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1.
Learn Mem ; 30(3): 55-62, 2023 03.
Artículo en Inglés | MEDLINE | ID: mdl-36921982

RESUMEN

The hippocampal formation (HF) facilitates declarative memory, with subfields providing unique contributions to memory performance. Maturational differences across subfields facilitate a shift toward increased memory specificity, with peripuberty sitting at the inflection point. Peripuberty is also a sensitive period in the development of anxiety disorders. We believe HF development during puberty is critical to negative overgeneralization, a common feature of anxiety disorders. To investigate this claim, we examined the relationship between mnemonic generalization and a cross-sectional pubertal maturity index (PMI) derived from partial least squares correlation (PLSC) analyses of subfield volumes and structural connectivity from T1-weighted and diffusion-weighted scans, respectively. Participants aged 9-14 yr, from clinical and community sources, performed a recognition task with emotionally valent (positive, negative, and neutral) images. HF volumetric PMI was positively associated with generalization for negative images. Hippocampal-medial prefrontal cortex connectivity PMI evidenced a behavioral relationship similar to that of the HF volumetric approach. These findings reflect a novel developmentally related balance between generalization behavior supported by the hippocampus and its connections with other regions, with maturational differences in this balance potentially contributing to negative overgeneralization during peripuberty.


Asunto(s)
Hipocampo , Memoria , Humanos , Estudios Transversales , Hipocampo/diagnóstico por imagen , Emociones , Reconocimiento en Psicología , Imagen por Resonancia Magnética/métodos
2.
Cogn Affect Behav Neurosci ; 23(6): 1568-1580, 2023 12.
Artículo en Inglés | MEDLINE | ID: mdl-37726588

RESUMEN

Repetitive thinking about negative emotions or events is strongly associated with worse mental health, whereas repetitive positive thought is generally believed to be beneficial. This observation is at odds with the idea that all forms of repetitive thinking share underlying neural mechanisms. To resolve this apparent discrepancy, the present study examined relationships between subjective affect and neural mechanisms during periods of sustained processing of positive (savoring) and negative (rumination) emotion. We also examined potential common moderators of savoring and rumination including memory specificity and sleep quality. Results indicated that individuals who experience high positive affect during savoring also are likely to experience more intense negative affect during rumination. fMRI-derived brain activity revealed common mechanisms of rumination and savoring. Memory specificity had common effects on neural correlates of rumination and savoring; sleep quality was not associated with mechanisms of savoring or rumination. These results suggest that repetitive engagement with positive and negative affect is similar both subjectively and mechanistically. Clinical interventions for rumination may benefit from capitalizing on preserved capacity for savoring.


Asunto(s)
Emociones , Salud Mental , Humanos
3.
Cogn Affect Behav Neurosci ; 23(2): 415-426, 2023 04.
Artículo en Inglés | MEDLINE | ID: mdl-36788201

RESUMEN

Sleep-related problems often precede escalating anxiety in early adolescence. Pushing beyond broad sleep-mental health associations and toward mechanistic theories of their interplay can inform etiological models of psychopathology. Recent studies suggest that sleep depotentiates neural (e.g., amygdala) reactivity during reexposure to negative emotional stimuli in adults. Persistent amygdala reactivity to negative experiences and poor sleep characterize anxiety, particularly at the transition to adolescence. We propose that sleep depotentiates amygdala reactivity in youth but fails to do so among youth with anxiety. Participants (n = 34; 18 males; age, mean [M] = 11.35, standard deviation [SD] = 2.00) recruited from the community and specialty anxiety clinics viewed valenced images (positive, negative, and neutral) across two fMRI sessions (Study, Test), separated by a 10-12-hour retention period of sleep or wake (randomized). Mixed linear models regressed basolateral amygdala (BLA) activation and BLA-medial prefrontal cortex (mPFC) functional connectivity to negative images on Time, Condition, and Anxiety Severity. There were greater reductions in BLA activations to negative target images from Study to Test in the Sleep Condition, which was blunted with higher anxiety (b = -0.065, z = -2.355, p = 0.019). No such sleep- or anxiety-related effects were observed for BLA-mPFC functional connectivity (ps > 0.05). Sleep supports depotentiation of amygdala reactivity to negative stimuli in youth, but this effect is blunted at higher levels of anxiety. Disruptions in sleep-related affective habituation may be a critical, modifiable driver of anxiety.


Asunto(s)
Amígdala del Cerebelo , Emociones , Masculino , Adulto , Adolescente , Humanos , Emociones/fisiología , Amígdala del Cerebelo/fisiología , Ansiedad , Corteza Prefrontal/fisiología , Sueño , Imagen por Resonancia Magnética
4.
J Child Psychol Psychiatry ; 64(1): 83-90, 2023 01.
Artículo en Inglés | MEDLINE | ID: mdl-35817759

RESUMEN

BACKGROUND: Poor sleep and anxiety disorders are highly comorbid in youth, and each predicts altered ventral striatum (VS) response to rewards, which may impact mental health risk. Contrasting evidence suggests previously reported negative associations between sleep health and VS response may be stronger or weaker in youth with anxiety, indicating sensitivity to win/loss information or blunted reward processing, respectively. We cross-sectionally examined the role of sleep in VS response to rewards among youth with anxiety versus a no-psychiatric-diagnosis comparison (ND) group. We expected a group*sleep interaction on VS response to rewards but did not hypothesize directionality. METHODS: As part of the pretreatment battery for a randomized clinical trial, 74 youth with anxiety and 31 ND youth (ages 9-14 years; n = 55 female) completed a monetary reward task during fMRI. During the same pretreatment window, actigraphy and diary-estimated sleep were collected over 5 days, and participants and their parents each reported participants' total sleep problems. We examined group*sleep interactions on VS response to monetary rewards versus losses via three mixed linear models corresponding to actigraphy, diary, and questionnaires, respectively. RESULTS: Each model indicated group*sleep interactions on VS response to rewards. Actigraphy and diary-estimated time awake after sleep onset predicted reduced VS response in youth with anxiety but not ND youth. Parent-reported sleep problems similarly interacted with group, but simple slopes were nonsignificant. CONCLUSIONS: Wake after sleep onset was associated with blunted reward response in youth with anxiety. These data suggest a potential pathway through which sleep could contribute to perturbed reward function and reward-related psychopathology (e.g., depression) in youth with anxiety.


Asunto(s)
Trastornos del Sueño-Vigilia , Estriado Ventral , Adolescente , Humanos , Femenino , Niño , Vigilia , Sueño/fisiología , Trastornos de Ansiedad , Estriado Ventral/diagnóstico por imagen , Ansiedad , Recompensa
5.
J Clin Child Adolesc Psychol ; : 1-11, 2023 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-37796228

RESUMEN

OBJECTIVE: Positive associations between therapeutic alliance and outcome (e.g. youth symptom severity) have been documented in the youth anxiety literature; however, little is known about the conditions under which early alliance contributes to positive outcomes in youth. The present study examined the relations between therapeutic alliance, session attendance, and outcomes in youths (N = 135; 55.6% female) who participated in a randomized clinical trial testing the efficacy of cognitive-behavioral therapy or client-centered therapy for anxiety. METHOD: We evaluated a conceptual model wherein: (1) early alliance indirectly contributes to positive outcomes by improving session attendance; (2) alliance-outcome associations differ by intervention type, with stronger associations in cognitive-behavioral therapy compared to client-centered therapy; and (3) alliance-outcome associations vary across outcome measurement timepoints, with the effect of early alliance on outcomes decaying over time. RESULTS: Contrary to hypotheses, provider ratings of early alliance predicted greater youth-rated anxiety symptom severity post-treatment (i.e. worse treatment outcomes). Session attendance predicted positive youth-rated outcomes, though there was no indirect effect of early alliance on outcomes through session attendance. CONCLUSIONS: Results show that increasing session attendance is important for enhancing outcomes and do not support early alliance as a predictor of outcomes.

6.
Artículo en Inglés | MEDLINE | ID: mdl-38036742

RESUMEN

Youth with anxiety disorders report difficulty falling asleep and returning to sleep after sleep onset (i.e., poor sleep efficiency). Anxiety sensitivity, the excessive attention to physical symptoms of anxiety and their threatening interpretations, has been linked to poor sleep efficiency. We tested a conceptual model wherein attentional control, attentional focusing and attentional shifting would account for the relationship between anxiety sensitivity and poor sleep efficiency. 255 youths (6-17 years old, 78% Hispanic/Latino) who presented to a university-based research clinic completed measures on anxiety sensitivity, sleep, and attentional control. Poorer sleep efficiency was significantly correlated with higher anxiety sensitivity and lower attentional control, attentional focusing, and attentional shifting. Higher anxiety sensitivity was significantly correlated with lower attentional control and attentional focusing. Attentional control and attentional focusing, not attentional shifting, accounted for the relationship between anxiety sensitivity and poor sleep efficiency. These findings identify attentional control and attentional focusing as variables that may explain the association between anxiety sensitivity and sleep efficiency in youth.

7.
Psychosom Med ; 84(4): 410-420, 2022 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-35100181

RESUMEN

OBJECTIVE: Sleep changes over the human life span, and it does so across multiple dimensions. We used individual-level cross-sectional data to characterize age trends and sex differences in actigraphy and self-report sleep dimensions across the healthy human life span. METHODS: The Pittsburgh Lifespan Sleep Databank consists of harmonized participant-level data from sleep-related studies conducted at the University of Pittsburgh (2003-2019). We included data from 1065 (n = 577 female; 21 studies) Pittsburgh Lifespan Sleep Databank participants aged 10 to 87 years without a major psychiatric, sleep, or medical condition. All participants completed wrist actigraphy and the self-rated Pittsburgh Sleep Quality Index. Main outcomes included actigraphy and self-report sleep duration, efficiency, and onset/offset timing, and actigraphy variability in midsleep timing. RESULTS: We used generalized additive models to examine potentially nonlinear relationships between age and sleep characteristics and to examine sex differences. Actigraphy and self-report sleep onset time shifted later between ages 10 and 18 years (23:03-24:10 [actigraphy]; 21:58-23:53 [self-report]) and then earlier during the 20s (00:08-23:40 [actigraphy]; 23:50-23:34 [self-report]). Actigraphy and self-report wake-up time also shifted earlier during the mid-20s through late 30s (07:48-06:52 [actigraphy]; 07:40-06:41 [self-report]). Self-report, but not actigraphy, sleep duration declined between ages 10 and 20 years (09:09-07:35). Self-report sleep efficiency decreased over the entire life span (96.12-93.28), as did actigraphy variability (01:54-01:31). CONCLUSIONS: Awareness of age trends in multiple sleep dimensions in healthy individuals-and explicating the timing and nature of sex differences in age-related change-can suggest periods of sleep-related risk or resilience and guide intervention efforts.


Asunto(s)
Actigrafía , Longevidad , Actigrafía/métodos , Estudios Transversales , Femenino , Humanos , Masculino , Autoinforme , Sueño
8.
Child Psychiatry Hum Dev ; 53(3): 526-537, 2022 06.
Artículo en Inglés | MEDLINE | ID: mdl-33656632

RESUMEN

Cognitive behavioral therapy (CBT) has been shown to be an efficacious treatment for youth anxiety, but we need to know more about the process of change. Affective network variability, or the "spread" of positive and negative emotions activated across a given time period, has been found to be positively associated with anxiety disorder symptomatology, but it is not yet known how this construct changes in response to intervention or its association with anxiety-focused treatment outcomes. The present study used a dynamical systems framework to model ecological momentary assessment (EMA) data collected via a cellular telephone from 114 youth aged 9-14 years (Mage = 10.94, SD = 1.46) who were seeking treatment for a primary anxiety disorder. We examined patterns of affective network variability over time and across (a) CBT and (b) client-centered therapy (CCT) to determine whether affective network changes were specific to CBT or due to nonspecific factors. Associations between treatment outcomes and patterns of affect at pretreatment and over the course of the treatments were also examined. Results revealed significant decreases in affective network variability over the course of treatment for youth who received CBT, but not for youth who received CCT. Changes in affective network variability over the course of treatment did not predict treatment outcomes. Findings provide initial support for the dynamical systems approach to examining changes that occur during treatment. Implications and future research are discussed.


Asunto(s)
Trastornos de Ansiedad , Terapia Cognitivo-Conductual , Adolescente , Ansiedad , Trastornos de Ansiedad/psicología , Trastornos de Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Evaluación Ecológica Momentánea , Humanos , Resultado del Tratamiento
9.
J Clin Psychol ; 78(7): 1516-1539, 2022 07.
Artículo en Inglés | MEDLINE | ID: mdl-35150595

RESUMEN

OBJECTIVE: This study examined sleep disorders and sleep medication use rates, nighttime tics, and sleep and chronotype in relation to tic and co-occurring symptoms in adults with persistent tic disorders (PTDs), including Tourette's disorder (TD). METHODS: One hundred twenty-five adult internet survey respondents rated sleep history, sleep, chronotype, tic severity, impairment, attention deficit hyperactivity disorder, obsessive-compulsive symptoms, anxiety, depression, and emotional and behavioral dyscontrol. RESULTS: Bruxism, insomnia, tic-related difficulty falling asleep, and melatonin use were commonly endorsed. Sleep disturbance correlated with impairment, obsessive-compulsive symptoms, and emotional and behavioral dyscontrol. Eveningness correlated with vocal and total tic severity only in TD. Controlling for age and sex, age, impairment, and obsessive-compulsive symptoms predicted sleep disturbance, and age and tic severity predicted chronotype. CONCLUSIONS: Impairment and obsessive-compulsive symptoms play a role in sleep disturbance in adults with PTDs, and may be intervention targets. Eveningness relates to tic severity, which may suggest the utility of interventions to advance chronotype.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Trastorno Obsesivo Compulsivo , Trastornos de Tic , Tics , Síndrome de Tourette , Adulto , Humanos , Trastorno Obsesivo Compulsivo/diagnóstico , Trastorno Obsesivo Compulsivo/epidemiología , Sueño , Trastornos de Tic/diagnóstico , Trastornos de Tic/epidemiología
11.
J Clin Child Adolesc Psychol ; 48(sup1): S284-S297, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-29873503

RESUMEN

Sleep disturbance is prevalent in anxious youth and prospectively predicts poor emotional adjustment in adolescence. Study 1 examined whether anxiety treatment improves subjective and objective sleep disturbance in anxious youth. Study 2 examined whether a sleep intervention called Sleeping TIGERS can further improve sleep following anxiety treatment. Study 1 examined 133 youth (ages 9-14; 56% female; 11% ethnic/racial minority) with generalized, social, or separation anxiety over the course of anxiety treatment (cognitive behavioral treatment or client-centered treatment). Sleep-related problems (parent-, child-report) and subjective (diary) and objective (actigraphy) sleep patterns were assessed across treatment in an open trial design. Study 2 included 50 youth (ages 9-14; 68% female; 10% ethnic/racial minority) who continued to report sleep-related problems after anxiety treatment and enrolled in an open trial of Sleeping TIGERS. Pre- and postassessments duplicated Study 1 and included the Focal Interview of Sleep to assess sleep disturbance. Study 1 demonstrated small reductions in sleep problems and improvements in subjective sleep patterns (diary) across anxiety treatment, but outcomes were not deemed clinically significant, and 75% of youth stayed above clinical cutoff. Study 2 showed clinically significant, large reductions in sleep problems and small changes in some subjective sleep patterns (diary). Anxiety treatment improves, but does not resolve, sleep disturbance in peri-pubertal youth, which may portend risk for poor emotional adjustment and mental health. The open trial provides preliminary support that Sleeping TIGERS can improve sleep in anxious youth to a clinically significant degree.


Asunto(s)
Trastornos de Ansiedad/terapia , Trastornos del Sueño-Vigilia/terapia , Adolescente , Trastornos de Ansiedad/psicología , Niño , Femenino , Humanos , Masculino , Trastornos del Sueño-Vigilia/psicología
12.
J Neurosci ; 37(9): 2425-2434, 2017 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-28143960

RESUMEN

Cognitive models propose a negative memory bias as one key factor contributing to the emergence and maintenance of social anxiety disorder (SAD). The long-term consolidation of memories relies on memory reactivations during sleep. We investigated in SAD patients and healthy controls the role of memory reactivations during sleep in the long-term consolidation of positive and negative information. Socially anxious and healthy children and adolescents learnt associations between pictures showing ambiguous situations and positive or negative words defining the situations' outcome. Half of the words were re-presented during postlearning sleep (i.e., they were cued). Recall of picture-word associations and subjective ratings of pleasantness and arousal in response to the pictures was tested for cued and uncued stimuli. In the morning after cueing, cueing facilitated retention of positive and negative memories equally well in SAD patients and healthy controls. One week later, cueing led to reduced ratings of pleasantness of negative information in SAD but not in healthy controls. Coincidental to these findings was more pronounced EEG theta activity over frontal, temporal and parietal regions in response to negative stimuli in SAD patients. Our findings suggest that the preferential abstraction of negative emotional information during sleep might represent one factor underlying the negative memory bias in SAD.SIGNIFICANCE STATEMENT We aim to uncover mechanisms underlying the characteristic negative memory bias in social anxiety disorder (SAD). The formation of long-lasting memories-a process referred to as memory consolidation-depends on the reactivation of newly acquired memories during sleep. We demonstrated that experimentally induced memory reactivation during sleep renders long-term memories of negative experiences more negative in SAD patients but not in healthy controls. We also found in SAD patients that the reactivation of negative experiences coincided with more pronounced oscillatory theta activity. These results provide first evidence that memory reactivation during sleep might contribute to the negative memory bias in SAD.


Asunto(s)
Afecto/fisiología , Aprendizaje por Asociación/fisiología , Trastornos de la Memoria/etiología , Fobia Social/complicaciones , Sueño/fisiología , Adolescente , Nivel de Alerta , Mapeo Encefálico , Estudios de Casos y Controles , Niño , Señales (Psicología) , Potenciales Evocados , Femenino , Humanos , Masculino , Memoria a Largo Plazo , Pruebas Neuropsicológicas , Estimulación Luminosa , Escalas de Valoración Psiquiátrica , Retención en Psicología , Factores de Tiempo
13.
J Child Psychol Psychiatry ; 59(6): 637-649, 2018 06.
Artículo en Inglés | MEDLINE | ID: mdl-29164609

RESUMEN

BACKGROUND: The aim of this study was to test moderators of therapeutic improvement in an adolescent cognitive-behavioral and mindfulness-based group sleep intervention. Specifically, we examined whether the effects of the program on postintervention sleep outcomes were dependent on participant gender and/or measures of sleep duration, anxiety, depression, and self-efficacy prior to the interventions. METHOD: Secondary analysis of a randomized controlled trial conducted with 123 adolescent participants (female = 59.34%; mean age = 14.48 years, range 12.04-16.31 years) who had elevated levels of sleep problems and anxiety symptoms. Participants were randomized into either a group sleep improvement intervention (n = 63) or group active control 'study skills' intervention (n = 60). The sleep intervention ('Sleep SENSE') was cognitive behavioral in approach, incorporating sleep education, sleep hygiene, stimulus control, and cognitive restructuring, but also had added anxiety-reducing, mindfulness, and motivational interviewing elements. Components of the active control intervention ('Study SENSE') included personal organization, persuasive writing, critical reading, referencing, memorization, and note taking. Participants completed the Pittsburgh Sleep Quality Index (PSQI), Spence Children's Anxiety Scale (SCAS), Center for Epidemiologic Studies Depression Scale (CES-D), and General Self-Efficacy Scale (GSE) and wore an actigraph and completed a sleep diary for five school nights prior to the interventions. Sleep assessments were repeated at postintervention. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12612001177842; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12612001177842&isBasic=True). RESULTS: The results showed that compared with the active control intervention, the effect of the sleep intervention on self-reported sleep quality (PSQI global score) at postintervention was statistically significant among adolescents with relatively moderate to high SCAS, CES-D, and GSE prior to the intervention, but not among adolescents with relatively low SCAS, CES-D, and GSE prior to the intervention. The results were consistent across genders. However, the effects of the sleep intervention on actigraphy-measured sleep onset latency and sleep diary-measured sleep efficiency at postintervention were not dependent on actigraphy-measured total sleep time, SCAS, CES-D, or GSE prior to the intervention. CONCLUSIONS: This study provides evidence that some sleep benefits of adolescent cognitive-behavioral sleep interventions are greatest among those with higher levels of anxiety and depressive symptoms, suggesting that this may be an especially propitious group to whom intervention efforts could be targeted. Furthermore, adolescents with lower levels of self-efficacy may need further targeted support (e.g. additional motivational interviewing) to help them reach treatment goals.


Asunto(s)
Ansiedad/terapia , Terapia Cognitivo-Conductual/métodos , Depresión/terapia , Autoeficacia , Trastornos del Sueño-Vigilia/terapia , Adolescente , Niño , Femenino , Humanos , Masculino , Atención Plena/métodos , Entrevista Motivacional/métodos , Psicoterapia de Grupo/métodos
14.
J Child Psychol Psychiatry ; 59(12): 1309-1322, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29718535

RESUMEN

BACKGROUND: Vigilant attention to threat is commonly observed in anxiety, undergoes developmental changes in early adolescence, and has been proposed to interfere with sleep initiation and maintenance. We present one of the first studies to use objective measures to examine associations between vigilant attention to threat and difficulties initiating and maintaining sleep in an early adolescent anxious sample. We also explore the moderating role of development (age, puberty) and sex. METHODS: Participants were 66 peripubertal youth (ages 9-14) with a primary anxiety disorder and 24 healthy control subjects. A dot-probe task was used to assess attentional bias to fearful relative to neutral face stimuli. Eye-tracking indexed selective attentional bias to threat, and reaction time bias indexed action readiness to threat. Sleep was assessed via actigraphy (e.g. sleep onset delay, wake after sleep onset, etc.), parent report (Children's Sleep Habits Questionnaire), and child report (Sleep Self-Report). The Pediatric Anxiety Rating Scale assessed anxiety severity. RESULTS: Eye-tracking initial threat fixation bias (ß = .33, p = .001) and threat dwell time bias (ß = .22, p = .041) were positively associated with sleep onset latency. Reaction time bias was positively associated with wake after sleep onset (ß = .24, p = .026) and parent-reported sleep disturbance (ß = .25, p = .019). Anxiety (severity, diagnosis) was not associated with these outcomes. Sex (ß = -.32, p = .036) moderated the relation between initial threat fixation bias and sleep onset latency, with a positive association for males (p = .005), but not for females (p = .289). Age and pubertal status did not moderate effects. CONCLUSIONS: Vigilant attention to threat is related to longer sleep onset and reduced sleep maintenance. These associations are not stronger in early adolescents with anxiety. Implications for early intervention or prevention that targets vigilant attention to threat to impact sleep disturbance, and vice versa, are discussed.


Asunto(s)
Ansiedad/etiología , Nivel de Alerta , Sueño , Actigrafía , Adolescente , Ansiedad/psicología , Estudios de Casos y Controles , Niño , Femenino , Humanos , Masculino , Escalas de Valoración Psiquiátrica , Trastornos del Inicio y del Mantenimiento del Sueño/etiología
15.
J Child Psychol Psychiatry ; 59(11): 1152-1161, 2018 11.
Artículo en Inglés | MEDLINE | ID: mdl-29603219

RESUMEN

BACKGROUND: Anxiety disorders are associated with an overactive action monitoring system as indexed by a larger error-related negativity (ERN). This study tests whether ERN magnitude changes following treatment, predicts response to treatment, and varies by treatment type. METHODS: The sample included 130 youth (9-14 years): youth with an anxiety disorder (ANX; n = 100) and healthy control (HC; n = 30) youth with no lifetime DSM-IV disorders. ANX youth were randomized to either a manualized cognitive-behavior therapy (CBT) or a comparison child-centered therapy (CCT). The ERN was assessed before and after 16 sessions of treatment and within a comparable interval for HC. Subjective ratings about making errors on the task were obtained following each testing session. The ClinicalTrials.gov identifier is NCT00774150. RESULTS: The ERN was larger in ANX than HC youth but ERN magnitude did not significantly change following treatment in the ANX youth, regardless of treatment type, and baseline ERN did not predict treatment response. Post-task ratings revealed that ANX youth worried more about task performance feedback than HC. Like the ERN, mean ratings did not significantly change following treatment. However, these ratings were not correlated with ERN amplitude. CONCLUSIONS: Findings of greater ERN in pediatric anxiety disorders are replicated in a larger sample. More importantly, findings from this randomized control trial show that a larger ERN and feeling worried about performance feedback remain unchanged following treatment and are unrelated to treatment response. Such findings suggest that action monitoring systems remain overactive in anxious youth treated with psychotherapy, suggesting the need for future investigation of whether novel complimentary cognitive and emotional training programs can modify these systems would be warranted.


Asunto(s)
Trastornos de Ansiedad/fisiopatología , Encéfalo/fisiopatología , Terapia Cognitivo-Conductual , Potenciales Evocados/fisiología , Adolescente , Trastornos de Ansiedad/terapia , Estudios de Casos y Controles , Niño , Electroencefalografía , Femenino , Humanos , Masculino , Pruebas Neuropsicológicas , Escalas de Valoración Psiquiátrica
16.
J Clin Child Adolesc Psychol ; 47(4): 542-554, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-26983904

RESUMEN

This study compared individual cognitive behavioral therapy (CBT) and a supportive child-centered therapy (CCT) for child anxiety disorders on rates of treatment response and recovery at posttreatment and 1-year follow-up, as well as on real-world measures of emotional functioning. Youth (N = 133; ages 9-14) with anxiety disorders (generalized, separation, and/or social anxiety) were randomized using a 2:1 ratio to CBT (n = 90) or CCT (n = 43), which served as an active comparison. Treatment response and recovery at posttreatment and 1-year follow-up were assessed by Independent Evaluators, and youth completed ecological momentary assessment of daily emotions throughout treatment. The majority of youth in both CBT and CCT were classified as treatment responders (71.1% for CBT, 55.8% for CCT), but youth treated with CBT were significantly more likely to fully recover, no longer meeting diagnostic criteria for any of the targeted anxiety disorders and no longer showing residual symptoms (66.7% for CBT vs. 46.5% for CCT). Youth treated with CBT also reported significantly lower negative emotions associated with recent negative events experienced in daily life during the latter stages of treatment relative to youth treated with CCT. Furthermore, a significantly higher percentage of youth treated with CBT compared to CCT were in recovery at 1-year follow-up (82.2% for CBT vs. 65.1% for CCT). These findings indicate potential benefits of CBT above and beyond supportive therapy on the breadth, generalizability, and durability of treatment-related gains.


Asunto(s)
Trastornos de Ansiedad/psicología , Adolescente , Niño , Terapia Cognitivo-Conductual , Femenino , Humanos , Masculino , Resultado del Tratamiento
17.
Child Psychiatry Hum Dev ; 49(3): 352-359, 2018 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-29222620

RESUMEN

Although recent studies have linked pediatric anxiety to irritability, research has yet to examine the mechanisms through which youth anxiety may be associated with irritability. Importantly, sleep related problems (SRPs) have been associated with both child anxiety and irritability, but research has not considered whether the link between youth anxiety and irritability may be accounted for by SRPs. The present study investigated whether SRPs mediated the relationship between anxiety severity and irritability in a large sample of treatment-seeking anxious youth (N = 435; ages 7-19 years, M = 12.7; 55.1% female). Anxiety severity, SRPs and irritability showed significant pairwise associations, and the indirect effect of youth anxiety severity on irritability, via SRPs, was positive and significant. The present analysis is the first to examine youth anxiety, irritability, and SPRs in a single model in a sample of anxious youth, and provides preliminary evidence that SRPs partially mediate links between child anxiety and irritability.


Asunto(s)
Trastornos de Ansiedad/complicaciones , Trastornos de Ansiedad/psicología , Ansiedad/complicaciones , Ansiedad/psicología , Genio Irritable , Trastornos del Sueño-Vigilia/complicaciones , Trastornos del Sueño-Vigilia/psicología , Adolescente , Niño , Femenino , Humanos , Masculino , Adulto Joven
18.
J Child Psychol Psychiatry ; 57(9): 1027-37, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-27302148

RESUMEN

BACKGROUND: Short sleep duration is highly prevalent in adolescence, and it prospectively predicts problems with emotional adjustment and psychiatric health. To move beyond epidemiological associations and inform models of developmental psychopathology, we experimentally restricted sleep to observe impacts on affective functioning. Based on the importance of social contexts to adolescent emotional experiences, we also examined the impact of restricted sleep on socioaffective functioning in an ecologically valid peer interaction task. METHODS: In Study 1, adolescents (ages 11.5-15.0, n = 48) were randomly assigned to two nights of polysomnography-monitored sleep restriction (4 hr in bed) or extension (10 hr in bed). One week later, they completed the other sleep manipulation. Affective functioning was assessed by self-report and pupil response to standardized affective sounds. Study 2 used a similar protocol and invited adolescents (ages 12-15.0, n = 16) to the sleep laboratory along with 2-4 friends to observe affective behavior in a social context primed for peer conflict. Mixed effects models were used to evaluate the effect of sleep condition on affective outcomes. RESULTS: Study 1 demonstrated increased negative affect following sleep restriction, relative to extension, on self-report (p = .02) and pupil measures (p = .01). Study 2 replicated these effects (both p = .04) and demonstrated greater negative affective behavior in a peer social context (p = .01). Exploratory analyses for positive affect showed reductions as assessed by self-report (p = .005), but not pupil (p = .81), in Study 1; and no significant effects in Study 2 (self-report, p = .14; pupil, p = .29; positive affective behavior, p = .43). CONCLUSIONS: Experimental sleep restriction in adolescence impacts negative affective functioning as evidenced by self-report and pupil reactivity, as well as observed behavior in a social context primed for peer conflict. Implications for the impact of short sleep on developmental trajectories of emotional adjustment and psychiatric health, and opportunities for early intervention, are briefly discussed.


Asunto(s)
Conducta del Adolescente/fisiología , Afecto/fisiología , Privación de Sueño/fisiopatología , Conducta Social , Adolescente , Niño , Conflicto Psicológico , Femenino , Humanos , Masculino , Grupo Paritario
19.
J Child Psychol Psychiatry ; 57(7): 835-42, 2016 07.
Artículo en Inglés | MEDLINE | ID: mdl-26549516

RESUMEN

BACKGROUND: Childhood anxiety is associated with low levels of parental autonomy granting and child perceived control, elevated child emotional reactivity and deficits in child emotion regulation. In early childhood, low levels of parental autonomy granting are thought to decrease child perceived control, which in turn leads to increases in child negative emotion. Later in development, perceived control may become a more stable, trait-like characteristic that amplifies the relationship between parental autonomy granting and child negative emotion. The purpose of this study was to test mediation and moderation models linking parental autonomy granting and child perceived control with child emotional reactivity and emotion regulation in anxious youth. METHODS: Clinically anxious youth (N = 106) and their primary caregivers were assessed prior to beginning treatment. Children were administered a structured diagnostic interview and participated in a parent-child interaction task that was behaviorally coded for parental autonomy granting. Children completed an ecological momentary assessment protocol during which they reported on perceived control, emotional reactivity (anxiety and physiological arousal) and emotion regulation strategy use in response to daily negative life events. RESULTS: The relationship between parental autonomy granting and both child emotional reactivity and emotion regulation strategy use was moderated by child perceived control: the highest levels of self-reported physiological responding and the lowest levels of acceptance in response to negative events occurred in children low in perceived control with parents high in autonomy granting. Evidence for a mediational model was not found. In addition, child perceived control over negative life events was related to less anxious reactivity and greater use of both problem solving and cognitive restructuring as emotion regulation strategies. CONCLUSION: Both parental autonomy granting and child perceived control play important roles in the everyday emotional experience of clinically anxious children.


Asunto(s)
Desarrollo del Adolescente/fisiología , Trastornos de Ansiedad/psicología , Desarrollo Infantil/fisiología , Emociones/fisiología , Control Interno-Externo , Responsabilidad Parental/psicología , Autonomía Personal , Autocontrol/psicología , Adolescente , Niño , Femenino , Humanos , Masculino
20.
J Clin Child Adolesc Psychol ; 45(3): 279-90, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-25581086

RESUMEN

Although multiple studies find that offspring of depressed mothers are at risk for depressive disorders, there is uncertainty about the specific mechanisms that are at work--particularly with respect to modifiable factors that might be targeted for early intervention. The present work examines that parenting behaviors may operate as mediators, moderators, or independent influences on the development of youth depressive symptoms. One hundred one mothers and their early adolescent children participated in positive and negative interaction tasks. Maternal and youth self-reports of youth depressive symptoms were collected at baseline, 9-month, and 18-month assessments. Maternal history of depression was significantly associated with maternal-reported, but not youth self-reported, depressive symptomatology. Maternal positive and negative interaction behaviors in positive contexts were associated with higher youth self-reported depressive symptoms. Maternal positive interaction behaviors in positive contexts and maternal negative interactive behaviors in conflict contexts were associated with higher youth self-reported depressive symptoms. We found no evidence for maternal interaction behaviors serving as a mediator and little evidence of maternal interaction behaviors serving as a moderator of the relationship between maternal and offspring depression. Low maternal positive engagement tended to be more consistently associated with maternal- and self-reported youth depressive symptoms. The present findings suggest that characteristics of mother-child interactions that are associated with youth depressive symptomatology are pertinent to youth with and without a mother with a history of depression.


Asunto(s)
Depresión/diagnóstico , Relaciones Madre-Hijo , Madres/psicología , Responsabilidad Parental/psicología , Adolescente , Adulto , Niño , Hijo de Padres Discapacitados , Depresión/psicología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Femenino , Humanos , Estudios Longitudinales , Masculino , Conducta Materna/psicología
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