The Healthy Primary School of the Future: study protocol of a quasi-experimental study.

BACKGROUND: Unhealthy lifestyles in early childhood are a major global health challenge. These lifestyles often persist from generation to generation and contribute to a vicious cycle of health-related and social problems. This design article presents a study evaluating the effects of two novel healthy school interventions. The main outcome measure will be changes in children's body mass index (BMI). In addition, lifestyle behaviours, academic achievement, child well-being, socio-economic differences, and societal costs will be examined. METHODS: In close collaboration with various stakeholders, a quasi-experimental study was developed, for which children of four intervention schools (n = 1200) in the southern part of the Netherlands are compared with children of four control schools (n = 1200) in the same region. The interventions started in November 2015. In two of the four intervention schools, a whole-school approach named 'The Healthy Primary School of the Future', is implemented with the aim of improving physical activity and dietary behaviour. For this intervention, pupils are offered an extended curriculum, including a healthy lunch, more physical exercises, and social and educational activities, next to the regular school curriculum. In the two other intervention schools, a physical-activity school approach called 'The Physical Activity School', is implemented, which is essentially similar to the other intervention, except that no lunch is provided. The interventions proceed during a period of 4 years. Apart from the effectiveness of both interventions, the process, the cost-effectiveness, and the expected legal implications are studied. Data collection is conducted within the school system. The baseline measurements started in September 2015 and yearly follow-up measurements are taking place until 2019. DISCUSSION: A whole-school approach is a new concept in the Netherlands. Due to its innovative, multifaceted nature and sound scientific foundation, these integrated programmes have the potential to form a template for primary schools worldwide. The effects of this approach may extend further than the outcomes associated with well-being and academic achievement, potentially impacting legal and cultural aspects in our society. TRIAL REGISTRATION: The study protocol was registered in the database ClinicalTrials.gov on 14-06-2016 with the reference number NCT02800616 .

[Developmental trajectories of anxiety disorder symptoms in adolescents: a five-year prospective community study]. / Ontwikkelingstrajecten van angstsymptomen: een vijfjarig prospectief onderzoek onder adolescenten uit de algemene populatie.

BACKGROUND: The relatively recent adoption of modern statistical analysis methods, such as latent growth modelling (lgm), makes it possible to study differences in the individual trajectories of development over time. AIM: To examine prospectively the developmental trajectories of anxiety disorder symptoms in a large sample of adolescents (N = 1,318) from the general population over a period of five years. METHOD: The adolescents were divided into two cohorts: early adolescents (average age 12 at the first measurement) and middle adolescents (average age 16 at the first measurement). Age and gender differences in the developmental trajectories of adolescent anxiety disorder symptoms over time were examined by means of lgm. results Over the course of five years there was a slight decrease in panic disorder, school anxiety and separation anxiety disorder symptoms for all adolescents, with the exception of social phobia symptoms, which remained fairly stable over time. Adolescent girls showed a slight increase in generalised anxiety disorder symptoms over time, whereas these symptoms decreased among adolescent boys. CONCLUSION: The use of individual trajectory-based analyses, enabled us to study advance our understanding of age and gender differences in the development of adolescent anxiety symptoms.

Worry in normal children.

OBJECTIVE: To investigate worry in a nonclinical sample of children aged 8 to 13 years (N = 193). METHOD: Children were interviewed about the content, characteristics, origins, and severity of their main intense worry. Furthermore, children completed questionnaires to study the relationship between worry, trait anxiety, and depression. RESULTS: Almost 70% of the children reported that they worried every now and then. The content of these worries predominantly pertained to school performance, dying and health, and social contacts. An examination of the characteristics of children's main intense worries revealed that these worries occurred on average 2 to 3 days per week, were accompanied by modest levels of interference and anxiety, elicited relatively high levels of resistance, and were rather difficult to control. A minority of the children were found to exhibit symptoms of worry in the pathological range: the percentages of children who met the DSM-III-R criteria of overanxious disorder and generalized anxiety disorder were 4.7% and 6.2%, respectively. Finally, worry, anxiety, and depression seemed to be strongly related. CONCLUSION: Worry seems to be a common phenomenon in normal children aged between 8 and 13 years.

Paradoxical and less paradoxical effects of thought suppression: a critical review.

The process of consciously trying to avoid certain thoughts is referred to as thought suppression. Experimental research has documented that thought suppression may have paradoxical effects in that it leads to an increased frequency of the to-be-suppressed thought intruding consciousness. It has also been claimed that suppression has disruptive effects on episodic memory (i.e., a less paradoxical effect). The present article critically evaluates studies on the paradoxical and less paradoxical effects of thought suppression. More specifically, the issue of whether thought suppression plays a causative role in the development of various psychopathological symptoms is addressed. While laboratory studies have come up with highly consistent findings about the paradoxical effects of thought suppression, there is, as yet, little reason to believe that such effects are implicated in the etiology of obsessions, phobias, or other psychopathological conditions. Relatively little work has been done on the alleged memory effects of thought suppression. The studies that have examined this issue have found mixed results. Accordingly, the case for the amnestic power of thought suppression is weak. Alternative explanations and competing theories are discussed, and it is concluded that research concerned with the psychopathological consequences of thought suppression would benefit from development of better taxonomies of intrusive thinking and cognitive avoidance strategies.

Cognitive correlates of dental anxiety.

This study examined cognitive correlates of dental anxiety among 24 highly anxious patients and 17 low-anxious patients. In both groups, anxiety expectations, dental trait anxiety, and state anxiety (in the waiting room and in the dental chair) were rated. Negative cognitions and cognitive control were also assessed. It was found that dentally high-anxious patients claimed to experience more negative thoughts than those with low anxiety (p < 0.001). None of the highly anxious patients reported relatively few negative cognitions, and none of the patients in the low-anxiety group reported relatively numerous negative cognitions. While patients from both groups reported that cognitive control declined with the imminence of treatment, highly anxious patients were found to have less control over their negative thoughts (p < 0.001). A series of stepwise regression analyses revealed that both the number of negative cognitions and perceived cognitive control accounted for 75% of the variance in dental trait anxiety. The results of the present study suggest that cognitive activities, such as negative thinking (catastrophizing) and cognitive control, are important moderators of dental anxiety.

Treating phobic children: effects of EMDR versus exposure.

This study examined the efficacy of eye movement desensitization and reprocessing (EMDR) and exposure in the treatment of a specific phobia. Twenty-six spider phobic children were treated during 2 treatment phases. During the first phase, which lasted 2.5 hr, children were randomly assigned to either (a) an EMDR group (n = 9), (b) an exposure in vivo group (n = 9), or (c) a computerized exposure (control) group (n = 8). During the 2nd phase, all groups received a 1.5-hr session of exposure in vivo. Therapy outcome measures (i.e., self-reported fear and behavioral avoidance) were obtained before treatment, after Treatment Phase 1, and after Treatment Phase 2. Results showed that the 2.5-hr exposure in vivo session produced significant improvement on all outcome measures. In contrast, EMDR yielded a significant improvement on only self-reported spider fear. Computerized exposure produced nonsignificant improvement. Furthermore, no evidence was found to suggest that EMDR potentiates the efficacy of a subsequent exposure in vivo treatment. Exposure in vivo remains the treatment of choice for childhood spider phobia.

UCS inflation and human aversive autonomic conditioning.

Fifty students participated in a differential conditioning paradigm. In the first part of the experiment, one neutral slide (CS+) was paired with a tone (UCS) and another neutral slide (CS-) was never followed by a tone. During the subsequent inflation phase, unsignalled UCSs gradually increased in strength for the inflation group while they were kept constant for the control group. During extinction trials, the inflation group initially showed relatively stronger UCS expectancies on the CS+ trials than the control group. In contrast to what was predicted, the UCS inflation procedure did not result in stronger conditioning effects of the skin conductance response compared to the control procedure. The effectiveness of the UCS inflation procedure was not related to trait anxiety.

Dimensions of hostility and myocardial infarction in adult males.

The present case-control study investigated the association between dimensions of hostility and myocardial infarction (MI) in adult males. Hostility was measured with the Buss-Durkee Hostility Inventory (BDHI), which assesses two distinct dimensions of hostility, namely experiential and expressive hostility. Cases were 81 males who were admitted in hospital because of a first MI. The reference group consisted of 168 age-matched, healthy male neighbourhood controls. Analyses revealed that especially experiential hostility (comprised of the subscales Resentment and Suspicion) was significantly associated with MI. These results are in contrast with the findings of previous studies, which showed expressive hostility to be positively related to coronary heart disease (CHD). Explanations for these contradictory findings are discussed.

The TOM test: a new instrument for assessing theory of mind in normal children and children with pervasive developmental disorders.

This article describes a first attempt to investigate the reliability and validity of the TOM test, a new instrument for assessing theory of mind ability in normal children and children with pervasive developmental disorders (PDDs). In Study 1, TOM test scores of normal children (n = 70) correlated positively with their performance on other theory of mind tasks. Furthermore, young children only succeeded on TOM items that tap the basic domains of theory of mind (e.g., emotion recognition), whereas older children also passed items that measure the more mature areas of theory of mind (e.g., understanding of humor, understanding of second-order beliefs). Taken together, the findings of Study 1 suggest that the TOM test is a valid measure. Study 2 showed for a separate sample of normal children (n = 12) that the TOM test possesses sufficient test-retest stability. Study 3 demonstrated for a sample of children with PDDs (n = 10) that the interrater reliability of the TOM test is good. Study 4 found that children with PDDs (n = 20) had significantly lower TOM test scores than children with other psychiatric disorders (e.g., children with Attention-deficit Hyperactivity Disorder; n = 32), a finding that underlines the discriminant validity of the TOM test. Furthermore, Study 4 showed that intelligence as indexed by the Wechsler Intelligence Scale for Children was positively associated with TOM test scores. Finally, in all studies, the TOM test was found to be reliable in terms of internal consistency. Altogether, results indicate that the TOM test is a reliable and valid instrument that can be employed to measure various aspects of theory of mind.

How serious are common childhood fears? II. The parent's point of view.

In an earlier study [Muris, P., Merckelbach, H., Mayer, B., & Prins, E. (1999). How serious are common childhood fears? Behaviour Research and Therapy, in press.], the severity of common childhood fears was explored by means of a structured child interview measuring specific phobias as defined by the Diagnostic and Statistical Manual of Mental Disorders. It was found that in a substantial minority of the children, specific fears reflect clinically significant phobias. The present study examined further the connection between childhood fears and specific phobias by interviewing children's parents. The Diagnostic Interview Schedule for Children was administered to the parents of 160 children aged 4-12 years. In line with our previous study, results indicate that a sizable proportion of children (i.e. 17.6%) met the full criteria for specific phobia.

The causal link between self-reported trauma and dissociation: a critical review.

The idea that traumatic experiences cause dissociative symptoms is a recurrent theme in clinical literature. The present article summarizes evidence that cast doubts on the commonly voiced view that the connection between self-reported trauma and dissociation is a simple and robust one. It is argued that: (1) the correlations between self-reported traumatic experiences and dissociative symptoms reported in the literature are, at best, modest; (2) other factors may act as a third variable in the relationship between trauma and dissociation; and (3) high scores on the Dissociative Experiences Scale are accompanied by fantasy proneness, heightened suggestibility, and susceptibility to pseudomemories. These correlates of dissociation may promote a positive response bias to retrospective self-report instruments of traumatic experiences. Thus, the possibility that dissociation encourages self-reported traumatic experiences rather than vice versa merits investigation. While attractive, simple models in which trauma directly causes dissociation are unlikely to be true.

The etiology of childhood spider phobia.

Twenty-six girls with a clinical spider phobia and 26 matched control girls were interviewed about conditioning, modeling, and negative information experiences in connection with spiders. In addition, parents of the phobic girls were independently interviewed about the origins of their child's phobia. Phobic children more often reported aversive conditioning experiences with spiders than did control children. Also, in a number of cases, conditioning events described by the phobic children were confirmed by their parents, a result that replicates the findings of Merckelbach, Muris and Schouten (1996; Behaviour Research and Therapy, 34, 935-938). Taken together, the results contradict a strong version of the non-associative account of phobias and suggest that in at least some cases, conditioning events may contribute to the development of (childhood) spider phobia.

Pathways to fear in spider phobic children.

Twenty-two children with spider phobia were interviewed about the origins of their fear. More specifically, children were asked about conditioning events, modeling experiences, and negative information transmission. To evaluate the reliability of the information provided by the children, parents were independently interviewed about the origins of their children's phobias. While 46% of the children claimed to have always been afraid, 41% ascribed the onset of their fear to aversive conditioning events. The large majority of these events were confirmed by parents. These findings cast doubts on a strong version of the non-associative account of spider phobia, i.e. the idea that spider phobia is acquired in the complete absence of learning experiences.

Individual differences in thought suppression. The White Bear Suppression Inventory: factor structure, reliability, validity and correlates.

The White Bear Suppression Inventory [WBSI; Wegner, D.M. & Zanakos, S. (1994), Journal of Personality, 62, 615-640] is a self-report questionnaire measuring people's general tendency to suppress unwanted negative thoughts. The current article describes two studies investigating the reliability, factor structure, validity, and correlates of the WBSI. Study 1 (n = 172) showed that the WBSI is a reliable instrument in terms of internal consistency and test-retest stability. Factor analyses of the WBSI revealed a 1-factor solution. Furthermore, the WBSI was found to correlate positively with measures of emotional vulnerability and psychopathological symptoms. In Study 2 (n = 40), the relationship between WBSI and levels of intrusive thinking was examined in more detail, using a thought suppression task. In general, results of this thought suppression experiment provided evidence for the validity of the WBSI. That is, subjects with high WBSI scores exhibited higher frequencies of unwanted intrusive thoughts than subjects with low WBSI scores.

Common childhood fears and their origins.

The present study examined rank orders and characteristics of childhood fears. A 'free option' approach ('What do you fear most?') deviated markedly from the fear rank order based on the Fear Survey Schedule for Children. A second aim of the study was to investigate the origins of prevalent childhood fears. In contrast to the results of Ollendick and King (1991, Behaviour Research and Therapy, 29, 117-123), conditioning was found to be the most commonly reported pathway related to exacerbation and onset of fears. Finally, special attention was given to the top intense fear in children, namely fear of spiders. Children who reported 'none', 'some' or 'a lot' of spider fear were compared with each other in terms of pathways. No differences between the three groups were found with respect to the frequency of modeling and information experiences. However, high fearful children more often reported conditioning experiences than low or moderate fearful children.

The structure of specific phobia symptoms among children and adolescents.

Previous research [Frederikson, M., Annas, P., Fisher, H. & Wik, G. (1996). Gender and age differences in the prevalence of specific fears and phobias. Behaviour Research and Therapy, 34, 33-39.] has shown that specific phobia symptoms of adults cluster into three subtypes: animal phobia, blood-injection-injury phobia and environmental-situational phobia. The present study examined whether these specific phobia subtypes can also be found in children. 996 children aged between 7 and 19 years completed a brief questionnaire regarding the frequency with which they experienced specific phobia symptoms. Confirmatory factor analysis was employed to examine the structure of these data. Results showed that childhood specific phobia symptoms indeed cluster into the three subtypes as described by Frederikson et al. and that these subtypes are either intercorrelated or the product of a single higher order factor. This structure appeared to be largely invariant across genders and age groups.

Abnormal and normal compulsions.

Previous research by Rachman and de Silva (1978, Behaviour Research and Therapy, 16, 233-248) and by Salkovskis and Harrison (1984, Behaviour Research and Therapy, 22, 549-552) has shown that abnormal and normal obsessions are similar in content. The present study examined whether the same is true for abnormal and normal rituals. A sample of normal subjects (N = 150) were asked about their idiosyncratic rituals. A majority of them (54.7%) indicated that they had such rituals. While these rituals were less frequent, less intense, and less often associated with negative affect than the compulsions of a sample of patients with obsessive-compulsive disorder, differences in terms of content between normal and abnormal rituals were small. Experts often tended to misclassify abnormal compulsions as normal rituals. By and large, the present findings indicate that there is continuity between abnormal and normal compulsions.

Effects of thought suppression on episodic memory.

Subjects were shown a short film fragment. Following this, one group of subjects (n = 26) was instructed to suppress their thoughts about the film, while the other group (n = 24) received no instructions. After 5 hrs subjects returned to the laboratory and completed a questionnaire testing their memory about the film. Results showed that suppression subjects reported a higher frequency of thoughts about the film than control subjects. No evidence was obtained for Wegner, Quillian, and Houston's (1996; Journal of Personality and Social Psychology, 71, 680-691) claim that suppression has an undermining effect on memory for chronology. Possible causes for the differences between the results as obtained by Wegner et al., and those found in the present study are discussed. These causes may pertain to the experimental design, but also to differences in emotional impact of the stimulus material that was used in both studies.

The relationship between anxiety sensitivity and fear of pain in healthy adolescents.

The present study investigated the relationship between anxiety sensitivity and fear of pain in a large group of healthy adolescents (N=200). Participants completed the childhood anxiety sensitivity index for children-revised, a questionnaire measuring four specific domains of anxiety sensitivity: fear of cardiovascular symptoms, fear of respiratory symptoms, fear of cognitive dyscontrol, and fear of publicly observable anxiety symptoms, and a simplified version of the pain anxiety symptoms scale, a self-report instrument assessing pain-related anxiety and avoidance (i.e. fear of pain). In line with previous research in adult populations, it was found that anxiety sensitivity is substantially and positively related to fear of pain. Even when controlling for other potential predictors of fear of pain (i.e. pain symptoms, other somatization symptoms, trait anxiety, and panic disorder symptoms), anxiety sensitivity appeared to declare a unique proportion of the variance in pain anxiety symptoms.