Jami M. Furr

Symptom Presentation and Outcome of Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder

Previous researchers have classified obsessive-compulsive disorder (OCD) patients by the themes of their obsessions and compulsions (e.g., washing, checking); however, mental compulsions have not been adequately assessed in these studies. The authors conducted 2 studies using a large sample of OCD patients (N=132). In the 1st study, they categorized patients on the basis of symptom presentation, giving adequate consideration to mental compulsions. Five patient clusters were identified: harming, contamination, hoarding, unacceptable thoughts, and symmetry. Mental compulsions were most prevalent among patients with intrusive, upsetting religious, violent, or sexual thoughts. In the 2nd study, they compared response to cognitive-behavioral therapy across symptom categories, finding poorer outcomes among patients with hoarding symptoms compared with those with other symptom themes.

Disasters and Youth: A Meta-Analytic Examination of Posttraumatic Stress

OBJECTIVE Meta-analyze the literature on posttraumatic stress (PTS) symptoms in youths post-disaster. METHOD Meta-analytic synthesis of the literature (k = 96 studies; Ntotal = 74,154) summarizing the magnitude of associations between disasters and youth PTS, and key factors associated with variations in the magnitude of these associations. We included peer-reviewed studies published prior to 1/1/2009 that quantitatively examined youth PTS (≤ 18 years at event) after a distinct and identifiable disaster. RESULTS Despite variability across studies, disasters had a significant effect on youth PTS (small-to-medium magnitude; rpooled = .19, SEr = .03; d = 0.4). Female gender (rpooled = .14), higher death toll (disasters of death toll ≤ 25: rpooled = .09; vs. disasters with ≥ 1,000 deaths: rpooled = .22), child proximity (rpooled = .33), personal loss (rpooled = .16), perceived threat (rpooled = .34), and distress (rpooled = .38) at time of event were each associated with increased PTS. Studies conducted within 1 year post-disaster, studies that used established measures, and studies that relied on child-report data identified a significant effect. CONCLUSION Youths are vulnerable to appreciable PTS after disaster, with pre-existing child characteristics, aspects of the disaster experience, and study methodology each associated with variations in the effect magnitude. Findings underscore the importance of measurement considerations in post-disaster research. Areas in need of research include the long-term impact of disasters, disaster-related media exposure, prior trauma and psychopathology, social support, ethnicity/race, prejudice, parental psychopathology, and the effects of disasters in developing regions of the world. Policy and clinical implications are discussed.

Internet-Delivered, Family-Based Treatment for Early-Onset OCD: A Preliminary Case Series

Given the burdens of early-onset obsessive-compulsive disorder (OCD), limitations in the broad availability and accessibility of evidence-based care for affected youth present serious public health concerns. The growing potential for technological innovations to transform care for the most traditionally remote and underserved families holds enormous promise. This article presents the rationale, key considerations, and a preliminary case series for a promising behavioral telehealth innovation in the evidence-based treatment of early-onset OCD. We developed an Internet-based format for the delivery of family-based treatment for early-onset OCD directly to families in their homes, regardless of their geographic proximity to a mental health facility. Videoteleconferencing (VTC) methods were used to deliver real-time cognitive-behavioral therapy centering on exposure and response prevention to affected families. Participants in the preliminary case series included 5 children between the ages of 4 and 8 (M Age = 6.5) who received the Internet-delivered treatment format. All youth completed a full treatment course, all showed OCD symptom improvements and global severity improvements from pre- to posttreatment, all showed at least partial diagnostic response, and 60% no longer met diagnostic criteria for OCD at posttreatment. No participants got worse, and all mothers characterized the quality of services received as “excellent.” The present work adds to a growing literature supporting the potential of VTC and related computer technology for meaningfully expanding the reach of supported treatments for OCD and lays the foundation for subsequent controlled evaluations to evaluate matters of efficacy and engagement relative to standard in-office evidence-based care.

Interpretation Bias in Social Anxiety: A Dimensional Perspective

Interpretation bias, the tendency to interpret ambiguous situations in a positive or negative fashion, has been implicated in the maintenance of social anxiety. To examine this hypothesis, off-line interpretations of ambiguous social and nonsocial situations were examined separately for positive and negative bias in a sample of 102 participants who represented a continuum of social anxiety ranging from low to high anxiety. A modest correlation was found between positive and negative social interpretation biases suggesting that negative and positive interpretation bias do not lie on opposite ends of a single continuum. Negative interpretation bias for social situations was positively related to social anxiety, but not to general negative affect. In contrast, positive social interpretation bias was negatively related to general negative affect, and to a lesser extent, to social anxiety. We discuss the implication of these findings for the methodology and interpretations of previous findings as well as for general theories of social anxiety and its disorders.

Children and Terrorism-Related News : Training Parents in Coping and Media Literacy

This study examined associations between televised news regarding risk for future terrorism and youth outcomes and investigated the effects of training mothers in an empirically based approach to addressing such news with children. This approach--Coping and Media Literacy (CML)--emphasized modeling, media literacy, and contingent reinforcement and was compared via randomized design to Discussion as Usual (DAU). Ninety community youth (aged 7-13 years) and their mothers viewed a televised news clip about the risk of future terrorism, and threat perceptions and state anxiety were assessed preclip, postclip, and postdiscussion. Children responded to the clip with elevated threat perceptions and anxiety. Children of CML-trained mothers exhibited lower threat perceptions than DAU youth at postclip and at postdiscussion. Additionally, CML-trained mothers exhibited lower threat perceptions and state anxiety at postclip and postdiscussion than did DAU mothers. Moreover, older youth responded to the clip with greater societal threat perception than did younger youth. Findings document associations between terrorism-related news, threat perceptions, and anxiety and support the utility of providing parents with strategies for addressing news with children. Implications and research suggestions are discussed.

The Intolerance of Uncertainty Scale for Children: A Psychometric Evaluation

Intolerance of uncertainty (IU) has contributed to our understanding of excessive worry and adult anxiety disorders, but there is a paucity of research on IU in child samples. This gap is due to the absence of a psychometrically sound measure of IU in youth. The present study adapted parallel child- and parent-report forms of the Intolerance of Uncertainty Scale (IUS) and examined the internal consistency, convergent validity, and classification properties of these forms in youth aged 7-17 (M = 11.6 years, SD = 2.6). Participating youth (N = 197; 100 girls, 97 boys) either met diagnostic criteria for an anxiety disorder (n = 73) or were nonreferred community participants (n = 124). The child-report form (i.e., IUS for Children, or IUSC), and to a lesser extent the parent-report form, demonstrated strong internal consistency and convergent validity, evidenced by significant associations with anxiety and worry (and reassurance-seeking in the case of the child-report form). Children diagnosed with anxiety disorders scored higher than nonreferred community youth on both forms. Receiver operating characteristic (ROC) analysis demonstrated acceptable overall utility in distinguishing the 2 groups of youth. Findings provide preliminary support for use of the IUSC for continuous measurement of childrens ability to tolerate uncertainty.

Experiential avoidance in the parenting of anxious youth: Theory, research, and future directions

Empirical findings support the notion that overprotective and intrusive parenting practices may contribute to the maintenance of anxiety in youth (e.g., Ginsburg & Schlossberg, 2002). It appears that parents of anxious youth are more likely to intervene during anxiety-provoking situations for their child when he/she displays negative emotion or distress (e.g., Hudson, Comer, & Kendall, 2008). It remains unclear, however, why anxious childrens displays of negative emotion are difficult for parents to tolerate. One possible explanation is that parents of anxious youth are more likely to engage in experiential avoidance, the inability or unwillingness to tolerate ones own internal distress, which manifests as intrusive behaviour designed to reduce the childs distress, and thereby the parents own internal distress. This article reviews the theoretical and empirical underpinnings of experiential avoidance, describes its potential role in the parenting of anxious children, and discusses implications for treatment and future directions for research.

Media use and children's perceptions of societal threat and personal vulnerability

This study examined childrens media use (i.e., amount of television and Internet usage) and relationships to childrens perceptions of societal threat and personal vulnerability. The sample consisted of 90 community youth aged 7 to 13 years (M = 10.8; 52.2% male) from diverse economic backgrounds. Analyses found childrens television use to be associated with elevated perceptions of personal vulnerability to world threats (i.e., crime, terrorism, earthquakes, hurricanes, and floods). An interactive model of television use and child anxiety in accounting for childrens personal threat perceptions was supported, in which the strength of television consumption in predicting childrens personal threat perceptions was greater for children with greater anxiety. Relationships were found neither between childrens Internet use and threat perceptions nor between media use and perceptions of societal threat.

Anxiety, Mood, and Substance Use Disorders in Parents of Children With Anxiety Disorders

Examined the prevalence of anxiety, mood, and substance use disorders in the parents of anxiety disordered (AD) children relative to children with no psychological disorder (NPD). The specificity of relationships between child and parent anxiety disorders was also investigated. Results revealed higher prevalence rates of anxiety disorders in parents of AD children relative to NPD children. Specific child–mother relationships were found between child separation anxiety and panic disorder and maternal panic disorder, as were child and maternal social phobia, obsessive compulsive disorder, and specific phobias. Findings are discussed with reference to theory, clinical implications, and future research needs.

Adapting Manualized CBT for a Cognitively Delayed Child With Multiple Anxiety Disorders

This study examined the effectiveness of a modified cognitive-behavioral therapy (CBT) program for the treatment of a cognitively delayed 8-year-old girl presenting with social phobia, selective mutism, and generalized anxiety disorder (GAD). Multimethod assessment, at pretreatment and posttreatment, included a semistructured diagnostic interview, self-reports, and parent and teacher reports. Cognitive delays were apparent at the initial assessment and confirmed on review of previous evaluations. CBT for anxious youth was implemented in a modified fashion to ensure that the methods built on the child’s competencies and were compatible with her developmental capacities. Following 20 CBT sessions, posttreatment assessment indicated significant reduction in anxiety symptoms, as indicated by the diagnostic interview and self-report and other report of symptomatology. The child no longer met diagnostic criteria for GAD or selective mutism at posttreatment. The case study illustrates how CBT can be modified and applied flexibly in response to individual needs and limitations of the child.