Yasmin Rey

Evaluating the Interpersonal Needs Questionnaire: Comparison of the Reliability, Factor Structure, and Predictive Validity across Five Versions

Five versions of the Interpersonal Needs Questionnaire (INQ), a self-report measure of perceived burdensomeness and thwarted belongingness, have been used in recent studies (including 10-, 12-, 15-, 18-, and 25-items). Findings regarding the associations between perceived burdensomeness, thwarted belongingness, and suicidal ideation using different versions have been mixed, potentially due to differences in measurement scales. This study evaluated factor structure, internal consistency, and concurrent predictive validity of these five versions in three samples. Samples 1 and 2 were comprised of 449 and 218 undergraduates, respectively; Sample 3 included 114 adolescent psychiatric inpatients. All versions demonstrated acceptable internal consistency. The 10-item version and 15-item version demonstrated the best, most consistent model fit in confirmatory factor analyses. Both perceived burdensomeness and thwarted belongingness consistently predicted concurrent suicidal ideation on the 10-item INQ only. Future research should consider using the 15-item or 10-item versions.

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).

Factor Structure and Psychometric Properties of English and Spanish Versions of the Edinburgh Postnatal Depression Scale Among Hispanic Women in a Primary Care Setting

BACKGROUND Although a number of studies have examined the factor structure of the Edinburgh Postnatal Depression Scale (EPDS) in predominately White or African American samples, no published research has reported on the factor structure among Hispanic women who reside in the United States. OBJECTIVE The current study examined the factor structure of the EPDS among Hispanic mothers in the United States. METHOD Among 220 Hispanic women, drawn from a pediatric primary care setting, with an infant aged 0 to 10 months, 6 structural models guided by the empirical literature were evaluated using confirmatory factor analysis. RESULTS Results supported a 2-factor model of depression and anxiety as the best fitting model. Multigroup models supported the factorial invariance across women who completed the EDPS in English and Spanish. CONCLUSION These findings provide initial support for the 2-factor structure of the EPDS among Hispanic women in the United States.

Failures in cognitive‐behavior therapy for children

This article discusses treatment failures in child therapy, specifically cognitive-behavioral therapy (CBT) for anxiety and its disorders. The theoretical foundations and principles of CBT are discussed first, followed by a summary of the treatment outcome literature. Also discussed is how treatment failure is defined and gauged in CBT, as well as factors implicated in treatment failure. A case illustration highlights these factors, which resulted in the child not advancing positively in treatment. The article concludes with key practice recommendations.

The Relations between Anxiety Sensitivity and Anxiety Control in the Prediction of Anxiety Symptoms among Children and Adolescents

The present study investigated the relations between youth anxiety sensitivity and perceived anxiety control over Internal Reactions and perceived anxiety control over External Threats within the context of a (partially) mediated model in the prediction of anxiety symptoms. Youth sex also was investigated as a moderator of the conceptual model. The sample consisted of 333 children and adolescents (51.4% boys; M = 10.27 years old) referred to a youth anxiety disorders specialty research clinic. Findings showed that high anxiety sensitivity predicted high levels of anxiety symptoms for both boys and girls. Findings also showed that for both boys and girls, high anxiety sensitivity predicted low perceived anxiety control over Internal Reactions, as well as low perceived anxiety control over External Threats. Interestingly, perceived anxiety control over Internal Reactions was a partial mediator of the relation between anxiety sensitivity and anxiety for boys, but not girls. In contrast, perceived anxiety control over External Threats was a partial mediator of the relation between anxiety sensitivity and anxiety for girls, but not boys. The results are discussed within the context of the studys conceptual model as well as potential clinical implications.

Moving to Second-Stage Treatments Faster: Identifying Midtreatment Tailoring Variables for Youth with Anxiety Disorders

The current study presents an approach for empirically identifying tailoring variables at midtreatment of cognitive behavioral therapy (CBT) protocols for youth with anxiety disorders that can be used to guide moves to second-stage treatments. Using 2 independent data sets (Study 1 N = 240, M age = 9.86 years; Study 2 N = 341; M age = 9.53 years), we examined treatment response patterns after 8 sessions of CBT (i.e., CBT midtreatment). We identified and replicated 3 classes of response patterns at CBT midtreatment: Early Responders, Partial Responders, and Nonresponders. Class membership at CBT midtreatment was predictive of outcome at CBT posttreatment. Receiver operating characteristics curves were used to derive guidelines to optimize accuracy of assignment to classes at CBT midtreatment. These findings support the promise of treatment response at CBT midtreatment to identify tailoring variables for use in abbreviating first-stage treatments and facilitating moves to second-stage treatments.

Attentional Control Scale for Children: Factor Structure and Concurrent Validity Among Children and Adolescents Referred for Anxiety Disorders

OBJECTIVE The present study examined the factor structure and concurrent validity of the Attentional Control Scale for Children (ACS-C; Muris, de Jong, & Engelen, 2004), a youth self-rating scale of attentional control. METHOD A multisource assessment approach was used with 186 children and adolescents referred to an anxiety disorders specialty clinic. RESULTS Exploratory factor analysis yielded a 2-factor structure with internally consistent and moderately correlated subscales of Attentional Focusing and Attentional Shifting. Total ACS-C and subscale scores demonstrated significant associations with youth and parent ratings of youth anxiety symptoms, youth self ratings of depressive symptoms, and youth diagnosis of attention deficit-hyperactivity disorder. CONCLUSIONS These findings support use of the ACS-C as a self-rating scale of attentional control among referred youth. Future research is encouraged to examine retest reliability of the ACS-C and to evaluate whether its internal structure could be enhanced by removing or modifying items that performed poorly.

Assessment of Anxiety Disorders: Categorical and Dimensional Perspectives

This chapter provides an overview of evidence-based instruments for the assessment of pediatric anxiety disorders from both categorical and dimensional perspectives. The chapter begins with a brief discussion of a categorical perspective to pediatric anxiety assessment and how interview schedules best capture this perspective. This is followed by a summary of the most widely used interview schedules to assess pediatric anxiety, including the evidence base for accomplishing specific assessment goals (i.e., diagnosis and treatment evaluation). The chapter follows with a brief discussion on a dimensional perspective and how rating scales best capture this perspective. This is followed by a summary of the most widely used rating scales for assessing pediatric anxiety, including research support for their use across contexts (i.e., identifying and quantifying anxiety, screening, and treatment evaluation). Next is a brief summary of objective measures of pediatric anxiety. The chapter concludes with a discussion of future research directions.

Parental acculturation level moderates outcome in peer-involved and parent-involved CBT for anxiety disorders in Latino youth.

Cognitive-behavioral therapies (CBTs) are efficacious treatments for anxiety disorders in Latino youth. However, there is a gap in knowledge about moderators of CBT outcomes in Latino youth. This study addresses this gap by examining parental acculturation as a moderator of youth anxiety outcomes in a randomized controlled trial (RCT) of parent-involved CBT (CBT/P) and peer-involved group CBT (GCBT) in 139 Latino youth (ages 6 to 16 years; mean age = 9.68 years). Comparable youth anxiety reduction effects were found for CBT/P and GCBT. Parental acculturation to majority United States culture, but not identification with country of origin, significantly moderated youth anxiety outcomes: at low levels of parental acculturation to majority United States culture, youth posttreatment anxiety scores were lower in GCBT than CBT/P; at high levels of parental acculturation to majority United States culture, youth posttreatment anxiety scores were lower in CBT/P than GCBT. These findings provide further evidence for the efficacy of CBTs for anxiety disorders in Latino youth and also provide guidance for moving toward personalization of CBTs’ selection depending on parental acculturation levels. Las terapias cognitivo-conductuales (CBT) son tratamientos eficaces para los trastornos de ansiedad en jóvenes Latinos. Sin embargo, existe una limitación en el conocimiento sobre los moderadores de los resultados de CBT en jóvenes Latinos. El presente estudio aborda esta limitación al examinar el nivel de aculturación de los padres como moderador de resultados de CBT para la ansiedad en un estudio clínico controlado aleatorizado de CBT con participación de los padres (CBT/P) y CBT con pares en formato de grupo (GCBT) en 139 jóvenes Latinos (de 6 a los 16 años; edad promedio = 9.68 años). Se encontraron efectos comparables en la reducción de la ansiedad de los jóvenes entre CBT/P y GCBT. El nivel de aculturación de los padres moderó significativamente los resultados de la ansiedad de los jóvenes: a niveles bajos de aculturación de los padres, las puntuaciones de ansiedad de los jóvenes de postratamiento fueron más bajas en GCBT que en CBT/P; a niveles altos de aculturación de los padres, las puntuaciones de ansiedad de los jóvenes de postratamiento fueron más bajas en CBT/P que en GCBT. Estos resultados sugieren evidencia sobre la eficacia de las CBTs para los trastornos de ansiedad en jóvenes Latinos y también ofrecen una guía hacia la personalización de la selección de las CBTs según el nivel de aculturación de los padres.

The impact of treatment delivery format on response to cognitive behaviour therapy for preadolescent children with anxiety disorders

Background Several delivery formats of cognitive behaviour therapy (CBT) for child anxiety have been proposed, however, there is little consensus on the optimal delivery format. The primary goal of this study was to investigate the impact of the childs primary anxiety diagnosis on changes in clinical severity (of the primary problem) during individual CBT, group CBT and guided parent‐led CBT. The secondary goal was to investigate the impact of the childs primary anxiety diagnosis on rates of remission for the three treatment formats. Methods A sample of 1,253 children (5–12 years; Mage = 9.3, SD = 1.7) was pooled from CBT trials carried out at 10 sites. Children had a primary diagnosis of generalised anxiety disorder (GAD), social anxiety disorder (SoAD), specific phobia (SP) or separation anxiety disorder (SAD). Children and parents completed a semistructured clinical interview to assess the presence and severity of DSM‐IV psychiatric disorders at preintervention, postintervention and follow‐up. Linear mixture modelling was used to evaluate the primary research question and logistic modelling was used to investigate the secondary research question. Results In children with primary GAD, SAD or SoAD, there were no significant differences between delivery formats. However, children with primary SP showed significantly larger reductions in clinical severity following individual CBT compared to group CBT and guided parent‐led CBT. The results were mirrored in the analysis of remission responses with the exception that individual CBT was no longer superior to group CBT for children with a primary SP. The difference between individual and group was not significant when follow‐up data were examined separately. Conclusions Data show there may be greater clinical benefit by allocating children with a primary SP to individual CBT, although future research on cost‐effectiveness is needed to determine whether the additional clinical benefits justify the additional resources required.