Susan M. Bögels

Social anxiety disorder: Questions and answers for the DSM-V.

Background: This review evaluates the DSM‐IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM‐IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues. Method: A literature review was conducted, using the validators provided by the DSM‐V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM‐V. Results/Conclusions: Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a “predominantly performance” variety of SAD. A specifier based on “fear of showing anxiety symptoms” (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young childs avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options. Depression and Anxiety, 2010.

Mindfulness Training for Adolescents with Externalizing Disorders and their Parents

Mindfulness training was evaluated as a new treatment for attention and impulsivity problems in adolescents with a variety of different externalizing disorders: attention deficit-hyperactivity disorder, oppositional-defiant and/or conduct disorder, and autism spectrum disorder if characterized by externalizing problem behaviour. It was argued that the large overlap between these three disorders may be partially explained by common underlying attention and behaviour control deficits. Fourteen clinically referred adolescents suffering from externalizing disorders followed mindfulness training in a group format. Parallel, their parents received mindful parenting training. Adolescents and their parents were measured before and after waitlist, after 8-week training, and at 8-week follow-up. No improvement occurred during waitlist on most variables. After mindfulness training, children self-reported substantial improvement on personal goals, internalizing and externalizing complaints, attention problems, happiness, and mindful awareness, and performed better on a sustained attention test. Likewise, parents reported improvement on childrens goals, externalizing and attention problems, self-control, attunement to others and withdrawal. In addition, parents improved on their own goals. Improvement was maintained 8 weeks after the training. Consistent with mindfulness theory, increased child awareness after training predicted longer-term improvement in parent-rated child symptoms. Concomitant parent and child mindfulness training appears to be a promising approach for clinic-referred adolescents with attention and impulsivity problems.

Dysfunctional Cognitions in Children with Social Phobia, Separation Anxiety Disorder, and Generalized Anxiety Disorder

According to cognitive theories of anxiety, anxious adults interpret ambiguous situations in a negative way: They overestimate danger and underestimate their abilities to cope with danger. The present study investigated whether children with social phobia, separation anxiety disorder, and generalized anxiety disorder have such a bias, compared to a clinical and a normal control group. Children were exposed to stories in which ambiguous situations were described, and asked to give their interpretations, using open and closed responses. Results showed that anxious children reported more negative cognitions than control children. However, anxious children did not overestimate danger on the free responses, but they did judge the situations as more dangerous on the closed responses. Anxious children had lower estimations of their own competency to cope with danger than the control groups on both open and closed responses. The results indicate that children with anxiety disorders have dysfunctional cognitions about ambiguous situations.

Research Review: The relation between child and parent anxiety and parental control: a meta‐analytic review

BACKGROUND There is growing research interest in the association between parental control and child anxiety. Parental control may enhance child anxiety and parents may exert control in anticipation of their childs anxiety-related distress. Moreover, high levels of anxiety in parents could influence the development of parental control. Whereas past reviews have solely examined the relation between child anxiety and parental control, this meta-analysis focuses on the associations between both child and parent anxiety and parental control. METHODS The associations of parent anxiety and child anxiety with observed parental control (k = 23 studies, N = 1,305 parent-child dyads) were investigated using a meta-analytic approach. Moreover, factors were identified that may function as moderators of these relations, such as parent and child gender, family socioeconomic status, child age, and design and measurement characteristics. RESULTS A substantial association between child anxiety and parental control (d = .58) was found. Moderator analyses yielded the strongest effect sizes for studies with an overrepresentation of girls, for school-aged children, for families from higher socioeconomic backgrounds, and for studies using a discussion task to assess parental control. Although a nonsignificant relation was found for the relation between parent anxiety and parental control (d = .08), small but significant effects were found for school-aged children, for studies using a discussion task to assess parental control, and for samples with an overrepresentation of boys. CONCLUSIONS As the direction of the association between child anxiety and parental control is unknown, future studies should use experimental designs to further explore the causal link between child anxiety and parental control.

The influence of emotion-focused rumination and distraction on depressive symptoms in non-clinical youth: a meta-analytic review

This review examined evidence for some core predictions of the response styles theory (RST) concerning the relation between response styles and symptoms of depression and gender differences in the use of response styles in non-clinical children and adolescents. In summarizing the literature, effect sizes (pooled correlation coefficients) were calculated for cross-sectional and longitudinal studies. Stability of the obtained effect sizes was evaluated by means of a fail-safe N analysis. Results indicated that stable and significant effect sizes were found for rumination being associated with concurrent and future levels of depression. When controlling for baseline levels of depression, effect sizes for rumination and distraction were not stable, indicating that these findings should be interpreted with considerable caution. Finally, significant and stable effect sizes for gender differences in response styles were found only for rumination among adolescents. Taken together, the findings partly support the predictions of the response styles theory examined in this meta-analysis and may implicate that rumination is a cognitive vulnerability factor for depressive symptoms among adolescents.

Child versus family cognitive-behavioral therapy in clinically anxious youth: An efficacy and partial effectiveness study

OBJECTIVE The efficacy and partial effectiveness of child-focused versus family-focused cognitive-behavioral therapy (CBT) for clinically anxious youths was evaluated, in particular in relation to parental anxiety disorders and childs age. METHOD Clinically referred children with anxiety disorders (N = 128) and their parents were randomly assigned to child or family CBT and evaluated at pretreatment, posttreatment, and 3-month follow-up. Twenty-five families were measured before and after a 2- to 3-month waitlist period. RESULTS None of the waitlisted children recovered from their anxiety disorders. In contrast, 41% of the treated children no longer met criteria for any anxiety disorder after CBT, and 52% demonstrated continued improvement at the 3-month follow-up. Significantly more children were free of anxiety disorders (53%) in the child CBT condition compared with family CBT condition (28%) at posttreatment, whereas at 3-month follow-up, the superior effect of child CBT was no longer significant. Similar results were obtained from the questionnaire measures. Both child and family CBT were less effective if parents had an anxiety disorder themselves. On some of the measures, child CBT was superior if parents had anxiety disorders themselves, whereas family CBT was superior if parents had no anxiety disorders. Finally, younger children had better outcomes than older children, regardless of the treatment condition. CONCLUSIONS Overall, child CBT seems slightly more beneficial than family CBT. Because this study was conducted in a clinical setting with clinically referred children, results indicate partial effectiveness for child CBT.

Family processes in the development of youth depression: translating the evidence to treatment

There is strong evidence that family factors play a role in the development, maintenance and course of youth depression. However, to date few clinical trials of psychotherapy for youth depression employ family therapy interventions or target the known family risk factors. This is surprising given recent meta-analytic findings showing only modest effect sizes for psychotherapy for youth depression, and that cognitive therapies do not outperform non-cognitive therapies. The aim of this review is to 1) use a developmental systems approach to review empirical evidence on family risk factors for youth depression to identify potential targets for treatment, 2) examine the extent to which these family risk factors have been targeted in clinical trials for youth depression, and 3) provide a road map for the development of empirically validated family-based interventions for youth depression. Strong evidence was found supporting a relationship between family factors at multiple system levels and depressive symptoms or disorders. Support for several different hypothesized causal mechanisms as well as bidirectional effects was found. A comparison of the identified risk factors and psychotherapy trials for youth depression indicated that few RCTs target family factors; among those that do, only a few of the family risk factors are targeted. Recommendations for translation of empirical knowledge of family risk factors and mechanisms to develop empirically valid family-based interventions to enhance existing treatments for youth depression are provided.

The Relation Between Insecure Attachment and Child Anxiety: A Meta-Analytic Review

Attachment theory suggests that childrens attachment insecurity plays a key role in the development of anxiety. In the present study we evaluated the empirical evidence for the link between insecure attachment and anxiety from early childhood to adolescence. A meta-analysis of 46 studies, from 1984 to 2010, including 8,907 children, was conducted. The results show an overall effect size of r = .30, indicating that attachment is moderately related to anxiety. Moderator analyses indicated that ambivalent attachment showed the strongest association with anxiety. Further, the relation was stronger during adolescence, when attachment and anxiety were measured through questionnaires, when the informant was the child, when attachment was measured as internal working model, in cross-sectional studies, and in studies conducted in Europe. No difference was found between studies that measured anxiety as symptoms or as a disorder, and when different kinds of anxiety were considered.

Psychometric Properties of the Five Facets Mindfulness Questionnaire (FFMQ) in a Meditating and a Non-Meditating Sample.

The factor structure, internal consistency, construct validity, and predictive validity of the Dutch version of the Five Facet Mindfulness Questionnaire (FFMQ-NL) were studied in a sample of meditators (n = 288) and nonmeditators (n = 451). A five-factor structure was demonstrated in both samples, and the FFMQ-NL and its subscales were shown to have good internal consistencies. Meditators scored higher on all facets of the FFMQ-NL than the participants in the nonmeditating sample. For both samples, expected negative correlations between most mindfulness facets (all except for the Observing facet) and the constructs of alexithymia, thought suppression, rumination, worry, and dissociation were found. The Observing facet of the FFMQ-NL showed an unexpected positive correlation with thought suppression in the nonmeditating sample. Furthermore, as expected, mindfulness facets were negatively related to psychological symptoms, and all mindfulness facets except for Observing and Describing significantly predicted psychological symptoms. Overall, the Dutch FFMQ demonstrated favorable psychometric properties, commensurate with its (original) English language version.

Mindful parenting in mental health care

Mindfulness is a form of meditation based on the Buddhist tradition, which has been used over the last two decades to successfully treat a multitude of mental health problems. Bringing mindfulness into parenting (“mindful parenting”) is one of the applications of mindfulness. Mindful parenting interventions are increasingly being used to help prevent and treat mental disorders in children, parenting problems, and prevent intergenerational transmission of mental disorders from parents to children. However, to date, few studies have examined the hypothesized mechanisms of change brought about by mindful parenting. We discuss six possible mechanisms through which mindful parenting may bring about change in parent–child interactions in the context of child and parent mental health problems. These mechanisms are hypothesized to be mediated by the effects of mindfulness on parental attention by: (1) reducing parental stress and resulting parental reactivity; (2) reducing parental preoccupation resulting from parental and/or child psychopathology; (3) improving parental executive functioning in impulsive parents; (4) breaking the cycle of intergenerational transmission of dysfunctional parenting schemas and habits; (5) increasing self-nourishing attention; and (6) improving marital functioning and co-parenting. We review research that has applied mindful parenting in mental health settings, with a focus on evidence for these six mechanisms. Finally, we discuss directions for future research into mindful parenting and the crucial questions that this research should strive to answer.