Carol Newall

The Impact of Brief Parental Anxiety Management on Child Anxiety Treatment Outcomes: A Controlled Trial

Parental anxiety is a risk to optimal treatment outcomes for childhood anxiety disorders. The current trial examined whether the addition of a brief parental anxiety management (BPAM) program to family cognitive behavioral therapy (CBT) was more efficacious than family CBT-only in treating childhood anxiety disorders. Two hundred nine children (aged 6–13 years, 104 female, 90% Caucasian) with a principal anxiety disorder were randomly allocated to family CBT with a five-session program of BPAM (n = 109) or family CBT-only (n = 100). Family CBT comprised the Cool Kids program, a structured 12-week program that included both mothers and fathers. Overall, results revealed that the addition of BPAM did not significantly improve outcomes for the child or the parent compared to the CBT-only group at posttreatment or 6-month follow-up. Overall, however, children with nonanxious parents were more likely to be diagnosis free for any anxiety disorder compared to children with anxious parents at posttreatment and 6-month follow-up. BPAM did not produce greater reductions in parental anxiety. The results support previous findings that parent anxiety confers poorer treatment outcomes for childhood anxiety disorders. Nevertheless the addition of BPAM anxiety management for parents in its current format did not lead to additional improvements when used as an adjunct to family CBT in the treatment of the childs anxiety disorder. Future benefits may come from more powerful methods of reducing parents’ anxiety.

The role of perfectionism in cognitive behaviour therapy outcomes for clinically anxious children

The main aim of this study was to determine whether pre-treatment levels of child perfectionism impacted on anxiety treatment outcomes for school-aged children. In addition, it was investigated whether child perfectionism decreased following treatment for anxiety. Participants were sixty-seven clinically anxious children aged 6-13 years (female = 34; majority Caucasian) who were enrolled in a group-based cognitive behaviour therapy program, and their parents. They completed self-report questionnaires on anxiety and depressive symptoms and were administered a diagnostic interview to determine the type and clinician rated severity of anxiety and related disorders pre- and post-treatment and at 6-month follow-up. Self- and parent-rated perfectionism were also measured pre-treatment, while a subset of children completed perfectionism measures post-treatment as well. Self-Oriented Perfectionism, but not Socially Prescribed Perfectionism, predicted poorer self-reported treatment outcome (higher levels of anxiety symptoms) immediately following treatment and at 6-month follow-up when using a multi-informant approach. Additionally, both Self-Oriented and Socially Prescribed child perfectionism significantly reduced immediately following treatment. Despite reductions in child perfectionism following anxiety treatment, higher Self-Oriented Perfectionism may impact negatively on child anxiety treatment outcome.

Teens that fear screams: A comparison of fear conditioning, extinction, and reinstatement in adolescents and adults

This study investigated differences between adolescents and adults on fear conditioning, extinction, and reinstatement (i.e., the recovery of conditioned fear following re-exposure to the unconditioned stimulus [US] post-extinction). Participants underwent differential conditioning (i.e., the Screaming Lady) where one neutral face (CS+) was followed by the same face expressing fear and a loud scream (US) while another neutral face (CS-) remained neutral. Extinction involved non-reinforced presentations of both CSs, after which participants were reinstated (2xUSs) or not. On two self-report measures, both ages showed conditioning, good extinction learning and retention, and reinstatement-induced relapse. However, only adolescents showed conditioning, extinction, and reinstatement on the eye tracking measure; relapse on this measure could not be assessed in adults given they did not show initial conditioning. Lastly, higher levels of depression predicted stronger conditioning and weaker extinction in adolescents only. These findings are discussed in terms of their implications for adolescent anxiety disorders.

Longitudinal investigation of the role of temperament and stressful life events in childhood anxiety.

The current study investigated the longitudinal relationships among behavioral inhibition (BI), life events, and anxiety in a sample of 102 BI children and 100 behaviorally uninhibited (BUI) children aged 3 to 4 years. Childrens parents completed questionnaires on BI, stressful life events, and anxiety symptoms, and were administered a diagnostic interview three times in a 5-year period. In line with our hypotheses, negative life events, particularly negative behavior-dependent life events (i.e., life events that are related to the childrens own behaviors), and the impact of negative life events were predictive of increases in subsequent anxiety symptoms, the likelihood of having an anxiety disorder, and increased number of anxiety diagnoses over the 5-year follow-up period. Experiencing more positive, behavior-independent life events decreased the risk of being diagnosed with an anxiety disorder. Furthermore, differences were found in life events between BI and BUI children. That is, BI children experienced fewer positive and specifically positive behavior-dependent life events, and the impact of these positive life events was also lower in BI children than in BUI children. However, BI did not interact with life events in the prediction of anxiety problems as hypothesized. Therefore, this study seems to indicate that BI and life events act as additive risk factors in the development of anxiety problems.

Short message service prompts for skills practice in Internet-delivered cognitive behaviour therapy for chronic pain - are they feasible and effective?

Patients face numerous challenges adopting skills taught within pain self‐management programmes. The present study reports the acceptability and preliminary outcomes of supplementing an Internet‐delivered cognitive behavioural therapy (iCBT) course for chronic pain, the Pain Course, with brief automated short message service (SMS) prompts that encourage skills practice.

Psychological distress, help-seeking, and perceived barriers to psychological treatment among Australian parents

Abstract Objective Parental psychological distress is an influential predictor of maladaptive parenting practices, negative outcomes in children, and poorer outcomes of parenting programs. Despite these negative outcomes, treatment engagement among parents appears to be low. This study aimed to explore Australian parents’ history of help‐seeking behaviour and perceived barriers to psychological treatment for their own and their childrens psychological wellbeing. Method A sample of 2,555 Australian parents completed an online survey exploring psychological distress, help‐seeking, perceived barriers to treatment for parents and their children, and interest in an online parental wellbeing course. Results Parents reported high levels of personal psychological distress (70.4% in the moderate to very high ranges) and high rates of emotional and behavioural difficulties in their children (34.2% in abnormal range). Parents were more likely to seek informal types of help‐seeking, such as advice from family and friends. They were less likely to enlist formal types of help seeking, such as psychotherapy. The most commonly endorsed barriers to seeking treatment for parents and their children included lack of time and money and the belief that mental health difficulties were insufficient to warrant treatment. However, parents expressed a high level of interest in a free online parental wellbeing course. Conclusion The findings highlight the need for effective and accessible psychological treatments to target the psychological wellbeing of parents and their dependent children. Early evidence suggests that an online parental wellbeing course may offer an acceptable alternative to face‐to‐face treatment that may overcome many barriers reported in this study.

Physical context regulates the renewal of fear in indirect pathways: An examination of fear reduction processes using verbal information provision and modelling

Among adults, classically conditioned fears that have been extinguished can recover through a change of physical context. Recovery of fear via a change of physical context is typically termed ‘renewal’. In this study, we investigated whether adults also exhibit renewal via the verbal threat information pathway. Fifty adult participants (M = 20 years-old; range: 18 to 45 years of age) acquired fear beliefs about a novel and fictitious animal through the provision of threatening information about the animal. Fears were reduced via the verbal provision of positive information and modelling. Participants were randomised to receive fear reduction in either the same context (Context A) or in a different context (Context B) to the context used for fear acquisition (Context A). All participants were then tested back in the context of acquisition. Results showed fears recovered when the context of fear reduction and the context of test were different, indicating physical context regulates the renewal of verbally acquired and reduced fear. The findings are discussed in terms of current theoretical and developmental models for fear extinction and the implications for relapse models of adult anxiety disorders.

Online cognitive-behaviour therapy is similarly effective to clinic-based CBT for reducing adolescent anxiety

ED FROM Spence SH, Donovan CL, March S, et al. A randomized controlled trial of online versus clinic-based CBT for adolescent anxiety. J Consult Clin Psychol 2011;79:629–42. Correspondence to: Caroline L Donovan, School of Psychology, Griffi th University, Brisbane, Queensland, Australia; c.donovan@griffi th.edu.au Sources of funding: National Health and Medical Research Council. OM M EN TA RY In the last two decades, a number of trials have been conducted to assess the applicability of cognitive behavioural therapy (CBT) to anxious youth. Overall, the empirical evidence supports the effi cacy of CBT in children and adolescents.1 The effi cacy of CBT specifi cally for adolescents is less well studied, as many trials focus on children aged 7 to 13 years old. Recruitment of adolescents is not only a problem for researchers but also refl ects an important practical obstacle in adolescent mental health. Unlike children, adolescents have greater autonomy in decisionmaking than younger age groups and therefore, are more able to resist their parent’s efforts at seeking treatment. Adolescents also often fi nd it more diffi cult to engage in psychological treatment. Available evidence suggests that most young people do not seek treatment for anxiety problems. Using a well-designed randomised controlled trial, Spence et al examined the effi cacy of internet delivery of CBT in a sample of anxious adolescents to address this important gap. Internet-based CBT is a delivery format that may encourage adolescents to seek professional help and engage in therapy. A promising aspect of these fi ndings is that internet delivery was as effi cacious as face-to-face delivery of CBT for anxious youth and both treatment formats were superior to waiting list controls on diagnostic outcomes. Although the results from parent and child symptom measures were less convincing, the follow-up assessment points clearly showed that internet and face-to-face delivery demonstrated large effect sizes on both child and parent report measures. Parents and adolescents perceived internet delivery as equally credible as face-to-face treatments, however parents reported greater satisfaction with face-to-face than internet-delivered treatment. These fi ndings have important implications, particularly for families for whom access to adequate mental health services is limited, suggesting that we can have confi dence in delivering CBT via the internet. Carol Newall, Jennifer L Hudson Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia Competing interests None. REFERENCE 1. Rapee RM, Schniering CA, Hudson JL. Anxiety disorders during childhood and adolescence: origins and treatment. Annu Rev Clin Psychol 2009;5:335–65. 24_ebmental-2011-100435.indd 49 4/13/2012 5:04:19 PM