Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial.

This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11-16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.

The normative development of emotion regulation strategy use in children and adolescents: a 2-year follow-up study.

BACKGROUND: Emotion regulation involves intrinsic and extrinsic processes responsible for managing one's emotions toward goal accomplishment. Research on emotion regulation has predominantly focused on early developmental periods and the majority of emotion regulation research examining the pre-adult years has lacked a comprehensive theoretical framework. The current study examined the use of two strategies of emotion regulation during childhood and adolescents, as conceptualised within Gross's (1998) process-oriented model. METHODS: To determine the use, norms and development of the Expressive Suppression and Cognitive Reappraisal strategies, the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) was administered to 1,128 participants aged between 9 and 15 years. Three data collection phases, each one year apart, enabled investigation of developmental patterns in the use of the two strategies. RESULTS: As predicted, Suppression use was found to be lower for older participants compared to their younger peers, and over time participants reported less use of this strategy. Older participants also scored lower on Reappraisal but stability over time was found. Also as expected, males reported more Suppression use compared to females. CONCLUSIONS: By documenting the development and norms for Cognitive Reappraisal and Expressive Suppression in a community sample of children and adolescents, the current study makes a significant contribution to our understanding of these two ER strategies during these developmental periods.

Discrepancies between adolescent, mother, and father reports of adolescent internalizing symptom levels and their association with parent symptoms.

Discrepancies among informants on measures of internalizing symptoms in children and adolescents are common in the literature. One reason proposed for such discrepancies is that psychopathology may distort or bias third-party reports. In the present study, measures of adolescent internalizing symptom levels were completed by adolescents aged 13 to 18 years and their mothers and fathers. Parents also completed measures of their own depression, anxiety, and stress symptoms. Parent symptoms explained a small amount of variance in discrepancies between informants. Specifically, mothers' depression and stress symptoms were associated with discrepancies regarding sons' symptomatology and fathers' anxiety and stress symptoms were associated with discrepancies regarding daughters' symptomatology. Implications of informant discrepancies for both clinical practice and research are discussed.

An examination of emotion regulation, temperament, and parenting style as potential predictors of adolescent depression risk status: a correlational study.

Given that depression is a debilitating disorder, it is critical that we advance our understanding about the aetiology of this disorder. This study investigated both traditional (temperament and parenting) and novel (emotion regulation strategy) risk factors associated with adolescent depression. Forty-four adolescents (12-16 years; 64% females) with high scores on a self-report depressive symptomatology questionnaire were compared to a similar group of 44 adolescents with low scores, matched for age, gender, and ethnicity. Significant group differences were present on all assessed risk factors. The presence of high depressive symptomatology was found to be associated with (1) low levels of temperamentally based positive mood, flexibility, and approach behaviours, (2) a parenting style characterized by low nurturance and high overprotection, and (3) emotion regulation characterized by higher levels of expressive suppression and lower levels of cognitive reappraisal. It was concluded that, in addition to specific temperament characteristics and parenting style, use of particular emotion regulation strategies is associated with varying levels of depressive symptomatology. These findings reinforce the importance of incorporating emotion regulation into explanatory models of depression symptomatology. Further research that tests the direction of effects for these cross-sectional findings is warranted.

"It's a Dog's Life": Culture, Empathy, Gender, and Domestic Violence Predict Animal Abuse in Adolescents-Implications for Societal Health.

Whereas the majority of previous research conducted on animal abuse has been in environments where animal abuse is rarely evidenced, the current study investigated the ramifications of animal abuse in an environment wherein the national culture creates an ethos of the "social acceptability" of animal abuse in society. Two survey studies were conducted with adolescent participants, to investigate the role played by several factors in the prediction of animal abuse in this age group. In Study 1, with samples from two different national cultures (101 from Germany and 169 from Romania; 143 boys/135 girls; age 13 to 17), animal abuse was negatively associated with affective empathy and national culture; more frequent animal abuse was found in Romania. Affective empathy fully mediated the association between gender and animal abuse. Specifically, girls were found to be higher in affective empathy; in turn, participants who were higher in affective empathy committed less animal abuse. Witnessing animal abuse was also predictive of engaging in animal abuse, but not independent of national culture. In Study 2, 15-year-old males ( n = 21) and females ( n = 39) took part, 29 from rural and 31 from urban locations in Romania. Rural adolescents were more likely to abuse animals and had higher exposure to domestic violence, which (in turn) was associated with more animal abuse. The implications of these findings in a society where animal abuse is encouraged and enacted on a national scale are discussed.

Internalizing symptoms and disorders in families of adolescents: a review of family systems literature.

Internalizing symptoms and disorders are relatively common during adolescence and impact considerably on social and emotional functioning. Using a family systems framework, this paper reviews the current literature examining the impact of internalizing symptoms and disorders on the functioning of the family system, the spouse subsystem and the parent-child subsystem. Moreover, literature examining the relationship between parents' and adolescents' internalizing symptoms and disorders is reviewed. The reviewed research demonstrates that there exists an association between internalizing symptoms and disorders and poorer functioning at various levels of the family system. Longitudinal studies have generally reported that parent internalizing symptoms and disorders predict poorer functioning in the family system as well as internalizing symptoms and disorders in adolescents. However, few longitudinal studies have examined whether adolescent internalizing symptoms and disorders predict poorer family functioning and internalizing symptoms and disorders in parents. Those that have examined such effects report mixed results. On the basis of our review, we make recommendations about future research directions. In particular, it is argued that more research on the reciprocal effects of internalizing symptoms and disorders within families is needed to better understand the antecedents and consequences of these conditions for families of adolescents.

The relationship between domestic violence and animal abuse: an Australian study.

Several North American studies have found a connection between domestic violence and animal abuse. This article reports on the first Australian research to examine this connection. A group of 102 women recruited through 24 domestic violence services in the state of Victoria and a nondomestic violence comparison group (102 women) recruited from the community took part in the study. Significantly higher rates of partner pet abuse, partner threats of pet abuse, and pet abuse by other family members were found in the violent families compared with the nondomestic violence group. As hypothesized, children from the violent families were reported by their mothers to have witnessed and committed significantly more animal abuse than children from the nonviolent families. Logistic regression analyses revealed, for the group as a whole, that a woman whose partner had threatened the pets was 5 times more likely to belong to the intimate partner violence group.

Treatment of children's nighttime fears: the need for a modern randomised controlled trial.

Children's nighttime fears are common and cause significant interference to the child's functioning as well as causing much distress for the child and family. Therefore, effective and cost-efficient interventions are urgently needed by mental health professionals and counsellors. The authors review 29 studies, which investigated the efficacy of psychosocial treatment for children's nighttime fears. Most studies employed multiple baseline across subject designs or between group designs and most employed cognitive-behavioral techniques (i.e., desensitisation, emotive imagery, cognitive self-instruction, and reinforcement procedures). Although multi-method, informant assessments were not always conducted, in most studies rapid reduction of nighttime fears was typically achieved after only a few sessions with maintenance of gains. On the basis of our review, we make recommendations about assessment and intervention issues for the effective treatment of children's nighttime fears. Finally, future research directions are discussed including the need for a modern randomised clinical trial to more fully investigate treatment efficacy and the role of non-specific treatment factors.

Nighttime fears of children and adolescents: frequency, content, severity, harm expectations, disclosure, and coping behaviours.

The present school-based study investigated the nighttime fears of 511 children and adolescents, aged 8-16 years. Participants were assessed using a structured interview about the frequency, content, severity, harm expectations, coping strategies, and disclosure of nighttime fears. Results indicated that nighttime fears are a common experience, with nearly two-thirds (64.2%) of children and adolescents reporting nighttime fears. Fear of intruders/home invasion was the most frequently reported nighttime fear. Females more frequently reported nighttime fears than males (72.9% and 54.6%, respectively) and a greater number of children reported nighttime fears compared to adolescents (79.4% and 48.8%, respectively). Nighttime fears were given moderate severity ratings, and harm expectations were most strongly associated with 'personal security' fears. Respondents reported a variety of coping strategies to manage their nighttime fears with self-control/distraction techniques being the most common. Most respondents reported disclosing their nighttime fear(s) to another person. The clinical implications of these findings and the methodological limitations are discussed.

The Shame and Guilt Scales of the Test of Self-Conscious Affect-Adolescent (TOSCA-A): Factor Structure, Concurrent and Discriminant Validity, and Measurement and Structural Invariance Across Ratings of Males and Females.

This study examined various psychometric properties of the items comprising the shame and guilt scales of the Test of Self-Conscious Affect-Adolescent. A total of 563 adolescents (321 females and 242 males) completed these scales, and also measures of depression and empathy. Confirmatory factor analysis provided support for an oblique two-factor model, with the originally proposed shame and guilt items comprising shame and guilt factors, respectively. Also, shame correlated with depression positively and had no relation with empathy. Guilt correlated with depression negatively and with empathy positively. Thus, there was support for the convergent and discriminant validity of the shame and guilt factors. Multiple-group confirmatory factor analysis comparing females and males, based on the chi-square difference test, supported full metric invariance, the intercept invariance of 26 of the 30 shame and guilt items, and higher latent mean scores among females for both shame and guilt. Comparisons based on the difference in root mean squared error of approximation values supported full measurement invariance and no gender difference for latent mean scores. The psychometric and practical implications of the findings are discussed.

The clinical significance of loneliness: a literature review.

Satisfying social relationships are vital for good mental and physical health. Accordingly, we recommend that the alleviation and prevention of social relationship deficits be a key focus of clinicians. In this review, we focus on loneliness as a crucial marker of social relationship deficits and contend that loneliness should command clinicians' attention in its own right--not just as an adjunct to the treatment of other problems such as depression. With a particular focus on the adolescent developmental period, this review is organized into five sections: Drawing on developmental and evolutionary psychology theories, the nature of social relationships and the function they serve is first discussed. In the second section, loneliness is introduced as an exemplar of social relationship deficits. Here a definition of loneliness is provided, as well as an explanation of why it may pose a situation of concern. This is followed by a review of the prototypic features of loneliness through examination of its affective, cognitive, and behavioral correlates. The fourth section includes a review of theories related to the antecedent and maintenance factors involved in loneliness. Finally, methodological and theoretical considerations are addressed, and conclusions and proposals for future research directions are put forth.

The Shame and Guilt Scales of the Test of Self-Conscious Affect-Adolescent (TOSCA-A): Psychometric Properties for Responses from Children, and Measurement Invariance Across Children and Adolescents.

This study examined various psychometric properties of the items comprising the shame and guilt scales of the Test of Self-Conscious Affect-Adolescent (TOSCA-A) in a group children between 8 and 11 years of age. A total of 699 children (367 females and 332 males) completed these scales, and also measures of depression and empathy. Confirmatory factor analysis (CFA) provided support for an oblique two-factor model, with the originally proposed shame and guilt items comprising shame and guilt factors, respectively. There was good internal consistency reliability for the shame and guilt scales, with omega coefficient values of 0.77 and 0.81 for shame and guilt, respectively. Also, shame correlated with depression symptoms positively (0.34, p < 0.001) and had no relation with empathy (-0.07, ns). Guilt correlated with depression symptoms negatively (-0.28, p < 0.001), and with empathy positively (0.13. p < 0.05). Thus there was support for the convergent and discriminant validity of the shame and guilt factors. Multiple-group CFA comparing this group of children with a separate group of adolescents (320 females and 242 males), based on the chi-square difference test, supported full metric invariance, the intercept invariance of 17 of the 30 shame and guilt items, and higher latent mean scores among children for both shame and guilt. The non-equivalency for intercepts and mean scores were of small effect sizes. Comparisons based on the difference in root mean squared error of approximation values supported full measurement invariance and no group difference for latent mean scores. The findings in the current study support the use of the TOSCA-A in children and the valid comparison of scores between children and adolescents, thereby opening up the possibility of evaluating change in the TOSCA-A shame and guilt factors over these developmental age groups.

The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA): a psychometric evaluation.

Despite the recognized importance of emotion regulation (ER) for healthy psychological development, ER research has focused predominantly on the developmental periods of infancy, early childhood, and adulthood, while the middle childhood to adolescence years have been relatively neglected. An obstacle to ER research during these periods is the paucity of valid age-appropriate measures. This study reports on the psychometric evaluation of the Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA), a revision of the adult measure. The ERQ-CA was evaluated with a sample of 827 participants aged between 10 and 18 years. Results indicate sound internal consistency as well as stability over a 12-month period. Sound construct and convergent validity are also demonstrated. It is concluded that the ERQ-CA is a valid age-appropriate measure for investigating the use of 2 specific strategies of ER during the childhood and adolescence developmental periods.

Conceptualising Animal Abuse with an Antisocial Behaviour Framework.

This paper reviews current findings in the human aggression and antisocial behaviour literature and those in the animal abuse literature with the aim of highlighting the overlap in conceptualisation. The major aim of this review is to highlight that the co-occurrence between animal abuse behaviours and aggression and violence toward humans can be logically understood through examination of the research evidence for antisocial and aggressive behaviour. From examination through this framework, it is not at all surprising that the two co-occur. Indeed, it would be surprising if they did not. Animal abuse is one expression of antisocial behaviour. What is also known from the extensive antisocial behaviour literature is that antisocial behaviours co-occur such that the presence of one form of antisocial behaviour is highly predictive of the presence of other antisocial behaviours. From such a framework, it becomes evident that animal abuse should be considered an important indicator of antisocial behaviour and violence as are other aggressive and antisocial behaviours. The implications of such a stance are that law enforcement, health and other professionals should not minimize the presence of animal abuse in their law enforcement, prevention, and treatment decisions.

Emotion regulation moderates relationships between body image concerns and psychological symptomatology.

The study investigated the moderating role of emotion regulation (ER) in relationships between body image concerns and psychological symptomatology. A community sample of 533 boys and girls (11-20 years) completed measures assessing body image thoughts and feelings, domain-specific and general ER strategies, drive for thinness, and bulimic, depressive and anxiety symptoms. Results indicated that ER moderated relationships between body image concerns and both bulimic and depressive symptoms, but not relationships between body image concerns and drive for thinness or anxiety symptoms. Adolescents who reported frequent body image concerns were more likely to have higher levels of bulimic symptoms if they tended to use avoidance and internal dysfunctional ER strategies. Furthermore, adolescents who reported frequent body image concerns were more likely to have higher levels of depressive symptoms if they used positive rational acceptance and internal functional strategies infrequently. Implications of the findings for prevention and intervention are discussed.

Child and adolescent emotion regulation: the role of parental emotion regulation and expression.

This paper reviews current literature relating to parent and child emotional functioning, specifically their emotion regulatory skills and emotional expression. Included are considerations regarding theoretical, methodological, and sampling strengths and weaknesses of existing literature. On the basis of the review, several directions for future research are proposed. First, it is argued that consistency in the measurement of emotion regulation is necessary, including assessment of more refined theoretical conceptualizations of regulatory types, skills, or strategies. Second, it is argued that emotion regulation developmental research examining the post-early childhood period is necessary in order to contribute to a more comprehensive understanding of youths' emotion regulation. Finally, it is argued that greater examination of paternal influences on child emotional functioning, in addition to maternal influences, is required. Consideration of these issues in future emotion regulation research will ideally contribute to a greater understanding of the mechanisms involved in child and adolescent development of optimal regulatory capacities.

Reciprocal relationships between parent and adolescent internalizing symptoms.

Previous investigations of the association between parent and adolescent internalizing problems have been largely restricted to the unidirectional effect of parent symptoms on their children. This study therefore aimed to investigate potential reciprocal relationships between parent and adolescent internalizing symptoms. One-hundred and seventy-seven adolescents ages 14 to 18 years and their parents (172 mothers, 124 fathers) completed measures of depressive and anxiety symptoms at two time points, 6 months apart. Results supported reciprocity between maternal and adolescent internalizing symptoms but not between paternal and adolescent internalizing symptoms. In addition, the relationship between maternal symptoms and later adolescent symptoms was found to be partially mediated by maternal parenting self-esteem. The study highlights the potential impact of adolescent internalizing problems on maternal well-being, a phenomenon previously neglected in the literature.

Mindful emotion regulation: An integrative review.

This review aims to integrate the constructs of mindfulness and emotion regulation. Research into both of these areas is relatively new, and while several reviews have emerged for each area independently, none has directly proposed a conceptual integration. The current review explores how key axioms and assumptions of traditional psychological models of emotion regulation and the psychological interventions that are derived from them (e.g., cognitive behavior therapy) differ fundamentally from mindfulness-based approaches in terms of the underlying processes they address. Accordingly, mindfulness and emotion regulation are each reviewed, followed by a conceptual integration. Fundamental difficulties arising from the attempt to integrate the two domains are highlighted, especially as to the "reality" of thoughts, the relationship between thoughts and emotions, and the need to move beyond a valence model of emotion. Finally, a model is proposed outlining the likely critical processes and mechanisms that underlie "mindful emotion regulation."

Current conceptualisation of body image dissatisfaction: have we got it wrong?

BACKGROUND: This study addresses limitations of previous research by examining the prevalence of body image dissatisfaction within two developmental periods: childhood and adolescence. METHODS: A sample of 448 boys and 508 girls completed self-report measures of global body image dissatisfaction. Weight and height of all participants were also determined. RESULTS: Our results indicated that body image dissatisfaction differs significantly depending upon sex and body mass. Importantly, the results revealed a multi-modal distribution in the data, particularly for boys. That is, for females there was a significant increase in body dissatisfaction across bodyweight, reflecting a predominant desire to be thinner. In contrast, for boys, there was a differential pattern; with those who were overweight wanting to be thinner, but those who were underweight wanting to be larger. Moreover, whilst for both sexes, body image dissatisfaction was found to be evident in childhood as well as adolescence, during the former developmental period, it appeared to be less pronounced. CONCLUSIONS: These findings indicate that, contrary to previous propositions, body image dissatisfaction is of concern for males as well as females, although the distribution of such is strikingly different. The outcomes suggest that it is time to reframe our conceptualisation of this construct. Specifically, the identified non-linear distribution of means indicates that inferential analysis of body image dissatisfaction data needs to be conducted independently for each sex, as well as each body mass grouping.