacher-rated BRIEF), other psychological symptoms (parent/teacher-rated), well-being (parent-rated) and mindfulness (self-rated). Secondary parent outcomes included self-ratings of ADHD symptoms, other psychological symptoms, well-being, self-compassion and mindful parenting. Assessments were conducted at post-treatment, 2- and 6-month follow-up. RESULTS: Relative to CAU-only, MBI+CAU resulted in a small, statistically non-significant post-treatment improvement on the BRIEF (intention-to-treat: d = 0.27, p = .18; per protocol: d = 0.33, p = .11). Significantly more children showed reliable post-treatment improvement following MBI+CAU versus CAU-only (32% versus 11%, p

Objectives Although the effectiveness of mindfulness-based intervention for various populations is well-documented, research examining these effects for police officers is limited. This study aimed to increase knowledge on (1) the effects of a mindfulness-based intervention in police officers and (2) potential mechanisms of change by relating changes in facets of mindful awareness to changes in stress. Methods In the present study, we investigated the effects of a 6-session group-based mindfulness-based intervention in police officers (n = 82) on self-report measures, using a quasi-experimental design consisting of a within-group 6-week baseline period; pre-test, 6-week intervention; and post-test, 6-week follow-up. Multilevel analyses were used to test intervention effects. Using structural equation modeling, we analyzed whether changes in facets of mindfulness were associated with changes in various types of stress. Results After the intervention, police officers significantly and substantially improved on stress (primary outcome), facets of mindful awareness (explanatory variables), and related secondary outcomes including somatic complaints, sleep disturbances, positive affect, happiness, and work ability, while in baseline period, outcome measures did not change. Effects remained significant or improved further during the follow-up period. Further, we found that increases in particularly the facets of mindful awareness of acting with awareness and non-judging were associated with reductions in stress. Conclusions Mindfulness-based intervention appears beneficial for police officers. Further, increases in both attention and acceptance skills such as acting with awareness and non-judging seem to be most important in explaining reductions of stress in police officers.

ObjectiveThere is increasing evidence that mindfulness-based interventions reduce stress and improve wellbeing in employees. However, less is known about the factors that mediate these effects. The aim of this study was to assess short- and long-term–mediating effects of mindfulness and self-compassion on the effects of the Mindful2Work training.MethodsEmployees with burnout complaints (N = 124) filled in questionnaires concerning perceived stress, chronic fatigue, mindfulness, and self-compassion. Assessments took place before, directly after the training and at 6 weeks follow-up. The intervention consisted of 6 weekly sessions of 2 h, combining mindful physical activity, yoga, and mindful meditation, and a follow-up session 6 weeks later.ResultsMultiple parallel and serial mediation analyses indicated that increases in mindfulness mediated the effects from pre- to post-test on stress and fatigue. Regarding the mindfulness facets; acting with awareness mediated the effects during the training on both stress and fatigue, and non-reactivity on stress. Furthermore, increases in self-compassion mediated the effects from post-test to follow-up on stress and fatigue. Lastly, it was found that during and after the training, increases in mindfulness led to more self-compassion, which in turn led to less stress (and after the training also to less fatigue).ConclusionThis study indicates that part of employees’ stress and fatigue reduction over the course of the Mindful2Work training can be explained by increased mindfulness, and by increased self-compassion, directly and through increases of mindfulness.

Mindful parenting (MP) as a group-based training for parents of clinically referred children with psychopathology has shown to effectively reduce child and parent mental health problems. This study investigated the effects of MP as a “preventive” intervention for parents who experienced parental stress or problems in parenting (non-clinical setting) compared to MP as a “curative” intervention (clinical setting). Parents from a non-clinical setting (n = 98, 18% fathers) and a clinical setting (n = 87, 21% fathers) completed questionnaires about themselves, their partner relationship, and their child at waitlist (non-clinical setting only), pre-test, post-test, and 8-week follow-up. Before the intervention, the children of parents in the non-clinical setting, as expected, showed higher well-being and lower behavior problems, but parental stress levels, parental overreactivity, mindful parenting, partner relationship, and parental well-being were no different in the clinical and preventive group pre-intervention. No improvement was observed at waitlist, except for parental well-being, while improvement on parent and child functioning measures did occur after MP. No differences in MP effects in both settings were found in improved parental functioning (parental stress, overreactivity, mindful parenting, partner relationship, and well-being [small to medium effect size improvements]) and child functioning (well-being and behavior problems, small effect size improvements). Improvements in child functioning were associated with improved mindful parenting. Results suggest that MP training may be an effective intervention not only for families of children referred to mental health care because of child mental disorders but also for parents who experience parental stress or parenting problems as it is.

A common belief is that narcissism is a manifestation of high self-esteem. Here, we argue that self-esteem and narcissism are fundamentally distinct and have unique early physiological indicators. We hypothesized that children predisposed to narcissism would show elevated, whereas children predisposed to high self-esteem would show lowered, physiological arousal in social-evaluative contexts. We tested this in a prospective study including 113 children, who were first assessed at age 4.5, a critical age when children begin evaluating themselves through others' eyes. At age 4.5, children sang a song in front of an audience while being videotaped. Children's physiological arousal (skin conductance, heart rate, and heart rate variability) was assessed while children anticipated, performed, and recovered from the singing task. At age 7.5, children's narcissism and self-esteem levels were assessed. Consistent with our predictions, children predisposed to higher narcissism levels showed elevated skin conductance levels during anticipation. Their skin conductance levels further rose during performance (but less so than for other children) and failed to return to baseline during recovery. By contrast, children predisposed to higher self-esteem levels showed lowered skin conductance levels throughout the procedure. The effects emerged for skin conductance but not heart rate or heart rate variability, suggesting that arousal was sympathetically driven. Effects were larger and more robust for self-esteem than for narcissism. Together, these findings uncover distinct physiological indicators of narcissism and self-esteem: Narcissism is predicted by indicators reflecting early social-evaluative concerns, whereas self-esteem is predicted by indicators reflecting an early sense of comfort in social-evaluative contexts.

This study investigated the feasibility and preliminary effectiveness of a concurrent mindfulness program (MYmind) on Chinese adolescents with autism spectrum disorder and their parents in Hong Kong, China using a randomized controlled trial with a waitlist control group. Results showed the study had 80% compliance rate, 0% dropout rate, and 89% response rate. Between-group comparisons showed mindfulness had trend effects on parent’s rumination (g = 1.16), mindful parenting (d = 0.6), parenting style (d = 0.59), and parenting stress (d = 0.5). The study demonstrated the feasibility of the MYmind program in the Chinese context. A larger trial with longer follow-up period is suggested to better examine the effect of mindfulness on adolescents with ASD and their parents.

Early behavioural inhibition, a temperamental characteristic defined by fearful, overly-sensitive, avoidant, or withdrawn reactions to the unknown, is a predictor of later social anxiety. However, not all behaviourally inhibited children develop anxiety problems, and attentional bias to threat has been proposed to moderate the relation between behavioural inhibition and anxiety. The current study aimed to further specify the relation between early behavioural inhibition and later social anxiety by testing this potentially moderating role of childhood attentional bias to threat. Behavioural inhibition was assessed during toddlerhood (age 2.5 years) using laboratory observations of children's behaviours in response to unknown objects and situations. When children were 7.5 years old, attentional bias was measured in 86 children (46 girls) using both a visual probe task and a visual search task with angry and happy faces. Child social anxiety was measured using questionnaires completed by the child and both parents, and clinical interviews conducted with both parents. Our results showed that while early behavioural inhibition was related to later social anxiety, there was no evidence for a moderation of this relation by attentional bias, suggesting that the relation between early fearful temperament and later social anxiety holds across children, independent of their attentional biases.

Background: Self-conscious emotional reactivity and its physiological marker—blushing, has been proposed to be an etiological mechanism of social anxiety disorder (SAD), but so far, untested in longitudinal designs. This study tested, for the first time, if self-conscious emotional reactivity (indexed as physiological blushing) contributes to the development of SAD symptoms over and above social behavioral inhibition (BI), which has been identified as the strongest predictor of SAD development in early childhood. Methods: One-hundred-fifteen children (45% boys) and their mothers and fathers participated at ages 2.5, 4.5, and 7.5 years. Social BI was observed at all time points in a Stranger-approach task and physiological blushing (blood volume, blood pulse amplitude, and temperature increases) was measured during a public performance (singing) and watching-back the performance at ages 4.5 and 7.5. Child early social anxiety was reported by both parents at 4.5 years and SAD symptoms were diagnosed by clinicians and reported by both parents at 7.5 years. Results: Higher social BI at 2.5 and 4.5 years predicted greater social anxiety at 4.5 years, which, in turn, predicted SAD symptoms at 7.5 years. Blushing (temperature increase) at 4.5 years predicted SAD symptoms at 7.5 years over and above the influence of social BI and early social anxiety. Conclusions: That blushing uniquely contributes to the development of SAD symptoms over and above social BI suggests two pathways to childhood SAD: one that entails early high social BI and an early onset of social anxiety symptoms, and the other that consists of heightened self-conscious emotional reactivity (i.e., blushing) in early childhood.

Objectives Insomnia is highly prevalent among adolescents, with severe consequences for daily life, including mental disorders. Cognitive behavioral therapy for insomnia (CBTI) can be effective in internet-delivered and face-to-face modalities. However, it is yet unclear what the contribution is of mindfulness-based techniques to the effectiveness of traditional CBTI. The present study investigated whether use of a body scan mindfulness meditation influenced the effectiveness of CBTI for adolescents. Methods Adolescents who had received 6 weeks of internet CBTI were divided into a group who had practiced a body scan meditation (N = 26, age M = 15.33 years, SD = 1.42, 77% girls) and a group who had not (N = 28, age M = 15.64 years, SD = 1.80, 82% girls). Differences between the groups were analyzed for subjective and objective sleep outcomes from baseline to post-treatment and to 2-month follow-up. Results Moderate to large effect size improvements appeared for sleep parameters from 7-day actigraphy and sleep logs, and large effect size decreases of self-reported symptoms of insomnia and chronic sleep reduction, at post-treatment for both groups. Improvements were maintained at follow-up. However, where the non-body scan group showed no significant change of wake after sleep onset from actigraphy, and self-reported shortness of sleep and irritation, there were medium effect size improvements of these outcomes in the body scan group. Conclusions These results indicate that the use of a body scan mindfulness meditation in CBTI may have an additional positive effect on sleep, above and beyond traditional CBTI techniques.

Contains fulltext : 218120.pdf (Publisher’s version ) (Open Access) The current study aimed to investigate the discrepancy between self-reported and peer-reported likeability among children, and the relation with social anxiety, depression, and social support. In total, 532 children between 7 and 12 years completed questionnaires about social anxiety symptoms, depressive symptoms, and social support, estimated their own likeability, and indicated how much they liked their classmates. Children with higher levels of social anxiety or depression overestimated their likeability less or even underestimated their likeability. Social anxiety symptoms, but not depressive symptoms, were significant predictors of the discrepancy. Social support was positively related to likeability and negatively related to social anxiety, but did not moderate the association between social anxiety symptoms and perception accuracy of likeability. These results are in line with cognitive theories of childhood social anxiety, and they stress the importance of using multi-informant measures when studying the relation between social anxiety and social functioning in children. 18 p.

Organizations are confronted with a constant need for efficiency, which affects the working atmosphere, often typified by velocity, time pressure, competition, job insecurity, and information overload, which may lead to stress, burnout, work-life disbalance, and lowered work functioning. This study evaluated an 8-week, 1.5 h-per-week group-based standardized mindfulness program (“Finding peace in a frantic world”), applied on-site in a large multinational company. In a naturalistic longitudinal design self-selected employees (n = 150) completed measurements at wait-list, pre-test, post-test, and 2 and 6 months follow-up. Nearly all participants followed at least five out of eight sessions, were highly satisfied with the training (8.3 out 10), and almost 90% intended to continue with mindfulness practices. Primary outcomes were stress and risk for dropout from work. Using multilevel analyses, mean pre-test scores were compared to the other measurement occasions, and the rate of change in the training period (M = 67 days; SD = 12) was compared to the rate of change in the wait-list period (M = 29 days; SD = 8). Direct and long-term positive effects on risk for dropout from work (p p p

ObjectivesMindfulness-based programs could support children with autism spectrum disorder (ASD) and their parents to cope with autism spectrum symptoms and reduce comorbid mental health problems. In this study, we aimed to explore which change processes are involved in a mindfulness-based program for children with ASD and their parents (MYmind), according to a qualitative analysis of the families’ experiences.MethodFourteen children aged 9–17 years and 31 parents (18 mothers, 11 fathers, 2 caring relatives) participated in an interview 2 to 5 months after the 9-week MYmind training, about their experiences with the training, experienced changes, and how mindfulness works for them. We used constructivist grounded theory methodology to develop a theory of the key change processes and their relations.ResultsEight main change processes resulted from the analysis, namely connecting with peers, pausing, being aware, being in the here and now, letting be, determining a strategy, being and responding calm, and attuning to others. We proposed a model reflecting the interdependency and direction of these change processes.ConclusionThe findings deepen our understanding of how multiple change processes are involved in the MYmind program for children with ASD and their parents. Theoretical and research implications are discussed.

Contains fulltext : 209180.pdf (Publisher’s version ) (Closed access) The purpose of this study was to examine the relation of social anxiety with self-perceived and peer-reported likability, while controlling for the possible influence of depression. In total, 586 children (7 to 13 years) completed questionnaires to measure social anxiety, self-assessed likability, and depression. Peer-reported likability was derived from sociometric data on likability. As expected, children with higher self-reported social anxiety perceived themselves as less liked by classroom peers than children with lower self-reported social anxiety. In reality, children with higher levels of social anxiety were more liked by peers than children with lower levels of social anxiety. Multilinear regression analyses indicated no confounding effect of depression: Social anxiety, but not depression, was a significant predictor of biased perceived likability. Correcting the discrepancy between objective versus subjective likability may be a crucial target in the prevention and treatment of social anxiety disorders in children. 8 p.

OBJECTIVE: Integrative data analysis was used to combine existing data from nine trials of cognitive-behavioral therapy (CBT) for anxious youth (N = 832) and identify trajectories of symptom change and predictors of trajectories.METHOD: Youth- and parent-reported anxiety symptoms were combined using item-response theory models. Growth mixture modeling assessed for trajectories of treatment response across pre-, mid-, and posttreatment and 1-year follow-up. Pretreatment client demographic and clinical traits and treatment modality (individual- and family-based CBT) were examined as predictors of trajectory classes.RESULTS: Growth mixture modeling supported three trajectory classes based on parent-reported symptoms: steady responders, rapid responders, and delayed improvement. A 4-class model was supported for youth-reported symptoms: steady responders, rapid responders, delayed improvement, and low-symptom responders. Delayed improvement classes were predicted by higher number of diagnoses (parent and youth report). Receiving family CBT predicted membership in the delayed improvement class compared to all other classes and membership in the steady responder class compared with rapid responders (youth report). Rapid responders were predicted by older age (parent report) and higher number of diagnoses (parent report). Low-symptom responders were more likely to be male (youth report).CONCLUSIONS: Integrative data analysis identified distinct patterns of symptom change. Diagnostic complexity, age, gender, and treatment modality differentiated response classes. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Shame and guilt are common during the course of parenting and can reflect feelings of “bad self “and “bad behaviour” in relation to parenting events. Self-compassion is known to be beneficial for well-being by reducing negative emotions, yet there is little research examining whether self-compassion might reduce parental guilt and shame. The current study examined the effects of dispositional and induced self-compassion on guilt and shame in a sample of 167 parents (Mage = 37.23, SD = 6.73, 83.1% female) of children 12 years and under recruited online. After completing baseline measures, parents were randomly assigned to recall a guilt versus shame provoking parenting event, and randomly allocated to either a self-compassion prompt versus a control condition. Analyses confirmed that those who received the self-compassion prompt reported higher levels of self-compassion, and reduced feelings of guilt and shame compared to the control group. Effects did not differ as a function of the guilt versus shame instructions. Multivariate analyses revealed that, when controlling for dispositional self-compassion, and baseline guilt and shame, differences between conditions were maintained for post-manipulation guilt and shame. Findings extend our understanding of the role of self-compassion for improving well-being when dealing with the challenges of parenting.

Blushing is an involuntary reddening of the face that typically occurs when people are concerned about making negative impressions on others. Although people typically blush for their mishaps or misdeeds, Darwin observed that some people, and especially children, also blush when they are lavished with praise. We theorize that socially anxious children blush when praised in inflated ways because they believe they do not match the inflated image others hold of them. Such praise-induced blushing might be particularly common in late childhood, when children's worries about their social image escalate. In this randomized experiment, 105 children (ages 8–12, 85% Caucasian) sang in front of an audience. Afterwards, children received inflated praise (“You sang incredibly well!”), noninflated praise (“You sang well!”), or no praise. Children's physiological blushing was assessed through photoplethysmography and a temperature sensor. As predicted, inflated praise—but not non-inflated praise—increased blushing in socially anxious children. This emerged for blood pulse amplitude changes (AC reactivity) and self-reported blushing, not for blood volume (DC reactivity) and temperature changes. Socially anxious children may blush to “apologize” in advance for not being as incredible as others think they are. Thus, blushing may be elicited in situations that seem benign but actually evoke the fear of being evaluated negatively.

Adolescent insomnia can be treated effectively with cognitive behavioural therapy for insomnia (CBTI). However, little is known about effects of CBTI on psychopathology in adolescents. This study aimed to investigate whether (a) CBTI improves psychopathology in Internet- (IT) and face-to-face group treatment (GT) compared to waitlist (WL), (b) improvement in psychopathology can be attributed to reduced insomnia, (c) improvement in psychopathology remains stable for up to 1 year. One hundred and sixteen participants (age = 15.6 years, 25% males) with DSM-5 insomnia, were randomly assigned to IT, GT or WL. http://www.controlledtrials.com (ISRCTN33922163). Assessments of psychopathology, insomnia and objectively and subjectively measured sleep occurred at baseline, post-treatment, and at 2-, 6- and 12-month follow-up. Multilevel and mediation analyses were run to test hypotheses. The CBTI protocol, 'Sleeping Smart' for both IT and GT consisted of six weekly sessions and a booster session after 2 months. Psychopathology symptoms, insomnia and sleep problems as measured by actigraphy and sleep logs decreased substantially in IT and GT compared with WL at 2-month follow-up with medium to large effect sizes (ESs). Psychopathology symptoms remained stable or further improved for up to 12-month follow-up. ESs at 12-month follow-up for IT and GT were respectively: affective (d = -0.87 and -0.97), anxiety (d = -0.81 for IT), somatic (d = -0.38 and d = -0.52), oppositional (d = -0.42 for GT) and attention deficit hyperactivity disorder (ADHD) problems (d = -0.47 and -0.46). Mediation analyses indicated that reduction of insomnia symptoms after CBTI fully mediated the effects of CBTI on affective and anxiety problems, and partially mediated the effect on ADHD problems. This is the first study demonstrating that Internet and face-to-face CBT for insomnia achieves long-term reduction in adolescent psychopathology and does so by improving insomnia. This finding can have profound implications for youth mental health care.

This study investigated associations between parental and child psychopathology with parenting stress as a possible mediator, in order to get more insight in mothers' and fathers' roles in the development of psychopathology in children. Parents of 272 clinically referred (aged 6-20, 66% boys) reported about their own and their child's behavioral problems, and about parenting stress. Data were analyzed using Structural Equation Modeling. Outcomes of path models demonstrated that mothers' higher internalizing and externalizing problems were associated with respectively children's higher internalizing and externalizing problems. Fathers' higher externalizing problems were associated with both children's higher internalizing and externalizing problems, but fathers' internalizing problems were only associated with children's lower externalizing problems. Parenting stress fully mediated the relation between mothers' and children's externalizing problems, and partly mediated the relation between mothers' and children's internalizing problems. For fathers, parenting stress partly mediated the relation between fathers' internalizing problems and children's externalizing problems. Findings indicate that for mothers, the association between parental and child psychopathology is specific, whereas for fathers it is non-specific. Furthermore, results suggest that reducing parenting stress may decrease child problem behavior. Longitudinal studies are needed in order to gain more insight in the direction and underlying mechanisms of the relation between parental and child psychopathology, including parental stress.

Objective: Challenging parenting behavior (CPB), a novel construct involving active physical and verbal behaviors that encourage children to push their limits, has been identified as a potential buffer against child anxiety. This study aimed to 1) evaluate the measurement invariance of the Challenging Parenting Behavior Questionnaire (CPBQ4-6) across Dutch and Australian mothers and fathers of preschoolers; 2) examine differences in levels of CPB across mothers and fathers, and across countries; 3) examine whether parents’ CPB predicts less child anxiety symptoms and disorders. \ud Methods: Participants were 312 families, 146 Dutch and 166 Australian, with their 3 to 4-year-old child (55.8% girls). Fathers’ and mothers’ CPB was measured using the CPBQ4-6, child anxiety symptoms and presence of anxiety disorders were assessed using maternal reports. \ud Results: Multigroup confirmatory factor analyses revealed equivalence of factor structure and factor loadings (all significant) of the CPBQ4-6 across mothers and fathers, and countries. Evidence of partial scalar invariance indicated that the groups differed on some subscales of the CPBQ4-6. Australian mothers scored lower on the CPB factor than Australian fathers and Dutch parents. Structural equation models showed that CPB predicted fewer child anxiety symptoms and anxiety disorders for all groups. \ud Conclusion: The study confirms that the CPBQ4-6 is appropriate for use with Dutch and Australian parents of pre-school aged children, and identifies CPB as a multifaceted and coherent construct. The negative relations between CPB and child anxiety suggest that CPB has a protective role in childhood anxiety, and is important to examine in future research and interventions.

Werkgerelateerde stress en stressgerelateerde ziektes nemen toe in de Westerse maatschappij. Mindfulness meditatie, yoga en lichaamsbeweging hebben allemaal hun positieve effecten hierop bewezen. Deze studie onderzocht de voorlopige effecten van de nieuw ontwikkelde Mindful2Work training, bestaande uit zes wekelijkse groepssessies en een follow-up sessie, waarin lichaamsbeweging, restoratieve yoga en mindfulness meditatie worden gecombineerd. Deelnemers (n = 26) vulden voor en na de interventie metingen in, evenals na 6 weken (FU-1) en 6 maanden (FU-2). Resultaten laten significante verbeteringen zien met (zeer) grote effectgroottes op stress en fysiek en mentaal werkvermogen, risico op lange termijn uitval op het werk en gewerkte contracturen per week. Met de tijd bleven de effecten (zeer) groot of namen nog verder toe. Concluderend, de effecten van de nieuw ontwikkelde Mindful2Work training zijn veelbelovend. Vergeleken met andere interventies is het programma korter (en dus goedkoper) en de uitval is lager.

Cultivating empathy is a presumed benefit of mindfulness, but this possibility has rarely been investigated experimentally. We examined whether a five-minute mindfulness exercise would cultivate empathy relative to two equally brief control exercises: relaxation and mind-wandering. We further examined whether mindfulness would be especially beneficial for people with autistic or narcissistic traits. Results showed no effect of mindfulness relative to both control conditions on mind reading, empathic responding, or prosocial behavior. Mindfulness effects were independent of autistic traits. Unexpectedly, people higher in autistic traits did show increased prosocial behavior across conditions. Intriguingly, mindfulness improved mind reading in non-narcissistic people, but reduced it in narcissistic people. These findings question whether a brief mindfulness exercise is sufficient for building empathy.

With DSM‐5, the American Psychiatric Association encourages complementing categorical diagnoses with dimensional severity ratings. We therefore examined the psychometric properties of the DSM‐5 Dimensional Anxiety Scales, a set of brief dimensional scales that are consistent in content and structure and assess DSM‐5‐based core features of anxiety disorders. Participants (285 males, 255 females) completed the DSM‐5 Dimensional Anxiety Scales for social anxiety disorder, generalized anxiety disorder, specific phobia, agoraphobia, and panic disorder that were included in previous studies on the scales, and also for separation anxiety disorder, which is included in the DSM‐5 chapter on anxiety disorders. Moreover, they completed the Screen for Child Anxiety Related Emotional Disorders Adult version (SCARED‐A). The DSM‐5 Dimensional Anxiety Scales demonstrated high internal consistency, and the scales correlated significantly and substantially with corresponding SCARED‐A subscales, supporting convergent validity. Separation anxiety appeared present among adults, supporting the DSM‐5 recognition of separation anxiety as an anxiety disorder across the life span. To conclude, the DSM‐5 Dimensional Anxiety Scales are a valuable tool to screen for specific adult anxiety disorders, including separation anxiety. Research in more diverse and clinical samples with anxiety disorders is needed. © 2016 The Authors International Journal of Methods in Psychiatric Research Published by John Wiley & Sons Ltd.

Mindful parenting training is an application of mindfulness-based interventions that allows parents to perceive their children with unbiased and open attention without prejudgment and become more attentive and less reactive in their parenting. This study examined the effectiveness of mindful parenting training in a clinical setting on child and parental psychopathology and of mindfulness as a predictor of these outcomes. Seventy parents of 70 children (mean age=8.7) who were referred to a mental health care clinic because of their children's psychopathology participated in an 8-week mindful parenting training. Parents completed questionnaires at pre-test, post-test and 8-week follow-up. A significant decrease was found in children's and parents' psychopathology and a significant increase in mindful parenting and in general mindful awareness. Improvement in general mindful awareness, but not mindful parenting, was found to predict a reduction in parental psychopathology, whereas improvement in mindful parenting, but not general mindful awareness, predicted the reduction of child psychopathology. This study adds to the emerging body of evidence indicating that mindful parenting training is effective for parents themselves and, indirectly, for their children suffering from psychopathology. As parents' increasedmindful parenting, but not increased general mindfulness, is found to predict child psychopathology, mindful parenting training rather than general mindfulness training appears to be the training of choice. However, RCTs comparing mindful parenting to general mindfulness training and to parent management training are needed in order to shed more light on the effects of mindful parenting and mechanisms of change.

Cognitive models of social anxiety disorder propose self-focused attention as a key maintenance factor of the disorder. However, whether this holds true for different cultural contexts has not been investigated. The present experiment investigated the influence of self-construal (interdependent versus independent) on self-focused attention in high and low socially anxious individuals. Eighty-seven participants, divided into high versus low socially anxious and interdependent versus independent self-construal, performed a self-focused attention probe detection paradigm. A reaction time metric relating to attention deployment on the self versus the other served as an index of self-focused attention. In individuals with an interdependent self-construal those who are highly socially anxious showed decreased self-focused attention compared to those who are low socially anxious. In individuals with an independent self-construal the effect of social anxiety was less strong and in the opposite direction (but congruent with cognitive models). These results indicate that self-focused attention in social anxiety depends on self-construal. These findings implicate different therapies for people with social anxiety disorder, depending on their self-construal.

To get additional insight into the phenotype of attentional problems, we examined to what extent genetic and environmental factors explain covariation between lack of dispositional mindfulness and attention-deficit/hyperactivity disorder (ADHD) traits in youth, and explored the incremental validity of these constructs in predicting life satisfaction. We used data from a UK population-representative sample of adolescent twins (N = 1092 pairs) on lack of dispositional mindfulness [Mindful Attention Awareness Scale (MAAS)], ADHD traits [Conners’ Parent Rating Scale-Revised (CPRS-R): inattentive (INATT) and hyperactivity/impulsivity (HYP/IMP) symptom dimensions] and life satisfaction (Students’ Life Satisfaction Scale). Twin model fitting analyses were conducted. Phenotypic correlations (rp) between MAAS and CPRS-R (INATT: rp = 0.18, HYP/IMP: rp = 0.13) were small, but significant and largely explained by shared genes for INATT (% rp INATT–MAAS due to genes: 93%, genetic correlation rA = 0.37) and HYP/IMP (% rp HYP/IMP–MAAS due to genes: 81%; genetic correlation rA = 0.21) with no significant contribution of environmental factors. MAAS, INATT and HYP/IMP significantly and independently predicted life satisfaction. Lack of dispositional mindfulness, assessed as self-reported perceived lapses of attention (MAAS), taps into an aspect of attentional functioning that is phenotypically and genetically distinct from parent-rated ADHD traits. The clinically relevant incremental validity of both scales implicates that MAAS could be used to explore the underlying mechanisms of an aspect of attentional functioning that uniquely affects life satisfaction and is not captured by DSM-based ADHD scales. Further future research could identify if lack of dispositional mindfulness and high ADHD traits can be targeted by different therapeutic approaches resulting in different effects on life satisfaction. Electronic supplementary material The online version of this article (10.1007/s00787-019-01279-8) contains supplementary material, which is available to authorized users.

IntroductionMindfulness is one of the potential alternative interventions for children with attention-deficit hyperactivity disorder (ADHD). Some evidence suggests that mindfulness is related to changes in brain regions associated with ADHD. The potential benefits of mindfulness on children with ADHD, as well as the feasibility of this intervention approach, are warranted through prior local and foreign studies. This study aims to evaluate the effect of mindfulness-based group intervention for children with ADHD and their respective parents through a robust research design.Methods and analysisThis study will adopt a randomised controlled trial design including 140 children aged 8–12 years with ADHD together with one of their parents (n=140). These families will be randomised into intervention group (n=70) who will be offered the MYmind programme delivered by trained healthcare professionals, and an active control group (n=70) who will be offered the CBT programme. The intervention includes 8 weekly 90 min group sessions for children with ADHD (aged 8–12 years) and their respective parents. The primary and secondary outcomes will include children’s attention, ADHD-related symptoms, behaviours, executive function and mindfulness levels measured by validated objective measures and parent’s reported instruments. Parents’ parental stress, parenting styles, ADHD related symptoms, well-being, rumination level and mindfulness levels will also be measured. Analysis is by intention to treat. The effects of intervention will be evaluated by comparing outcomes between the two arms, as well as comparing outcomes within subject through comparing measurements at baseline (T0), immediately after the 8 week intervention (T1) and at 3 (T2) and 6 (T3) months postintervention.Ethics and disseminationEthics approval has been granted by the Joint Chinese University of Hong Kong – New Territories East Cluster Clinical Research Ethics Committee (The Joint CUHK-NTEC CREC). Participants will be required to sign informed consent form from both parents and children. Findings will be reported in conferences and peer-reviewed publications in accordance with recommendations of Consolidated Standards of Reporting Trials.Trial registration numberChiCTR1800014741; Pre-results.

Blushing was recently introduced in the DSM-5 as a "hallmark" physiological response of social anxiety disorder, and it is now acknowledged as an important aspect of social anxiety. Three meta-analyses were performed to examine the association between blushing and social anxiety. The relationship between blushing and social anxiety was strong for self-perceived blushing, small for physiological blushing, and medium for observed blushing. In addition, the relationship between self-perceived blushing and social anxiety was stronger when social anxiety was measured as a state and when blushing was measured using questionnaires with five or more items. Results suggest that socially anxious people perceive themselves as blushing more than do less socially anxious people and overestimate the intensity of their physiological blushing.

Objective: To examine the effects of online Cognitive Behavior Therapy for Insomnia (CBTI) on adolescents' sleep and cognitive functioning.Methods: 32 adolescents (13-19 years, M = 15.9, SD = 1.6) with DSM-5 insomnia disorder, were randomly assigned to a treatment group (n = 18) or a waiting list (n = 14). Treatment consisted of six guided self-help online CBTI sessions. Both groups were assessed at baseline and post-treatment. Sleep was measured with actigraphy, sleep logs, and questionnaires. Cognitive functioning was assessed with a battery of standard cognitive tests.Results: After CBTI the treatment group showed significant improvements compared to the waiting list group in sleep efficiency from actigraphy and sleep logs. This finding was confirmed by improvements in other sleep variables from sleep logs, and in symptoms of chronic sleep reduction and insomnia. Most participants from the treatment group improved to sub clinical levels of insomnia. Cognitive functioning of the treatment group showed more improvement compared to the waiting list in visuospatial processing, selective attention and phonological working memory, and a trend of improvement in response inhibition and set shifting, letter fluency and sustained attention, but not in declarative memory, visuospatial working memory, category fluency, and general cognitive speed. Changes in sleep appeared to be related to changes in cognitive functioning.Conclusions: These results indicate that CBTI can have positive effects on cognitive functions in adolescents, with notable improvements in visuospatial processing and phonological working memory but not in visuospatial working memory.

Objective: The effectiveness of cognitive-behavioral therapy (CBT) for anxiety disorders in children with autism spectrum disorders (ASD) was examined, and compared with children without ASD. Method: Children with ASD and comorbid anxiety disorders (n = 79, 58 boys; Mage = 11.76) and children with anxiety disorders (n = 95, 46 boys; Mage = 12.85), and their parents, participated. All families were referred to 1 of 7 mental health care centers and received the same CBT. Anxiety, quality of life, ASD-like behaviors, and emotional-behavioral problems were measured at waitlist (ASD-group only, n = 17), pretest, posttest, and 3 months, 1 year, and 2 years after CBT. Results: CBT was more effective than waitlist for treating anxiety disorders (d = −1.45) and anxiety symptoms (d = −0.48) in children with ASD. At 2 years follow-up, 61% of the children with and 64% without ASD were free of their primary anxiety disorder (percentages not significantly different). The decrease in severity of anxiety disorders after CBT (d values ranging between −1.05 and −1.46) was not different for children with and without ASD. Improvements were less in children with ASD for (only) 2 out of 7 continuous outcomes measures: anxiety symptoms (d values ranging between −0.68 and −0.94 vs. d values ranging between −0.98 and −1.25) and quality of life (d values ranging between 0.39 and 0.56 vs. d values ranging between 0.77 and 0.98). Conclusions: CBT for anxiety disorders is effective for children with ASD, also in the long-term. Treatment gains may be somewhat less compared with children without ASD.

Within the light of the DSM-5, the current study examined (1) how many and which children with a DSM-IV classification of autism spectrum disorder (ASD) fulfill the DSM-5 symptom-criteria, and (2) whether children who did and did not meet DSM-5 symptom-criteria and children with social anxiety disorder (SAD) can be differentiated from each other based on ASD symptomatology. In total, 90 referred children with a DSM-IV classification of high-functioning ASD, and 21 referred children with SAD participated (age range 7-17 years). ASD-symptoms were examined with the Autism Diagnostic Interview-Revised and the Children’s Social Behavior Questionnaire. It was found that 30 % of the ASD sample did not meet DSM-5 symptom-criteria for ASD, mainly because they failed to meet the DSM-5 criteria of the repetitive domain. Children with ASD who did and did not meet DSM-5 symptom-criteria differed on the repetitive domain, while children with ASD (according to DSM-IV and DSM-5 symptom criteria) had higher scores on the social-communication domain than children with SAD. Findings suggest a continuum of ASD-symptoms in the DSM-5 for children with SAD, social communication disorder and ASD. More research is needed to examine how these three disorders differ with respect to their etiology, neuropsychological profiles and clinical characteristics.

The current shift in the DSM towards the inclusion of a dimensional component allows clinicians and researchers to demonstrate not only the presence or absence of psychopathology in an individual, but also the degree to which the disorder and its symptoms are manifested. This study evaluated the psychometric properties and utility of a set of brief dimensional scales that assess DSM-based core features of anxiety disorders, for children and their parents. The dimensional scales and the Screen for Child Anxiety Related Emotional Disorders (SCARED-71), a questionnaire to assess symptoms of all anxiety disorders, were administered to a community sample of children (n = 382), aged 8-13 years, and their mothers (n = 285) and fathers (n = 255). The dimensional scales assess six anxiety disorders: specific phobia, agoraphobia, panic disorder, social anxiety disorder, generalized anxiety disorder, and separation anxiety disorder. Children rated their own anxiety and parents their child's anxiety. The dimensional scales demonstrated high internal consistency (α > 0.78, except for father reported child panic disorder, for reason of lack of variation), and moderate to high levels of convergent validity (rs = 0.29-0.73). Children who exceeded the SCARED cutoffs scored higher on the dimensional scales than those who did not, providing preliminary support for the clinical sensitivity of the scales. Given their strong psychometric properties and utility for both child and parent report, addition of the dimensional scales to the DSM-5 might be an effective way to incorporate dimensional measurement into the categorical DSM-5 assessment of anxiety disorders in children.

Objectives: Comparing the overall and differential effects of psychodynamic psychotherapy (PDT) versus cognitive behavior therapy (CBT) for social anxiety disorder (SAD). Design: Patients with a primary SAD (N = 47) were randomly assigned to PDT (N = 22) or CBT (N = 27). Both PDT and CBT consisted of up to 36 sessions (average PDT 31.4 and CBT 19.8 sessions). Assessments took place at waitlist: pretest, after 12 and 24 weeks for those who received longer treatment: posttest, 3-month and 1-year follow-up. Methods: Changes in the main outcome measure self-reported social anxiety composite, as well as in other psychopathology, social skills, negative social beliefs, public self-consciousness, defense mechanisms, personal goals, independent rater's judgments of SAD and general improvement, and approach behavior during an objective test, were analyzed using multilevel analysis. Results: No improvement occurred during waitlist. Treatments were highly efficacious, with large within-subject effect sizes for social anxiety, but no differences between PDT and CBT on general and treatment-specific measures occurred. Remission rates were over 50% and similar for PDT and CBT. Personality disorders did not influence the effects of PDT or CBT. Conclusions: PDT and CBT are both effective approaches for SAD. Further research is needed on the cost-effectiveness of PDT versus CBT, on different lengths PDT, and on patient preferences and their relationship to outcome of PDT versus CBT.

Cognitieve gedragstherapie is de effectiefste behandeling voor angststoornissen bij kinderen. Toch is na behandeling ongeveer een derde van de kinderen niet vrij van hun angststoornis. Een belangrijke vraag voor ons om te onderzoeken is: Welke factoren spelen een rol in de effectiviteit van angstbehandeling bij kinderen? In maart 2015 zijn wij daarom een onderzoek gestart aan de Universiteit van Amsterdam om meer zicht te krijgen op de werking van kind-, ouder- en therapeutfactoren in angstbehandeling van kinderen.

The study's aim was to evaluate the cost-effectiveness of CBT compared to treatment as usual (TAU). In total, 49 children aged 8–18 years with ASD and comorbid anxiety disorders, and their parents, participated; 24 were assigned to CBT and 25 were assigned to TAU. Outcome measures were the percentage of children free from their primary anxiety disorder and quality adjusted life years (QALYs). Costs were measured using a retrospective cost-questionnaire. Effects and costs were assessed at pre-, post-, and three months after treatment. Effects and costs were not statistically different between CBT and TAU, however the incremental cost-effectiveness ratio (ICER) demonstrated that CBT dominates TAU. Bootstrapped ICERs demonstrated that CBT has a high probability to be more effective than TAU, however, the probability that either CBT or TAU is more costly did not differ much. Secondary analyses demonstrated fairly robust results. CBT seems a cost-effective intervention compared to TAU, however, long-term follow-ups and comparisons between CBT and specific TAUs are necessary. Cost-effectiveness analyses may help inform policy makers to decide how to treat anxiety disorders in children with ASD.