Efficacy of a transdiagnostic internet-based program for adolescents with emotional disorders: A randomized controlled trial.

OBJECTIVE: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is a well-established transdiagnostic cognitive-behavioral therapy (T-CBT) intervention. The aim of the present study was to examine the efficacy of the program Learn to Manage your Emotions [Aprende a Manejar tus Emociones] (AMtE), a self-applied transdiagnostic internet-delivered program based on the Spanish version of the UP-A. This is the first transdiagnostic internet-based program designed for the treatment of emotional disorders in adolescents. METHOD: A sample of Spanish adolescents with a primary diagnosis of an anxiety and/or depressive disorder (n = 58; age range = 12-18 years; 78.3% girls; 90% Caucasian) were randomly allocated to receive AMtE (n = 28) or the UP-A via videocall (n = 30). Pre-treatment, post-treatment and 3-month follow-up data were collected using self-reports and clinician-rated measures of anxiety, depression, positive and negative affect, anxiety sensitivity and emotional avoidance. RESULTS: Based on generalized estimating equations (GEE) models, both intervention programs were effective in significantly reducing self-reported anxiety and depressive disorder symptoms and clinician-rated severity of anxiety and depression, as well as self-reported transdiagnostic outcome variables. CONCLUSIONS: Data provide empirical support for the efficacy of AMtE as a transdiagnostic online CBT treatment for anxiety and depressive disorders in adolescents. No marked nor consistent differences were observed between the UP-A and AMtE, highlighting the potential usefulness of the online self-administered AMtE program.

The Spanish Version of the Childhood Anxiety Sensitivity Index: Factorial Dimensions and Invariance across Gender in a Sample of Adolescents.

Anxiety sensitivity is a transdiagnostic construct that has been associated with the etiology of emotional disorders, especially panic and other anxiety disorders. Although it is well known that, for the adult population, the factor structure of anxiety sensitivity includes three separate facets (physical, cognitive, and social concerns), the facets of anxiety sensitivity for adolescents have not yet been established. The main goal of the present study was to examine the factor structure of the Spanish version of the Childhood Anxiety Sensitivity Index (CASI). A large sample of nonclinical adolescents completed the Spanish version of the CASI in school settings (N = 1655; aged 11-17 years; 800 boys and 855 girls). Exploratory and confirmatory factor analyses of the full scale (CASI-18) indicate that a three first-order factor solution represents appropriately the three anxiety sensitivity facets previously defined for the adult population. The 3-factor structure had a better fit and was more parsimonious than a 4-factor solution. Results also indicate that the 3-factor structure remains invariant across genders. Girls scored significantly higher than boys on the total scale and on all three dimensions of anxiety sensitivity. In addition, the present study provides information concerning normative data for the scale. The CASI holds promise as a useful tool for assessing general and specific facets of anxiety sensitivity. It could be helpful for the assessment of this construct in clinical and preventive settings. The limitations of the study and suggestions for further research are outlined.

Prevention of Depression and Anxiety in Subclinical Adolescents: Effects of a Transdiagnostic Internet-Delivered CBT Program.

Anxiety and depressive symptoms are common problems in adolescence that could be addressed by means of preventive interventions. Even though transdiagnostic cognitive behavior therapy (T-CBT) is potentially an ideal strategy to deal with anxiety and depression, it has rarely been used for preventive purposes. In addition, so far, no study has used internet-delivered T-CBT to prevent anxiety and depression in adolescents. This study aimed to examine the utility of AMTE, an internet-delivered T-CBT program, for the indicated prevention of anxiety and depression in adolescents. AMTE was applied to 30 adolescents (56.7% females, age range = 12-18 years, Mage = 14.00, SDage = 1.89) who showed subclinical symptoms of anxiety and/or depression. Participants were assessed at pre- and post-treatment and follow-up (3 months). We found that after the program, the symptoms of self-reported anxiety and depression, clinician-rated symptom severity, and self-reported and parent-reported severity of the main problems had significantly improved. In addition, there were significant improvements in anxiety sensitivity and emotional avoidance. Finally, we found high feasibility and acceptability of the program. AMTE is feasible and potentially effective for the indicated prevention of anxiety and depression as well as of clinical transdiagnostic factors, in adolescents.

Effects of Coronavirus Fears on Anxiety and Depressive Disorder Symptoms in Clinical and Subclinical Adolescents: The Role of Negative Affect, Intolerance of Uncertainty, and Emotion Regulation Strategies.

Fears related to COVID-19 ("coronavirus fears") have emerged as a new psychological effect of the current COVID-19 pandemic and have been associated with psychological distress and impairment. Other adverse effects include an increase in anxiety and depression symptoms and the respective disorders. The purpose of the current study was to examine the incremental validity of coronavirus fears and transdiagnostic factors in the prediction of the severity of anxiety and depressive disorder symptoms. A sample of 144 adolescents [aged 12-18 years, 55 boys (38.2%) and 89 girls (61.8%)] most of whom showed elevated levels of anxiety and depressive disorder symptoms completed several self-report measures online assessing coronavirus fears, transdiagnostic vulnerability and protective factors, and emotion regulation strategies. Results based on a series of hierarchical multiple regression analyses revealed that coronavirus fears, negative affect, intolerance of uncertainty, acceptance/tolerance, rumination and suppression explained unique variance in the severity of anxiety and depressive disorder symptoms. Path analysis demonstrated that acceptance/tolerance, rumination and suppression mediated the association between higher level transdiagnostic factors and the severity of major depressive disorder symptoms. Findings provide support for the hierarchical transdiagnostic model of emotional disorders and suggest that clinicians should be aware of coronavirus fears. Also, the results warrant the need to consider transdiagnostic vulnerability and protective processes in the new protocols for the treatment of emotional disorders.

Clinical Utility of an Internet-Delivered Version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (iUP-A): A Pilot Open Trial.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al., 2018) has been shown to be effective for reducing symptoms of anxiety and depression in adolescents with emotional disorders. Internet-delivered psychological treatments have great potential to improve access to evidence-based psychological therapy since they are associated with reduced human and economic costs and less social stigma. Recently, our group developed an online version of the UP-A (the iUP-A) for the treatment of emotional disorders in adolescents. The aim of this pilot trial was to test the clinical utility of the iUP-A in a small sample (n = 12) of adolescents with elevated anxiety and/or depressive symptoms. Intention-to-treat and completer analyses revealed pre- to post-intervention self-reported decreases of anxiety and depressive symptoms, anxiety sensitivity, emotional avoidance, panic disorder symptoms, panic disorder severity, generalized anxiety disorder symptoms, pathological worry, and major depressive disorder symptoms. We found high feasibility and acceptability of the program with all participants and responsible parents reporting an improvement in the adolescents' ability to cope with emotions. Results suggest that the iUP-A may provide a new approach to improve access to treatment for anxious and depressive adolescents in Spain; however, further research must be conducted before firm conclusions can be drawn.

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Anxiety and Depression Prevention Program: An Initial Cluster Randomized Wait-List-Controlled Trial.

Anxiety and depression are common debilitating conditions that show high comorbidity rates in adolescence. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A; Ehrenreich-May et al., 2018) is one of the few existing resources aimed at applying transdiagnostic treatment principles across the core dysfunctions implicated in the development of both anxiety and depression using a single protocol. This is the first known controlled study to examine the efficacy of the UP-A adapted as a nine-session universal preventive intervention program delivered in a school setting. A total of 151 students (mean age: 15.05) participated in this randomized wait-list-controlled trial conducted in Madrid, Spain. An unexpected decline in anxiety and depression levels from pre- to posttreatment and follow-up was found in both groups (p = .009, d = -0.22), and overall differences between conditions did not reach significance. Exploratory analyses of baseline emotional symptom severity as a potential predictor trended toward a significantly greater decrease in symptoms of depression for those with greater baseline emotional symptoms in the UP-A group compared to the wait-list-control group. Future trials with larger samples are justified to estimate the effect of the UP-A adapted as a selective prevention program for anxiety and depression.

Spanish translation and validation of the Interpersonal Needs Questionnaire.

The present study reports the multistage development and evaluation of a Spanish translation of the Interpersonal Needs Questionnaire (INQ). The INQ measures the constructs of thwarted belongingness and perceived burdensomeness, which the interpersonal theory of suicide proposes are proximal causes of suicidal desire. Participants were bilingual Hispanic college students in the United States (n = 56), heritage Spanish-speaking college students in the United States (n = 281), college students in Spain (n = 1,016), psychiatric inpatients in Mexico (n = 181), college students in Mexico (n = 239), and Spanish-speaking U.S. adults (n = 104). Results indicated that a 9-item 2-factor solution (INQ-S-9) provided good fit. Multiple group analyses were also consistent with measurement invariance across nationalities and clinical severity. Finally, both subscale scores demonstrated good internal consistency, test-retest reliability, convergent validity, and concurrent associations with scores on measures of suicide ideation. Cultural considerations and implications for use in clinical and research settings are discussed. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The Spanish Version of the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) Adapted as a School-Based Anxiety and Depression Prevention Program: Study Protocol for a Cluster Randomized Controlled Trial.

BACKGROUND: Anxiety and depression are common, impairing conditions that evidence high comorbidity rates in adolescence. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Adolescents (UP-A) is one of the few existing resources aimed at applying transdiagnostic treatment principles to target core dysfunctions associated with both anxiety and depression within a single protocol. To our knowledge, this is the first study examining the efficacy of the UP-A adapted as a universal preventive intervention program. OBJECTIVE: The primary aim of this study is to examine whether the Spanish version of the UP-A is more effective than a waitlist (WL) control group in reducing and preventing symptoms of anxiety and depression when employed as a universal, classroom-based preventive intervention. The secondary aim is to investigate changes in a broad range of secondary outcome measures, including negative and positive affect, anxiety sensitivity, emotional avoidance, top problems ratings, school grades, depression and anxiety-related interference, self-esteem, life satisfaction, quality of life, conduct problems, hyperactivity/inattention symptoms, peer problems, prosocial behavior, school adjustment, and discipline problems. Other aims are to assess a range of possible predictors of intervention effects and to examine the feasibility and the acceptability of implementing UP-A in a prevention group format and in a school setting. METHODS: A cluster, randomized, WL, controlled trial design with classroom as the unit of randomization was used in this study. Five classes including a total of 152 adolescents were randomized to the experimental or WL control groups. Participants in the experimental group received 9 55-minute sessions delivered by advanced doctoral and masters students in clinical psychology. The WL control group will receive the intervention once the 3-month follow-up assessment is completed. RESULTS: We have recruited participants to the cluster randomized controlled trial (RCT) and have conducted the intervention with the experimental group. We expect the WL control group to complete the intervention in July 2017. Data analysis will take place during the second semester of 2017. CONCLUSIONS: We expect the experimental group to outperform the WL control group at post-intervention and 3-month follow-up. We also expect the WL control group to show improvements in primary and secondary outcome measures after receiving the intervention. Results will have implications for researchers, families, and education providers. TRIAL REGISTRATION: Clinicaltrials.gov NCT03123991; https://clinicaltrials.gov/ct2/show/NCT03123991 (Archived by WebCite at http://www.webcitation.org/6qp7GIzcR).

Psychometric properties of the spanish version of The Distress Tolerance Scale and its relationship with personality and psychopathological symptoms.

BACKGROUND: Distress tolerance is defined as the individual’s capacity to experience and withstand negative psychological states. The goal of this study was to examine the psychometric properties and the factor structure of the Spanish version of the Distress Tolerance Scale (DTS) and to test its relationship with psychopathological symptoms and personality. METHOD: A sample of 650 participants completed the DTS, the Eysenck Personality Questionnaire Revised–Abbreviated) (EPQR-A), and the Symptom Assessment-45 Questionnaire (SA-45). RESULTS: The DTS showed good internal consistency (Cronbach’s alpha) and adequate temporal stability (7-month test-retest). Results of a confirmatory factor analysis supported the hypothesized 4-factor structure (tolerance, appraisal, absorption, and regulation) that load onto a higher-order general factor. A structural equation model (SEM) was tested to provide evidence of construct validity. Neuroticism was inversely associated with distress tolerance, and distress tolerance partially mediated the effects of neuroticism on current symptoms. Results indicated that the Spanish DTS mediated associations between personality traits and current psychiatric symptoms. CONCLUSIONS: Results support the use of this version as a useful tool for assessing distress tolerance in clinical and research settings in Spanish-speaking countries. In addition, we found that distress tolerance may form a link between neuroticism and psychopathology.

Perceived parental child rearing and attachment as predictors of anxiety and depressive disorder symptoms in children: The mediational role of attachment.

The present study aimed to examine (a) the relative contribution of perceived parental child-rearing behaviors and attachment on anxiety and depressive symptoms, and (b) the role of attachment as a possible mediator of the association between parental rearing and anxiety and depression. A sample of 1002 children (aged 9-12 years) completed a booklet of self-report questionnaires measuring parental rearing behaviors, attachment towards peers, and DSM anxiety and depressive disorder symptoms. We found that parental aversiveness, parental neglect, and fearful/preoccupied attachment, each accounted for a significant amount of the variance in both anxiety and depressive symptoms. In addition, parental overcontrol was found to account for unique variance in anxiety whereas communication/warmth accounted for a significant proportion of the variance in depression. A relevant finding was that fearful/preoccupied attachment was found to mediate the association between parental rearing behaviors and both anxiety and depression. Parental rearing behaviors and attachment to peers may act as risk factors to the development and/or maintenance of anxiety and depressive symptomatology in children. Findings may contribute to outline preventive and/or treatment programs to prevent or reduce both clinical anxiety and depression during childhood.

Anxiety sensitivity, catastrophic misinterpretations and panic self-efficacy in the prediction of panic disorder severity: towards a tripartite cognitive model of panic disorder.

The present study examined the contribution of three main cognitive factors (i.e., anxiety sensitivity, catastrophic misinterpretations of bodily symptoms, and panic self-efficacy) in predicting panic disorder (PD) severity in a sample of patients with a principal diagnosis of panic disorder. It was hypothesized that anxiety sensitivity (AS), catastrophic misinterpretation of bodily sensations, and panic self-efficacy are uniquely related to panic disorder severity. One hundred and sixty-eight participants completed measures of AS, catastrophic misinterpretations of panic-like sensations, and panic self-efficacy prior to receiving treatment. Results of multiple linear regression analyses indicated that AS, catastrophic misinterpretations and panic self-efficacy independently predicted panic disorder severity. Results of path analyses indicated that AS was direct and indirectly (mediated by catastrophic misinterpretations) related with panic severity. Results provide evidence for a tripartite cognitive account of panic disorder.

[SA-45: a brief form of the SCL-90]. / SA-45: forma abreviada del SCL-90.

The Symptom Assessment-45 Questionnaire (SA-45) is a 45-item self-report instrument of psychiatric symptomatology derived from the original SCL-90. The SA-45 consists of nine 5-item scales assessing each of the same symptom domains as its parent instrument with no item overlap across domains. This paper provides preliminary validation of the Spanish version of the questionnaire in an undergraduate sample. Exploratory and confirmatory factor analyses supported a 9-factor structure, which corresponds to the nine proposed scales. Normative data, reliability (internal consistency) and validity were also examined, finding support for sound psychometric properties.

Body vigilance: bi-national examination of the construct.

Two inter-related studies evaluated the measurement model and construct validity of body vigilance, as indexed by the body vigilance scale [BVS; Schmidt et al., 1997: J Consulting Clin Psychol 65:214-220]. Confirmatory factor analyses (CFA) and convergent, discriminant, and incremental tests of validity of body vigilance were conducted among separate nonclinical samples from the United States (US) (study 1) and Spain (study 2). In both the US and Spanish samples, poor fit for the four-item unidimensional measurement model of body vigilance was observed; good fit, however, was found for a unidimensional, three-item measurement model. Subsequent analyses demonstrated both theoretically predicted as well as a number of unexpected associations between body vigilance and a variety of theoretically relevant external criterion variables. Results are discussed in terms of their clinical implications for advancing assessment of body vigilance and theoretical implications for better understanding the nomological nature of the construct.

The role of negative and positive affectivity on perceived stress-subjective health relationships.

This article reviews the arguments that support the approach regarding the 'inflationary' influence of the negative affectivity (NA) trait, or neuroticism, on relationships between perceived stress (e.g. different means of self-report of psychosocial stress such as major life events or daily stress) and subjective physical health (e.g. somatic symptomatology, health complaints). It has been explained that the said inflationary effect could distort the interpretation of the results that are found if it is done in terms of stress-objective health relationships (known in terms of health behavior, biological markers, morbidity and mortality) and that, in this sense, the NA would be a contaminant. This is why it has been suggested that in these cases, the effect of NA on predictor and criterion relationships should be controlled. The present critical review doesn't support these conclusions. Also, this paper deals with the empirical analysis of some matters that refer to one of the arguments mentioned, namely that NA is a general and penetrating factor that impregnates perceived stress (we will focus on daily stress or hassles) and subjective health measures (we will focus on somatic symptoms), as well as its relationships. We also analyze the role of positive affectivity (PA). The empirical analysis carried out uses a combination of within and interindividual methods. Contrary to the hypothesis regarding the moderating effects (specifically, inflationary) of NA on relationships between daily stress and somatic symptomatology, NA has only presented direct significant effects on both variables (between subjects), while its moderating effects are modest and non-significant. However, PA appears not to have any direct significant effects, but it does have moderating effects (specifically, buffering effects). Finally, we discuss the implications of these findings and we make some suggestions for future research.

Resistance to extinction of conditioned electrodermal responses: a study of the incubation fear hypothesis.

In the present study we examined Eysenck's incubation hypothesis of fear. Probability of skin conductance response (SCR) was analyzed for a sample of 79 undergraduate women, ranging in age from 18 to 25 years. Different groups of participants were conditioned to two levels of unconditioned stimuli (UCS) intensity and presented to three levels of unreinforced conditioned stimuli (CS) exposures (extinction phase) in a delay differential conditioning paradigm. The CSs were fear-relevant slides (snakes and spiders) and the UCSs were aversive tones. Analysis did not show a clear incubation effect; instead an increased resistance to extinction of SCR probability in association to the high-UCS and the short unreinforced CS presentation was evident. Findings support partially Eysenck's incubation theory of fear/anxiety.

Adverse psychological effects in women attending a second-stage breast cancer screening.

OBJECTIVE: The purpose of this study was to examine the emotional and psychopathological impact associated with a second-stage screening for breast cancer. METHOD: We used a short-term longitudinal design. Interviews were conducted with 1195 women of 45-65 years old in three temporal conditions (premammogram, postmammogram, and follow-up). Participants included women attending for regular breast cancer screening who were recalled for a further mammogram (i.e., second-stage breast cancer screening) and women who were not recalled. Affective-cognitive concerns about cancer (worry, fear, and perceived vulnerability) were rated using a 10-point Likert scale. Psychopathology was assessed using the Hopkins Symptom Check List-Revised (SCL-90-R). RESULTS: Women attending the second-stage screening exhibited significantly higher levels of breast cancer worries, fears, and beliefs than women attending for routine screening before obtaining the results of the mammogram. This affective-emotional impact disappeared quickly and was not relevant 2 months following the mammogram. Despite the fact that levels of psychopathological symptoms were higher in the premammogram condition, there were no differences between groups on these measures. CONCLUSION: These results provide support for the hypothesis that women recalled for further mammograms tend to experience high levels of affective-cognitive distress but not psychopathological symptoms. Moreover, results do not sustain the prediction that this psychological impact persists beyond receipt of a negative result. Some recommendations to reduce these psychological side effects are suggested.