INTRODUCTION: Initial examination of treatment worries suggest they may represent an important construct; however, previously used measures were limited by their specificity, scale format, and lack of parent report. Therefore the present study sought to examine the initial outcomes and psychometrics of newly developed corresponding measures of treatment worries in youth (Treatment Worries Questionnaire – Child; TWQ-C) and their parents (Treatment Worries Questionnaire – Parent; TWQ-P). METHODS: Participants were 94 youth (7-17-years old) and parent dyads presenting for psychosocial treatment of an anxiety disorder. Prior to initiation of treatment, dyads completed the TWQ-C and TWQ-P along with a host of additional child and parent report measures, and three clinician-rated measures. RESULTS: Treatment worries were endorsed in the mild-moderate range by youth and the TWQ-C demonstrated good-excellent internal consistency and test-retest reliability, a strong three-factor structure, and consistent convergent and divergent relationships. Treatment worries were endorsed in the low mild range by parents and the TWQ-P demonstrated fair-good internal consistency and test-retest reliability, a less empirically, but theoretically, supported four-factor structure, and consistent divergent relationships, but variable (by factor) convergent relationships. DISCUSSION: The results of the present study provide information on the concept of treatment worries and support the use of the TWQ-C and TWQ-P as broad assessments of the concept in a variety of populations. Low endorsement of worries among parents likely relates to the nature of the present sample (treatment-seeking) and may have contributed significantly to the less ideal psychometrics of the TWQ-P in comparison to the TWQ-C. Future investigation of treatment worries using the TWQ-C and TWQ-P in a variety of samples is warranted.

Anxiety sensitivity is a multifaceted cognitive risk factor currently being examined in relation to anxiety and depression. The paucity of research on the relative contribution of the facets of anxiety sensitivity to anxiety and depression, coupled with variations in existing findings, indicate that the relations remain inadequately understood. In the present study, the relations between the facets of anxiety sensitivity, anxiety, and depression were examined in 730 Hispanic-Latino and European-American youth referred to an anxiety specialty clinic. Youth completed the Childhood Anxiety Sensitivity Index, the Revised Children’s Manifest Anxiety Scale, and the Children’s Depression Inventory. The factor structure of the Childhood Anxiety Sensitivity Index was examined using ordered-categorical confirmatory factor analytic techniques. Goodness-of-fit criteria indicated that a two-factor model fit the data best. The identified facets of anxiety sensitivity included Physical/Mental Concerns and Social Concerns. Support was also found for cross-ethnic equivalence of the two-factor model across Hispanic-Latino and European-American youth. Structural equation modeling was used to examine models involving anxiety sensitivity, anxiety, and depression. Results indicated that an overall measure of anxiety sensitivity was positively associated with both anxiety and depression, while the facets of anxiety sensitivity showed differential relations to anxiety and depression symptoms. Both facets of anxiety sensitivity were related to overall anxiety and its symptom dimensions, with the exception being that Social Concerns was not related to physiological anxiety symptoms. Physical/Mental Concerns were strongly associated with overall depression and with all depression symptom dimensions. Social Concerns was not significantly associated with depression or its symptom dimensions. These findings highlight that anxiety sensitivity’s relations to youth psychiatric symptoms are complex. Results suggest that focusing on anxiety sensitivity’s facets is important to fully understand its role in psychopathology. Clinicians may want to target all facets of anxiety sensitivity when treating anxious youth. However, in the context of depression, it might be sufficient for clinicians to target Physical/Mental Incapacitation Concerns.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Separation anxiety disorder (SAD) is the most common and impairing childhood anxiety disorder. Left untreated, SAD is associated with heightened risk for the development of additional internalizing disorders as well as impairments in educational attainment and social functioning. Numerous clinical trials have demonstrated the efficacy of cognitive-behavior therapy (CBT) for the treatment of childhood anxiety disorders, including SAD. However, additional research is needed to enhance the compatibility (e.g., fit of the treatment to the patient population) and ultimate uptake of evidence-based interventions for anxious youth. The current research evaluates the feasibility and preliminary efficacy of an intensive, cognitive-behavioral intervention for school-aged girls with SAD provided within the novel context of a one-week camp-like setting. This alternative treatment format was predicated on evidence supporting the need for treatments that allow for creative and developmentally-sensitive applications of intervention components, incorporate a child's social context, target relevant parenting variables, and provide additional models for treatment delivery. Twenty-nine female children aged 7 to 12 with a principal or co-principal diagnosis of SAD were randomized to an immediate treatment (n = 15) or waitlist (i.e., delayed treatment; n = 14) condition during the course of this randomized-controlled trial. Measures were administered at pretreatment/ pre-waitlist, post-treatment/post-waitlist, and six weeks following treatment to assess changes in symptom reports, functional outcomes, and overall program satisfaction. Analyses of covariance were conducted to assess effects of treatment condition and repeated measures analyses of variance were conducted to evaluate change over the three data collection time points. Relative to waitlist, children in the immediate treatment group evidenced significant reductions in SAD severity by clinician report on a diagnostic interview measure. Moreover, treatment gains strengthened over time. Contrary to hypotheses, children receiving the intervention did not display significantly greater improvements relative to waitlist on parent-rated fear and avoidance scores or on parent or child self-report measures. Potential explanations for non-significant findings are discussed. Overall, the intervention's positive therapeutic response on SAD diagnostic status and severity suggests one possible delivery model for surmounting difficulties faced in the dissemination of standard, weekly treatments for this condition. / 2031-01-02

Aus der Einleitung: A wide range of epidemiological community studies worldwide converge on several incontrovertible facts regarding anxiety disorders: they occur frequently, begin at an early age, significantly impair multiple areas of development and life, and are associated with numerous adverse correlates and consequences. Furthermore, evidence clearly points to the fact that the majority of patients who have anxiety disorders still go undetected and undertreated, despite considerable efforts over the last two decades to improve this situation. Less than half receive any treatment at all and only a fraction of those receive what can be considered even "minimally adequate treatment."

The experience of mental disorders while part of humanity, reveal inequities that are inhumane due to a lack of quality clinical service provisions globally. In Haiti, a formalized mental healthcare infrastructure developed after the 2010 earthquake where emerging dissemination and implementation studies demonstrated the potential for treatment utilization within recently established primary care. Partners in Health (PIH) and Zanmi Lasante (ZL) the frontline healthcare team have coordinated with the Haitian Ministry of Health to lead this initiative. A community-based mental healthcare system has proven to be sustainable through a task-sharing model, which delivers mental healthcare for common mental disorders (CMDs), severe mental disorders (SMDs), and neurological conditions (NCs)–with specific care pathways for major depression, psychotic disorders, and epilepsy. The extent to which patient mental healthcare are evaluated in lower-middle income countries (LMICs) like Haiti, however, have been limited. The primary aim of this study was to therefore evaluate patterns of mental disorders and to assess current patient care priorities in Haiti. The present study, builds upon previous literature by examining the continuum of mental disorders. A latent class analysis provides a data-driven approach to examine features of mental disorders to inform clinical treatment and best practices. EHR data from PIH and ZL were obtained from patients (N=914) who met criterion for a primary diagnosis and had completed mental health evaluations that were assessed at 13 sites in Haiti from 2016-2018. Known characteristics of mental disorders include the patient’s primary diagnosis, mood symptoms such as depression and suicidality, and the level of functional impairment. Accordingly, each were included as an LCA model indicator. Post-hoc multinomial logistic regression (MLR) models predicted mental health class selection and correlates based on the descriptive and clinical symptom variables. Results suggested there are six distinct mental health subgroups, that were distinguished by functional impairment: class 1a “common mental disorders– none to low functional impairment” (11.5%), class 2a “severe mental disorders–none to low functional impairment” (4.9%), class 3a “neurological conditions–none to low functional impairment” (11.1%), class 4b “common mental disorders–high functional impairment” (38.62%), class 5b “severe mental disorders–high functional impairment” (13.02%), and class 6b “neurological conditions–high functional impairment” (20.9%). MLR model 1 revealed CMDs were 2–3 times more likely female and received psychosocial interventions more often, and by comparison SMDs and NCs typically received psychiatric medication. MLR model 2 included patient’s clinical symptoms, that suggested severe CMDs with high functional impairment were somewhat more likely depressed when compared to other LCA subgroups. Although, in all likelihood this finding was probably attributed to CMDs including mild to severe forms of major depression, whereas SMDs were mostly psychotic disorder and bipolar disorder. Taken together, the most frequent primary diagnosis included: 1) major depressive disorder (60.3%) and generalized anxiety disorder (27.2%) for CMDs, 2) psychotic spectrum disorders (47.6%) and bipolar disorder (23.7%) for SMDs, and 3) epilepsy (88.8%) for NCs. Patients were infrequently diagnosed with co-occurring psychological disorders. The varied mental health disorder subgroups that participated in psychotherapy and psychiatric medication management, demonstrate such mental health treatments for Haitian’s are feasible and acceptable. While the present analysis was exploratory, LCA provides potential tools for treatment specification and best practices. The WHODAS, a measure of functional impairment, may be useful as a screening tool for triage, and primary outcome to determine patient improvement. Mental healthcare pathways based on results should expand to include women’s mental health and bipolar disorder. These findings are generalizable due to the data being from a community sample and directly from EHRs with inclusion criterion that was not limited by diagnostic specification, symptom severity, or co–occurring disorders. Overall, there is a vast need for mental health services that are broadly accessible for CMDs, SMDs, and NCs. This study highlights, specific clinical training and supervision needs, and the necessity for increased nursing, psychiatry, and neurology collaboration in Haiti. There is hope that healthcare expansion will strengthen and continue to empower communities in Haiti.

The relationship between DSM-IV anxiety disorders and their clinical characteristics in mothers and anxiety in offspring was examined in 933 mother-child pairs from a longitudinal community study. Offspring of mothers with an anxiety disorder had an elevated risk of developing any anxiety disorder, compared with offspring of mothers with no anxiety disorder. Increased risk of anxiety in the offspring was especially associated with maternal social phobia and generalised anxiety disorder, and with maternal diagnoses of early onset, greater number and more severe impairment. These results suggest that the type of maternal anxiety disorder and its severity of manifestation contribute to mother-offspring aggregation of anxiety.

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.

Exposure therapy (ET) is an extensively studied and supported treatment for anxiety and trauma-related disorders. ET works by exposing the patient to the feared object or situation without any danger in order to overcome the related anxiety. Over the past few years, various technologies including head-mounted displays (HMDs), scent machines, and headphones have been used to augment the exposure therapy process by presenting multi-sensory cues (e.g., sights, smells, sounds) to increase the patient*s sense of presence. While studies have shown that scents can elicit emotionally charged memories, no prior research could be identified that examined the effect of olfactory stimuli upon the patient*s sense of presence during exposure tasks. In this study, the effect of olfactory stimuli on subject*s sense of presence was assessed via psychophysiological response (electrodermal activity), visual scanning, and self-report measures. Linear Mixed Modeling showed relationships between olfactory stimuli and presence ratings as well as self-reported anxiety levels, but not visual scanning or physiological arousal. Recommendations were made for continued research in the union of olfactory stimuli, presence, and exposure therapy.

No description available.

Objective: This study examined (a) the distribution of physical symptoms in youth with specific primary anxiety disorders (i.e. separation anxiety disorder [SAD], generalized anxiety disorder [GAD], and social phobia [SP]) and (b) their response to treatment with cognitive-behavioral therapy (CBT; 14 sessions of CBT over the course of 12 weeks), medication, combination therapy (CBT + medication), or pill placebo in a sample. Method: Anxiety disordered youth (N = 488, age 7-17) who met criteria for a primary diagnosis of GAD, SAD, and/or SP as part of the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al. 2008) were included in this study. The sample was diverse and included children with comorbid secondary diagnoses. Results: The most common somatic complaints were headache, stomach pain or aches, feeling drowsy or too sleepy, head cold or sniffles, and sleeplessness. The distribution of these complaints did not differ across diagnostic groups. The number and severity of physical symptoms decreased over the course of treatment. Treatment condition, including placebo, was unrelated to the number and severity of physical symptoms posttreatment. Conclusions: Treatment of anxiety leads to a decrease in the number and severity of physical symptoms experienced in anxiety-disordered youth, irrespective of treatment type. / Psychology