Applications of the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents

The Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C and UP-A) are evidence-based, transdiagnostic intervention programs that target core emotion regulation processes that may be shared across varying presentations of internalizing distress or disorders in youth. Given their popular transdiagnostic and modular structures, the UP-C and UP-A have quickly been disseminated and implemented with a variety of populations and in differing treatment settings. This volume aims to aid UP-C and UP-A therapists in understanding varied applications and modifications of these approaches and assist them in applying such in their own practice. To that end, chapters are offered on not only standard UP-C and UP-A research and practice but also applications for youth with obsessive-compulsive symptoms, tic-related concerns, substance use, serious mental illness, and eating disorders. Structural modifications to the UP-C and UP-A using a stepped care model and when delivering care in pediatric or community practice settings and in differing cultures or languages are also discussed. To aid in their use, each chapter includes a brief, user-friendly description of the modifications or adaptations of the UP-C and/or UP-A that are described therein.

Mothers’ neural response to valenced infant interactions predicts postpartum depression and anxiety

It is currently unknown whether differences in neural responsiveness to infant cues observed in postpartum affective disturbance are specific to depression/anxiety or are better attributed to a common component of internalizing distress. It is also unknown whether differences in mothers’ brain response can be accounted for by effects of past episodes, or if current neural processing of her child may serve as a risk factor for development of future symptoms. Twenty-four mothers from a community-based sample participated in an fMRI session viewing their 3-month- old infant during tasks evoking positive or negative emotion. They were tracked across the ensuing 15 months to monitor changes in affective symptoms. Past and current episodes of depression and anxiety, as well as future symptoms, were used to predict differences in mothers’ hemodynamic response to their infant in positive compared to negative emotion contexts. Lower relative activation in largely overlapping brain regions involving frontal lobe structures to own infant positive vs. negative emotion was associated with concurrent (3-month) depression diagnosis and prospective (3–18 month) depression and anxiety symptoms. There was little evidence for impacts of past psychopathology (more limited effect of past anxiety and nonsignificant effect of past depression). Results suggest biased maternal processing of infant emotions during postpartum depression and anxiety is largely accounted for by a shared source of variance (internalizing distress). Furthermore, differential maternal responsiveness to her infant’s emotional cues is specifically associated with the perpetuation of postpartum symptoms, as opposed to more general phenotypic or scarring effects of past psychopathology.

Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health

Background Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use. However, the acceptability of online SSI and their efficacy have remained unexamined outside of controlled trials, and their practical utility is poorly understood. Objective We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment & Support), an open-access platform offering three online SSIs for youth internalizing distress. Methods After selecting one of three SSIs to complete, participants (ages 11-17 years) reported pre- and post-SSI levels of clinically relevant outcomes that SSIs may target (eg, hopelessness, self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES. Results From September 2019 through March 2020, 694 youths accessed YES, 539 began, and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically elevated depressive symptoms, on average, and were diverse on several dimensions (53.75% non-white; 78.10% female; 43.23% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (dav=0.53; dz=0.71), self-hate (dav=0.32; dz=0.61), perceived control (dav=0.60; dz=0.72) and agency (dav=0.39; dz=0.50). Youths rated all SSIs as acceptable (eg, enjoyable, likely to help peers). Conclusions Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress. Trial Registration Open Science Framework; osf.io/e52p3

Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health (Preprint)

BACKGROUND Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, promising to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be uniquely scalable, particularly if they are freely available for as-needed use. However, the acceptability of online SSI and their efficacy have remained unexamined outside of controlled trials, and their practical utility is poorly understood. OBJECTIVE We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment &amp; Support), an open-access platform offering three online SSIs for youth internalizing distress. METHODS After selecting one of three SSIs to complete, participants (ages 11-17 years) reported pre- and post-SSI levels of clinically relevant outcomes that SSIs may target (eg, hopelessness, self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES. RESULTS From September 2019 through March 2020, 694 youths accessed YES, 539 began, and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically elevated depressive symptoms, on average, and were diverse on several dimensions (53.75% non-white; 78.10% female; 43.23% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (<i>d</i>_av=0.53; <i>d</i>_z=0.71), self-hate (<i>d</i>_av=0.32; <i>d</i>_z=0.61), perceived control (<i>d</i>_av=0.60; <i>d</i>_z=0.72) and agency (<i>d</i>_av=0.39; <i>d</i>_z=0.50). Youths rated all SSIs as acceptable (eg, enjoyable, likely to help peers). CONCLUSIONS Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress. CLINICALTRIAL Open Science Framework; osf.io/e52p3

Acceptability and Utility of an Open-Access, Online Single-Session Intervention Platform for Adolescent Mental Health

Background. Many youths with mental health needs are unable to access care. Single-session interventions (SSIs) have helped reduce youth psychopathology across multiple trials, suggesting promise to broaden access to effective, low-intensity supports. Online, self-guided SSIs may be especially scalable, particularly if freely available for as-needed use. However, online SSIs’ acceptability and effects have remained unexamined outside of controlled trials, leaving their practical utility poorly understood. Objective. We evaluated the perceived acceptability and proximal effects of Project YES (Youth Empowerment &amp; Support; www.schleiderlab.org/yes), an open-access platform offering three online SSIs for youth internalizing distress. Method. After selecting one of three SSIs to complete, youth participants (ages 11-17 years) reported pre- and post-SSI levels of clinically-relevant outcomes that SSIs may target (e.g. hopelessness; self-hate) and perceived SSI acceptability. User-pattern variables, demographics, and depressive symptoms were collected to characterize youths engaging with YES. Results. From 9/2019-3/2020, 694 youths accessed YES, of whom 539 began and 187 completed a 30-minute, self-guided SSI. SSI completers reported clinically-elevated depressive symptoms, on average, and were diverse on several dimensions (53.75% non-white; 78.10% female; 43.23% sexual minorities). Regardless of SSI selection, completers reported pre- to post-program reductions in hopelessness (dav = .53; dz = .71), self-hate (dav = .32; dz = .61), perceived control (dav = .60; dz = .72) and agency (dav = .39; dz = .50). Youths rated all SSIs as acceptable (e.g., enjoyable; likely to help peers). Conclusions. Results support the perceived acceptability and utility of open-access, free-of-charge SSIs for youth experiencing internalizing distress.

Contributions of fixed mindsets and hopelessness to anxiety and depressive symptoms: A commonality analysis approach

Background. Fixed mindsets (beliefs that personal traits are unchangeable) show consistent associations with internalizing symptoms. However, the mindset-internalizing symptom link has previously been studied in isolation of other maladaptive cognitions that relate to internalizing symptoms. Thus, the unique contributions of mindsets to internalizing symptoms remains unclear. Method. We used commonality analysis (CA), which yields unique and shared effects of independent variables on an outcome, to assess unique contributions of emotion and anxiety mindsets to anxiety and depression symptoms, relative to the contributions of hopelessness. Participants in two online studies (Ns=200, 430) self-reported depression and anxiety symptoms, hopelessness, and emotion and anxiety mindsets.Results. In Study 1, neither mindset type contributed unique variance to depression or anxiety beyond the contribution of hopelessness. In Study 2, emotion mindsets again explained no unique symptom variance. Anxiety mindsets uniquely contributed 2.0% and 6.5% of depression and anxiety variance, respectively— but far larger proportions of symptom variance (20.0%-60.9%) were contributed by hopelessness alone, variance shared by hopelessness and anxiety mindsets, and variance shared among hopelessness, anxiety mindsets, and emotion mindsets. Limitations. The cross-sectional design precludes causal conclusions, and the non-referred adult samples may limit generalizability. Discussion. Mindsets contributed little unique variance to internalizing symptoms beyond hopelessness. Interventions teaching growth mindsets have been shown to reduce internalizing problem in past studies. However, these interventions may operate might not necessarily operate by shaping mindsets; rather, they may affect symptom change by shaping closely-linked maladaptive cognitions—like hopelessness—with stronger ties to internalizing distress.

Using the Depression, Anxiety, Stress Scales–21 With U.S. Adolescents: An Alternate Models Analysis

As part of universal screening efforts in schools, validated measures that identify internalizing distress are needed. One promising available measure, the Depression, Anxiety, and Stress Scales–21 (DASS–21), has yet to be thoroughly investigated with adolescents in the United States. This study investigated the underlying factor structure of the DASS–21 in a sample of U.S. adolescents ( N = 2,454) by using confirmatory factor analytic techniques to test several alternate models. A bifactor model specifying general Negative Affectivity and three specific factors of Depression, Anxiety, and Stress yielded the best fit. Results from this study suggest that (a) the DASS–21 scales reflect a common factor, indicating that a total score of the DASS–21 can be derived as a measure of general negative affectivity, and (b) the DASS–21 may not adequately differentiate between the experiences of negative affectivity, anxiety, and stress in U.S. adolescents.

Convergence of Self-Reports and Informant Reports on the Personality Assessment Screener

The present study is the first to investigate the Personality Assessment Screener, a brief self-report measure of risk for emotional and behavioral dysfunction, in relation to the informant report version of this instrument, the Personality Assessment Screener–Other. Among a sample of undergraduate roommate dyads ( N = 174), self-report and informant report total scores on the Personality Assessment Screener/Personality Assessment Screener–Other moderately converged ( r = 0.45), with generally greater agreement between perspectives observed for externalizing behaviors compared with internalizing distress. In addition, selves tended to report more psychological difficulties relative to informant ratings ( d = 0.45) with an average absolute discrepancy between sources of 6.31 ( SD = 4.96) out of a possible range of 66. Discrepancies between self-report and informant report were significantly associated with characteristics of the dyadic relationship (e.g., length of acquaintanceship) as well as the severity of self-reported psychological difficulties and positive impression management.