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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.

The first aim of this study was to construct/validate a subscale—with cut-offs considering gender/age differences—for the school-age Child Behavior CheckList (CBCL) to screen for Autism Spectrum Disorder (ASD) applying both data-driven (N = 1666) and clinician-expert (N = 15) approaches. Further, we compared these to previously established CBCL ASD profiles/subscales and DSM-oriented subscales. The second aim was to cross-validate results in two truly independent samples (N = 2445 and 886). Despite relatively low discriminative power of all subscales in the cross-validation samples, results indicated that the data-driven subscale had the best potential to screen for ASD and a similar screening potential as the DSM-oriented subscales. Given beneficial implications for pediatric/clinical practice, we encourage colleagues to continue the validation of this CBCL ASD subscale.

BACKGROUND Online mindfulness-based programs (MBPs) for parents and families, especially in clinical populations, are limited. Low engagement and substantial dropout are major issues in MBP implementation. OBJECTIVE In this pilot study, we examined the effects of an online MBP on parents of children with attention deficit/hyperactivity disorder (ADHD). METHODS A mixed methods study was applied to evaluate the effects of the online MBP. Forty-three parents were recruited and randomly assigned to the intervention group and waitlist control group. The MBP lasted for 28 days and consisted of 20 psychoeducation videos, with homework guidance audios, and 4 instructor-led online group meetings. Purposive sampling was then used to recruit parents who had completed the program to share their experiences and suggestions for improving the program in semi-structured online interviews. RESULTS The quantitative data showed that the participants of the online MBP perceived a medium to large effect on the reduction of child ADHD symptoms. The participants of the semi-structured interviews reported positive experiences regarding their help-seeking intention and regarding personal changes, such as in emotion regulation and paying quality attention to their children. The interview participants further made suggestions for the improvement of the MBP. CONCLUSIONS The online MBP had promising effects. A large-scale randomized controlled trial should be conducted to investigate the effects of the MBP in clinical populations. CLINICALTRIAL ClinicalTrials.gov NCT05480423

Background Parents’ fear of negative evaluation (FNE) has been proposed to play a role in the intergenerational transmission of social anxiety. We investigated whether (1) parents’ own FNE, a core belief of social anxiety, extends to their child’s environment resulting in fear of negative child evaluation (FNCE); and (2) parents’ FNCE mediates the association between parents’ social anxiety, parenting behavior and children’s social anxiety. Methods In this cross-sectional study, fathers (n = 84) and mothers (n = 92) from 99 Caucasian families completed questionnaires on social anxiety, FNE, FNCE, and parenting (intrusiveness, negative parenting and encouragement of social daring) when their child was 7.5 years old. Child social anxiety was measured by questionnaires (child and parent report). Results For both parents, FNE mediated the association between their social anxiety and FNCE. Furthermore, FNCE mediated the relation between both parents’ social anxiety and intrusiveness and the relation between mothers’ social anxiety and negative parenting. In addition, FNCE mediated the relation between fathers’ social anxiety and children’s social anxiety (parents’ report only) directly and through intrusive parenting. Conclusions Our study suggests that parents’ FNE extends to their children’s environment and provides support for the role of FNCE in various pathways of intergenerational transmission of social anxiety during middle childhood.

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.

This study examined clinical outcomes of a modular individual CBT for children with anxiety disorders (AD), and predictors of outcomes, in usual clinical practice. Participants were 106 children with ADs (7–17 years), and parents. Assessments were pre-, mid-, post-test, and 10 weeks after CBT (follow-up). Predictors (measured pre-treatment) were child characteristics (gender, age, type of AD, comorbid disorders), fathers’ and mothers’ anxious/depressive symptoms, and parental involvement (based on parents’ presence during treatment sessions and the use of a parent module in treatment). At follow-up, 59% (intent-to-treat analyses) to 70% (completer analysis) of the children were free from their primary anxiety disorder. A significant decrease in anxiety symptoms was found. Higher parental involvement was related to lower child anxiety at follow-up, but only for children with comorbid disorders. Findings suggest that it is beneficial to treat anxiety with modular CBT. Future steps involve comparisons of modularized CBT with control conditions.

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.

ObjectivesMindful parenting (MP) interventions show promising results, but they mostly target parents (of children) with mental health problems. This study examined an online MP intervention for mothers with toddlers in a population-based sample. Aims were to assess acceptability and effectiveness of the intervention for mothers with and without parental stress, and examine their predetermined personal goals.MethodsThe study included 157 mothers with toddlers from the general population of whom 73 reported parental stress. The mothers participated in an 8-week online MP training. Questionnaires were completed at waitlist, pretest, posttest, and follow-up.ResultsMothers rated the training positively, although only 23.1% completed the training. Personal goals were analyzed qualitatively, establishing four different themes: attention, well-being, patience, and balance. Significant improvements in personal goals posttest and follow-up were found (large and very large effect size, respectively). We found no significant improvements from waitlist to pretest for all outcome variables, except personal goals (medium effect size). Mixed-linear model analyses showed significant improvements posttest and follow-up as compared to pretest regarding Self-compassion, Parental over-reactivity and Symptoms of anxiety and depression (small to medium effect sizes). There was an effect at posttest for Parenting problems, and for Parental role restriction at follow-up (small effect sizes). Levels of parental stress and theme of personal goal did not influence the effectiveness of the intervention.ConclusionsThe current study provides initial evidence that an online MP training could be an easily accessible, inexpensive, and valuable intervention for parents without an indication for a therapist-assisted intervention.Trial RegistrationDutch Trial Register (NTR7401)

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.

Objective: Children with autism spectrum disorder (ASD) show atypical attention. Mindfulness-based programs (MBPs), with self-regulation of attention as a basic component, could benefit these children. Method: We investigated how 49 children with ASD differed from 51 typically developing (TD) children in their attention systems; and whether their attention systems were improved by an MBP for children and their parents (MYmind), using a cognitive measure of attention, the Attention Network Test. Results: Children with ASD did not differ from TD children in the speed of the attention systems, but were somewhat less accurate in their orienting and executive attention. Also, MYmind did not significantly improve attention, although trend effects indicated improved orienting and executive attention. Robustness checks supported these improvements. Conclusion: Trend effects of the MBP on the attention systems of children with ASD were revealed, as well as minor differences between children with ASD and TD children in their attention systems.

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

Contains fulltext : 248892.pdf (Publisher’s version ) (Open Access) Objective: We describe qualitative results on facilitators and barriers to participating in a family mindfulness-based intervention (MBI) for youth with ADHD and their parents and perceived effects on child and parent. Method: Sixty-nine families started the 8-week protocolized group-based MBI called "MYmind." After the MBI, individual semi-structured interviews were conducted with a purposive sample of parents (n = 20), children (n = 17, ages 9-16 years), and mindfulness teachers (n = 3). Interviews were analyzed using Grounded Theory. Results: Facilitators and barriers regarding contextual factors (e.g., time investment), MBI characteristics (e.g., parallel parent-child training), and participant characteristics (e.g., ADHD-symptoms) are described. Perceived effects were heterogeneous: no/adverse effects, awareness/insight, acceptance, emotion regulation/reactivity, cognitive functioning, calmness/relaxation, relational changes, generalization. Conclusion: MYmind can lead to a variety of transferable positively perceived effects beyond child ADHD-symptom decrease. Recommendations on MYmind participant inclusion, program characteristics, mindfulness teachers, and evaluating treatment efficacy are provided. 12 p.

Parent-to-child transmission of information processing biases to threat is a potential causal mechanism in the family aggregation of anxiety symptoms and traits. This study is the first to investigate the link between infants’ and parents’ attention bias to dynamic threat-relevant (versus happy) emotional expressions. Moreover, the associations between infant attention and anxiety dispositions in infants and parents were explored. Using a cross-sectional design, we tested 211 infants in three age groups: 5-to-7-month-olds (n = 71), 11-to-13-month-olds (n = 73), and 17-to-19-month-olds (n = 67), and 216 parents (153 mothers). Infant and parental dwell times to angry and fearful versus happy facial expressions were measured via eye-tracking. The parents also reported on their anxiety and stress. Ratings of infant temperamental fear and distress were averaged across both parents. Parents and infants tended to show an attention bias for fearful faces with marginally longer dwell times to fearful versus happy faces. Parents dwelled longer on angry versus happy faces, whereas infants showed an avoidant pattern with longer dwell times to happy versus angry expressions. There was a significant positive association between infant and parent attention to emotional expressions. Parental anxiety dispositions were not related to their own or their infant’s attention bias. No significant link emerged between infants’ temperament and attention bias. We conclude that an association between parental and infant attention may already be evident in the early years of life, whereas a link between anxiety dispositions and attention biases may not hold in community samples.

Observing others’ emotions triggers physiological arousal in infants as well as in adults, reflected in dilated pupil sizes. This study is the first to examine parents’ and infants’ pupil responses to dynamic negative emotional facial expressions. Moreover, the links between pupil responses and negative emotional dispositions were explored among infants and parents. Infants’ and one of their parent's pupil responses to negative versus neutral faces were measured via eye tracking in 222 infants (5- to 7-month-olds, n = 77, 11- to 13-month-olds, n = 78, and 17- to 19-month-olds, n = 67) and 229 parents. One parent contributed to the pupil data, whereas both parents were invited to fill in questionnaires on their own and their infant's negative emotional dispositions. Infants did not differentially respond to negative expressions, while parents showed stronger pupil responses to negative versus neutral expressions. There was a positive association between infants' and their parent's mean pupil responses and significant links between mothers’ and fathers’ stress levels and their infants’ pupil responses. We conclude that a direct association between pupil responses in parents and offspring is observable already in infancy in typical development. Stress in parents is related to their infants’ pupillary arousal to negative emotions.

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.

The stress in family members of individuals with chronic mental or somatic health conditions may be great, and interferes with healthy adaptation of individuals and their families. Interventions that address these systemic factors may be beneficial. Mindfulness-based interventions (MBIs) are effective in helping individuals living with chronic health conditions. However, most MBIs are directed towards individuals with the condition. We present research showing that individual mindfulness improves relational functioning, mindful parenting improves child outcomes, and mindful partners positively affect their partner's health and wellbeing. Regulating stress in relations appears an important underlying mechanism. We conclude that MBIs that target the system and not just the individual with a health condition, and target family relations, deserve a place in health care.

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.

BACKGROUND AND OBJECTIVES: In two experiments, we investigated the effects of Attentional Bias Modification (ABM) on emotion regulation, i.e. the manner in which people influence emotional experiences. We hypothesized that decreases in attentional bias to threat would impair upregulation and improve downregulation of negative emotions, while increases in attentional bias to threat would improve upregulation and impair downregulation of negative emotions.METHODS: Using the emotion-in-motion paradigm (Experiment 1, N = 60) and the visual search task (Experiment 2, N = 58), we trained participants to attend to either threatening or positive stimuli and we assessed emotion intensity while observing, upregulating, and downregulating emotions in response to grids of mixed emotional pictures.RESULTS: In Experiment 1, the attend positive group reported more positive emotions while merely watching grids of training pictures and the attend threat group showed impaired upregulation of negative affect. In Experiment 2, the attend threat group reported intensified negative emotions for all three instructions, while the attend positive group remained largely stable over time.LIMITATIONS: We cannot unequivocally attribute these changes in emotion regulation to changes in attentional bias, as neither of the experiments yielded significant changes in attentional bias to threat.CONCLUSIONS: By showing that attentional bias modification procedures affect the manner in which people deal with emotions, we add empirical weight to the conceptual overlap between attentional bias modification and emotion regulation.

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).

Parent-to-child transmission of information processing biases to threat is a potential causal mechanism in the family aggregation of anxiety symptoms and traits. This study is the first to investigate the link between infants' and parents' attention bias to dynamic threat-relevant (versus happy) emotional expressions. Moreover, the associations between infant attention and anxiety dispositions in infants and parents were explored. Using a cross-sectional design, we tested 211 infants in three age groups: 5-to-7-month-olds (n = 71), 11-to-13-month-olds (n = 73), and 17-to-19-month-olds (n = 67), and 216 parents (153 mothers). Infant and parental dwell times to angry and fearful versus happy facial expressions were measured via eye-tracking. The parents also reported on their anxiety and stress. Ratings of infant temperamental fear and distress were averaged across both parents. Parents and infants tended to show an attention bias for fearful faces with marginally longer dwell times to fearful versus happy faces. Parents dwelled longer on angry versus happy faces, whereas infants showed an avoidant pattern with longer dwell times to happy versus angry expressions. There was a significant positive association between infant and parent attention to emotional expressions. Parental anxiety dispositions were not related to their own or their infant's attention bias. No significant link emerged between infants' temperament and attention bias. We conclude that an association between parental and infant attention may already be evident in the early years of life, whereas a link between anxiety dispositions and attention biases may not hold in community samples.

As a clinical intervention, Mindful Parenting has positive effects on parental stress and psychopathology, as well as child psychopathology. However, previous studies have not considered what characterizes parents and families who receive this type of intervention. The current study utilized a quasi-experimental design to determine the characteristics that distinguish parents seeking or referred to a mindful parenting intervention in community child mental health care centers. Two groups of parents were recruited to the study: treatment-seeking parents (n = 89), and a comparison group of parents from a community population (n = 66). All parents completed measures relating to their child’s psychopathology, their own psychopathology, general mindful awareness, and parenting measures of stress, over-reactivity, experiential avoidance and mindful parenting. A cross-sectional comparison confirmed that the treatment-seeking parents reported significantly higher psychopathology in their child (d = 0.91–1.19) and in themselves (d = 0.99–1.21), lower general mindful awareness, and higher parenting stress, over-reactivity, parental experiential avoidance and lower mindful parenting than the community parents. Across all outcomes, group differences in mindful parenting indicated the largest effect (d = 1.77), followed by parenting stress (d = 1.42), general mindfulness (d = 1.34), parental over-reactivity (d = 1.32), and parental experiential avoidance (d = 1.21). Hierarchical binary logistic regression analyses indicated that, next to higher child internalizing problems, lower mindful parenting distinguished treatment-seeking parents from community parents. Those parents seeking or referred to a mindful parenting intervention may benefit most from improvements in the very construct that the intervention targets: cultivating mindful parenting.

Questionnaire measures offer a time and cost-effective alternative to full diagnostic assessments for identifying and differentiating between potential anxiety disorders and are commonly used in clinical practice. Little is known, however, about the capacity of questionnaire measures to detect specific anxiety disorders in clinically anxious preadolescent children. This study aimed to establish the ability of the Spence Children's Anxiety Scale (SCAS) subscales to identify children with specific anxiety disorders in a large clinic-referred sample (N = 1,438) of children aged 7 to 12 years. We examined the capacity of the Separation Anxiety, Social Phobia, Generalized Anxiety, and Physical Injury Fears (phobias) subscales to discriminate between children with and without the target disorder. We also identified optimal cutoff scores on subscales for accurate identification of children with the corresponding disorder, and examined the contribution of child, mother, and father reports. The Separation Anxiety subscale was able to accurately identify children with separation anxiety disorder, and this was replicated across all 3 reporters. Mother- and father-reported Social Phobia subscales also accurately identified children with social anxiety disorder, although child report was only able to accurately detect social anxiety disorder in girls. Using 2 or more reporters improved the sensitivity of the Separation Anxiety and Social Phobia subscales but reduced specificity. The Generalized Anxiety and Physical Injury Fears subscales failed to accurately identify children with the corresponding disorders. These findings have implications for the potential use of mother-, father-, and child-report SCAS subscales to detect specific disorders in preadolescent children in clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Purpose of review: To review mechanisms of blushing and fear of blushing from physiological, neuropharmacological and psychological viewpoints, and to evaluate current forms of treatment for blushing-related fear. Recent findings: Blushing appears to be driven primarily by sympathetic adrenomedullary and neural vasodilator discharge, possibly in association with secondary neurovascular inflammation. Psychological risk factors for fear of blushing include social anxiety, coupled with heightened self-focused attention and inflated beliefs about the likelihood and social costs of blushing. In addition, schemas of emotional inhibition, social isolation and alienation may underlie blushing-related fears. Established psychological treatments for fear of blushing include task concentration training; exposure; cognitive therapy; social skills training; and applied relaxation. More novel approaches include mindfulness and mindful self-compassion, video feedback and imagery rescripting. There are no established pharmacological treatments specifically for fear of blushing. However, selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors are effective treatments for social anxiety disorder and may thus help some patients manage their fear of blushing. Summary: A reactive sympathetic nervous system may interact with psychological predispositions to intensify fear of blushing. These physiological and psychological risk factors could be promising targets for treatment.

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.

Background and objectivesExtensive research investigated maternal parenting behaviors of children with anxiety disorders (ADs). No research has compared parenting behaviors of children with anxiety disorders (ADs) and ADHD, which is important to understand the common or specific role of parenting in both disorders, and also to inform interventions including parents.MethodsWe compared the presence of paternal and maternal behaviors of autonomy granting, control, and rejection in youths with AD (n = 16; Mage = 11.63, SD = 2.96) to the presence of these behaviors in youth with ADHD (n = 14; Mage = 10.64, SD = 2.65) and in community sample (CS) youths (n = 24; Mage = 11.4, SD = 2.64) using aggregated child, parent-about-self, and parent-about-partner report. Parental anxiety was also assessed.ResultsFathers of youths with ADs were less controlling than fathers of youths with ADHD and CS fathers. Fathers of youths with ADHD were more rejecting of their children than fathers of children with ADs and CS fathers. With respect to maternal behaviors, no differences between the three groups occurred. No group differences were found in parental anxiety.ConclusionResults provide little evidence for the assumed controlling and lack of autonomy encouragement style of parents of children with ADs. This study points to the importance of involving fathers in the treatment of youth ADHD. Irrespective of whether paternal dysfunctional behaviors are involved in the development of ADHD or are a consequence of ADHD, it is likely that such behaviors negatively contribute to the therapy course and pace and should be targeted during treatment.

Background Many children and adolescents suffer from problematic levels of anxiety, but the multitude of these children do not receive an intervention. It is of importance to increase the accessibility and availability of child anxiety interventions, as to identify and treat anxious children early and successfully. Online platforms that include information, assessments and intervention can contribute to this goal. Interventions for child anxiety are frequently based on Cognitive Behavioral Therapy, because of its strong theoretical and empirical basis. However, the working mechanisms of Cognitive Behavioral Therapy in children are poorly studied. To our knowledge, mediation studies on child anxiety are non-existent regarding online Cognitive Behavioral Therapy. Methods We will aim at children aged 8–13 years with problematic anxiety. We recruit these children via the community setting, and refer them to our online platform ‘Learn to Dare!’ (in Dutch: ‘Leer te Durven!’), https://leertedurven.ou.nl, where information about child anxiety and our research is freely accessible. After an active informed consent procedure, the participants can access the screening procedure, which will select the children with problematic anxiety levels. Thereafter, these children will be randomized to an online intervention based on Cognitive Behavioral Therapy (n = 120) or to a waitlist control (WL, n = 120). The intervention consists of 8 sessions with minimal therapist support and contains psycho-education, exposure (based on inhibitory learning), cognitive restructuring and relapse prevention. Child anxiety symptoms and diagnoses, cognitions, avoidance behavior and level of abstract reasoning are measured. Assessments are the same for both groups and are performed before and after the proposed working mechanisms are offered during the intervention. A follow-up assessment takes place 3 months after the final session, after which children in the waitlist control group are offered to take part in the intervention. Discussion This protocol paper describes the development of the online platform ‘Learn to Dare!’, which includes information about child anxiety, the screening procedure, anxiety assessments, and the online intervention. We describe the development of the online intervention. Offering easy accessible interventions and providing insight into the working mechanisms of Cognitive Behavioral Therapy contributes to optimizing Cognitive Behavioral Therapy for anxious youth.

This study examined the effectiveness of Mindful with your toddler, a 9-week mindful parenting group training for mother–toddler dyads experiencing (co-)regulation difficulties. Eighteen clinically referred mothers and toddlers (18–48 months) with (co-)regulation problems participated in groups, each comprising three to six dyads. At waitlist, pretest, and post-test, mothers completed questionnaires on parenting (overreactivity, parental stress, sense of incompetence), psychopathology (internalizing and externalizing), partner relationship, mindful parenting (listening with full attention, compassion for child, non-judgmental acceptance of parental functioning), mindfulness (acting with awareness, non-judging of inner experience, non-reactivity), self-compassion, and child outcomes (psychopathology and dysregulation) and mother–toddler freeplay observations were conducted, and coded for maternal sensitivity and acceptance. Questionnaires were completed again at 2-month and 8-month follow-up. No significant differences occurred between waitlist and pretest, except for a deterioration in listening with full attention and an improvement in compassion for child. Between pretest and post-test, observed maternal sensitivity and acceptance improved (medium effect sizes). Child psychopathology, maternal listening with full attention, acting with awareness, non-reactivity, and self-compassion also improved (medium effect sizes). Effects were stable or further improved during follow-up (medium/large effect sizes). Improvement in child dysregulation, maternal internalizing psychopathology, maternal stress, sense of parental incompetence, non-judgmental acceptance of parental functioning, and non-judging of inner experience was only seen at 2- and 8-month follow-up (medium/large effect sizes). No changes in maternal externalizing psychopathology, overreactivity, compassion for child, and partner relationship occurred. Mindful with your toddler is a promising intervention for mothers with toddlers with (co-)regulation problems.

Item does not contain fulltext Background and objectives: Cognitive theories of fear suggest that biases in interpretation are content-specific: Fearful children should only interpret materials negatively if they are specifically related to the content of their fear. So far, there are only a few studies available that report on this postulated content-specificity of interpretation processes in childhood fear. The goal of this study was to examine interpretation bias and its content-specificity in children with varying levels of Generalized Anxiety Disorder (GAD) symptoms. Methods: In an Auditory Interpretation Task (AIT), two words that differ by one phoneme are acoustically blended so that one can hear only one of the words. In the current AIT, we included GAD-related blends, negatively-valenced fear-related blends and positive blends. Multiple-choice (n = 371) or open-ended (n = 295) responses were collected from 666 nonclinical children between 7 and 13 years of age. Results: Children with higher levels of self-reported GAD showed significantly more negative interpretations of ambiguous GAD-related blends in the multiple-choice version than children with lower levels of GAD. There were no differences when interpreting the other ambiguous blends. This result was not found with the open-ended version. Limitations: Effects were relatively small, some GAD-stimuli were sub-optimal, and the task was administered in a classroom setting. Even though we ensured that all children were able to hear all words clearly, this may have impacted the results. Conclusions: The findings only partly support the idea that fearful children display cognitive biases specific for fear-relevant stimuli, and more research is needed to replicate the results and test the usability of the AIT. 7 p.

Contains fulltext : 196717.pdf (Publisher’s version ) (Open Access) We investigated the role of self-reports and behavioral measures of interpretation biases and their content-specificity in children with varying levels of spider fear and/or social anxiety. In total, 141 selected children from a community sample completed an interpretation bias task with scenarios that were related to either spider threat or social threat. Specific interpretation biases were found; only spider-related interpretation bias and self-reported spider fear predicted unique variance in avoidance behavior on the Behavior Avoidance Task for spiders. Likewise, only social-threat related interpretation bias and self-reported social anxiety predicted anxiety during the Social Speech Task. These findings support the hypothesis that fearful children display cognitive biases that are specific to particular fear-relevant stimuli. Clinically, this insight might be used to improve treatments for anxious children by targeting content-specific interpretation biases related to individual disorders. 9 p.