Sam Cartwright-Hatton

Beliefs about worry and intrusions: the Meta-Cognitions Questionnaire and its correlates.

This report describes the development of the Meta-Cognitions Questionnaire to measure beliefs about worry and intrusive thoughts. Factor analyses of the scale demonstrated five empirically distinct and relatively stable dimensions of meta-cognition. Four of the factors representing beliefs were: Positive Beliefs About Worry: Negative Beliefs About the Controllability of Thoughts and Corresponding Danger; Cognitive Confidence; and Negative Beliefs about Thoughts in General, including Themes of Superstition, Punishment and Responsibility. The fifth factor represented Meta-Cognitive processes-Cognitive Self-Consciousness-a tendency to be aware of and monitor thinking. The measure showed good psychometric properties on a range of indices of reliability and validity. Scores on the questionnaire subscales predicted measures of worry proneness, proneness to obsessional symptoms, and anxiety. Regression analyses showed that the independent predictors of worry were: Positive Beliefs about Worry; Negative Beliefs About the Controllability of Thoughts and Corresponding Danger: and Cognitive Confidence. Significant differences in particular MCQ subscales were demonstrated between patients with intrusive thoughts, clinical controls and normals. The implications of these findings for models of worry and intrusive thoughts are discussed.

A New Parenting-Based Group Intervention for Young Anxious Children: Results of a Randomized Controlled Trial

OBJECTIVEnDespite recent advances, there are still no interventions that have been developed for the specific treatment of young children who have anxiety disorders. This study examined the impact of a new, cognitive-behaviorally based parenting intervention on anxiety symptoms.nnnMETHODnFamilies of 74 anxious children (aged 9 years or less) took part in a randomized controlled trial, which compared the new 10-session, group-format intervention with a wait-list control condition. Outcome measures included blinded diagnostic interview and self-reports from parents and children.nnnRESULTSnIntention-to-treat analyses indicated that children whose parent(s) received the intervention were significantly less anxious at the end of the study than those in the control condition. Specifically, 57% of those receiving the new intervention were free of their primary disorder, compared with 15% in the control condition. Moreover, 32% of treated children were free of any anxiety diagnosis at the end of the treatment period, compared with 6% of those in the control group. Treatment gains were maintained at 12-month follow-up.nnnCONCLUSIONSnThis new parenting-based intervention may represent an advance in the treatment of this previously neglected group.

Future directions for child anxiety theory and treatment

The aim of this introductory paper, and of this special issue of Cognition and Emotion, is to stimulate debate about theoretical issues that will inform child anxiety research in the coming years. Papers included in this special issue have arisen from an Economic and Social Research Council (ESRC, UK) funded seminar series, which we called Child Anxiety Theory and Treatment (CATTS). We begin with an overview of the CATTS project before discussing (1) the application of adult models of anxiety to children, and (2) the role of parents in child anxiety. We explore the utility of adult models of anxiety for child populations before discussing the problems that are associated with employing them uncritically in this context. The study of anxiety in children provides the opportunity to observe the trajectory of anxiety and to identify variables that causally influence its development. Parental influences are of particular interest and new and imaginative strategies are required to isolate the complex network of causal relationships therein. We conclude by suggesting that research into the causes and developmental course of anxiety in children should be developed further. We also propose that, although much is known about the role of parents in the development of anxiety, it would be useful for research in this area to move towards an examination of the specific processes involved. We hope that these views represent a constructive agenda for people in the field to consider when planning future research.

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.

Parenting in mothers with borderline personality disorder and impact on child outcomes

Question This systematic review explores two questions: what parenting difficulties are experienced by mothers with borderline personality disorder (BPD); and what impact do these have on her children? Study selection and analysis Studies had to include mothers with a diagnosis of BPD, who was the primary caregiver to a child/children under 19u2005years. PsycINFO and MEDLINE were screened (update: July 2014), yielding 17 relevant studies. Findings Mothers with BPD are often parenting in the context of significant additional risk factors, such as depression, substance use and low support. Interactions between mothers with BPD and their infants are at risk of low sensitivity and high intrusiveness, and mothers have difficulty in correctly identifying their emotional state. Levels of parenting stress are high, and self-reported competence and satisfaction are low. The family environment is often hostile and low in cohesion, and mothers with BPD show low levels of mind-mindedness but high levels of overprotection of older children. Outcomes for children are poor compared with both children of healthy mothers, and mothers with other disorders. Infants of mothers with BPD have poorer interactions with their mother (eg, less positive affect and vocalising, more dazed looks and looks away). Older children exhibit a range of cognitive–behavioural risk factors (eg, harm avoidance, dysfunctional attitudes and attributions), and have poorer relationships with their mothers. Unsurprisingly, given these findings, children of mothers with BPD have poorer mental health in a range of domains. Conclusions This review highlights the elevated need for support in these mother–child dyads.

A Meta-Analysis of Transdiagnostic Cognitive Behavioural Therapy in the Treatment of Child and Young Person Anxiety Disorders

BACKGROUNDnPrevious meta-analyses of cognitive-behavioural therapy (CBT) for children and young people with anxiety disorders have not considered the efficacy of transdiagnostic CBT for the remission of childhood anxiety.nnnAIMnTo provide a meta-analysis on the efficacy of transdiagnostic CBT for children and young people with anxiety disorders.nnnMETHODSnThe analysis included randomized controlled trials using transdiagnostic CBT for children and young people formally diagnosed with an anxiety disorder. An electronic search was conducted using the following databases: ASSIA, Cochrane Controlled Trials Register, Current Controlled Trials, Medline, PsycArticles, PsychInfo, and Web of Knowledge. The search terms included anxiety disorder(s), anxi*, cognitive behavio*, CBT, child*, children, paediatric, adolescent(s), adolescence, youth and young pe*. The studies identified from this search were screened against the inclusion and exclusion criteria, and 20 studies were identified as appropriate for inclusion in the current meta-analysis. Pre- and posttreatment (or control period) data were used for analysis.nnnRESULTSnFindings indicated significantly greater odds of anxiety remission from pre- to posttreatment for those engaged in the transdiagnostic CBT intervention compared with those in the control group, with children in the treatment condition 9.15 times more likely to recover from their anxiety diagnosis than children in the control group. Risk of bias was not correlated with study effect sizes.nnnCONCLUSIONSnTransdiagnostic CBT seems effective in reducing symptoms of anxiety in children and young people. Further research is required to investigate the efficacy of CBT for children under the age of 6.

Maternal anxiety and cognitive biases towards threat in their own and their child's environment

Cognitive biases are known to play an important role in anxiety. In this study we investigate whether maternal anxiety is associated with biases in interpretation, attention, and catastrophic processing about self-referent stimuli that may signal potential threat in the mothers own environment. We also investigate whether maternal anxiety is associated with biases about stimuli that their own child may encounter or to child-related stimuli more broadly. Three hundred mothers with a child aged 6 to 10 years participated. All participants completed a trait anxiety measure and an ambiguous sentences task to assess interpretation bias for self- and child-referent situations. A subset of the sample completed a catastrophizing interview about a self- (n = 194) or child-referent (n = 99) worry topic and an attentional dot-probe task (n = 99) with general threat and child threat stimuli. Maternal anxiety was not significantly associated with an attentional bias for general or child threat stimuli but was significantly associated with a bias for threat interpretations of both self and child-referent situations. Higher maternal anxiety was also significantly associated with generating more catastrophic outcomes to both a self-referent and child-referent hypothetical worry situation. We consider whether maternal cognitive biases, which extend to influence how mothers process potential threats in their childs world, may be an important mechanism through which intergenerational transmission of anxiety could occur.

What do Parents Worry About? Examination of the Construct of Parent Worry and the Relation to Parent and Child Anxiety

BACKGROUNDnPrevious research has indicated that parent cognition, including anxious beliefs and expectations, are associated with both parent and child anxiety symptoms and may be transferred from parent to child. However, the content and frequency of parent worry in relation to their children has yet to be examined as a potential form of anxious parent cognition, and little is known about normative parent worry.nnnAIMSnThe purpose of the current study is to extend the research on parent cognition and child anxiety by focusing on parent worry (i.e. parent worry in relation to their children) as a potential predictor of child anxiety.nnnMETHODnA comprehensive self-report measure of parent worry was developed and administered to a community-based sample of parents.nnnRESULTSnAn exploratory factor analysis yielded a single factor solution. Parent worry was found to be a more robust predictor of child anxiety than parent anxiety symptoms, and parent worry mediated the association between parent anxiety symptoms and child anxiety. Most common worries reported by parents fell within the domains of life success and physical well-being.nnnCONCLUSIONnOverall, this study adds to the literature on parent cognitive biases and has the potential to inform parent-based interventions for the treatment of child anxiety. Further, this study provides initial data on normative parent worry.

Maternal disciplinary style with preschool children: Associations with children's and mothers' trait anxiety

This study explored associations between maternal discipline, maternal trait anxiety and anxiety in preschool-aged children. The sample comprised 47 mothers and their children, aged 2-3 years. Maternal discipline was assessed by maternal self-report; and child anxiety by maternal and play leader report. Positive associations were found between self-reported, ineffective, maternal discipline and symptoms of anxiety in preschool-aged children. Associations were not found between self-reported verbose discipline (long reprimands or reliance on talking) and preschoolers anxiety. There were also no associations between play leaders reports of preschoolers anxiety and any of the mothers self-reported discipline measures. Positive associations were found between maternal trait anxiety and the use of self-reported ineffective disciplinary behaviours. Over-reactive discipline was shown to be a stronger predictor of preschoolers anxiety symptoms than maternal anxiety or lax discipline. It was concluded that childrens internalizing symptoms (according to mother report) may be associated with use of ineffective disciplinary strategies. Increased use of these strategies was also associated with anxiety in mothers, and it is suggested that use of ineffective discipline strategies might partially account for the association between maternal and child anxiety.

Metacognitive beliefs in adolescents with an at‐risk mental state for psychosis.

The self‐regulatory executive function model suggests that metacognitive beliefs play a role in all forms of psychological disorder, including psychosis. However, our understanding of these beliefs and their relationship with symptoms in adolescents with an at‐risk mental state (ARMS) for psychosis is limited.