Kristen L. Lavallee

Clinical Predictors of Response to Cognitive-Behavioral Therapy in Pediatric Anxiety Disorders: The Genes for Treatment (GxT) Study

Objective The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first from the study, examined demographic and clinical predictors of response to CBT. We hypothesized that the child’s gender, type of anxiety disorder, initial severity and comorbidity, and parents’ psychopathology would significantly predict outcome. Method A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analyzed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points. Results Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and follow-up, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up. Conclusion SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes.

Disorder-Specific Cognitive-Behavioral Therapy for Separation Anxiety Disorder in Young Children: A Randomized Waiting-List-Controlled Trial

Background: Separation anxiety disorder (SAD) is one of the earliest and most common mental disorders in childhood, and a strong predictor of adult psychopathology. Despite significant progress in psychotherapy research on childhood anxiety disorders, no randomized controlled trial has been conducted with a disorder-specific treatment program for young children suffering from SAD. Methods: Forty-three children (ages 5–7) with SAD and their parents were assigned to either a 16-session disorder-specific SAD treatment program including parent training and classical cognitive-behavioral therapy (CBT) components, or to a 12-week waiting list group. Categorical and/or continuous data for anxiety, impairment/distress and quality of life were collected at baseline, after treatment/waiting list condition, and at a 4-week follow-up. Results: Intention-to-treat analyses indicate that 76.19% of children allocated to the treatment group definitively no longer fulfilled DSM-IV criteria for SAD at follow-up, compared to 13.64% in the waiting list group. Between 91 and 100% of children rated themselves or were rated by their father, mother or therapist as very much or much improved on the global success rating immediately after treatment. Results indicated large time by treatment condition interaction effect sizes (d = 0.98–1.41) across informants for reduction of distress/avoidance in separation situations after the test for the treatment condition. Further, parents reported significant improvements in impairment/distress in the child’s major life domains and the child’s quality of life. Treatment gains were maintained at the 4-week follow-up assessment. Conclusions: Results indicate the short-term efficacy of a disorder-specific treatment approach for SAD, and are among the first to indicate that CBT programs work with young children.

DSM-IV criteria for childhood separation anxiety disorder: informant, age, and sex differences.

BACKGROUND The present study examines frequency of DSM-IV symptom and diagnostic criteria for separation anxiety disorder (SAD) by informant, age, and sex. METHODS Children aged 4-15 years with a primary DSM-IV diagnosis of SAD (N=106) were assessed using structured diagnostic interviews (Kinder-DIPS; DSM-IV-TR Version). Frequency of DSM-IV symptom and diagnostic criteria were examined as a function of informant and child characteristics, along with impairment and distress ratings. RESULTS The most frequently reported symptoms were separation-related distress, avoidance of being alone/without an adult and sleeping away from caregivers or from home, with nightmares the least frequently endorsed criterion. Child report did not yield any significant sex or age differences. However, parent report revealed greater reluctance or avoidance of school attendance for girls than boys, and for younger children (<8 years). Parent report indicated greater symptom-related impairment than child report, and the number of symptoms was correlated with impairment based on parent report, and with distress based on child report. CONCLUSIONS The primary indicators of SAD appear to be separation distress, avoidance of being alone, and sleeping away from caregivers. Findings suggest that parents may be best placed to determine impairment, while children may be the most accurate reporters of more covert internal distress. Implications for clinicians are that reports from multiple informants should be used to gain the most comprehensive information about childhood SAD.

The efficacy of a family-based cognitive-behavioral treatment for separation anxiety disorder in children aged 8-13: a randomized comparison with a general anxiety program.

BACKGROUND This randomized controlled trial examines the relative efficacy of a disorder-specific treatment program (TrennungsAngstprogramm Für Familien [TAFF]; English: Separation Anxiety Family Therapy) for children suffering from separation anxiety disorder (SAD) in comparison with a general anxiety program. METHOD Sixty-four children aged 8-13 with SAD and their parents were assigned either to a 16-session disorder-specific SAD treatment program, including parent training and classical cognitive-behavioral therapy (CBT) components (TAFF), or to a general child-focused 16-week comparison group (Coping Cat [CC]) without any parent training. Diagnoses and parent cognitions were assessed at baseline and at follow-ups. Global success ratings were collected at end of treatment and at follow-up. Ratings for anxiety, impairment/distress, and life quality were collected at Baseline 1, again after a 4-week waiting period, repeatedly throughout treatment, at 4 weeks, and at 1-year follow-up. RESULTS The response rate (no SAD diagnosis) at 4-week follow-up among the 52 treatment completers was 87.5% vs. 82.1% (TAFF vs. CC; intent-to-treat: 67.7% vs. 69.7%). At 1-year follow-up, the response was 83.3% versus 75% (TAFF vs. CC; intent to treat: 64.5% vs. 63.6%). Differences were nonsignificant. Results from rating scales indicated improvement for both groups across time points and assessment areas, with few between-group differences, and some small effects favoring the TAFF program. Both treatment programs yielded a reduction in parental dysfunctional beliefs. CONCLUSIONS Results indicate a slight advantage of the TAFF program over a general child-based treatment for SAD. However, these differences were less strong than hypothesized, indicating that the inclusion of parent training does not add large effects to classical child-based CBT in school-age children with SAD. (PsycINFO Database Record (c) 2013 APA, all rights reserved).

Lifestyle choices and mental health : a representative population survey

BackgroundIdentifying healthy lifestyle behaviours that promote psychological wellbeing is crucial to preventing mental disorders. The aim of the current study was to evaluate the individual and combined associations between different aspects of everyday life and mental health within a representative community sample in Germany.MethodThe study was conducted in 2012/2013 and included 7,937 participants representative of the German population. Lifestyle factors were assessed via self-report and included frequency of physical and mental activity, alcohol consumption, smoking, body mass index as well as circadian and social regularity. Outcome variables were depression, anxiety, stress and satisfaction with life.ResultsAll lifestyle factors were associated with the mental health outcomes. Better mental health was linked to higher frequency of physical and mental activity, moderate alcohol consumption (i.e. not increased or no alcohol consumption), non-smoking, a body mass index within the range of normal to overweight (i.e. not underweight or obese) and a regular life rhythm. The more healthy lifestyle choices an individual makes, the higher life satisfaction and lower psychological distress he or she tends to have.ConclusionsThe current study underlines the importance of healthy lifestyle choices in respect to psychological wellbeing.

Well-Being From the Knife? Psychological Effects of Aesthetic Surgery

Many people surgically alter their physical appearance with the intent of boosting their social and psychological well-being; however, the long-term effectiveness of aesthetic surgery on improving well-being is unconfirmed. The present comparison-controlled study examines outcomes in a sample of 544 patients who underwent aesthetic surgery (surgery group) and 264 participants who were interested in aesthetic surgery but did not undergo it (comparison group). Participants were followed 3, 6, and 12 months after aesthetic surgery or after contacting the clinic (comparisons). Overall, the results reveal positive outcomes of receiving aesthetic surgery across areas, including anxiety, social phobia, depression, body dysmorphia, goal attainment, quality of life, life satisfaction, attractiveness, mental and physical health, well-being, self-efficacy and self-esteem. Among those dissatisfied with a particular physical feature and considering aesthetic surgery, undergoing surgery appears to result in positive self-reported psychological changes.

Early Predictors of Separation Anxiety Disorder: Early Stranger Anxiety, Parental Pathology and Prenatal Factors

Objective: The present study seeks to extend research on the etiology of separation anxiety disorder (SAD) in a German-speaking sample by examining differences between children with SAD and healthy comparisons, using a retrospective-reporting paradigm. Method: The sample included 106 children with SAD and 44 healthy children between the ages of 4 and 14 years. Parents completed questionnaires and structured clinical interviews to assess parental pathology, pregnancy variables and strong early stranger anxiety. Results: Children with SAD were more likely than healthy children to have had a phase of stronger stranger anxiety in infancy. Further, early stranger anxiety remained a significant predictor of SAD after controlling for maternal depression. Meaningful effects were not found for the influence of parental age at birth or other pregnancy factors. Conclusion: This study provides beginning evidence of the potential predictive value of strong stranger anxiety in distinguishing children with SAD from those with no disorder, above and beyond the influence of parental pathology.

Social Rhythm and Mental Health: A Cross- Cultural Comparison

Background Social rhythm refers to the regularity with which one engages in social activities throughout the week, and has established links with bipolar disorder, as well as some links with depression and anxiety. The aim of the present study is to examine social rhythm and its relationship to various aspects of health, including physical health, negative mental health, and positive mental health. Method Questionnaire data were obtained from a large-scale multi-national sample of 8095 representative participants from the U.S., Russia, and Germany. Results Results indicated that social rhythm irregularity is related to increased reporting of health problems, depression, anxiety, and stress. In contrast, greater regularity is related to better overall health state, life satisfaction, and positive mental health. The effects are generally small in size, but hold even when controlling for gender, marital status, education, income, country, and social support. Further, social rhythm means differ across Russia, the U.S., and Germany. Relationships with mental health are present in all three countries, but differ in magnitude. Conclusions Social rhythm irregularity is related to mental health in Russia, the U.S., and Germany.

Genome-wide association study of response to cognitive–behavioural therapy in children with anxiety disorders

Background Anxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent. Aims To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980). Method Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up. Results No variants passed a genome-wide significance threshold (P = 5 × 10−8) in either analysis. Four variants met criteria for suggestive significance (P<5 × 10−6) in association with response post-treatment, and three variants in the 6-month follow-up analysis. Conclusions This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.

Predictors of Incidence, Remission and Relapse of Axis I Mental Disorders in Young Women: A Transdiagnostic Approach

An understanding of etiological and maintaining factors of mental disorders is essential for the treatment of mental disorders, as well as mental health promotion and protection. The present study examines predictors of the incidence, remission and relapse of a wide range of Axis I mental disorders, using data from the Dresden Predictor Study. A sample of 1394 young German women completed questionnaires evaluating psychological factors (positive mental health, self-efficacy, life satisfaction, neuroticism, psychopathology and dysfunctional attitudes) and global assessment of functioning, as well as structured diagnostic interviews assessing incidence and change (remission, relapse) in mental disorders. Predictors were analysed using a multivariate logistic regression model. Significant factors for incidence of mental disorders included neuroticism and global functioning. A remitting course of mental disorders was predicted by positive mental health, self-efficacy and global assessment of functioning. Relapse was significantly predicted by neuroticism and dysfunctional attitudes. Results imply that mental health promotion is particularly important for women with high neuroticism and low functioning, as they tend to be at risk for incidence. Mental disorder treatment may benefit from strengthening positive mental health and functioning, as these factors promote remission. Relapse-prevention may benefit from attention to neuroticism and dysfunctional attitudes in order to reduce the likelihood of relapse. Copyright