Parental Early Life Maltreatment and Related Experiences in Treatment of Youth Anxiety Disorder.

The role of parents' early life maltreatment (ELM) (e.g. physical, sexual abuse) and related experiences, in relation to offspring anxiety is not well understood. The current study investigated the association between self-reported depression and ELM and related experiences in mothers (n = 79) and fathers (n = 50), and mother-, father-, and youth-reported symptoms of youth anxiety (n = 90). Outcomes were assessed at pre,- and posttreatment and 3-, 6-, and 12-months follow-up. Parental ELM were not associated with pre-treatment differences or differences in outcome of treatment. However ELM related experiences were associated with increased mother-, father-, and youth-rated youth anxiety at pretreatment. Fathers depressive symptoms were found to mediate the relationship between father ELM related experiences and father-rated youth anxiety symptoms. Future research is warranted on parental ELM and depression as factors affecting outcomes of treatment of youth anxiety. Trial registered at: helseforskning.etikkom.no (reg. nr. 2017/1367).

Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment.

Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (ß = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (ß = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety.

Efficacy of Emotion-Focused Parenting Programs for Children's Internalizing and Externalizing Symptoms: A Randomized Clinical Study.

OBJECTIVE: Emotion-Focused Skills Training (EFST) is a 12-week parental program based on Emotion-Focused Therapy, developed to improve children and adolescents' mental health problems. METHODS: In a randomized clinical dismantling study, including parents of 236 children and adolescents (ages 6-13, Mage 8.9, 60.6% boys, 95.8% Caucasian) with externalizing and/or internalizing problems within clinical range, we examined the efficacy of two versions of EFST: one experiential condition (n = 120) involving emotionally evocative techniques and two-chair interventions, and one psychoeducational only condition (n = 116) involving didactic teaching of emotion skills. Both groups received a 2-day group training and 6 hours of individual supervision. Outcomes were parent- and teacher-reported symptoms at baseline, posttreatment, and 4-, 8-, and 12-month follow-up. Analyses were conducted using multilevel growth curve modeling and Bayesian post hoc analysis. RESULTS: EFST showed efficacy in reducing parent-reported externalizing (b = -1.72, p < .001, d = 1.0) and internalizing (b = -1.71, p < .001, d = 0.9) symptoms, and teacher-reported externalizing (b = -.96, p < .001, d = 0.4), but not internalizing (b = -.13, p > .05, d = 0.2) symptoms. Multilevel analyses showed nonsignificant differences between conditions (all p's > .05), although a Bayesian longitudinal sensitivity analysis indicated a better outcome for the experiential condition. CONCLUSION: EFST showed efficacy in symptom reduction for children and adolescents with internalizing and externalizing symptoms. Outcomes were maintained over 12 months for both conditions, supporting EFST as a transdiagnostic parental approach for early intervention.

Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder.

Although cognitive-behavioral therapy (CBT) is an effective treatment for adolescents with anxiety disorders, the majority remain impaired following treatment. We developed a group CBT program (RISK) with high degrees of exposure practice and family and school involvement delivered in a community-based setting and investigated its effectiveness. The treatment involved adolescents (N = 90), with a primary diagnosis of anxiety disorder (82%) or obsessive-compulsive disorder (18%), and their families who received 38 hours of group treatment over 10 weeks. Diagnostic status and symptom severity were assessed at pre- and post-treatment, and a 12-month follow-up and benchmarked against previous effectiveness studies. Our results showed that, at post-treatment, the RISK-treatment was comparably effective as benchmarks on measures of diagnostic status, parent-rated measures, adolescent-rated measures, and clinician-rated measures. At 12-month follow-up all outcomes were superior to benchmarks, including the proportion of participants in remission (79.5%, 95% Highest Posterior Density Interval [74.7, 84.2]), indicating that the RISK-treatment enhanced effectiveness over time. The combination of group format, a high degree of exposure practice, and school and family involvement is a promising format for real-world settings that may help sustain and increase treatment effectiveness. Trial registered at helseforskning.etikkom.no (reg. nr. 2017/1367).

Bayes factor benefits for clinical psychology: review of child and adolescent evidence base.

Background: Statistical methods are a cornerstone of research in clinical psychology and are used in clinical trials and reviews to determine the best available evidence. The most widespread statistical framework, frequentist statistics, is often misunderstood and misused. Even when properly applied, this framework can lead to erroneous conclusions and unnecessarily prolonged trials. The implications for clinical psychology are difficulties in interpreting best available evidence and unnecessarily costly and burdensome research. An alternative framework, Bayesian statistics, is proposed as a solution to several issues with current practice. Methods: Statistical tests of primary outcome measures were extracted from 272 studies, which were cited in 11 recent reviews in the Evidence-based updates series in the Journal of Clinical Child and Adolescent Psychology. The extracted tests were examined regarding relevant features and re-analyzed using Bayes Factors. Results: When statistical tests were significant, the majority (98%) of re-analyzed tests agreed with such claims. When statistical tests were nonsignificant almost half (43%) of re-analyzed tests disagreed with such claims. Equally important for clinical research, an average of 13% fewer participants per study would have been required if the studies had used Bayes Factors. Conclusions: Bayes Factors offer benefits for research in clinical psychology through intuitive interpretations, and less costly trials.