Cynthia Suveg

Cognitive-behavioral therapy for anxiety disordered youth: a randomized clinical trial evaluating child and family modalities.

This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/ attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed.

Emotion Regulation in Children With Anxiety Disorders

This study examined emotion management skills in addition to the role of emotional intensity and self-efficacy in emotion regulation in 26 children with anxiety disorders (ADs) ages 8 to 12 years and their counterparts without any form of psychopathology. Children completed the Childrens Emotion Management Scales (CEMS) and Emotion Regulation Interview (ERI), and mothers reported on their childrens emotion regulation using the Emotion Regulation Checklist (ERC). Results indicated that children who met Diagnostic and Statistical Manual for Mental Disorders (4th ed., American Psychiatric Association, 1994) criteria for an anxiety disorder had difficulty managing worried, sad, and anger experiences, potentially due to their report of experiencing emotions with high intensity and having little confidence in their ability to regulate this arousal. These findings indicate that emotion regulation needs to be considered centrally in research with anxious populations.

Anger and Sadness Regulation: Predictions to Internalizing and Externalizing Symptoms in Children

Examined the relation between childrens self-reported anger and sadness regulation and the presence of internalizing and externalizing symptoms. Participants were 121 boys and 106 girls in the fourth and fifth grades who completed the Childrens Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), Emotion Expression Scale for Children (EESC), and Childrens Emotion Management Scales (CSMS, CAMS) and rated each other on aggressive behavior. Results of multiple regression analyses indicated that the inability to identify emotional states, the inhibition of anger, the dysregulation of anger and sadness, and the constructive coping with anger predicted internalizing symptoms. The dysregulated expression of sadness and constructive coping with anger were inversely related to externalizing symptoms.

Considering CBT with Anxious Youth? Think Exposures

Following a historical precis regarding exposure and a brief description of a representative cognitive-behavioral therapy (CBT) program for anxiety disorders in youth, we discuss several factors related to conducting exposure tasks in youth. Topics include assessing anxious situations, creating a hierarchy, and using imaginal, as well as in vivo and in- and out-of-session exposure tasks. We also describe and discuss the posture of the therapist with regard to the development and maintenance of rapport, the process of consulting with the child, the use of shaping and rewarding effort, the restraining from reinforcing avoidance, modeling for parents, and how to deal with the occasional less-than-successful exposure task. Developmental level of the child and contextual factors are examined as they might influence the design and implementation of exposure tasks. Last, we consider professional practice issues of liability, applications in private practice, and the challenges that face new therapists undertaking exposures. Examples and illustrations from actual clinical cases are included throughout.

Emotion-focused cognitive-behavioral therapy for anxious youth: A multiple-baseline evaluation

Examined the efficacy of an Emotion-focused Cognitive-Behavioral Therapy (ECBT) for six anxious youths ages 7–13 years. All participants had a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia) based on the Anxiety Disorder Interview Schedule for Children—Child and Parent versions. Children and parents reported on anxious symptomatology using the Multidimensional Anxiety Scale for Children (MASC). To assess emotion-related competencies, children were administered the Kusche Affective Interview—Revised and children and parents completed the Emotion Expression Scale for Children (EESC) and Emotion Regulation Checklist (ERC), respectively. Cases began treatment after baselines of 0, 2, or 3 weeks. At posttreatment, the majority of children demonstrated improvements in anxious symptomatology, emotion understanding and regulation skills, and overall functioning. Such improvements in emotion-related skills, in addition to anxiety, are significant given that emotional competence is a crucial component in childrens adaptive social functioning and psychological adjustment. These findings provide initial support for ECBT.

In-session exposure tasks and therapeutic alliance across the treatment of childhood anxiety disorders.

The study examined the shape of therapeutic alliance using latent growth curve modeling and data from multiple informants (therapist, child, mother, father). Children (n = 86) with anxiety disorders were randomized to family-based cognitive-behavioral treatment (FCBT; N = 47) with exposure tasks or to family education, support, and attention (FESA; N = 39). Children in FCBT engaged in exposure tasks in Sessions 9-16, whereas FESA participants did not. Alliance growth curves of FCBT and FESA youths were compared to examine the impact of exposure tasks on the shape of the alliance (between-subjects). Within FCBT, the shape of alliance prior to exposure tasks was compared with the shape of alliance following exposure tasks (within-subjects). Therapist, child, mother, and father alliance ratings indicated significant growth in the alliance across treatment sessions. Initial alliance growth was steep and subsequently slowed over time, regardless of the use of exposure tasks. Data did not indicate a rupture in the therapeutic alliance following the introduction of in-session exposures. Results are discussed in relation to the processes, mediators, and ingredients of efficacious interventions as well as in terms of the dissemination of empirically supported treatments.

Feasibility of Exercise Training for the Short-Term Treatment of Generalized Anxiety Disorder: A Randomized Controlled Trial

Background: Exercise training may be especially helpful for patients with generalized anxiety disorder (GAD). We conducted a randomized controlled trial to quantify the effects of 6 weeks of resistance (RET) or aerobic exercise training (AET) on remission and worry symptoms among sedentary patients with GAD. Methods: Thirty sedentary women aged 18–37 years, diagnosed by clinicians blinded to treatment allocation with a primary DSM-IV diagnosis of GAD and not engaged in any treatment other than pharmacotherapy, were randomly allocated to RET, AET, or a wait list (WL). RET involved 2 weekly sessions of lower-body weightlifting. AET involved 2 weekly sessions of leg cycling matched with RET for body region, positive work, time actively engaged in exercise, and load progression. Remission was measured by the number needed to treat (NNT). Worry symptoms were measured by the Penn State Worry Questionnaire. Results: There were no adverse events. Remission rates were 60%, 40%, and 30% for RET, AET, and WL, respectively. The NNT was 3 (95% CI 2 to 56) for RET and 10 (95% CI –7 to 3) for AET. A significant condition-by-time interaction was found for worry symptoms. A follow-up contrast showed significant reductions in worry symptoms for combined exercise conditions versus the WL. Conclusions: Exercise training, including RET, is a feasible, low-risk treatment that can potentially reduce worry symptoms among GAD patients and may be an effective adjuvant, short-term treatment or augmentation for GAD. Preliminary findings warrant further investigation.

Changes in Emotion Regulation Following Cognitive-Behavioral Therapy for Anxious Youth

This study examined emotion-related functioning following cognitive-behavioral therapy (CBT) with 37 youth with anxiety disorders (22 boys, 15 girls) ranging in age from 7 to 15 with a principal diagnosis of generalized anxiety disorder (n = 27), separation anxiety disorder (n = 12), and/or social phobia (n = 13). Treated youth exhibited a reduction in anxiety and increased anxiety self-efficacy and emotional awareness at posttreatment. Treated youth also demonstrated improved coping and less emotional dysregulation with worry but not with anger or sadness. The results suggest that the gains made in worry regulation do not generalize to other emotions that are not specifically targeted within the CBT protocol.

The Emotion Dysregulation Model of Anxiety: A preliminary path analytic examination

Both temperamental (e.g., behavioral inhibition) and environmental (e.g., family emotional environment) factors are associated with etiology and maintenance of anxiety; however, few studies have explored mechanisms through which these risk factors operate. The present study investigation of a developmental model of anxiety (i.e., the Emotion Dysregulation Model of Anxiety; EDMA) that hypothesizes that emotion dysregulation is the mechanism through which temperamental and emotion parenting variables relate to anxiety. Emerging adults (N=676, M age=19.5) retrospectively reported on behavioral inhibition and emotion parenting factors in childhood, and current emotion regulation skills and symptoms of anxiety. Results of path analyses provide initial support for the EDMA. Emotion dysregulation fully mediated the relationship between behavioral inhibition and anxiety and partially mediated the relationship between family emotional environment and anxiety.

They're Not Just "Little Adults": Developmental Considerations for Implementing Cognitive-Behavioral Therapy With Anxious Youth

Developmental factors direct optimal implementations of cognitive-behavioral therapy (GBT) protocols with children and adolescents. Although chronological age can approximate level of development, youthful clients benefit v^rhen clinicians carefully assess each childs cognitive, social, and emotional skills and adjust manualized treatments accordingly. Using several components of manualized GBT for anxiety in youth (i.e., affective education, cognitive restructuring, exposure tasks) as a framework, this article reviews empirical literature and provides practical suggestions for modifying these aspects of treatment to fit a childs level of development. Important issues such as engaging youth in treatment, and involving school personnel and parents in this process are also discussed. This article concludes with a call for