CBT for Childhood Anxiety: Reviewing the State of Personalised Intervention Research.
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ABSTRACT:
SUBMITTER: Bertie LA
PROVIDER: S-EPMC8663921 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Does delivery of the same manual-based individual cognitive-behavioral treatment (ICBT) program for youth anxiety differ across research and practice settings? We examined this question in a sample of 89 youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with a primary anxiety disorder. The youths received (a) ICBT in a research setting, (b) ICBT in practice settings, or (c) non-manual-based usual care (UC) in practice settings. Treatment delivery was assessed using four theory-based subscales (Cognitive-behavioral, Psychodynamic, Client-Centered, Family) from the Therapy Process Observational Coding System for Child Psychotherapy-Revised Strategies scale (TPOCS-RS). Reliable independent coders, using the TPOCS-RS, rated 954 treatment sessions from two randomized controlled trials (1 efficacy and 1 effectiveness trial). In both settings, therapists trained and supervised in ICBT delivered comparable levels of cognitive-behavioral interventions at the beginning of treatment. However, therapists trained in ICBT in the research setting increased their use of cognitive-behavioral interventions as treatment progressed whereas their practice setting counterparts waned over time. Relative to the two ICBT groups, the UC therapists delivered a significantly higher dose of psychodynamic and family interventions and a significantly lower dose of cognitive-behavioral interventions. Overall, results indicate that there were more similarities than differences in manual-based ICBT delivery across research and practice settings. Future research should explore why the delivery of cognitive-behavioral interventions in the ICBT program changed over time and across settings, and whether the answers to these questions could inform implementation of ICBT programs.
| S-EPMC5458533 | biostudies-literature
Project description:BACKGROUND: To inform early intervention practice, the present research examines how child anxiety, behavioural inhibition, maternal overinvolvement, maternal negativity, mother-child attachment and maternal anxiety, as assessed at age four, predict anxiety at age nine. METHOD: 202 children (102 behaviourally inhibited and 100 behaviourally uninhibited) aged 3-4 years were initially recruited and the predictors outlined above were assessed. Diagnostic assessments, using the Anxiety Disorders Interview Schedule, were then conducted five years later. RESULTS: Behavioural inhibition, maternal anxiety, and maternal overinvolvement were significant predictors of clinical anxiety, even after controlling for baseline anxiety (p<.05). No significant effect of negativity or attachment security was found over and above baseline anxiety (p>.1). CONCLUSIONS: Preschool children who show anxiety, are inhibited, have overinvolved mothers and mothers with anxiety disorders are at increased risk for anxiety in middle childhood. These factors can be used to identify suitable participants for early intervention and can be targeted within intervention programs.
| S-EPMC3414481 | biostudies-other
Project description:Fall accidents among older adults can be devastating events that, in addition to their physical consequences, lead to disabling anxiety warranting the attention of mental health practitioners. This article presents "Back on My Feet," an exposure-based cognitive-behavioral therapy (CBT) protocol that is designed for older adults with posttraumatic stress disorder (PTSD), subthreshold PTSD, or fear of falling resulting from a traumatic fall. The protocol can be integrated into care once patients have been discharged from hospital or rehabilitation settings back to the community. Following a brief description of its development, the article presents a detailed account of the protocol, including patient evaluation and the components of the eight home-based sessions. The protocol addresses core symptoms of avoidance, physiological arousal/anxiety, and maladaptive thought patterns. Because older patients face different coping challenges from younger patients (for whom the majority of evidence-based CBT interventions have been developed), the discussion ends with limitations and special considerations for working with older, injured patients. The article offers a blueprint for mental health practitioners to address the needs of patients who may present with fall-related anxiety in primary care and other medical settings. Readers who wish to develop their expertise further can consult the online appendices, which include a clinician manual and patient workbook, as well as guidance on additional resources.
| S-EPMC4214866 | biostudies-literature
Project description:Anxiety is a significant mental health issue in modern society and empirical research into effective interventions to address anxiety has been extensive. Spending time in nature is one approach that has demonstrated anxiolytic effects. However, in some situations and contexts spending time in nature in order to reduce anxiety symptoms may not be possible. For example, in therapeutic settings delivered in a space with no access or exposure to any nature stimuli in the immediate surrounding environment. Guided imagery (GI) has also proven to be effective for reducing anxiety symptoms. Thus, nature-based GI might help to overcome the limitation of access to nature and strengthen the impact of GI interventions. The current study investigated the effectiveness of nature-based GI on anxiety reduction. Participants (n = 48, 18 males, 30 females, M age = 34.54, SD age = 12.91, age range = 19 - 71 years) with moderate levels of either trait or state anxiety as measured by the state-trait anxiety inventory (STAI) were recruited. Participants undertook both a nature-based GI session and a traditional non-nature-based GI session and their pre- and post- state anxiety levels were measured in each GI session. It was anticipated that post state anxiety scores would be significantly lower for both GI conditions and that a significantly greater anxiety reduction would be found in the nature-based GI than the urban-based GI. A two-way analysis of variance for repeated measures revealed results that supported both hypotheses. This study was the first to compare a nature based GI intervention with a traditional (non-nature based) GI intervention. Findings indicate that nature-based GI interventions are effective anxiety management interventions that have the added benefit of being cost-effective and easily accessible.
| S-EPMC6176042 | biostudies-literature
Project description:BackgroundLittle is known about the association between stressors (especially positive stressors) during pregnancy and postpartum depression and anxiety.AimsWe investigated the association between positive and negative stress events during different stages of pregnancy and postpartum mental health outcomes among low-income pregnant women with symptoms of anxiety in Pakistan and evaluated whether an intervention based on cognitive-behavioural therapy (CBT) had a regulatory effect.MethodsParticipants were 621 pregnant Pakistani women with mild anxiety. Using the Pregnancy Experience Scale-Brief Version, six scores were created to assess positive and negative stressors. We performed a multivariate linear regression to examine whether these six scores, measured both at baseline and in the third trimester, were associated with postpartum anxiety and depressive symptoms. The effect of the intervention on this relationship was examined by adding an interaction term to the regression model.ResultsHassles frequency measured in the third trimester was positively associated with depression (B=0.22, 95% confidence interval (CI): 0.09 to 0.36) and anxiety (B=0.19, 95% CI: 0.08to 0.30). At the same timepoint, uplifts intensity was negatively associated with symptoms of depression (B=-0.82, 95% CI: -1.46 to -0.18) and anxiety (B=-0.70, 95% CI: -1.25 to -0.15), whereas hassles intensity was positively related to symptoms of depression (B=1.02, 95% CI: 0.36 to 1.67) and anxiety (B=0.90, 95% CI: 0.34 to 1.47). The intensity ratio of hassles to uplifts reported in the third trimester was positively related to both depression (B=1.40, 95% CI: 0.59 to 2.20) and anxiety (B=1.26, 95% CI: 0.57 to 1.96). The intervention strengthened the overall positive effects of uplifts and the negative effects of hassles. Pregnancy experiences at baseline during early pregnancy to mid-pregnancy were not associated with mental health outcomes.ConclusionsStressors in the third trimester but not earlier in pregnancy were associated with postpartum symptoms of anxiety and depression. The CBT intervention modified the association between pregnancy stressors and postpartum mental health outcomes. Programmes that promote positive experiences and reduce negative experiences, especially in late pregnancy, may mitigate postpartum mental health consequences.Trial registration numberNCT03880032.
| S-EPMC10910396 | biostudies-literature
Project description:Human research ethics committees (HRECs) are evaluating increasing quantities of genomic research applications with complex ethical considerations. Genomic confidence is reportedly low amongst many non-genetics-experts; however, no studies have evaluated genomic confidence levels in HREC members specifically. This study used online surveys to explore genomic confidence levels, predictors of confidence, and genomics resource needs of members from 185 HRECs across Australia. Surveys were fully or partially completed by 145 members. All reported having postgraduate 94 (86%) and/or bachelor 15 (14%) degrees. Participants consisted mainly of researchers (n = 45, 33%) and lay members (n = 41, 30%), affiliated with either public health services (n = 73, 51%) or public universities (n = 31, 22%). Over half had served their HREC [Formula: see text]3 years. Fifty (44%) reviewed genomic studies [Formula: see text]3 times annually. Seventy (60%) had undertaken some form of genomic education. While most (94/103, 91%) had high genomic literacy based on familiarity with genomic terms, average genomic confidence scores (GCS) were moderate (5.7/10, n = 119). Simple linear regression showed that GCS was positively associated with years of HREC service, frequency of reviewing genomic applications, undertaking self-reported genomic education, and familiarity with genomic terms (p < 0.05 for all). Conversely, lay members and/or those relying on others when reviewing genomic studies had lower GCSs (p < 0.05 for both). Most members (n = 83, 76%) agreed further resources would be valuable when reviewing genomic research applications, and online courses and printed materials were preferred. In conclusion, even well-educated HREC members familiar with genomic terms lack genomic confidence, which could be enhanced with additional genomic education and/or resources.
| S-EPMC8633339 | biostudies-literature
Project description:The bioeconomy is currently being globally promoted as a sustainability avenue involving several societal actors. While the bioeconomy is broadly about the substitution of fossil resources with bio-based ones, three main (competing or complementary) bioeconomy visions are emerging in scientific literature: resource, biotechnology, and agroecology. The implementation of one or more of these visions into strategies implies changes to land use and thus ecosystem services delivery, with notable trade-offs. This review aims to explore the interdisciplinary space at the interface of these two concepts. We reviewed scientific publications explicitly referring to bioeconomy and ecosystem services in their title, abstract, or keywords, with 45 documents identified as relevant. The literature appeared to be emerging and fragmented but eight themes were discernible (in order of decreasing occurrence frequency in the literature): a. technical and economic feasibility of biomass extraction and use; b. potential and challenges of the bioeconomy; c. frameworks and tools; d. sustainability of bio-based processes, products, and services; e. environmental sustainability of the bioeconomy; f. governance of the bioeconomy; g. biosecurity; h. bioremediation. Approximately half of the documents aligned to a resource vision of the bioeconomy, with emphasis on biomass production. Agroecology and biotechnology visions were less frequently found, but multiple visions generally tended to occur in each document. The discussion highlights gaps in the current research on the topic and argues for communication between the ecosystem services and bioeconomy communities to forward both research areas in the context of sustainability science.
| S-EPMC7568744 | biostudies-literature
Project description:BACKGROUND:Expanding access to naloxone is crucial for mitigating the public health epidemic of opioid overdose deaths in America. Pharmacists now have greater independent authority to dispense naloxone to the public due to a wave of enhanced pharmacy naloxone access laws. It is unknown to what extent pharmacists are required to receive specialized training to serve in this capacity. OBJECTIVES:The goal of this study was to review naloxone training mandates from states with enhanced pharmacy naloxone access laws. METHODS:Structured internet searches were completed using publicly available legislative, regulatory, and administrative records to identify the type of enhanced pharmacy naloxone access law and the presence and characteristics of a pharmacist naloxone training mandate in each state. RESULTS:As of November 22, 2017, all 50 states have implemented an enhanced pharmacy naloxone access law. Only 19 states mandated targeted naloxone education before pharmacists engaged in independent naloxone dispensing/prescribing activities. CONCLUSIONS:A lack of standardized naloxone training requirements for naloxone-dispensing pharmacists may affect the rate of adoption of enhanced pharmacy naloxone dispensing practices at community pharmacies and suboptimal education of patients at risk of opioid overdose. Ensuring pharmacists' preparedness to serve as naloxone providers is necessary to meaningfully prevent opioid overdose deaths in their communities.
| S-EPMC6173665 | biostudies-literature
Project description:ObjectivesA very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how to access specialist services and their limited availability. A school-based programme that integrates screening to identify those children who are most likely to be experiencing anxiety problems with the offer of intervention has the potential to overcome many of these barriers. This article is a process-based account of how we used codesign to develop a primary school-based screening and intervention programme for child anxiety problems.DesignCodesign.SettingUK primary schools.ParticipantsData were collected from year 4 children (aged 8-9 years), parents, school staff and mental health practitioners.ResultsWe report how the developed programme was experienced and perceived by a range of users, including parents, children, school staff and mental health practitioners, as well as how the programme was adapted following user feedback.ConclusionsWe reflect on the mitigation techniques we employed, the lessons learnt from the codesign process and give recommendations that may inform the development and implementation of future school-based screening and intervention programmes.
| S-EPMC9214411 | biostudies-literature
Project description:Sleep quality may be an important, yet relatively neglected, predictor of treatment outcome in cognitive-behavioral therapy (CBT) for anxiety disorders. Specifically, poor sleep quality may impair memory consolidation of in-session extinction learning. We therefore examined sleep quality as a predictor of treatment outcome in CBT for social anxiety disorder and the impact of d-cycloserine (DCS) on this relationship.One hundred sixty-nine participants with a primary diagnosis of DSM-IV generalized social anxiety disorder were recruited across three sites. Participants were enrolled in 12 weeks of group CBT. Participants randomly received 50 mg of DCS (n = 87) or pill placebo (n = 82) 1 hr prior to sessions 3-7. Participants completed a baseline measure of self-reported sleep quality and daily diaries recording subjective feelings of being rested upon wakening. Outcome measures including social anxiety symptoms and global severity scores were assessed at each session.Poorer baseline sleep quality was associated with slower improvement and higher posttreatment social anxiety symptom and severity scores. Moreover, patients who felt more "rested" after sleeping the night following a treatment session had lower levels of symptoms and global severity at the next session, controlling for their symptoms and severity scores the previous session. Neither of these effects were moderated by DCS condition.Our findings suggest that poor sleep quality diminishes the effects of CBT for social anxiety disorder and this relation is not attenuated by DCS administration. Therapeutic attention to sleep quality prior to initiation of CBT and during the acute treatment phase may be clinically indicated.
| S-EPMC4043139 | biostudies-literature