Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment

Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (β = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (β = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety.

Longitudinal Effects of Supported Exercise on Elevated Anxiety and Depression Scores in Formerly Sedentary Adults With Severe Obesity

Persistent anxiety and depression may be particularly high in individuals with obesity. Increasing exercise reliably improves mood in the general population; however, it has rarely been tested specifically in adults with severe obesity. Volunteer participants (60% women) of a theory-based cognitive-behavioral weight-management treatment with severe obesity and elevated (highest 10% based on normative values) depression ( N = 89) or anxiety ( N = 60) were assessed at baseline and Month 6 on measures of exercise output (overall, and whether the equivalent of three moderate sessions/week [i.e., ≥ 15 METs/week] were completed), corresponding mood, and exercise barriers self-efficacy. There were significant improvements (large effect sizes) in exercise outputs and mood. Increase in exercise outputs was significantly associated with reduced depression (β = −.52) and anxiety (β = −.67) scores. At least 15 METs/week of exercise was reached by 61% and 60% of participants, respectively. Participants demonstrated significantly greater reductions in depression and anxiety scores over 6 months than those completing lower amounts. Change in exercise barriers self-efficacy significantly mediated the following: (a) the prediction of depression change by change in exercise output and (b) the prediction of change in anxiety by completion/non-completion of ≥ 15 METs/week of exercise. Findings suggest substantial benefits for depression and anxiety in adults with severe obesity under conditions of moderate exercise supported by a community-based cognitive-behavioral treatment. Because of its identified mediation properties, future behavioral treatments should seek to increase barriers self-efficacy to maximize effects on elevated depression and anxiety and possibly weight.

Cognitive behavioral treatment for irritable bowel syndrome: a recent literature review

Irritable bowel syndrome (IBS) is a gastrointestinal psychosomatic disorder that often develops and worsens with stress. Hence, it is important to treat it from both, its physical and mental aspects. We reviewed recent research on cognitive-behavioral therapy (CBT)—one of the most widely studied psychological treatments for IBS—since it focuses on addressing the cognitions and behaviors associated with IBS symptoms, and combines diverse content, such as cognitive techniques, exposure, stress management, and mindfulness, whose effects have been widely studied. Research on CBT for IBS varies not only in terms of content of the interventions, but also in terms of implementation (individual or group, face-to-face or online). Internet-delivered CBT has recently shown the possibility of providing more accessible and cost-effective psychological intervention to IBS patients in formats, other than face-to-face. In recent years, many standardized scales that allow for IBS-specific psychological assessments have been used in clinical studies of CBT for IBS. Tools that competently deliver effective interventions and properly measure their effectiveness are expected to spread to many people suffering from IBS.

Personalized Assessment of Anxiety and Avoidance in Children and Their Parents—Development and Evaluation of the Anxiety and Avoidance Scale for Children

In treating childhood anxiety disorders, therapists use highly individualized anxiety hierarchies to assess anxiety-eliciting situations and to personalize treatment. In contrast, psychometric assessment of anxiety symptoms in children usually consists of standardized questionnaires, assessing either total anxiety or disorder-specific symptom scores, prioritizing comparability over individual information. To account for interindividual differences, the Anxiety and Avoidance Scale for Children (AVAC) was developed, following a precise, personalized, assessment approach. In responding to the questionnaire, children and parents identify the most anxiety-eliciting situations before starting treatment, and rate them for anxiety and avoidance. Ratings are repeated over the course of treatment. The aim of this study is to introduce the new questionnaire and present first data on psychometric properties. The AVAC was administered to 389 children with separation anxiety disorder (N = 148), social anxiety disorder (N = 110) or specific phobia (N = 131) aged 8 to 16 and their parents, along with other measures of anxiety and psychopathology before and after cognitive behavioral treatment. Results showed adequate to good test-retest reliability. The AVAC items correlated significantly with established anxiety questionnaires, indicating convergent construct validity. Regarding divergent construct validity, the AVAC showed only small correlations with externalizing symptoms, demonstrating its precision in measuring anxiety and avoidance. The questionnaire was also sensitive to change after treatment, with medium to large effects in the reduction of anxiety and avoidance. The present analyses suggest that the new personalized assessment approach with the AVAC is a reliable and valid assessment of individualized anxiety and avoidance, as well as change in those constructs over the course of CBT treatment.

Psychoeducation focused on family accommodation: a practical intervention for parents of children and adolescents with obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that is frequently diagnosed in children and adolescents. In pediatric OCD, family plays an important role in the development and maintenance of the disease. In this relationship, both genetic and behavioral factors, such as parental modeling and family accommodation, are significant. Parental modeling concerns the daily enactment of dysfunctional behavioral patterns by a parent with OCD, which may influence children. Family accommodation, in contrast, describes the direct participation of parents in their child’s compulsive rituals, by modifying daily routines or by facilitating avoidance of OCD triggers, to decrease the child’s distress and time spent executing compulsions. Approximately 80–90% of the relatives of OCD patients actively participate in patients’ rituals. The literature demonstrates that a high level of family accommodation is associated with OCD symptom severity, reduced response to cognitive-behavioral treatment (CBT), and a higher risk of therapy dropout.Despite this, no studies have aimed at delineating practical guidance for psychotherapists to support parents in reducing family accommodation.The main aim of this paper is to propose a psychoeducation intervention focused on cognitive-behavioral strategies to help families to manage their child’s OCD behaviors without enacting dysfunctional family accommodation behaviors in order to support their child’s successful therapy.

Recidivism Rates of Treated, Non-Treated and Dropout Adolescent Who Have Sexually Offended: a Non-Randomized Study

The primary objective of this study was to evaluate the effectiveness of a cognitive-behavioral treatment in reducing recidivism by adolescents who have sexually offended (ASO). A secondary objective was to determine whether typologies based on victim age (child, adult/peer, mixed) and relationship (intrafamilial, extra familial, intra/extra familial) discriminate ASO in terms of response to treatment and recidivism. The sample comprised 327 adolescents 12–18 years old (M = 15.8 years, SD = 1.9) who were evaluated in an outpatient clinic after committing a contact sexual assault. Official data on recidivism (criminal charges) was collected after a follow-up period of 21–162 months (M = 7.8 years, SD = 32.2). Survival analysis indicated that adolescents who completed treatment (n = 62) had a recidivism rate for violence (including sexual violence) almost half that of adolescents who had either not completed the treatment or not received treatment (n = 261), (16.1 vs. 30.7%). Neither of the two typologies studied had any effect on the completion of treatment. However, sexual aggression against adults/peers was associated with an increased probability of violent re-offending. These results confirm the effectiveness of this cognitive-behavioral treatment —which targets risk factors associated with sexual aggression as well as those associated with violence in general—in ASO.

Efficacy of exposure in group settings for youth with posttraumatic stress symptoms

Background Exposure to traumatic experiences is a fundamental part of evidence-based trauma-focused cognitive behavioral treatment (CBT) but in group settings it is discussed controversially among researchers and practitioners. This study aims to examine the individual participants’ stress level during group sessions with exposure and disclosure of traumatic events. Method N = 47 traumatized youth (Mage = 17.00, 94% male) participated in a group intervention comprising six 90-min group sessions (exposure in sessions 2–5). It is based on trauma-focused CBT principles. The individual stress level was assessed by the participants and group facilitators at the beginning, during, and at the end of every session. Results During the sessions including exposure, the stress level of the participants was higher than during sessions without exposure (Z = − 3.79; p ≤ .001). During the exposure sessions, the participants showed significant changes in stress level (d = 0.34–0.87) following an inverse U-shaped trend. Conclusion The results show that exposure is feasible within the scope of a trauma-focused group intervention for youth. The further dissemination of trauma-focused group treatments is an important component in the mental health care of children and youth who are traumatized.