Marie Louise Reinholdt-Dunne

CBT for the treatment of child anxiety disorders: a review of why parental involvement has not enhanced outcomes.

Anxiety affects 10% of all children and disrupts educational, socio-emotional development and overall functioning of the child and family. Research has shown that parenting factors (i.e. intrusiveness, negativity, distorted cognitions) contribute to the development and maintenance of childhood anxiety. Recent studies have therefore investigated if the treatment effect of traditional cognitive behavioural therapy may be enhanced by adding a parental component. However, randomised controlled trials have not shown unequivocal support for this assumption. The results are inconsistent and ambiguous. This article investigates possible reasons for this inconsistency and in particular differences in methodology and the theoretical relevance of the applied parental components are highlighted as possible contributory factors. Another factor is that treatment effect is mainly measured by change in the childs diagnostic status rather than changes in parental or family functioning.

Effects of anxiety and attention control on processing pictorial and linguistic emotional information

This study investigated the role of executive attention control in modulating selective processing of emotional information in anxiety. It was hypothesized that the combination of high anxiety and poor attention control would be associated with greater difficulty in ignoring task-irrelevant threat-related information. The study included both faces and words as stimuli. Cognitive interference effects were assessed using two emotional Stroop tasks: one with angry, fearful, happy and neutral faces, and one with threat-related, positive, and neutral words. An objective measure of attention control was obtained from the Attention network task. There were four participant groups with high/low trait anxiety and high/low attention control. Results indicated that the combination of high anxiety and poor attention control was associated with greater cognitive interference by emotional faces (including angry faces), compared to neutral faces. This interference effect was not evident in participants with high anxiety and high attentional control, or in low-anxious individuals. There was no evidence of associations between anxiety, attention control, and the interference effect of emotional words. Results indicate that high anxiety and poor attention control together predict enhanced processing of emotionally salient information, such as angry facial expressions. Implications for models of emotion processing are discussed.

The Development of Anxiety Disorders: Considering the Contributions of Attachment and Emotion Regulation

Anxiety disorders are among the most common psychiatric disorders in childhood. Nonetheless, theoretical knowledge of the development and maintenance of childhood anxiety disorders is still in its infancy. Recently, research has begun to investigate the influence of emotion regulation on anxiety disorders. Although a relation between anxiety disorders and emotion regulation difficulties has been demonstrated, little attention has been given to the question of why anxious individuals have difficulties regulating their emotions. The present review examines the evidence of the link between emotion regulation and anxiety. It also explores the unique contributions of attachment style and dysfunctional emotion regulation to the development of anxiety disorders.

Assessing the Revised Child Anxiety and Depression Scale (RCADS) in a National Sample of Danish Youth Aged 8–16 Years

Early identification of anxiety among youth is required to prevent them from going unrecognised and untreated by mental health professionals. A precise identification of the young person’s primary difficulty is also required to guide treatment programs. Availability of a valid and easily administrable assessment tool is crucial for identifying youth suffering from anxiety disorders. The purpose of the present study was therefore to examine the psychometric properties of the Danish version of the Revised Children’s Anxiety and Depression Scale (RCADS). A total of 667 youth from community schools (4th through 9th grade) across Denmark participated in the study. The psychometric properties of the RCADS-DAN resembled those reported in US and Europe. Within scale reliability was excellent with Chronbach’s alpha of.96. All subscales also showed good to excellent internal reliability. The study provides convincing evidence that the RCADS-DAN is a valid assessment tool for screening anxiety in Danish youth.

Attention control: Relationships between self-report and behavioural measures, and symptoms of anxiety and depression

Individual differences in attention control are proposed to contribute to anxiety and depression. However, self-reported attention control, assessed on the Attentional Control Scale (ACS), appears to be a heterogeneous construct with separate components of focusing (e.g., concentrating, resisting distraction) and shifting (e.g., flexible switching of attention between tasks). Moreover, these constructs are proposed to relate differently to anxiety and depression. Two studies are reported which investigated relationships between ACS focusing and shifting and (i) an objective behavioural measure of attention control from the Attention Network Task (ANT); and (ii) anxiety and depression symptoms in two separate non-clinical samples (Ns = 165 and 193). Results of Study 1 indicated that only ACS focusing was significantly associated with ANT attention control; with both measures reflecting resistance to distraction. In both studies, self-reported ability to focus attention (ACS focusing) was associated with lower anxiety; and greater attentional flexibility (ACS shifting) was associated with fewer depression symptoms.

Anxiety and selective attention to angry faces: An antisaccade study

Cognitive models of anxiety propose that anxiety is associated with an attentional bias for threat, which increases vulnerability to emotional distress and is difficult to control. The study aim was to investigate relationships between the effects of threatening information, anxiety, and attention control on eye movements. High and low trait anxious individuals performed antisaccade and prosaccade tasks with angry, fearful, happy, and neutral faces. Results indicated that high-anxious participants showed a greater antisaccade cost for angry than neutral faces (i.e., relatively slower to look away from angry faces), compared with low-anxious individuals. This bias was not found for fearful or happy faces. The bias for angry faces was not related to individual differences in attention control assessed on self-report and behavioural measures. Findings support the view that anxiety is associated with difficulty in using cognitive control resources to inhibit attentional orienting to angry faces, and that attention control is multifaceted.

Meta-Worry, Worry, and Anxiety in Children and Adolescents: Relationships and Interactions

The metacognitive model has increased our understanding of the development and maintenance of generalized anxiety disorders in adults. It states that the combination of positive and negative beliefs about worry creates and sustains anxiety. A recent review argues that the model can be applied to children, but empirical support is lacking. The aim of the 2 presented studies was to explore the applicability of the model in a childhood sample. The first study employed a Danish community sample of youth (n = 587) ages 7 to 17 and investigated the relationship between metacognitions, worry and anxiety. Two multiple regression analyses were performed using worry and metacognitive processes as outcome variables. The second study sampled Danish children ages 7 to 12, and compared the metacognitions of children with a GAD diagnosis (n = 22) to children with a non-GAD anxiety diagnosis (n = 19) and nonanxious children (n = 14). In Study 1, metacognitive processes accounted for an additional 14% of the variance in worry, beyond age, gender, and anxiety, and an extra 11% of the variance in anxiety beyond age, gender, and worry. The Negative Beliefs about Worry scale emerged as the strongest predictor of worry and a stronger predictor of anxiety than the other metacognitive processes and age. In Study 2, children with GAD have significantly higher levels of deleterious metacognitions than anxious children without GAD and nonanxious children. The results offer partial support for the downward extension of the metacognitive model of generalized anxiety disorders to children.

Effects of Age and Anxiety on Processing Threat Cues in Healthy Children

This study investigated relationships between childhood anxiety, chronological age, and threat processing biases. It used a cross-sectional design comparing younger and older children, separated using a median-split on trait anxiety scores into low-anxious versus moderately-anxious groups. Participants were 67 schoolchildren, aged 7–14 years, who completed emotional Stroop and visual probe tasks with angry, happy, and neutral faces. Results from both tasks showed (i) a main effect of age on emotion processing, i.e., increased bias for emotional relative to neutral faces in younger than older children, and (ii) a moderating effect of age on anxiety-related bias for threat. That is, on the modified Stroop task, an enhanced processing bias for angry faces, relative to neutral faces, was found only in the group of moderately-anxious younger children. This bias appeared to be specific to angry faces, as it was not found for happy faces. On the visual probe task, moderately-anxious younger children also showed an enhanced attentional bias for angry faces, relative to neutral faces; in addition, they also showed a similar bias for happy relative to neutral faces. Taken together, findings suggest that moderately-anxious younger children show enhanced processing of threat, relative to neutral information, and that this anxiety-related threat bias lessens with age.

The Influence of Emotional Stimuli on Attention Orienting and Inhibitory Control in Pediatric Anxiety

BACKGROUND Anxiety disorders are highly prevalent in children and adolescents, and are associated with aberrant emotion-related attention orienting and inhibitory control. While recent studies conducted with high-trait anxious adults have employed novel emotion-modified antisaccade tasks to examine the influence of emotional information on orienting and inhibition, similar studies have yet to be conducted in youths. METHODS Participants were 22 children/adolescents diagnosed with an anxiety disorder, and 22 age-matched healthy comparison youths. Participants completed an emotion-modified antisaccade task that was similar to those used in studies of high-trait anxious adults. This task probed the influence of abruptly appearing neutral, happy, angry, or fear stimuli on orienting (prosaccade) or inhibitory (antisaccade) responses. RESULTS Anxious compared to healthy children showed facilitated orienting toward angry stimuli. With respect to inhibitory processes, threat-related information improved antisaccade accuracy in healthy but not anxious youth. These findings were not linked to individual levels of reported anxiety or specific anxiety disorders. CONCLUSIONS Findings suggest that anxious relative to healthy children manifest enhanced orienting toward threat-related stimuli. In addition, the current findings suggest that threat may modulate inhibitory control during adolescent development.

Exploring the Effect of Case Formulation Driven CBT for Children with Anxiety Disorders: A Feasibility Study

BACKGROUND Little is known about the effect of case-formulation based cognitive behaviour therapy (CBT) for anxious children. AIM The present study explores the feasibility of case-formulation driven CBT for anxious children. Parents were involved in treatment as either co-facilitators (involved only as the childs assistants, treatment being primarily directed at the child), or as co-clients (parents received therapy targeting theoretically established maintaining mechanisms; children received half of the sessions, parents the other half). METHOD Feasibility of the case-formulation driven CBT was established by comparing the completion rate and the percentage of children free of anxiety after treatment, with manualized treatments reported in existing meta-analyses. Children aged 7-12 years and their parents participated (n = 54). Families were assessed at pre- and posttreatment and at 6-month follow-up. RESULTS All families completed treatment and the percentage of recovery in the case-formulation driven approach was comparable to results obtained in manualized treatments. CONCLUSION The findings from this stage I study supports the notion that a case-formulation driven approach to CBT may be a feasible option when selecting treatment for anxious children; however, further studies must be conducted before firm conclusions can be drawn.