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1.
Assessment ; 27(8): 1901-1913, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-30288985

RESUMO

Emotional and behavioral problems among children and adolescents may be studied using the Strengths and Difficulties Questionnaire, containing five subscales, based on ratings by parents, teachers, or adolescents themselves. We investigate two measurement issues using data from a longitudinal sample of 8,806 participants aged 7 to 9 years and 11 to 13 years from the Bergen Child Study in Bergen, Norway. First, convergent validity of parent and teacher ratings is studied using a multitrait-multimethod approach. Second, longitudinal measurement equivalence is studied using confirmatory factor analysis, which requires us to deal with the considerable attrition. The multitrait-multimethod indicates not only good convergent validity but also considerable method variance for parents and teachers. The reliability and validity of some subscales are relatively low. Attrition analysis indicates that attrition is not missing completely at random, but estimation assuming missing at random makes no real difference. We conclude that assuming missing completely at random is acceptable. Comparing ratings by parents and teachers results in partial scalar equivalence. In addition, all subscales exhibit (partial) longitudinal scalar measurement equivalence. We recommend using latent variable modeling and not summated scales for longitudinal modeling using the Strengths and Difficulties Questionnaire.

2.
Sci Rep ; 9(1): 17587, 2019 11 26.
Artigo em Inglês | MEDLINE | ID: mdl-31772264

RESUMO

Infants undergo extensive developments during their first year of life. Although the biological mechanisms involved are not yet fully understood, changes in the DNA methylation in mammals are believed to play a key role. This study was designed to investigate changes in infant DNA methylation that occurs between 6 and 52 weeks. A total of 214 infant saliva samples from 6 or 52 weeks were assessed using principal component analyses and t-distributed stochastic neighbor-embedding algorithms. Between the two time points, there were clear differences in DNA methylation. To further investigate these findings, paired two-sided student's t-tests were performed. Differently methylated regions were defined as at least two consecutive probes that showed significant differences, with a q-value < 0.01 and a mean difference > 0.2. After correcting for false discovery rates, changes in the DNA methylation levels were found in 42 genes. Of these, 36 genes showed increased and six decreased DNA methylation. The overall DNA methylation changes indicated decreased gene expression. This was surprising because infants undergo such profound developments during their first year of life. The results were evaluated by taking into consideration the extensive development that occurs during pregnancy. During the first year of life, infants have an overall three-fold increase in weight, while the fetus develops from a single cell into a viable infant in 9 months, with an 875-million-fold increase in weight. It is possible that the findings represent a biological slowing mechanism in response to extensive fetal development. In conclusion, our study provides evidence of DNA methylation changes during the first year of life, representing a possible biological slowing mechanism. We encourage future studies of DNA methylation changes in infants to replicate the findings by using a repeated measures model and less stringent criteria to see if the same genes can be found, as well as investigating whether other genes are involved in development during this period.


Assuntos
Metilação de DNA , Regulação da Expressão Gênica no Desenvolvimento , Adulto , Algoritmos , Ilhas de CpG , Escolaridade , Células Epiteliais/química , Transportador 2 de Aminoácido Excitatório/genética , Feminino , Humanos , Lactente , Leucócitos/química , Masculino , Estado Civil , Análise de Componente Principal , Receptores de Somatostatina/genética , Saliva/química , Saliva/citologia , Fatores Socioeconômicos
3.
Psychol Assess ; 31(8): 1006-1018, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31070449

RESUMO

Questionnaire measures offer a time and cost-effective alternative to full diagnostic assessments for identifying and differentiating between potential anxiety disorders and are commonly used in clinical practice. Little is known, however, about the capacity of questionnaire measures to detect specific anxiety disorders in clinically anxious preadolescent children. This study aimed to establish the ability of the Spence Children's Anxiety Scale (SCAS) subscales to identify children with specific anxiety disorders in a large clinic-referred sample (N = 1,438) of children aged 7 to 12 years. We examined the capacity of the Separation Anxiety, Social Phobia, Generalized Anxiety, and Physical Injury Fears (phobias) subscales to discriminate between children with and without the target disorder. We also identified optimal cutoff scores on subscales for accurate identification of children with the corresponding disorder, and examined the contribution of child, mother, and father reports. The Separation Anxiety subscale was able to accurately identify children with separation anxiety disorder, and this was replicated across all 3 reporters. Mother- and father-reported Social Phobia subscales also accurately identified children with social anxiety disorder, although child report was only able to accurately detect social anxiety disorder in girls. Using 2 or more reporters improved the sensitivity of the Separation Anxiety and Social Phobia subscales but reduced specificity. The Generalized Anxiety and Physical Injury Fears subscales failed to accurately identify children with the corresponding disorders. These findings have implications for the potential use of mother-, father-, and child-report SCAS subscales to detect specific disorders in preadolescent children in clinical settings. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/diagnóstico , Escalas de Graduação Psiquiátrica/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino , Mães , Psicometria , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
4.
Transl Psychiatry ; 9(1): 150, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31123309

RESUMO

Major depressive disorder and the anxiety disorders are highly prevalent, disabling and moderately heritable. Depression and anxiety are also highly comorbid and have a strong genetic correlation (rg ≈ 1). Cognitive behavioural therapy is a leading evidence-based treatment but has variable outcomes. Currently, there are no strong predictors of outcome. Therapygenetics research aims to identify genetic predictors of prognosis following therapy. We performed genome-wide association meta-analyses of symptoms following cognitive behavioural therapy in adults with anxiety disorders (n = 972), adults with major depressive disorder (n = 832) and children with anxiety disorders (n = 920; meta-analysis n = 2724). We estimated the variance in therapy outcomes that could be explained by common genetic variants (h2SNP) and polygenic scoring was used to examine genetic associations between therapy outcomes and psychopathology, personality and learning. No single nucleotide polymorphisms were strongly associated with treatment outcomes. No significant estimate of h2SNP could be obtained, suggesting the heritability of therapy outcome is smaller than our analysis was powered to detect. Polygenic scoring failed to detect genetic overlap between therapy outcome and psychopathology, personality or learning. This study is the largest therapygenetics study to date. Results are consistent with previous, similarly powered genome-wide association studies of complex traits.


Assuntos
Transtornos de Ansiedade/genética , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Transtorno Depressivo Maior/genética , Transtorno Depressivo Maior/terapia , Estudo de Associação Genômica Ampla/estatística & dados numéricos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Adulto , Criança , Humanos
5.
J Anxiety Disord ; 59: 53-63, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30273789

RESUMO

Cognitive behavioral therapy (CBT) has proven long-term effects in youth with anxiety disorders. However, only a few studies have examined predictors of long-term outcomes of CBT treatment. The present study investigated possible predictors of long-term treatment outcomes in youth with mixed anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder, social anxiety disorder, and/or generalized anxiety disorder were evaluated a mean of 3.9 years post-treatment (range 2.2-5.9 years). Outcomes were loss of all inclusion anxiety diagnoses, loss of the principal inclusion anxiety diagnosis, and changes in youth- and parent-rated youth anxiety symptoms. Predictors encompassed youth, parent and demographic factors, and post-treatment recovery. The most consistent finding was that low family social class predicted poorer outcomes. Higher treatment motivation was associated with better outcome whereas a diagnosis of social anxiety was associated with poorer outcome. Identified predictors extend on previous findings from efficacy trials, and the results indicate a need for more specific treatment protocols.


Assuntos
Instituições de Assistência Ambulatorial , Transtornos de Ansiedade/psicologia , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Assistência de Longa Duração , Adolescente , Ansiedade/psicologia , Ansiedade/terapia , Transtornos de Ansiedade/diagnóstico , Ansiedade de Separação/psicologia , Ansiedade de Separação/terapia , Criança , Feminino , Seguimentos , Comportamentos Relacionados com a Saúde , Humanos , Masculino , Pais/psicologia , Fobia Social/psicologia , Fobia Social/terapia , Prognóstico , Classe Social , Resultado do Tratamento , Adulto Jovem
6.
Curr Opin Psychiatry ; 31(6): 484-489, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30256264

RESUMO

PURPOSE OF REVIEW: To present an updated review of recent studies into the effect of cognitive behavior therapy (CBT) for anxiety disorders in children and adolescents, ways to increase access to therapy, and predictors and moderators of therapy effect. RECENT FINDINGS: The evidence base of CBT for anxiety disorders in children and adolescents continues to grow, demonstrating short and long-term efficacy and effectiveness. However, compared with active control conditions its effect appear to be modest; and a substantial percentage of youth do not show stable long-term remission. Standard CBT is often costly, with high noncompletion rates. New strategies to increase access to effective therapy for the large number of youth with anxiety disorders is therefore of priority. Additionally, there is a need for developing new ways to treat nonresponders, and to identify predictors and moderators of the effects of CBT. SUMMARY: Although there is evidence for the efficacy and effectiveness of CBT for youth with anxiety disorders, there is doubt regarding its superiority over active control comparisons. Long-term outcome is uncertain, as a substantial percentage of youth remains impaired at follow-up. It is essential to develop more cost-efficient strategies to reach youth with anxiety disorders with effective treatments, and to identify early indicators for youth needing additional therapy.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Resultado do Tratamento , Adolescente , Criança , Humanos
7.
Clin Psychol Psychother ; 25(6): 865-877, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30159938

RESUMO

OBJECTIVE: The aim was to investigate whether clinical experience, formal cognitive behavioural therapy (CBT) training, adherence, and competence predict outcome in CBT for anxiety disorders in youth. METHOD: Videotapes (N = 181) from the sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014, Behaviour Research and Therapy, 57, 1-12) comprising youth (N = 182, M age = 11.5 years) with mixed anxiety disorders were assessed for treatment adherence and competence using the Competence and Adherence Scale for CBT for anxiety disorders in youth (Bjaastad et al., 2016, Psychological Assessment, 28, 908-916). Therapists' (N = 17) clinical experience and educational background were assessed. Participants completed a diagnostic interview (Anxiety Disorders Interview Schedule, child and parent versions) and an anxiety symptom measure (Spence Children's Anxiety Scale, child and parent versions) at pretreatment, posttreatment, and 1-year follow-up. RESULTS: Higher therapist adherence was related to better treatment outcomes, whereas number of years of clinical experience and competence was related to worse outcomes. However, these findings were not consistent across informants and the time points for the assessments. Interaction effects suggested that competence among therapists with formal CBT training was related to better patient outcomes. CONCLUSIONS: Therapist adherence, competence, and clinical experience are associated with outcomes of manualized CBT for youth anxiety disorders, but mixed findings indicate the need for more research in this area.


Assuntos
Transtornos de Ansiedade/terapia , Competência Clínica/estatística & dados numéricos , Terapia Cognitivo-Comportamental/métodos , Escolaridade , Cooperação do Paciente/estatística & dados numéricos , Relações Profissional-Paciente , Transtornos de Ansiedade/psicologia , Criança , Terapia Cognitivo-Comportamental/educação , Feminino , Humanos , Masculino , Resultado do Tratamento
9.
Br J Psychiatry ; 209(3): 236-43, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-26989097

RESUMO

BACKGROUND: Anxiety disorders are common, and cognitive-behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent. AIMS: To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980). METHOD: Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up. RESULTS: No variants passed a genome-wide significance threshold (P = 5 × 10(-8)) in either analysis. Four variants met criteria for suggestive significance (P<5 × 10(-6)) in association with response post-treatment, and three variants in the 6-month follow-up analysis. CONCLUSIONS: This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.


Assuntos
Transtornos de Ansiedade/genética , Terapia Cognitivo-Comportamental , Estudo de Associação Genômica Ampla , Adolescente , Transtornos de Ansiedade/terapia , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Masculino , Polimorfismo de Nucleotídeo Único/genética , Resultado do Tratamento
10.
J Abnorm Child Psychol ; 44(3): 445-57, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26126635

RESUMO

This study aimed to investigate the factor structure and external correlates of the constructs Reactive Attachment Disorder (RAD) and Disinhibited Social Engagement Disorder (DSED) from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The following were addressed: First, do our data support the DSM-5 conceptualization of RAD/DSED as two separate constructs? Second, are RAD and DSED distinct from other well-established dimensions of child psychopathology? Third, what are the external correlates of RAD/DSED in this sample? The study sample included 122 foster children aged 6-10 years. Foster parents completed the Strengths and Difficulties Questionnaire (SDQ), and the RAD/DSED-scale from the Developmental and Well-Being Assessment. Child protection caseworkers completed a questionnaire regarding exposure to maltreatment and placement history. Confirmatory factor analysis (CFA) of the RAD/DSED items identified a good fit for a model with a two-factor structure, which is congruent with the DSM-5 definition of RAD and DSED. A new CFA model, which included the RAD and DSED factors together with the four problem factors of the SDQ (emotional, conduct, hyperactivity-inattention, and peer problems), also demonstrated a good fit with our data. RAD and DSED were associated with the SDQ Impact scale and help seeking behavior. This was partly explained by the SDQ externalizing and peer problem subscales. Our findings lend support for the DSM-5 conceptualization of RAD and DSED as separate dimensions of child psychopathology. Thus, the assessment of RAD and DSED provides information beyond other mental health problems.


Assuntos
Emoções/fisiologia , Cuidados no Lar de Adoção/psicologia , Transtorno Reativo de Vinculação na Infância/diagnóstico , Transtorno Reativo de Vinculação na Infância/psicologia , Comportamento Social , Criança , Análise Fatorial , Feminino , Humanos , Masculino , Inquéritos e Questionários
11.
J Child Psychol Psychiatry ; 57(5): 625-32, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26647901

RESUMO

BACKGROUND: In individual cognitive behavioral therapy (ICBT) for youth anxiety disorders, it is unclear whether, and from whose perspective, the alliance predicts outcome. We examined whether youth- and therapist-rated alliance, including level of youth-therapist alliance agreement, predicted outcome in a randomized controlled trial. METHODS: Youth (N = 91, M age = 11.4 years (SD = 2.1), 49.5% boys, 86.8% Caucasian) diagnosed with separation anxiety disorder, social phobia, or generalized anxiety disorder drawn from the ICBT condition of an effectiveness trial were treated with an ICBT program. Youth- and therapist-rated alliance ratings, assessed with the Therapeutic Alliance Scale for Children (TASC-C/T), were collected following session 3 (early) and 7 (late). Early alliance, change in alliance from early to late, and level of youth-therapist agreement on early alliance and alliance change were examined, in relation to outcomes collected at posttreatment and 1-year follow-up. Outcome was defined as primary diagnosis loss and reduction in clinicians' severity ratings (CSR; Anxiety Disorders Interview Schedule; ADIS-C/P) based on youth- and parent-report at posttreatment and follow-up, and youth treatment satisfaction collected at posttreatment (Client Satisfaction Scale; CSS). RESULTS: Early TASC-C scores positively predicted treatment satisfaction at posttreatment. Higher levels of agreement on change in TASC-C and TASC-T scores early to late in treatment predicted diagnosis loss and CSR reduction at follow-up. CONCLUSIONS: Only the level of agreement in alliance change predicted follow-up outcomes in ICBT for youth anxiety disorders. The findings support further examination of the role that youth-therapist alliance discrepancies may play in promoting positive outcomes in ICBT for youth anxiety disorders. Clinical trial number NCT00586586, clinicaltrials.gov.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Avaliação de Processos e Resultados em Cuidados de Saúde , Relações Profissional-Paciente , Adolescente , Ansiedade de Separação/terapia , Criança , Feminino , Humanos , Masculino , Satisfação do Paciente , Fobia Social/terapia
12.
Br J Psychiatry ; 208(2): 182-8, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26294368

RESUMO

BACKGROUND: We previously reported an association between 5HTTLPR genotype and outcome following cognitive-behavioural therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome. AIMS: To replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829). METHOD: Logistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed. RESULTS: There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes. CONCLUSIONS: The association between 5HTTLPR genotype and CBT outcome did not replicate. Short-allele homozygotes showed more positive treatment outcomes, but with small, non-significant effects. Future studies would benefit from utilising whole genome approaches and large, homogenous samples.


Assuntos
Transtornos de Ansiedade/genética , Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental , Interação Gene-Ambiente , Proteínas da Membrana Plasmática de Transporte de Serotonina/genética , Adolescente , Alelos , Criança , Pré-Escolar , Feminino , Genótipo , Humanos , Masculino , Escalas de Graduação Psiquiátrica , Indução de Remissão , Resultado do Tratamento
13.
Behav Res Ther ; 76: 1-12, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26583954

RESUMO

A substantial number of children with anxiety disorders do not improve following cognitive behavioral therapy (CBT). Recent effectiveness studies have found poorer outcome for CBT programs than what is typically found in efficacy studies. The present study examined predictors of treatment outcome among 181 children (aged 8-15 years), with separation anxiety, social phobia, or generalized anxiety disorder, who participated in a randomized, controlled effectiveness trial of a 10-session CBT program in community clinics. Potential predictors included baseline demographic, child, and parent factors. Outcomes were as follows: a) remission from all inclusion anxiety disorders; b) remission from the primary anxiety disorder; and c) child- and parent-rated reduction of anxiety symptoms at post-treatment and at 1-year follow-up. The most consistent findings across outcome measures and informants were that child-rated anxiety symptoms, functional impairment, a primary diagnosis of social phobia or separation anxiety disorder, and parent internalizing symptoms predicted poorer outcome at post-treatment. Child-rated anxiety symptoms, lower family social class, lower pretreatment child motivation, and parent internalizing symptoms predicted poorer outcome at 1-year follow-up. These results suggest that anxious children with more severe problems, and children of parents with elevated internalizing symptom levels, may be in need of modified, additional, or alternative interventions to achieve a positive treatment outcome.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Adolescente , Ansiedade/terapia , Criança , Feminino , Humanos , Masculino , Pais/psicologia , Valor Preditivo dos Testes , Prognóstico , Psicoterapia de Grupo , Resultado do Tratamento
14.
Psychol Assess ; 28(8): 908-16, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-26460894

RESUMO

The aim of the present study was to evaluate the psychometric properties of the Competence and Adherence Scale for Cognitive Behavioral Therapy (CAS-CBT). The CAS-CBT is an 11-item scale developed to measure adherence and competence in cognitive-behavioral therapy (CBT) for anxiety disorders in youth. A total of 181 videotapes from the treatment sessions in a randomized controlled effectiveness trial (Wergeland et al., 2014) comprising youth (N = 182, M age = 11.5 years, SD = 2.1, range 8-15 years, 53% girls, 90.7% Caucasian) with mixed anxiety disorders were assessed with the CAS-CBT to investigate interitem correlations, internal consistency, and factor structure. Internal consistency was good (Cronbach's alpha = .87). Factor analysis suggested a 2-factor solution with Factor 1 representing CBT structure and session goals (explaining 46.9% of the variance) and Factor 2 representing process and relational skills (explaining 19.7% of the variance). The sum-score for adherence and competence was strongly intercorrelated, r = .79, p < .001. Novice raters (graduate psychology students) obtained satisfactory accuracy (ICC > .40, n = 10 videotapes) and also good to excellent interrater reliability when compared to expert raters (ICC = .83 for adherence and .64 for competence, n = 26 videotapes). High rater stability was also found (n = 15 videotapes). The findings suggest that the CAS-CBT is a reliable measure of adherence and competence in manualized CBT for anxiety disorders in youth. Further research is needed to investigate the validity of the scale and psychometric properties when used with other treatment programs, disorders and treatment formats. (PsycINFO Database Record


Assuntos
Ansiedade de Separação/terapia , Competência Clínica , Terapia Cognitivo-Comportamental/normas , Fobia Social/terapia , Avaliação de Processos em Cuidados de Saúde , Psicoterapia/normas , Adolescente , Adulto , Transtornos de Ansiedade/terapia , Criança , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Gravação de Videoteipe
15.
Behav Res Ther ; 77: 40-51, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26708332

RESUMO

OBJECTIVE: The research on the association between the working alliance and therapist competence/adherence and outcome from cognitive behavioral therapy (CBT) is limited and characterized by inconclusive findings. This study investigates the working alliance and competence/adherence as predictors of outcome of CBT for social anxiety disorder (SAD) and panic disorder (PD). METHOD: Eighty-two clinically referred patients (58.5% female; age: M = 33.6 years, SD = 10.3) with PD (n = 31) or SAD (n = 51) were treated with 12 sessions of manualized CBT by 22 clinicians with limited CBT experience in a randomized controlled effectiveness trial. Independent assessors rated the CBT competence/adherence of the therapists using a revised version of the Cognitive Therapy Adherence and Competence Scale, and the patients rated the quality of the working alliance using the Working Alliance Inventory-short form in therapy sessions 3 and 8. The outcome was assessed by independent assessors as well as by patients self-report. A total of 20.7% of the patients (27.5% SAD, 9.7% PD) dropped out during treatment. The association between the alliance, competence/adherence, outcome and dropout was investigated using multiple regression analyses. RESULTS: Higher therapist' competence/adherence early in the therapy was associated with a better outcome among PD patients, lower competence/adherence was associated with dropout among SAD patients. Higher rating of the alliance late in the therapy was associated with a better outcome, whereas lower alliance rating late in the therapy was associated with dropout. CONCLUSION: The findings indicate that the therapist competence/adherence and the working alliance have independent contributions to the outcome from CBT for anxiety disorders, but in different phases of the treatment.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Terapia Cognitivo-Comportamental/normas , Pessoal de Saúde/psicologia , Competência Profissional , Adulto , Feminino , Previsões , Humanos , Masculino , Pessoa de Meia-Idade , Transtorno de Pânico/terapia , Cooperação do Paciente/psicologia , Fobia Social/terapia , Relações Profissional-Paciente , Autorrelato , Resultado do Tratamento
16.
Behav Res Ther ; 71: 76-89, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26081010

RESUMO

OBJECTIVE: To investigate predictors and moderators of treatment outcome by comparing immediate face-to-face cognitive behavioral therapy (FtF-CBT) to a Stepped Care treatment model comprising three steps: Psychoeducation, Internet-delivered CBT, and FtF-CBT for panic disorder (PD) and social anxiety disorder (SAD). METHOD: Patients (N = 173) were recruited from nine public mental health out-patient clinics and randomized to immediate FtF-CBT or Stepped Care treatment. Characteristics related to social functioning, impairment from the anxiety disorder, and comorbidity was investigated as predictors and moderators by treatment format and diagnosis in multiple regression analyses. RESULTS: Lower social functioning, higher impairment from the anxiety disorder, and a comorbid cluster C personality disorder were associated with significantly less improvement, particularly among patients with PD. Furthermore, having a comorbid anxiety disorder was associated with a better treatment outcome among patients with PD but not patients with SAD. Patients with a comorbid depression had similar outcomes from the different treatments, but patients without comorbid depression had better outcomes from immediate FtF-CBT compared to guided self-help. CONCLUSIONS: In general, the same patient characteristics appear to be associated with the treatment outcome for CBT provided in low- and high-intensity formats when treated in public mental health care clinics. The findings suggest that patients with lower social functioning and higher impairment from their anxiety disorder benefit less from these treatments and may require more adapted and extensive treatment. CLINICALTRIALS.GOV: Identifier: NCT00619138.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Transtorno de Pânico/terapia , Terapia Assistida por Computador , Adulto , Transtornos de Ansiedade/complicações , Depressão/complicações , Depressão/terapia , Feminino , Humanos , Internet , Masculino , Transtorno de Pânico/complicações , Cooperação do Paciente , Educação de Pacientes como Assunto , Transtornos da Personalidade/complicações , Transtornos da Personalidade/terapia , Competência Profissional , Autorrelato , Comportamento Social , Resultado do Tratamento , Adulto Jovem
17.
J Am Acad Child Adolesc Psychiatry ; 54(6): 454-63, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26004660

RESUMO

OBJECTIVE: The Genes for Treatment study is an international, multisite collaboration exploring the role of genetic, demographic, and clinical predictors in response to cognitive-behavioral therapy (CBT) in pediatric anxiety disorders. The current article, the first from the study, examined demographic and clinical predictors of response to CBT. We hypothesized that the child's gender, type of anxiety disorder, initial severity and comorbidity, and parents' psychopathology would significantly predict outcome. METHOD: A sample of 1,519 children 5 to 18 years of age with a primary anxiety diagnosis received CBT across 11 sites. Outcome was defined as response (change in diagnostic severity) and remission (absence of the primary diagnosis) at each time point (posttreatment, 3-, 6-, and/or 12-month follow-up) and analyzed using linear and logistic mixed models. Separate analyses were conducted using data from posttreatment and follow-up assessments to explore the relative importance of predictors at these time points. RESULTS: Individuals with social anxiety disorder (SoAD) had significantly poorer outcomes (poorer response and lower rates of remission) than those with generalized anxiety disorder (GAD). Although individuals with specific phobia (SP) also had poorer outcomes than those with GAD at posttreatment, these differences were not maintained at follow-up. Both comorbid mood and externalizing disorders significantly predicted poorer outcomes at posttreatment and follow-up, whereas self-reported parental psychopathology had little effect on posttreatment outcomes but significantly predicted response (although not remission) at follow-up. CONCLUSION: SoAD, nonanxiety comorbidity, and parental psychopathology were associated with poorer outcomes after CBT. The results highlight the need for enhanced treatments for children at risk for poorer outcomes.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Pais/psicologia , Adolescente , Transtornos de Ansiedade/diagnóstico , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Modelos Logísticos , Masculino , Transtornos Fóbicos , Prognóstico , Índice de Gravidade de Doença , Resultado do Tratamento
18.
J Anxiety Disord ; 31: 1-10, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25637909

RESUMO

The aim was to investigate predictors of treatment dropout among 182 children (aged 8-15 years) participating in an effectiveness trial of manual-based 10-session individual and group cognitive behavior therapy (CBT) for anxiety disorders in community clinics. The dropout rate was 14.4%, with no significant difference between the two treatment conditions. We examined predictors for overall dropout (n=26), early (≤session 4, n=15), and late dropout (≥session 5, n=11). Overall dropout was predicted by low child and parent rated treatment credibility, and high parent self-rated internalizing symptoms. Low child rated treatment credibility predicted both early and late dropout. High parent self-rated internalizing symptoms predicted early dropout, whereas low parent rated treatment credibility predicted late dropout. These results highlight the importance of addressing treatment credibility, and to offer support for parents with internalizing symptoms, to help children and families remain in treatment.


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/estatística & dados numéricos , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Psicoterapia de Grupo/estatística & dados numéricos , Adolescente , Assistência Ambulatorial/psicologia , Assistência Ambulatorial/estatística & dados numéricos , Transtornos de Ansiedade/psicologia , Atitude Frente a Saúde , Criança , Terapia Cognitivo-Comportamental/métodos , Centros Comunitários de Saúde Mental/estatística & dados numéricos , Feminino , Humanos , Controle Interno-Externo , Masculino , Motivação , Pais/psicologia , Pacientes Desistentes do Tratamento/psicologia , Escalas de Graduação Psiquiátrica , Autoimagem , Inquéritos e Questionários
19.
Nord J Psychiatry ; 69(2): 81-92, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25142430

RESUMO

BACKGROUND: Previous meta-analyses of paediatric obsessive-compulsive disorder (OCD) have shown much higher effect size for standard individual cognitive behaviour therapy (SI-CBT) compared with control conditions than for serotonin reuptake inhibitors (SRIs) compared with placebo. Other factors, such as systematic differences in the provided care or exposure to factors other than the interventions of interest (performance bias) may be stronger confounders in psychotherapy research than in pharmacological research. AIMS: These facts led us to review SI-CBT studies of paediatric OCD with the aim to compare the effect estimates across different comparisons, including active treatments. METHOD: We included only randomized controlled trials (RCTs) or cluster RCTs with treatment periods of 12-16 weeks. Outcome was post-test score on the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS). RESULTS: Thirteen papers reporting from 13 RCTs with 17 comparison conditions were included. SI-CBT was superior to wait-list and placebo therapy but not active treatments. Effect estimates for SI-CBT in wait-list comparison studies were significantly larger than in placebo-therapy comparison studies. In addition, the SI-CBT effect estimate was not significantly different when compared with SRIs alone or combined SRIs and CBT. CONCLUSIONS: Performance bias may have inflated previous effect estimates for SI-CBT when comparison contingencies included wait-list. However, the calculated SI-CBT effect estimate was lower but significant when compared with placebo therapy. The effects of SI-CBT and active treatments were not significantly different. In conclusion, our data support the current clinical guidelines, although better comparisons between SI-CBT and SRIs are needed.


Assuntos
Terapia Cognitivo-Comportamental/métodos , Transtorno Obsessivo-Compulsivo/terapia , Criança , Terapia Combinada , Necessidades e Demandas de Serviços de Saúde , Humanos , Transtorno Obsessivo-Compulsivo/psicologia , Psicoterapia/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Inibidores de Captação de Serotonina/uso terapêutico , Listas de Espera
20.
PLoS One ; 9(7): e102134, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25006669

RESUMO

BACKGROUND: High prevalence of mental disorders among foster children highlight the need to examine the mental health of children placed out of home. We examined the properties of the Strengths and Difficulties Questionnaire (SDQ) in screening school-aged foster children for mental disorders. METHODS: Foster parents and teachers of 279 foster children completed the SDQ and the diagnostic interview Developmental and Well-Being Assessment (DAWBA). Using the diagnoses derived from the DAWBA as the standard, we examined the performance of the SDQ scales as dimensional measures of mental health problems using receiver operating characteristic (ROC) analyses. Recommended cut-off scores were derived from ROC coordinates. The SDQ predictive algorithms were also examined. RESULTS: ROC analyses supported the screening properties of the SDQ Total difficulties and Impact scores (AUC = 0.80-0.83). Logistic regression analyses showed that the prevalence of mental disorders increased linearly with higher SDQ Total difficulties scores (X2 = 121.47, df = 13, p<.001) and Impact scores (X2 = 69.93, df = 6, p<.001). Our results indicated that there is an additive value of combining the scores from the Total difficulties and Impact scales, where scores above cut-off on any of the two scales predicted disorders with high sensitivity (89.1%), but moderate specificity (62.1%). Scores above cut-off on both scales yielded somewhat lower sensitivity (73.4%), but higher specificity (81.1%). The SDQ multi-informant algorithm showed low discriminative ability for the main diagnostic categories, with an exception being the SDQ Conduct subscale, which accurately predicted the absence of behavioural disorders (LHR- = 0.00). CONCLUSIONS: The results support the use of the SDQ Total difficulties and Impact scales when screening foster children for mental health problems. Cut-off values for both scales are suggested. The SDQ multi-informant algorithms are not recommended for mental health screening of foster children in Norway.


Assuntos
Programas de Rastreamento/métodos , Transtornos do Neurodesenvolvimento/diagnóstico , Adolescente , Algoritmos , Criança , Pré-Escolar , Feminino , Cuidados no Lar de Adoção , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos do Neurodesenvolvimento/epidemiologia , Noruega/epidemiologia , Escalas de Graduação Psiquiátrica , Curva ROC
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