Termination in cognitive-behavioral therapy with children, adolescents, and parents.

The process of terminating cognitive-behavioral therapy (CBT) with families has been largely neglected in the literature, with the limited research focused on premature termination. This article describes the natural termination process in CBT with children, adolescents, and their parents. Based on existing theories, we describe a cognitive-behavioral model for: (a) initiating and engaging in discussion of termination, (b) processing the termination of treatment and the therapeutic relationship, (c) key aspects of the termination process in the final session, and (d) the very end of the final session (saying goodbye). For each of the 4 components, we review relevant theories, provide clinical exchanges to demonstrate techniques, and provide related research support. (PsycINFO Database Record

Excessive exercise among adolescents with eating disorders: examination of psychological and demographic variables.

Background While a large number of patients with eating disorders (EDs) engage in excessive exercise (EE), both for weight control and mood regulation, there has been minimal research evaluating the relationship between EE and demographic and psychological factors, especially in adolescent patients. Purpose The goals of this study were to identify the occurrence of EE compared to other ED behaviors and to develop a regression model examining psychological, behavioral and demographic predictors of EE among adolescents with EDs. Methods Demographic and clinical information was determined for 217 adolescent patients in several levels of care (126 outpatient, 61 day program, 28 inpatient) with diagnoses of anorexia nervosa (AN) (24.9%), bulimia nervosa (BN) (25.8%), and eating disorder not otherwise specified (EDNOS) (49.3%). These patients presented to a large ED program and completed a series of questionnaires on admission to the program. Descriptive statistics, t-tests, chi-square analyses and multiple logistic regression were utilized to describe the population of adolescent patients and develop the model for predicting EE. Results Forty-seven percent of patients indicated they participated in EE in the past 4 weeks, compared to 32% for binge eating, 35% for vomiting and 15% for laxative use; 42% of patients with anorexia nervosa participated in EE, compared to 54% with bulimia nervosa and 49% with EDNOS. The regression model that was developed to predict EE, which included factors of depression, anxiety, dietary restraint, age, body mass index (BMI), diagnosis and level of care, correctly classified EE in 71.5% of cases. Dietary restraint and BMI were the two factors found to be significantly associated with EE. Conclusions Forty-seven percent of adolescent patients presenting for treatment of an ED reported participating in EE. This was larger than the numbers of patients reporting other ED behaviors that are commonly assessed, indicating the need for psychoeducation for multidisciplinary treatment teams, assessment, prevention, and clinical treatment services for this problematic behavior. It is important that those who treat patients with ED assess for and monitor EE behaviors that can complicate the treatment.

Marital adjustment, child-rearing disagreements, and overreactive parenting: predicting child behavior problems.

Using structural equation modeling, the authors evaluated the hypothesis that the relation between marital adjustment and children's behavior problems is mediated by child-rearing disagreements, whose effects are mediated by parents' overreactive discipline. In a community sample, fully or partially mediated models of internalizing and externalizing behavior problems of 3- to 7-year-old boys (N = 99) and girls (N = 104) were supported for mothers and fathers in 7 of 8 cases. Child-rearing disagreements always mediated the relation of marital adjustment and child behavior problems, and overreactive discipline was a final mediator in 3 cases. More variance was accounted for in mothers' than fathers' ratings. For mothers' ratings, the most variance was accounted for in boys' externalizing and girls' internalizing behavior problems.

Targeting parental psychopathology in child anxiety.

The increased risk of anxiety in children of parents with psychopathology is a significant public health problem, as early-onset is associated with a variety of difficulties later in life. The aim of this article is to determine if treating parents is associated with improvements in child anxiety through the review of both top-down (parent identified for treatment) and family-focused child anxiety treatment studies. The authors present conclusions based on the state of the current literature, discuss implications for research and clinical practice, and propose utilizing a family-based model for treating parental psychopathology, parental behavior, and child anxiety.

Screening parents during child evaluations: exploring parent and child psychopathology in the same clinic.

OBJECTIVE: Children of depressed and/or anxious parents are at increased risk for developing psychiatric disorders. Little research has focused on screening parents bringing their children for psychiatric evaluation, and few studies have included fathers or Hispanic children. This study had the following aims: 1) to identify current symptom rates in parents bringing their children for evaluation; and 2) to determine whether parental symptoms were associated with children's symptoms, diagnoses, and functioning. METHOD: The sample included 801 mothers, 182 fathers, and 848 children (aged 6 through 17 years). The majority (55.66%) were Hispanic, who attended a child and adolescent psychiatric evaluation service. Parent and child symptoms were assessed via parental reports. Children's diagnoses and functioning were determined by clinicians. Multiple regression analyses were used to determine whether severity of parental symptoms was associated with clinical child variables adjusting for child and parent demographic variables. RESULTS: In all, 18.80% of mothers and 18.42% of fathers reported elevated internalizing symptoms. Maternal symptoms were significantly associated with problems in children's functioning and children's anxiety, depression, and oppositional/conduct diagnoses; but not attention-deficit/hyperactivity disorder. Adjusting for parental and child demographics had a reduction on the effect of maternal symptoms on child depression. Paternal symptoms and functioning were positively associated with children's diagnoses, but the associations were smaller and not significant. Both parents' symptoms were significantly associated with children's internalizing and externalizing symptoms. However, these significant effects were not moderated by marital status or child ethnicity. CONCLUSIONS: This study highlights the importance of screening parents when their children receive a psychiatric evaluation. The findings support the development of mental health services that address psychiatric needs of the entire family within one clinical setting.

Depressed parents' treatment needs and children's problems in an urban family medicine practice.

OBJECTIVE: The study examined interest in treatment and treatment preferences and obstacles of low-income depressed parents. METHODS: A total of 273 primarily low-income, Hispanic parents of children aged seven to 17 attending an urban family medicine practice agreed to complete a survey by interview or self-report, including screening diagnoses and treatment history. Three groups were compared: major, subthreshold, and no depression. RESULTS: Nearly one-third had major (9%) or subthreshold depression (23%), and many in the depressed groups reported recent treatment (50% and 31%, respectively). Parents with any depression were significantly more likely than nondepressed parents to report interest in receiving help, endorse treatment obstacles, and report children's problems. CONCLUSIONS: High rates of personal and child problems, interest in treatment, and treatment obstacles among low-income, depressed parents highlight the need to develop acceptable mental health services for them and their children, even when parents do not meet full diagnostic criteria for depression.

Maternal mood, video-mediated cognitions, and daily stress during home-based, family interactions.

This article presents an in vivo investigation of maternal negative mood, maternal video-mediated cognitions, and daily stressors in families with young children. Specifically, it was hypothesized that greater levels of maternal depressed, anxious, and hostile mood states immediately prior to a daily, reportedly routine, stressful parent-child interaction would be significantly associated with higher percentages of dysfunctional and lower percentages of functional cognitions. Forty-five mothers of 2- to 5-year-old children participated in this study by rating their mood before being videotaped in a daily routine with their child they reported as recurrent and stressful (e.g., mealtime). Using video-mediated recall (VMR) methodology, mothers were instructed to recall their cognitions upon immediate video review. Results indicated that greater levels of negative mood were associated with a greater percentage of dysfunctional cognitions and a smaller percentage of functional cognitions. Levels of maternal depressed mood were significantly and independently associated with greater rates of dysfunctional and lower rates of functional cognitions. Negative mood states were not consistently associated with the amount of maternal self-reported general irrationality, pointing to the utility of the VMR to elicit maternal cognitions specific to the observed interaction, which may have more implications for clinical intervention than more general irrationality measures. Evaluating maternal mood and using video-mediated maternal cognitions regarding daily family stressors can precipitate clinical interventions meant to reduce family-related stress and potentially improve maternal and child mental health outcomes.