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.

Exposure Quality in Cognitive Behavioral Treatment for Youth Anxiety Disorders—Predictors and Associations with Outcomes

To optimize cognitive behavioral therapy (CBT) outcomes for anxiety disorders in youth, more knowledge is needed about how specific CBT components work. Exposure to feared situations is an effective CBT component. However, there is little observation-based empirical research on how exposure relates to outcomes and other clinical variables. In a randomized controlled community clinic trial for youth with anxiety disorders, observers reliably rated exposure quality for 68 youths aged 8 to 15 years based on 118 videotaped sessions. The treatment program was the manual-based FRIENDS program. Three exposure quality elements (preparation, post-processing, and parent contribution to exposure) were examined in relation to pre-treatment demographic and clinical variables, outcomes, and youth- and therapist-rated alliance using multilevel hierarchical regression models. The outcomes were diagnostic recovery, clinical severity and anxiety symptoms change from pre- to post-treatment and one-year follow-up, and treatment dropout. The results showed that parent contribution to exposure was higher for boys and younger children. Parent contribution to exposure, but no other exposure element, was associated with a larger likelihood of diagnostic recovery and larger clinical severity reduction at one-year follow-up. Exposure quality was unrelated to outcomes at post-treatment, dropout, or alliance. We conclude that enhancing parent contribution to exposure during treatment could improve long-term outcomes after CBT for youth anxiety disorders. Exposure elements should be observed in larger samples to further examine their potential role for CBT outcomes.

Parent-Adolescent Reminiscing and Youth Psychopathology: A Cross-Sectional and Longitudinal Investigation

<p>Parent-child conversations about past experiences—reminiscing—are key in children’s growing emotional competency and their psychological well-being (Salmon & Reese, 2016). Very little research, however, has investigated the relationship between parent-adolescent reminiscing conversations and adolescent psychological adjustment, which is particularly important because adolescence is a period of heightened risk for the development of rumination and internalising disorders, especially anxiety and depression (Miller-Slough & Dunsmore, 2016). This thesis extended the literature on reminiscing in three ways. First, we examined different qualities of mother-adolescent reminiscing and their relationships to psychological outcomes during the period of middle adolescence. Second, we investigated the associations between mother-adolescent reminiscing qualities and youth rumination and internalising symptoms (anxiety and depression), cross-sectionally and longitudinally to help disentangle the direction of the associations. Finally, we applied dyadic methods of coding and statistical analyses in a novel approach that modelled the transactional nature of reminiscing conversations and their associations with youth psychological outcomes. In Study 1 we tested the discriminant and convergent validity of a dyadic coding scheme, for use on parent-adolescent conversations about past events. The aim of Study 1 was to establish the methodological foundations for examining parent-adolescent reminiscing conversations in a way that lends itself to dyadic analysis. To do this, two coding schemes (a traditional reminiscing scheme and a dyadic scheme) were applied to a community sample of 67 mother-adolescent dyad and their conversations about a past shared conflict event. Consistent with our predictions, parent-adolescent reminiscing qualities that extended the conversation and promoted highly detailed narratives were correlated with supportive interpersonal processes that endorsed co-construction and collaboration during the discussion. In contrast, qualities that discontinued the conversation were correlated with unsupportive interpersonal processes that promoted avoidance/disengagement and repetitive problem engagement. Next, we applied the dyadic coding scheme to assess the transactional relationships between parent-adolescent reminiscing qualities and youth rumination and internalising symptoms. In Study 2 we tested the cross-sectional (Study 2a) and longitudinal (Study 2b) relationships between parent-adolescent reminiscing qualities and youth rumination, anxiety, and depression. Using the same sample of 67 mother-adolescent dyads in Study 1, transcripts of the past conflict discussions were coded dyadically for unsupportive and supportive mother and adolescent reminiscing qualities. Self-report measures of rumination, anxiety, and depression were also collected from mothers and adolescents, respectively. The adolescents then completed the same self-report measures at a follow-up time-point one year later. Overall, dyadic analyses found no significant associations between mother-adolescent reminiscing qualities and youth rumination or depression, cross-sectionally or longitudinally. We did, however, find a bi-directional relationship between unsupportive mother-adolescent reminiscing qualities and heightened anxiety symptoms cross-sectionally. The concurrent findings suggest that mothers and adolescents are mutually reinforcing youth anxiety symptoms, in part, through the promotion of emotional avoidance. Furthermore, exploratory moderation findings, indicated a significant buffering effect of youth engagement in supportive conversational qualities during reminiscing about past negative events with their mothers, and lower levels of youth anxiety over time. These findings have implications for practice and theory. First, in terms of clinical intervention, the research refines our understanding of interpersonal factors related to youth anxiety during middle adolescence, in particular the role of the parent-adolescent reminiscing conversations. Second, the current research highlights the importance of adopting interpersonal methods when studying parent-adolescent interactions as a way to accurately model and test the inherently interpersonal nature of reminiscing.</p>

Parent-Adolescent Reminiscing and Youth Psychopathology: A Cross-Sectional and Longitudinal Investigation

<p>Parent-child conversations about past experiences—reminiscing—are key in children’s growing emotional competency and their psychological well-being (Salmon & Reese, 2016). Very little research, however, has investigated the relationship between parent-adolescent reminiscing conversations and adolescent psychological adjustment, which is particularly important because adolescence is a period of heightened risk for the development of rumination and internalising disorders, especially anxiety and depression (Miller-Slough & Dunsmore, 2016). This thesis extended the literature on reminiscing in three ways. First, we examined different qualities of mother-adolescent reminiscing and their relationships to psychological outcomes during the period of middle adolescence. Second, we investigated the associations between mother-adolescent reminiscing qualities and youth rumination and internalising symptoms (anxiety and depression), cross-sectionally and longitudinally to help disentangle the direction of the associations. Finally, we applied dyadic methods of coding and statistical analyses in a novel approach that modelled the transactional nature of reminiscing conversations and their associations with youth psychological outcomes. In Study 1 we tested the discriminant and convergent validity of a dyadic coding scheme, for use on parent-adolescent conversations about past events. The aim of Study 1 was to establish the methodological foundations for examining parent-adolescent reminiscing conversations in a way that lends itself to dyadic analysis. To do this, two coding schemes (a traditional reminiscing scheme and a dyadic scheme) were applied to a community sample of 67 mother-adolescent dyad and their conversations about a past shared conflict event. Consistent with our predictions, parent-adolescent reminiscing qualities that extended the conversation and promoted highly detailed narratives were correlated with supportive interpersonal processes that endorsed co-construction and collaboration during the discussion. In contrast, qualities that discontinued the conversation were correlated with unsupportive interpersonal processes that promoted avoidance/disengagement and repetitive problem engagement. Next, we applied the dyadic coding scheme to assess the transactional relationships between parent-adolescent reminiscing qualities and youth rumination and internalising symptoms. In Study 2 we tested the cross-sectional (Study 2a) and longitudinal (Study 2b) relationships between parent-adolescent reminiscing qualities and youth rumination, anxiety, and depression. Using the same sample of 67 mother-adolescent dyads in Study 1, transcripts of the past conflict discussions were coded dyadically for unsupportive and supportive mother and adolescent reminiscing qualities. Self-report measures of rumination, anxiety, and depression were also collected from mothers and adolescents, respectively. The adolescents then completed the same self-report measures at a follow-up time-point one year later. Overall, dyadic analyses found no significant associations between mother-adolescent reminiscing qualities and youth rumination or depression, cross-sectionally or longitudinally. We did, however, find a bi-directional relationship between unsupportive mother-adolescent reminiscing qualities and heightened anxiety symptoms cross-sectionally. The concurrent findings suggest that mothers and adolescents are mutually reinforcing youth anxiety symptoms, in part, through the promotion of emotional avoidance. Furthermore, exploratory moderation findings, indicated a significant buffering effect of youth engagement in supportive conversational qualities during reminiscing about past negative events with their mothers, and lower levels of youth anxiety over time. These findings have implications for practice and theory. First, in terms of clinical intervention, the research refines our understanding of interpersonal factors related to youth anxiety during middle adolescence, in particular the role of the parent-adolescent reminiscing conversations. Second, the current research highlights the importance of adopting interpersonal methods when studying parent-adolescent interactions as a way to accurately model and test the inherently interpersonal nature of reminiscing.</p>

The Effect of Caregiver Key Opinion Leaders on Increasing Caregiver Demand for Evidence-Based Practices to Treat Youth Anxiety: Protocol for a Randomized Control Trial

Background:Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments.Method:Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster-randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at three-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT.Discussion:This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments.Trial registration:This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post presentation data had been collected from 17 participants; thus, it was retrospectively registered.

The effect of caregiver key opinion leaders on increasing caregiver demand for evidence-based practices to treat youth anxiety: protocol for a randomized control trial

Background Research has identified cognitive behavioral therapy with exposures (CBT) as an effective treatment for youth anxiety. Despite implementation efforts, few anxious youth receive CBT. Direct-to-consumer marketing offers a different approach to address the unmet need for youth receiving effective treatments. Involving a local caregiver key opinion leader in direct-to-consumer initiatives may be an effective strategy to increase caregiver demand for CBT. Research indicates that key opinion leaders improve health promotion campaigns, but key opinion leaders have not been studied in the context of increasing caregiver demand for evidence-based treatments. Method Project CHAT (Caregivers Hearing about Anxiety Treatments) will test the role of key opinion leader participation in conducting outreach presentations to increase caregiver desire to seek CBT for their youth’s anxiety. Caregiver attendees (N = 180) will be cluster randomized by school to receive one of two different approaches for presentations on CBT for youth anxiety. Both approaches will involve community outreach presentations providing information on recognizing youth anxiety, strategies caregivers can use to decrease youth anxiety, and how to seek CBT for youth anxiety. The researcher-only condition will be co-facilitated by two researchers. In the key opinion leader condition, a caregiver key opinion leader from each local community will be involved in tailoring the content of the presentation to the context of the community, co-facilitating the presentation with a researcher, and endorsing strategies in the presentation that they have found to be helpful. In line with the theory of planned behavior, caregiver attendees will complete measures assessing their knowledge of, attitudes towards, perceived subjective norms about, and intention to seek CBT pre- and post-presentation; they will indicate whether they sought CBT for their youth at 3-month follow-up. Results will be analyzed using a mixed method approach to assess the effectiveness of a key opinion leader to increase caregiver demand for CBT. Discussion This study will be the first to examine the potential of key opinion leaders to increase caregiver demand for CBT. If proven effective, the use of key opinion leaders could serve as a scalable dissemination strategy to increase the reach of evidence-based treatments. Trial registration This trial was registered on clinicaltrials.gov (NCT04929262) on June 18, 2021. At the time of trial registration, pre/post-presentation data had been collected from 17 participants; thus, it was retrospectively registered.

Promoting helpful attention and interpretation patterns to reduce anxiety and depression in young people: weaving scientific data with young peoples’ lived experiences

Background Anxiety and depression are common, disabling and frequently start in youth, underscoring the need for effective, accessible early interventions. Empirical data and consultations with lived experience youth representatives suggest that maladaptive cognitive patterns contribute to and maintain anxiety and depression in daily life. Promoting adaptive cognitive patterns could therefore reflect “active ingredients” in the treatment and/or prevention of youth anxiety and depression. Here, we described and compared different therapeutic techniques that equipped young people with a more flexible capacity to use attention and/or promoted a tendency to positive/benign (over threatening/negative) interpretations of uncertain situations. Methods We searched electronic databases (PubMed, PsycINFO, EMBASE, and PsycARTICLES) for studies containing words relating to: intervention; youth; anxiety and/or depression and attention and/or interpretation, and selected studies which sought to reduce self-reported anxiety/depression in youth by explicitly altering attention and/or interpretation patterns. Ten young people with lived experiences of anxiety and depression and from diverse backgrounds were consulted on the relevance of these strategies in managing emotions in their daily lives and also whether there were additional strategies that could be targeted to promote adaptive thinking styles. Results Two sets of techniques, each targeting different levels of responding with different strengths and weaknesses were identified. Cognitive bias modification training (CBM) tasks were largely able to alter attention and interpretation biases but the effects of training on clinical symptoms was more mixed. In contrast, guided instructions that teach young people to regulate their attention or to evaluate alternative explanations of personally-salient events, reduced symptoms but there was little experimental data establishing the intervention mechanism. Lived experience representatives suggested that strategies such as deliberately recalling positive past experiences or positive aspects of oneself to counteract negative thinking. Discussion CBM techniques target clear hypothesised mechanisms but require further co-design with young people to make them more engaging and augment their clinical effects. Guided instructions benefit from being embedded in clinical interventions, but lack empirical data to support their intervention mechanism, underscoring the need for more experimental work. Feedback from young people suggest that combining complimentary techniques within multi-pronged “toolboxes” to develop resilient thinking patterns in youth is empowering.