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Background: Over the past two decades, the development of internet-based treatments for adolescents with anxiety and depressive disorders has advanced rapidly. To date, adolescents' preferences and perceived barriers for internet-based treatment remain largely unknown, especially in clinical samples. Therefore, this study explored the preferences and perceived barriers of adolescents with anxiety or depression regarding internet-based treatment. Methods: This qualitative study included 21 adolescent patients with anxiety or depressive disorder, and varied levels of experience with internet-based treatment. Two focus groups (N1 = 5, N2 = 6) and semi-structured interviews (N = 10) were conducted, recorded, transcribed, and analyzed using a reflexive thematic analysis approach. Results: The thematic analysis yielded five main themes, and 12 subthemes. The main themes were: independence, accessibility, content, therapist contact, and appearance. Adolescents highlighted self-direction as a benefit of internet-based treatment, and motivational challenges as a drawback. They found internet-based interventions convenient and particularly fitting for implementation during waiting periods before formal treatment. Guided interventions were preferred over mere self-help. Furthermore, adolescents stressed the importance of a clear, organized design, and recommended accessibility on both mobile phones and computers. Conclusion: Findings provide a clear overview of the needs and preferences of adolescents with anxiety or depressive disorder regarding internet-based treatment. To address their diverse needs, internet-based interventions should be tailorable, should incorporate therapist guidance, and should already be available during the treatment waiting period. Results of this study can guide the development and implementation of new internet-based interventions, and may thereby help to further optimize their uptake among adolescent patients.

ABSTRACTBackground: Individuals suffering from PTSD following childhood abuse represent a large subgroup of patients attending mental health services. The aim of phase-based treatment is to tailor treatment to the specific needs to childhood abuse survivors with PTSD with a Skills Training in Affective and Interpersonal Regulation (STAIR) phase, in which emotion dysregulation and interpersonal problems are targeted, and a trauma-focused phase.Objective: The purpose of this study was to compare STAIR + Eye Movement Desensitization and Reprocessing (EMDR) vs. STAIR + Narrative Therapy (NT) as treatments for PTSD following childhood-onset trauma in a routine clinical setting.Method: Sixty-eight adults were randomly assigned to STAIR/EMDR (8 STAIR-sessions followed by 12 EMDR-sessions) or STAIR/NT (8 STAIR-sessions followed by 12 NT-sessions). Assessments took place at pre-treatment, after each treatment phase and at 3 and 12 months post-intervention follow-up. Primary outcomes were interviewer-rated and self-reported symptom levels of PTSD. Secondary outcomes included symptom levels of depression and disturbances in emotion regulation and interpersonal skills.Results: Multilevel analyses in the intent-to-treat sample indicated that patients in both treatments improved substantially on PTSD symptom severity (CAPS: d = 0.81 to 1.29; PDS: d = 1.68 to 2.15), as well as on symptom levels of depression, anxiety, emotion regulation, dissociation and interpersonal skills. Effects increased or were maintained until 12-month follow-up. At mid-treatment, after STAIR, patients in both treatments improved moderately on PTSD symptom severity (PDS: d = 1.68 to 2.15), as well as on symptom levels of depression (BDI: d = .32 to .31). Symptoms of anxiety, emotion dysregulation, interpersonal problems and dissociation were not decreased after STAIR. There were no significant differences between the two conditions on any outcome.Conclusion: PTSD in adult survivors of childhood interpersonal trauma can effectively be treated by phase-based interventions using either EMDR or NT in the trauma-processing phase.Trial registration: ClinicalTrials.gov identifier: NCT01443182..

Abstract Background A combination of multiple factors, including a strong genetic predisposition and environmental factors, are considered to contribute to the developmental pathways to borderline personality disorder (BPD). However, these factors have mostly been investigated retrospectively, and hardly in adolescents. The current study focuses on maternal factors in BPD features in adolescence. Methods Actual parenting was investigated in a group of referred adolescents with BPD features (N = 101) and a healthy control group (N = 44). Self-reports of perceived concurrent parenting were completed by the adolescents. Questionnaires on parental psychopathology (both Axis I and Axis II disorders) were completed by their mothers. Results Adolescents reported significantly less emotional warmth, more rejection and more overprotection from their mothers in the BPD-group than in the control group. Mothers in the BPD group reported significantly more parenting stress compared to mothers in the control group. Also, these mothers showed significantly more general psychopathology and clusters C personality traits than mothers in the control group. Contrary to expectations, mothers of adolescents with BPD features reported the same level of cluster B personality traits, compared to mothers in the control group. Hierarchical logistic regression revealed that parental rearing styles (less emotional warmth, and more overprotection) and general psychopathology of the mother were the strongest factors differentiating between controls and adolescents with BPD symptoms. Conclusions Adolescents with BPD features experience less emotional warmth and more overprotection from their mothers, while the mothers themselves report more symptoms of anxiety and depression. Addition of family interventions to treatment programs for adolescents might increase the effectiveness of such early interventions, and prevent the adverse outcome that is often seen in adult BPD patients.

Abstract A series of primarily laboratory-based studies found attention bias modification in socially anxious participants to lead to reduced anxiety. It is argued that the failure to replicate the positive results of attention bias modification in the study of Carlbring et al. may be due to reasons other than the application through the Internet. A number of controlled studies failed to replicate the positive effects of attention bias modification in clinically rather than subclinically socially anxious subjects. Given the lack of robust evidence for attention bias modification in clinically socially anxious individuals, the author is inclined to consider attention bias modification as 'the Emperor's new suit'. Results achieved with regular Internet-based treatments for social anxiety disorder based on cognitive therapy and exposure methods are much better than those achieved with attention bias modification procedures delivered 'face to face' in clinically distressed participants. Given the lack of robust evidence for attention bias modification in clinical samples, there is no need yet to investigate the implementation of attention bias modification through the Internet. Please see related article: http://www.biomedcentral.com/1471-244X/12/66

Abstract Background The aim of the study was to assess levels of somatic and mental health distress, well-being, AS WELL AS utilization of primary and specialist health care services among war-related widowed and non-widowed female civilian survivors of war. Methods 100 war-related widowed lone mothers and 106 non-widowed mothers who had experienced the Kosovo war ten years previously participated in the study. Measures of somatic, depressive, post-traumatic stress, anxiety, and grief complaints, subjective well-being, and utilization of health care services during the previous three months were used. Results Compared to non-widowed mothers, widowed lone mothers reported significantly higher levels of somatic, depressive, post-traumatic stress, and anxiety complaints. Further, they reported significantly lower levels of subjective well-being as composed of positive and negative affect and satisfaction with life. More than half of both widowed and non-widowed mothers reported utilization of health care services during the last three months, without significant differences between the groups. However, only three percent of widowed lone mothers and four percent of non-bereaved mothers reported utilization of mental health services during the last three months, despite high levels of mental health distress especially among widowed lone mothers. Among widowed lone mothers, severity of prolonged grief symptoms significantly predicted number of contacts of specialist health care use over and above sociodemographic variables, number of war-related events, and other psychopathology. Conclusion War-related widowed lone mothers suffer from elevated somatic and mental distress even a decade after the war. The tiny proportion of widowed lone mothers in use of mental health services can be seen as a reflection of lack of previous and current mental health services to meet mental health needs of this population.

Abstract Background During adolescence, depressive and anxiety disorders are among the most common mental health disorders. Both disorders tend to persist, are predictive for other mental disorders, and are associated with severe impairment in diverse areas. Although Cognitive Behavioral Therapy (CBT) has proven to be an effective treatment, a considerable number of adolescents do not respond to CBT and residual symptoms often remain. Therefore, it is of great importance to improve treatment outcomes for depressed and/or anxious adolescents. Dysfunctional emotion regulation appears to be a transdiagnostic factor in the development and maintenance of aforementioned disorders. Enhancing emotion regulation skills may therefore reduce symptom severity. In light of this, we developed a guided internet-based emotion regulation training (E-TRAIN) that will be added to CBT. This study aims to evaluate the effectiveness of E-TRAIN + CBT compared to CBT alone on depressive and anxiety outcomes among adolescents with depressive and/or anxiety disorder. Methods In this multicenter two-arm randomized controlled trial with parallel group design, we aim to include 138 adolescents, aged 13–19 years, referred for treatment and diagnosed with depressive and/or anxiety disorder. Participants will be allocated to either CBT or CBT + E-TRAIN. Assessments will take place at baseline, and at 3 (T1), 6 (T2) and 12 (T3) months after baseline. We will conduct multi-informant assessments: the adolescent, a parent/caregiver, and the CBT therapist will be asked to fill in questionnaires. The continuous primary outcome measure is self-reported depressive and anxiety symptoms at six months after baseline, measured with the RCADS25. Secondary outcome measures include anxiety or depression diagnosis based on a semi-structured clinical interview, emotion (dys) regulation, and parent-report measures of anxiety, depression and emotion (dys) regulation. Discussion This study is the first randomized controlled trial to examine the additional value of a guided internet-based emotion regulation training to regular CBT in adolescents with depressive and/or anxiety disorders. If this intervention is effective, it can be implemented in mental health care and improve treatment for these young people. Trial registration Registered on June 23, 2021 in The Netherlands Trial Register (NL9564). Retrospectively registered. Recruitment started in May 2021 and is ongoing.

Background: Dysfunctional emotion regulation (ER) is associated with symptoms of depression and anxiety in adolescents. This pilot study aimed to examine the acceptability and feasibility of a guided internet-based emotion regulation training (ERT) added to cognitive behavioral therapy (CBT). Furthermore, we aimed to examine the feasibility of the randomized study design and to provide a first estimate of the effectiveness of CBT + ERT compared with CBT alone in adolescents with depressive or anxiety disorders. Methods: In a pilot randomized controlled trial (RCT) with a parallel group design, 39 patients (13–18 years) with depressive or anxiety disorder were assigned to CBT + ERT (n = 21) or CBT (n = 18). Assessments at baseline, three-months and six-months follow-up included treatment adherence, satisfaction, depressive symptoms, anxiety symptoms, and ER strategies. Results: Adherence to ERT was 66.5 %, and treatment satisfaction was adequate. 76.5 % of eligible patients participated in the study. Linear mixed-model analyses showed significantly reduced anxiety symptoms (p = .003), depressive symptoms (p = .017), and maladaptive ER (p = .014), and enhanced adaptive ER (p = .008) at six months follow-up in the CBT + ERT group compared to controls. Limitations: The sample size was small, and results regarding effectiveness remain preliminary. Data-collection took place during COVID-19, which may have influenced the results. Conclusions: Both the intervention and the study design were found to be feasible. In a larger RCT, however, improvement of recruitment strategy is necessary. Preliminary results indicate potential effectiveness in decreasing anxiety, depression, and emotion dysregulation in adolescents. The next step should be the development of an improved internet-based ERT and its evaluation in a larger RCT. Trial registration: Registered on January 14th, 2020 in The Netherlands Trial Register (NL8304).

Abstract Background Existing therapies for depression are effective, but many patients fail to recover or relapse. To improve care for patients, more research into the effectiveness and working mechanisms of treatments is needed. We examined the long-term efficacy of Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) for Major Depressive Disorder (MDD), testing the hypothesis that CBT outperforms ACT and that both therapies work through their designated mechanisms of change. Methods We conducted a randomized controlled trial with 82 patients suffering from MDD. Data were collected before, during and after treatment, and at 12-month follow-up, assessing symptoms of depression, quality of life, dysfunctional attitudes, decentering, and experiential avoidance. Results Patients in both conditions reported significant and large reductions of depressive symptoms (d = − 1.26 to − 1.60) and improvement in quality of life (d = 0.91 to − 1.28) 12 months following treatment. Our findings indicated no significant differences between the two interventions. Dysfunctional attitudes and decentering mediated treatment effects of depressive symptoms in both CBT and ACT, whereas experiential avoidance mediated treatment effects in ACT only. Conclusions Our results indicate that CBT is not more effective in treating depression than ACT. Both treatments seem to work through changes in dysfunctional attitudes and decentering, even though the treatments differ substantially. Change in experiential avoidance as an underlying mechanism seems to be an ACT-specific process. Further research is needed to investigate whether ACT and CBT may work differently for different groups of patients with depression. Trial registration clinicaltrials.gov; NCT01517503 . Registered 25 January 2012 - Retrospectively registered.

AimsThe objective of this study is to investigate whether type of depressive symptoms (i.e. cognitive-affective or somatic) is related to a patient-perceived need for professional psychological care in individuals with diabetes.MethodsIn total 2266 participants were recruited as part of the screening procedure for a multi-center randomized controlled trial on the treatment of depressive symptoms among individuals with diabetes. Individuals were invited to complete Beck Depression Inventory-II (BDI-II). Patients with elevated depressive symptoms (BDI-II ≥14) were interviewed about their psychological care need. Based on their care needs patients were categorized into: unmet need, no need, met need and unclear need. These groups were compared on type of depressive symptoms, as categorized into cognitive-affective symptoms and somatic symptoms.Results568 eligible individuals had elevated depressive symptoms, of whom 519 were reached. Among these depressed individuals, 19.7% (102 of 519) had an unmet need for psychological care. Participants with an unmet need were younger (pConclusionsCognitive-affective symptoms of depression-but not somatic symptoms-were associated with an unmet need for psychological care among depressed individuals with diabetes. Future research is needed to reveal better predictors explaining the discrepancy between distress and low care needs in order to optimize screening procedures.

Studies have found that male batterers are more often insecurely attached as compared with nonbatterers. However, it is still not clear how insecure attachment is related to domestic violence. Many studies compared batterers and nonbatterers regarding pathological personality characteristics that are related to attachment (e.g., dependency, jealousy) and generally found that batterers report more personality characteristics. However, these studies did not investigate which role these characteristics played in the relationship between insecure attachment and battering. The first aim of this study is to test which personality characteristics are good candidates to explain the relationship between insecure attachment and domestic violence. The second aim is to test whether personality characteristics are predictive of battering over and above attachment. Seventy-two mainly court-mandated family-only males who were in group treatment for battering are allocated to a securely and an insecurely attached group and compared with 62 nonbatterers. Using questionnaires, self-esteem, dependency, general distrust, distrust in partner, jealousy, lack of empathy, separation anxiety, desire for control, and impulsivity were assessed. This was the first study that examined distrust, separation anxiety, and desire for control in relation to battering. The results show that the relationship between insecure attachment and domestic violence can be explained by separation anxiety and partner distrust. Moreover, only partner distrust increased the risk for battering over and above insecure attachment. The findings suggest the presence of two subtypes among batterers based on attachment style, which has similarities to the family-only and dysphoric-borderline subtypes suggested by Holtzworth-Munroe and Stuart. Implications of the present findings for therapy are discussed. (Contains 2 tables.)

Objective: To investigate the effectiveness of behavioral parent training (BPT) as adjunct to routine clinical care (RCC). Method: After a first phase of RCC, 94 children with attention-deficit/hyperactivity disorder (ADHD) ages 4-12, all referred to a Dutch outpatient mental health clinic, were randomly assigned to 5 months of BPT plus concurrent RCC (n = 47) or to 5 months of RCC (n = 47) alone. BPT consisted of 12 sessions in group format; RCC included family support and pharmacotherapy when appropriate. Exclusionary criteria were minimized, and children with and without medication could participate. Parent-reported behavioral problems, ADHD symptoms, internalizing problems, and parenting stress were assessed before and after treatment. Follow-up assessment of the BPT + RCC group was completed 25 weeks post-BPT intervention. Repeated-measures analyses of variance were carried out on an intention-to-treat basis. Results: Both groups showed improvements over time on all measures. BPT + RCC was superior to RCC alone in reducing behavioral (p = 0.017) and internalizing (p = 0.042)problems. No outcome differences were found in ADHD symptoms (p = 0.161) and parenting stress (p = 0.643). These results were equal for children with and without medication. Children allocated to RCC alone received more polypharmaceutical treatment. Conclusions: Adjunctive BPT enhances the effectiveness of routine treatment of children with ADHD, particularly in decreasing behavioral and internalizing problems, but not in reducing ADHD symptoms or parenting stress. Furthermore, adjunctive BPT may limit the prescription of polypharmaceutical treatment. (Contains 2 tables.) [This study was supported by the University Medical Center, Groningen, Netherlands.]

This reflection on major developments in the past, present, and future of the wider field of violence and trauma is a personal (and probably biased) sampling of what the authors hold to be important. The authors reviewed advances for victims and perpetrators of violence separately. For victims, the authors note that empirical research has established the potential traumatic impact of violence as well as various predictors of what makes persons vulnerable to adverse psychological consequences. The authors also note that the definitions of violence and trauma have evolved to include such behavioral patterns as stalking. Finally, encouraging evidence regarding the efficacy of exposure-based treatments for victims of violence is reviewed, as well as discouraging evidence regarding the efficacy of single-session debriefing following trauma. For the perpetrators, the importance of individual assessment in planning interventions is underscored, and advances in explicit and implicit assessment techniques are discussed.

Objective: To evaluate the effectiveness of a social cognitive intervention program for Dutch aggressive boys and to compare it with a social skills training and a waitlist control group. Method: A randomized, controlled treatment outcome study with 97 aggressive boys (aged 9-13 years) was presented. An 11 session group treatment, a social cognitive intervention program (n = 42) based on Dodge's social information-processing theory, was compared with social skills training (n = 40) and waitlist control group (n = 15). Measures of aggressive behavior, self-control, social cognitive skills, and appropriate social behavior were completed before and after the group treatment and at 1-year follow-up. Results: The outcome of both treatment conditions indicated (1) a significant increase in appropriate social behavior, social cognitive skills, and self-control and (2) a significant decrease in aggressive behavior. There was a significant difference between treatment and no treatment and between the social cognitive intervention program and social skills trainingon various child, parent, and teacher measures. Conclusions: The expectation that focusing on the deficits and distortions in social cognitive processes (social cognitive intervention program) instead of merely focusing on social skills (social skills training) would enhance the effectiveness was supported on child, parent, and teacher measures. At 1-year follow-up, the mean effect sizes of the social cognitive intervention program and social skills training were 0.76 and 0.56, respectively. J. Am. Acad. Child Adolesc. Psychiatry, 2004;43(12):1478-1487. Key Words: aggressive behavior; self-control, social information processing, cognitive behavior therapy, social skills training.