Sanne M. Hogendoorn

Mediators of cognitive behavioral therapy for anxiety-disordered children and adolescents : cognition, perceived control, and coping

The purpose is to investigate whether a change in putative mediators (negative and positive thoughts, coping strategies, and perceived control over anxious situations) precedes a change in anxiety symptoms in anxiety-disordered children and adolescents receiving cognitive behavioral therapy (CBT). Participants were 145 Dutch children (8–18 years old, M = 12.5 years, 57% girls) with a primary anxiety disorder. Assessments were completed pretreatment, in-treatment, posttreatment, and at 3-month follow-up. Sequential temporal dependencies between putative mediators and parent- and child-reported anxiety symptoms were investigated in AMOS using longitudinal Latent Difference Score Modeling. During treatment an increase of positive thoughts preceded a decrease in child-reported anxiety symptoms. An increase in three coping strategies (direct problem solving, positive cognitive restructuring, and seeking distraction) preceded a decrease in parent-reported anxiety symptoms. A reciprocal effect was found for perceived control: A decrease in parent-reported anxiety symptoms both preceded and followed an increase in perceived control. Using a longitudinal design, a temporal relationship between several putative mediators and CBT-outcome for anxious children was explored. The results suggest that a change in positive thoughts, but not negative thoughts, and several coping strategies precedes a change in symptom reduction and, therefore, at least partly support theoretical models of anxiety upon which the anxiety intervention is based.

HPA AXIS RELATED GENES AND RESPONSE TO PSYCHOLOGICAL THERAPIES: GENETICS AND EPIGENETICS.

Hypothalamic–pituitary–adrenal (HPA) axis functioning has been implicated in the development of stress‐related psychiatric diagnoses and response to adverse life experiences. This study aimed to investigate the association between genetic and epigenetics in HPA axis and response to cognitive behavior therapy (CBT).

An indirect and direct measure of anxiety-related perceived control in children: The Implicit Association Procedure (IAP) and Anxiety Control Questionnaire for Children (ACQ-C)

A perceived lack of control over negative events is assumed central to the development of anxiety disorders. So far, only questionnaires were used to test this theory, but they have several disadvantages. In this study, the Implicit Association Procedure (IAP) was adapted to measure anxiety-related perceived control in an indirect way. IAP data of 33 non-selected children were compared to a direct measure of perceived control, the Anxiety Control Questionnaire for Children (ACQ-C). Results showed that higher anxious children had lower perceived control over anxiety-related events than lower anxious children, on both the indirect and the direct measure.

Positive thinking in anxiety disordered children reconsidered

Negatively valenced thoughts are assumed to play a central role in the development and maintenance of anxiety. However, the role of positive thoughts in anxiety is rather unclear. In the current study we examined the role of negative and positive self-statements in the anxiety level of anxious and non-anxious children. Participants were 139 anxiety disordered children and 293 non-anxious children (8-18 years). Compared to non-anxious children, anxious children reported more negative thoughts, less positive thoughts and lower State of Mind (SOM) ratios (ratio of positive to negative thoughts). Negative thoughts and SOM ratios were the strongest predictors of anxiety level in anxious children; whereas both negative and positive thoughts were the strongest predictors of anxiety level in non-anxious children. To conclude, a lack of positive thoughts might be more than just an epiphenomenon of anxiety level and might deserve a place in the cognitive model of anxiety.

The time-course of threat processing in children: a temporal dissociation between selective attention and behavioral interference

Abstract Although selective attention to threatening information is an adaptive mechanism, exaggerated attention to threat may be related to anxiety disorders. However, studies examining threat processing in children have obtained mixed findings. In the present study, the time-course of attentional bias for threat and behavioral interference was analyzed in a community sample of 8–18-year-old children (N=33) using a pictorial dot probe task. Threatening and neutral stimuli were shown during 17 ms (masked), 500 ms, and 1250 ms. Results provide preliminary evidence of an automatic attentional bias for threat at 17 ms that persists during later, more controlled stages of information processing (500 and 1250 ms). Furthermore, participants showed a delayed response to threat-containing trials relative to neutral trials in the 500 and 1250 ms condition, which may indicate interference by threat. Together, these results suggest that an attentional bias for threat precedes behavioral interference in children. Furthermore, results indicate that performance in daily life can be temporarily interrupted by the processing of threatening information. In addition, results of earlier studies into selective attention in children using tasks based on behavioral responses may have been confounded by interference effects of threat. For future studies, we recommend to take behavioral interference into account.

Evaluating Statistical and Clinical Significance of Intervention Effects in Single-Case Experimental Designs: An SPSS Method to Analyze Univariate Data

Single-case experimental designs are useful methods in clinical research practice to investigate individual client progress. Their proliferation might have been hampered by methodological challenges such as the difficulty applying existing statistical procedures. In this article, we describe a data-analytic method to analyze univariate (i.e., one symptom) single-case data using the common package SPSS. This method can help the clinical researcher to investigate whether an intervention works as compared with a baseline period or another intervention type, and to determine whether symptom improvement is clinically significant. First, we describe the statistical method in a conceptual way and show how it can be implemented in SPSS. Simulation studies were performed to determine the number of observation points required per intervention phase. Second, to illustrate this method and its implications, we present a case study of an adolescent with anxiety disorders treated with cognitive-behavioral therapy techniques in an outpatient psychotherapy clinic, whose symptoms were regularly assessed before each session. We provide a description of the data analyses and results of this case study. Finally, we discuss the advantages and shortcomings of the proposed method.

Psychometric properties of a Dutch version of the Obsessive Beliefs Questionnaire--Child Version (OBQ-CV)

To improve research in cognitive theories of childhood OCD, a child version of the Obsessive Beliefs Questionnaire (OBQ-CV) has been developed (Coles et al., 2010). In the present study, psychometric properties of the Dutch OBQ-CV were examined in a community sample (N=547; 8-18 years) and an OCD sample (N=67; 8-18 years). Results revealed good internal consistency and adequate retest reliability (retest interval 7-21 weeks and 6-12 weeks, respectively). Children with OCD reported more beliefs than non-clinical children. Obsessive beliefs were related to self-reported OCD symptoms, but not to clinician-rated OCD severity. Beliefs were also related to anxiety and depression. This is the first study examining the factor structure of the OBQ-CV. Confirmatory factor analyses revealed best fit for four factors representing Perfectionism/Certainty, Importance/Control of Thoughts, Responsibility, and Threat, and a higher-order factor. This is in line with results from adult samples. These results support the reliability and validity of the Dutch OBQ-CV.

Automatic Evaluations in Clinically Anxious and Nonanxious Children and Adolescents

Automatic evaluations of clinically anxious and nonanxious children (n = 40, aged 8–16, 18 girls) were compared using a pictorial performance-based measure of automatic affective associations. Results showed a threat-related evaluation bias in clinically anxious but not in nonanxious children. In anxious participants, automatic evaluations of anxiety-relevant stimuli were more negative than those of negative stimuli. In nonanxious participants, evaluations of negative and anxiety-relevant stimuli did not differ. Furthermore, anxious youth had stronger negative evaluations of anxiety-relevant stimuli than nonanxious children. Automatic evaluations of positive, neutral, and negative stimuli did not differ between groups. Threat-related evaluations were predictive of parent-reported, but not child-reported, anxiety.

Perceived control in clinically anxious and non-anxious children indirectly measured with the Implicit Association Procedure (IAP)

BACKGROUND Perceived control is thought to play an important role in the development and maintenance of anxiety disorders in children. The objective of the present study was to further investigate the Perceived Control Implicit Association Procedure (IAP, Hogendoorn et al., 2008) as an indirect measure of perceived control in children. METHODS The IAP was completed by 136 anxiety disordered children (aged 8-18 years old, M = 12.51) and 31 non-selected children (8-15 years old, M = 11.65). A second control group of 38 non-selected children (aged 8-18 years old, M = 12.08) was used to validate the pictorial stimuli in the computer task. RESULTS First, children were able to correctly classify the pictures into Control and No control categories. Second, as predicted, anxious children reported less perceived control than the control group on both the direct measure (the ACQ-C) and the indirect measure (IAP). For the No Control score however, this was only the case for children younger than twelve years old. Third, test-retest correlation in the anxious group was fair to good (ICCs .57-.58). CONCLUSIONS These results suggest that the perceived control IAP is still quite experimental, but could be an interesting departure point for future research on perceived control in children.

Psychometric properties of the Dutch version of the Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A) in non-clinical adolescents and adolescents with obsessive-compulsive disorder

Although the meta-cognitive model (Wells, 1997, 2000) for obsessive-compulsive disorder (OCD) has clearly influenced research and treatment of OCD, little research has been performed in youth samples. In the present study the psychometric properties of the Dutch Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A; Cartwright-Hatton et al., 2004) were examined in a clinical sample of adolescents with OCD (N = 40, 12-18 years) and a non-clinical sample (N = 317; 12-18 years). Results provided support for the 5-factor structure, and showed fair to good internal consistency and generally good retest reliability. Overall, adolescents with OCD reported more meta-cognitive beliefs than non-clinical adolescents. Several subscales were associated with self-reported obsessive-compulsive symptoms, anxiety and depression, but not with clinician-rated OCD severity. In conclusion, results suggest that the Dutch MCQ-A is a reliable and valid questionnaire to examine meta-cognitive beliefs in adolescents.