Avoidance Moderates Cognitive Behavioral Therapy for Panic Disorder and Agoraphobia.

Cognitive behavioral therapy (CBT), a well-validated treatment for panic disorder, includes interoceptive exposures and possibly in vivo exposures to agoraphobic situations. Testing predictors and moderators of CBT outcomes can improve treatment efficacy. Sixty-six individuals with panic disorder with or without agoraphobia were randomized to panic control therapy (PCT) (n = 32) or PCT and in vivo exposures to agoraphobic situations (PCT + IV) (n = 34). Secondary analyses using multilevel models with repeated measures design revealed that individuals who displayed more interoceptive avoidance and agoraphobic avoidance fared better after PCT than PCT + IV compared with individuals who displayed less avoidance. Results suggest that these individuals benefit from concentrated doses of exposures to their primary interoceptive concerns instead of additional exposures to agoraphobic situations. Exploratory analyses were also conducted on fear, demographic factors, and clinical characteristics. Findings inform clinical decision-making and personalized medicine. Limitations include low power for detecting small effect sizes.

Parental ADHD and Depression: Time-Varying Prediction of Offspring Externalizing Psychopathology.

Parental attention deficit/hyperactivity disorder (ADHD) and depression are risk factors for negative child outcomes, but given their frequent co-occurrence and variability over time, developmentally sensitive studies are needed. To characterize change in parental ADHD and depression as predictors of change in child ADHD and oppositional defiant disorder (ODD), 230 five- to ten-year-old children with (n = 110) and without (n = 120) ADHD were followed prospectively for 2 years with 90% retention. At baseline and again 2 years later (i.e., Wave 2), parents self-reported their ADHD and depression; parents and teachers also separately rated child ADHD and ODD, as well as broader attention and externalizing problems. Controlling for child sex, race-ethnicity, age, and parental depression, generalized estimating equations revealed that 2-year decreases in parental ADHD significantly predicted reduced child ADHD symptoms, but only among non-ADHD youth. Alternatively, increasing parental depression positively predicted change in teacher-rated ODD symptoms. These findings provide quasi-experimental evidence that parental ADHD and depression may be time-varying risk factors with respect to key dimensions of child externalizing behavior problems. We consider the potential dynamic and reciprocal interrelations among parental ADHD and depression with developmental change in offspring ADHD and ODD. We also discuss implications of parent psychopathology in the development of interventions to reduce the burden of youth ADHD and associated externalizing behavior.

Durability of Cognitive Behavioral Therapy Effects for Youth and Adolescents With Anxiety, Depression, or Traumatic Stress:A Meta-Analysis on Long-Term Follow-Ups.

Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis aimed to (a) examine the effects of youth CBT at posttreatment, 1-month, 3-month, 6-month, 1-year, and long-term (2+ years) follow-up as well as (b) identify research-related variables (e.g., measure respondent type) that relate to effects. Using a random effects model across 110 child and adolescent CBT groups, within-group effect sizes were large at posttreatment (g = 1.24) and from 1-month through long-term follow-up (g = 1.23-1.82), and effect sizes did not significantly differ by treatment target (i.e., anxiety, traumatic stress, depression). However, availability of outcome data for effect sizes diminished across later follow-up assessments. Moreover, effect sizes were significantly associated with outcome respondent type across assessment timing, with outcome measures from caregiver and youth respondents associated with smaller effect sizes (B = -0.97, p < 0.001) relative to outcome measures that were evaluator-reported. Results provide initial support for the durability of treatment effects for youth CBTs and highlight the importance of some confounding variables. Implications for improving treatment research standards and prioritizing assessment of long-term follow-up assessment are discussed.

Neural connectivity during affect labeling predicts treatment response to psychological therapies for social anxiety disorder.

BACKGROUND: Although psychological treatments for social anxiety disorder (SAD) can be highly effective, many individuals do not respond to treatment. Identifying factors associated with improved outcomes can facilitate individualized treatment choices. We investigated whether patterns of neural connectivity predicted treatment responses and whether treatment type, cognitive behavioral therapy (CBT) or acceptance and commitment therapy (ACT), moderated this effect. METHODS: Participants with SAD (n = 34) underwent fMRI prior to treatment and completed implicit and explicit emotion regulation tasks. Neural connectivity measures were estimates of amygdala-prefrontal cortex connectivity. Treatment responder status was defined using the 'clinically significant change index' (Loerinc et al., 2015). RESULTS: Right amygdala-right ventrolateral prefrontal cortex connectivity during implicit emotion regulation was a significant predictor of treatment response (OR = 9.01, 95% CI = 1.77, 46.0, p = .008). Stronger inverse connectivity was associated with greater likelihood of treatment response. There were no significant neural moderators of treatment response to CBT versus ACT. LIMITATIONS: The primary limitation of this work was the small sample size which restricted the power to detect significant moderation effects, and results should be interpreted as preliminary. CONCLUSIONS: Amygdala-vlPFC connectivity during affect labeling predicted treatment responder status following CBT or ACT for social anxiety disorder. This suggests that the functioning of neural circuitry supporting emotion regulation capacities may be a 'gateway' to receiving benefit from psychological treatments. Future work should aim to replicate this effect in a larger sample and consider methods for enhancing functional connectivity within this circuitry as a potential treatment adjunct.

Public speaking avoidance as a treatment moderator for social anxiety disorder.

BACKGROUND AND OBJECTIVES: Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have both garnered empirical support for the effective treatment of social anxiety disorder. However, not every patient benefits equally from either treatment. Identifying moderators of treatment outcome can help to better understand which treatment is best suited for a particular patient. METHODS: Forty-nine individuals who met criteria for social anxiety disorder were assessed as part of a randomized controlled trial comparing 12 weeks of CBT and ACT. Pre-treatment avoidance of social situations (measured via a public speaking task and clinician rating) was investigated as a moderator of post-treatment, 6-month follow-up, and 12-month follow-up social anxiety symptoms, stress reactivity, and quality of life. RESULTS: Public speaking avoidance was found to be a robust moderator of outcome measures, with more avoidant individuals generally benefitting more from CBT than ACT by 12-month follow-up. In contrast, clinician-rated social avoidance was not found to be a significant moderator of any outcome measure. LIMITATIONS: Results were found only at 12-month follow-up. More comprehensive measures of avoidance would be useful for the field moving forward. CONCLUSIONS: Findings inform personalized medicine, suggesting that social avoidance measured behaviorally via a public speaking task may be a more robust factor in treatment prescription compared to clinician-rated social avoidance.

The DSM-5 social anxiety disorder severity scale: Evidence of validity and reliability in a clinical sample.

With DSM-5, the APA began providing guidelines for anxiety disorder severity assessment that incorporates newly developed self-report scales. The scales share a common template, are brief, and are free of copyright restrictions. Initial validation studies have been promising, but the English-language versions of the scales have not been formally validated in clinical samples. Forty-seven individuals with a principal diagnosis of Social Anxiety Disorder (SAD) completed a diagnostic assessment, as well as the DSM-5 SAD severity scale and several previously validated measures. The scale demonstrated internal consistency, convergent validity, and discriminant validity. The next steps in the validation process are outlined.

Attentional bias and emotional reactivity as predictors and moderators of behavioral treatment for social phobia.

Cognitive behavioral therapy (CBT) is a well-established treatment for anxiety disorders, and evidence is accruing for the effectiveness of acceptance and commitment therapy (ACT). Little is known about factors that relate to treatment outcome overall (predictors), or who will thrive in each treatment (moderators). The goal of the current project was to test attentional bias and negative emotional reactivity as moderators and predictors of treatment outcome in a randomized controlled trial comparing CBT and ACT for social phobia. Forty-six patients received 12 sessions of CBT or ACT and were assessed for self-reported and clinician-rated symptoms at baseline, post treatment, 6, and 12 months. Attentional bias significantly moderated the relationship between treatment group and outcome with patients slow to disengage from threatening stimuli showing greater clinician-rated symptom reduction in CBT than in ACT. Negative emotional reactivity, but not positive emotional reactivity, was a significant overall predictor with patients high in negative emotional reactivity showing the greatest self-reported symptom reduction.