Ecological Momentary Assessment Of State Fluctuations In Mindfulness And Symptoms In Psychotic Disorders.

Mindfulness skills are a component of many modern cognitive-behavioral therapies that are used to treat a wide range of disorders, including psychotic disorders. While habitual (i.e., trait) mindfulness is associated with clinical outcomes, the effects of momentary (i.e., state) mindfulness are unclear. This is due in part to previous studies using cross-sectional designs relying on trait self-report questionnaires. Although such approaches are invaluable, they lack temporal specificity to evaluate momentary changes and effects of mindfulness. To address these limitations, the current study used ecological momentary assessment (EMA) to evaluate state levels of two mindfulness skills, acceptance and monitoring, and their association with state fluctuations in symptoms. Participants included individuals with affective and non-affective psychotic disorders (PD; n = 49) and healthy controls (CN; n = 53) who completed six days of EMA. Results indicated that the PD group endorsed lower state acceptance than CN; however, the groups did not significantly differ in monitoring. Further, greater state mindfulness skills in both acceptance and monitoring were associated with greater positive affect, reduced negative affect, and reduced negative symptoms. However, participants with a predominantly affective psychosis presentation showed differential effects compared to those with non-affective presentations. These findings suggest that mindfulness training for people with psychotic disorders may benefit from focusing on improving acceptance in order to improve emotional experience and build on existing monitoring skills. Further, mindfulness based psychosocial interventions may offer a novel means of treating negative symptoms in people with PD, which are currently stalled and largely unresponsive to other treatments.

Biological sensitivity to context as a dyadic construct: An investigation of child-parent RSA synchrony among low-SES youth.

Parenting behaviors are significantly linked to youths' behavioral adjustment, an association that is moderated by youths' and parents' self-regulation. The biological sensitivity to context theory suggests that respiratory sinus arrhythmia (RSA) indexes youths' varying susceptibility to rearing contexts. However, self-regulation in the family context is increasingly viewed as a process of "coregulation" that is biologically embedded and involves dynamic Parent×Child interactions. No research thus far has examined physiological synchrony as a dyadic biological context that may moderate associations between parenting behaviors and preadolescent adjustment. Using a two-wave sample of 101 low-socioeconomic status (SES) families (children and caretakers; mean age 10.28 years), we employed multilevel modeling to examine dyadic coregulation during a conflict task, indicated by RSA synchrony, as a moderator of the linkages between observed parenting behaviors and preadolescents' internalizing and externalizing problems. Results showed that high dyadic RSA synchrony resulted in a multiplicative association between parenting and youth adjustment. High dyadic synchrony intensified the relations between parenting behaviors and youth behavior problems, such that in the context of high dyadic synchrony, positive and negative parenting behaviors were associated with decreased and increased behavioral problems, respectively. Parent-child dyadic RSA synchrony is discussed as a potential biomarker of biological sensitivity in youth.

Emotional Awareness Predicts Specific Cognitive-Behavioral Therapy Outcomes for Anxious Youth.

The current study examined emotional awareness as a predictor of differential outcomes for youth treated for an anxiety disorder. 37 youth ages 7-15 received either individual cognitive-behavioral therapy or family cognitive-behavioral therapy to treat generalized anxiety disorder, separation anxiety disorder, and/or social phobia. Diagnoses were determined by independent evaluators, following semi-structured interviews (ADIS-IV-C/P) with youth and their parents. Self-report questionnaires, including the multidimensional anxiety scale for children and the emotion expressivity scale for children, were completed at pre- and posttreatment. Youth with higher levels of pretreatment emotional awareness had better treatment outcomes than youth with lower levels of emotional awareness, with specific regard to improved ability to cope with worry. Findings suggest that higher levels of emotional awareness facilitate better specific outcomes for anxious youth. Findings highlight the importance of understanding the emotions associated with worry during the treatment process.

Anxiety Disorders in Caucasian and African American Children: A Comparison of Clinical Characteristics, Treatment Process Variables, and Treatment Outcomes.

This study examined racial differences in anxious youth using data from the Child/Adolescent Anxiety Multimodal Study (CAMS) [1]. Specifically, the study aims addressed whether African American (n = 44) versus Caucasian (n = 359) children varied on (1) baseline clinical characteristics, (2) treatment process variables, and (3) treatment outcomes. Participants were ages 7-17 and met DSM-IV-TR criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Baseline data, as well as outcome data at 12 and 24 weeks, were obtained by independent evaluators. Weekly treatment process variables were collected by therapists. Results indicated no racial differences on baseline clinical characteristics. However, African American participants attended fewer psychotherapy and pharmacotherapy sessions, and were rated by therapists as less involved and compliant, in addition to showing lower mastery of CBT. Once these and other demographic factors were accounted for, race was not a significant predictor of response, remission, or relapse. Implications of these findings suggest African American and Caucasian youth are more similar than different with respect to the manifestations of anxiety and differences in outcomes are likely due to treatment barriers to session attendance and therapist engagement.

Predictors and moderators of treatment response in childhood anxiety disorders: results from the CAMS trial.

OBJECTIVE: We sought to examine predictors and moderators of treatment outcomes among 488 youths ages 7-17 years (50% female; 74% ≤ 12 years) meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) criteria for diagnoses of separation anxiety disorder, social phobia, or generalized anxiety disorder who were randomly assigned to receive either cognitive behavioral therapy (CBT), sertraline (SRT), their combination (COMB), or medication management with pill placebo (PBO) in the Child/Adolescent Anxiety Multimodal Study (CAMS). METHOD: Six classes of predictor and moderator variables (22 variables) were identified from the literature and examined using continuous (Pediatric Anxiety Ratings Scale; PARS) and categorical (Clinical Global Impression Scale-Improvement; CGI-I) outcome measures. RESULTS: Three baseline variables predicted better outcomes (independent of treatment condition) on the PARS, including low anxiety severity (as measured by parents and independent evaluators) and caregiver strain. No baseline variables were found to predict Week 12 responder status (CGI-I). Participants' principal diagnosis moderated treatment outcomes but only on the PARS. No baseline variables were found to moderate treatment outcomes on Week 12 responder status (CGI-I). DISCUSSION: Overall, anxious children responded favorably to CAMS treatments. However, having more severe and impairing anxiety, greater caregiver strain, and a principal diagnosis of social phobia were associated with less favorable outcomes. Clinical implications of these findings are discussed.