Emotion regulation as a mediator in the relationship between childhood maltreatment and symptoms of social anxiety among college students.

OBJECTIVE: The current study explored emotion regulation strategies (ie, suppression, cognitive reappraisal, experiential avoidance) as mediators in the relationship between childhood maltreatment and social anxiety. PARTICIPANTS: One hundred and ninety-three undergraduate students (Mage = 19.5 years; 83.9% female) were recruited from a public university in the northeastern United States. METHODS: Participants completed measures assessing childhood maltreatment, emotion regulation strategies, and social anxiety. RESULTS: Structural equation modeling was used to examine the mediation paths. Childhood maltreatment was negatively associated with cognitive reappraisal and experiential avoidance, and positively associated with suppression. Higher suppression was associated with higher social anxiety, and higher experiential avoidance was associated with lower social anxiety. The association between childhood maltreatment and symptoms of social anxiety was mediated by suppression and experiential avoidance, but not cognitive reappraisal. All other paths were nonsignificant. CONCLUSIONS: Findings suggest that treatments for childhood maltreatment should aim to bolster experiential avoidance and minimize suppression to address social anxiety symptoms.

Trauma, attentional biases, and revictimization among young adults.

Individuals with previous histories of trauma are at increased risk for subsequent victimization and the development of posttraumatic stress disorder, depression, and anxiety disorders. Attentional biases to threat-related stimuli are thought to impact one's ability to recognize future risk in his or her environment and may explain high rates of revictimization. Although the literature has identified three possible types of attentional biases among victims of trauma (i.e., interference, facilitation, and avoidance), findings are mixed. The current study examined attentional biases to threats among a sample of men and women with no, some, and multiple incident interpersonal and non-interpersonal trauma histories. It was hypothesized that those with multiple incident interpersonal trauma histories would demonstrate an interference effect (i.e., slower response times to threat-related words). Participants (N = 309) were 18- to 29-year-old college students. Self-report measures assessed trauma history, posttraumatic stress, and other psychological sequelae. Attentional biases were assessed using a dot probe computer task. Contrary to hypotheses, no significant differences in response times in the presence of threat-related words or neutral words were found among groups. Results suggest that multiple traumatized individuals do not exhibit attentional bias to threats compared to individuals with some or no trauma.

Parent cognitive-behavioral intervention for the treatment of childhood anxiety disorders: a pilot study.

Strong evidence supports cognitive-behavioral therapy (CBT) for the treatment of childhood anxiety. Many studies suggest that parents play an etiological role in the development and maintenance of child anxiety. This pilot study examined the efficacy of a cognitive-behavioral intervention delivered to the parents of 31 anxious children (ages 7-13). Parents were randomly assigned to an individual parent-only CBT intervention (PCBT, n = 18) or wait-list control (WL, n = 13). PCBT demonstrated significant reductions in children's number of anxiety disorder diagnoses, parent-rated interference and clinician-rated severity of anxiety, and maternal protective behaviors at post-treatment, which were maintained at 3-months. WL did not demonstrate significant changes. There were no significant differences between conditions in child self-reported or parent-report of child anxiety symptoms. Findings were replicated in a combined sample of treated participants, as well as in an intent-to-treat sample. Parent-only CBT may be an effective treatment modality for child anxiety, though future research is warranted.

Types of parental involvement in CBT with anxious youth: a preliminary meta-analysis.

OBJECTIVE: Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. METHOD: Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. RESULTS: All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CONCLUSIONS: CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.

Cognitive behavioral therapy age effects in child and adolescent anxiety: an individual patient data metaanalysis.

BACKGROUND: Investigations of age effects on youth anxiety outcomes in randomized trials (RCTs) of cognitive behavior therapy (CBT) have failed to yield a clear result due to inadequate statistical power and methodologic weaknesses. We conducted an individual patient data metaanalysis to address this gap. QUESTION: Does age moderate CBT effect size, measured by a clinically and statistically significant interaction between age and CBT exposure? METHODS: All English language RCTs of CBT for anxiety in 6-19 year olds were identified using systematic review methods. Investigators of eligible trials were invited to submit their individual patient data. The anxiety disorder interview schedule (ADIS) primary diagnosis severity score was the primary outcome. Age effects were investigated using multilevel modeling to account for study level data clustering and random effects. RESULTS: Data from 17 of 23 eligible trials were obtained (74%); 16 studies and 1,171 (78%) cases were available for the analysis. No interaction between age and CBT exposure was found in a model containing age, sex, ADIS baseline severity score, and comorbid depression diagnosis (power ≥ 80%). Sensitivity analyses, including modeling age as both a categorical and continuous variable, revealed this result was robust. CONCLUSIONS: Adolescents who receive CBT in efficacy research studies show benefits comparable to younger children. However, CBT protocol modifications routinely carried out by expert trial therapists may explain these findings. Adolescent CBT protocols are needed to facilitate the transportability of efficacy research effects to usual care settings where therapists may have less opportunity for CBT training and expertise development.

Children with co-morbid recurrent abdominal pain and anxiety disorders: results from a multiple-baseline intervention study.

Recurrent Abdominal Pain (RAP), one of the most common complaints of childhood, is associated with many adverse outcomes. However, few treatment studies have been conducted, especially for children with co-morbid RAP and anxiety disorders. The primary aim of the present study was to explore the utility of a cognitive-behavioral treatment (CBT) and a treatment that combined both CBT and family-based approaches in a community sample of children with co-morbid anxiety and RAP. A multiple-baseline across participants design utilizing repeated measures of anxiety and pain was implemented (n = 8 families). An examination of the clinical significance of both treatment approaches is suggestive of their utility in the treatment of anxiety and pain symptoms in children with RAP. More research is warranted in RAP treatment outcome research, particularly with family-based approaches to treatment.

Cognitive-behavioral therapy for anxiety-disordered youth: secondary outcomes from a randomized clinical trial evaluating child and family modalities.

This study examined secondary outcomes of a randomized clinical trial that evaluated an individual cognitive-behavioral (ICBT), family-based cognitive-behavioral (FCBT), and family-based education, support and attention (FESA) treatment for anxious youth. Participants (161) were between 7 and 14 years (M=10.27) of age and had a principal diagnosis of separation anxiety disorder, social phobia, and/or generalized anxiety disorder. Hierarchical linear modeling examined youth-reported depressive symptomatology and parent- and teacher-reported externalizing behavior and adaptive functioning at pretreatment, posttreatment, and 1-year follow-up. In general, youth in all treatments evidenced improvements in most domains, with improvements maintained at follow-up. Overall, gender and age did not moderate treatment outcomes. The results suggest that both child and family cognitive-behavioral therapy, and the family-based supportive approach used in this study, can be effective in addressing some of the associated symptoms and adaptive functioning deficits typically linked to anxiety in youth.

Cognitive-behavioral therapy for anxiety disordered youth: a randomized clinical trial evaluating child and family modalities.

This randomized clinical trial compared the relative efficacy of individual (child) cognitive-behavioral therapy (ICBT), family cognitive-behavioral therapy (FCBT), and a family-based education/support/ attention (FESA) active control for treating anxiety disordered youth ages 7-14 years (M = 10.27). Youth (N = 161; 44% female; 85% Caucasian, 9% African American, 3% Hispanic, 3% other/mixed) with a principal diagnosis of separation anxiety disorder, social phobia, or generalized anxiety disorder and their parents participated. Outcome analyses were conducted using hierarchical linear models on the intent-to-treat sample at posttreatment and 1-year follow-up using diagnostic severity, child self-reports, parent reports, and teacher reports. Chi-square analyses were also conducted on diagnostic status at post and 1-year follow-up. Children evidenced treatment gains in all conditions, although FCBT and ICBT were superior to FESA in reducing the presence and principality of the principal anxiety disorder, and ICBT outperformed FCBT and FESA on teacher reports of child anxiety. Treatment gains, when found, were maintained at 1-year follow-up. FCBT outperformed ICBT when both parents had an anxiety disorder. Implications for treatment and suggestions for research are discussed.

Reducing anxiety to prevent depression.

Depression is one of the most prevalent mental disorders. Accordingly, treatment research has flourished; however, prevention efforts have lagged behind. The extant literature is reviewed on the relationship between anxiety and depression and the potential for childhood anxiety interventions to reduce the risks of secondary depression. Additionally, methodologic issues and recommendations in the design of depression prevention programs are presented. Research appears to support the view that anxiety plays a role in the development of depression; yet, the nature of that role remains unclear.

A longitudinal look at parent-child diagnostic agreement in youth treated for anxiety disorders.

This study examined diagnostic agreement between children and their parents for seventy 9- to 13-year-olds (45 boys and 25 girls) who had received cognitive-behavioral treatment for anxiety disorders. Parent-child diagnostic rates and agreements for generalized anxiety disorder, separation anxiety disorder, and social phobia were evaluated at 3 time points: pretreatment, posttreatment, and 7.4-year follow-up. Results indicate that parent-child diagnostic agreement was typically poor to moderate (kappa = -.03 to .64) and that estimates of agreement remained relatively unchanged (a) following treatment and (b) as the children enter adolescence and young adulthood. Parent-daughter agreement was better than parent-son agreement in some cases. Although it remains unclear whether parent or child diagnostic information is most accurate, positive treatment outcome appears to be possible despite poor parent-child diagnostic agreement.

Emotion socialization in families of children with an anxiety disorder.

Compared emotion socialization in 26 children with anxiety disorders ages 8-12 years and their mothers to 26 nonclinical counterparts without psychopathology. Children and their mothers participated in an emotion interaction task in which they discussed occasions when the child felt worry, sadness, and anger. Responses were coded for length of discussion, proportion of words spoken by child vs. mother, frequency of positive and negative emotion words, explanatory discussion of emotion, and maternal facilitation of emotion discussion. Children and their mothers also completed the Expressiveness and Control scales of the Family Environment Scale. Results indicated that mothers of children with an anxiety disorder spoke less frequently than their child, used significantly fewer positive emotion words, and discouraged their children's emotion discussions more than did mothers of nonclinical children. Nonclinical children and their mothers indicated significantly more emotional expressiveness in their families than did children with an anxiety disorder and their mothers. These results highlight the potential role of truncated family emotional expressivity in the emotional development and functioning of children with an anxiety disorder.

Disclosure of distress among anxiety-disordered youth: differences in treatment outcome.

The present study evaluated treatment outcome differences in anxiety-disordered youth who differed in their disclosure of internal distress as measured in a structured diagnostic interview. One hundred and seventy-one clinic-referred, anxiety-disordered children served as participants. Participants' primary diagnoses were one of three anxiety disorders: separation anxiety, generalized anxiety/overanxious, or social phobia/avoidance. At a pretreatment assessment, children and their parents were interviewed separately using the Anxiety Disorders Interview Schedule (ADIS) to determine the child's diagnosis. The child's status as a discloser of high distress or discloser of low distress was determined by the parents' endorsement of an anxiety disorder and the child's endorsement or lack of endorsement of an anxiety disorder, respectively. Parents, teachers, and children also completed measures assessing the child's psychopathology (e.g., Revised Children's Manifest Anxiety Scale, Child Behavior Checklist). In general, findings indicated that the level of distress reported by the children moderated treatment outcome. Although both groups benefited from treatment, the children disclosing high distress experienced greater treatment gains than the children disclosing low distress.

Use of the Herb Gymnema sylvestre to Illustrate the Principles of Gustatory Sensation: An Undergraduate Neuroscience Laboratory Exercise.

The Indian herb Gymnema sylvestre has been used in traditional Ayurvedic medicine for 2000 years, most recently for the treatment of diabetes. Loose leaf Gymnema sylvestre can be prepared as a tea and will impair the ability to taste sugar by blocking sweet receptors on the tongue. This report describes a laboratory exercise easily applied to an undergraduate neuroscience course that can be used to illustrate the principles of gustatory sensation. Combined with a preceding lecture on the primary taste sensations, students experience and appreciate how the primary tastes are combined to produce overall taste. In addition, the exercises outlined here expand upon previously published demonstrations employing Gymnema sylvestre to include illustrations of the different sensory transduction mechanisms associated with each of the four or five primary taste modalities. Students compare their qualitative primary taste experiences to salt, sugar, aspartame, chocolate, and sweet-sour candy prior to and following exposure to Gymnema sylvestre. The herb's impairment of sweet sensation is profound and dramatically alters the perception of sweetness in sugar, chocolate, and candy without altering the perception of the other primary tastes. The exercise has an indelible effect on students because the herb's intense effect compels students to rely on their unique personal experiences to highlight the principles of gustatory sensation.

Child anxiety treatment: outcomes in adolescence and impact on substance use and depression at 7.4-year follow-up.

Research suggests that the sequelae of childhood anxiety disorders, if left untreated, can include chronic anxiety, depression, and substance abuse. The current study evaluated the maintenance of outcomes of children who received a 16-week cognitive-behavioral treatment for primary anxiety disorders (generalized, separation, and social anxiety disorders) an average of 7.4 years earlier. The 86 participants (ages 15 to 22 years; 91% of the original sample) and their parents completed diagnostic interviews and self- and parent-report measures. According to the diagnostic interviews, a meaningful percentage of participants maintained significant improvements in anxiety at long-term follow-up. With regard to sequelae, positive responders to anxiety treatment, as compared with less positive responders, had a reduced amount of substance use involvement and related problems at long-term follow-up. The findings are discussed with regard to child anxiety and some of its sequelae.

Is childhood separation anxiety disorder a predictor of adult panic disorder and agoraphobia? A seven-year longitudinal study.

OBJECTIVE: To examine whether separation anxiety disorder (SAD) in childhood is a risk factor for panic disorder and agoraphobia in adulthood. METHOD: Patients (n = 85) who had completed treatment for SAD, generalized anxiety disorder, and/or social phobia 7.42 years earlier (on average) were reassessed using structured diagnostic interviews. RESULTS: Subjects with a childhood diagnosis of SAD did not display a greater risk for developing panic disorder and agoraphobia in young adulthood than those with other childhood anxiety diagnoses. Subjects with a childhood diagnosis of SAD did not more frequently meet full diagnostic criteria for panic disorder and agoraphobia, generalized anxiety disorder, social phobia, or major depressive disorder in adulthood than subjects with childhood diagnoses of generalized anxiety disorder or social phobia, but were more likely to meet criteria for other anxiety disorders (i.e., specific phobia, obsessive compulsive disorder, posttraumatic stress disorder, and acute stress disorder). CONCLUSIONS: These results argue against the hypothesis that childhood SAD is a specific risk factor for adult panic disorder and agoraphobia.

A psychometric evaluation of the parent report form of the State-Trait Anxiety Inventory for Children--Trait Version.

We examined the psychometric characteristics of the State-Trait Anxiety Inventory for Children-Parent Report-Trait Version (STAIC-P-T) [Strauss, C. (1987). Modification of trait portion of State-Trait Anxiety Inventory for Children-Parent Form. Gainesville, FL: University of Florida], a brief, parent report paper-and-pencil measure of child chronic anxiety, in a large clinic-referred sample. Internal consistency coefficients were high and retest reliability coefficients were in the moderate range. Convergent validity evidence was mixed in its support for the measure, with evidence most supportive within reporter and within parental dyad. Divergent validity evidence provided less support for the measure, but was largely consistent with past research. Regression analyses indicated that parent reports on the STAIC-P-T were not significantly related to a parent's own level of symptomatology. Overall, the study provides mixed support for the psychometrics of the STAIC-P-T.