Comorbidity of Anxiety and Depression in Youth: Implications for Treatment and Prevention

[Clin Psychol Sci Prac 17: 293–306, 2010] The high level of concurrent and sequential comorbidity between anxiety and depression in children and adolescents may result from (a) substantial overlap in both the symptoms and items used to assess these putatively different disorders, (b) common etiologic factors (e.g., familial risk, negative affectivity, information‐processing biases, neural substrates) implicated in the development of each condition, and (c) negative sequelae of anxiety conferring increased risk for the development of depression. Basic research on their various common and unique etiologic mechanisms has guided the development of efficacious treatments for anxiety and depressive disorders in youth. Potential processes through which the successful treatment of childhood anxiety might prevent subsequent depression are described.     

Anxiety Prevention Programs for Youth: Practical and Theoretical Considerations

Empirical evidence addressing the effectiveness of anxiety prevention programs is limited. Caps identified in this literature provide a lifetime of opportunity for prevention scientists. This commentary extends the discussion of anxiety prevention to issues relevant for designing preventive interventions for youth. Three specific questions are discussed: a) Which “at‐risk” youth should be targeted? b) When developmentally might preventive interventions have the greatest impact? and c) What specific intervention strategies might be most effective? Key components of the Child Anxiety Prevention Study are presented to illustrate one approach to designing a child anxiety prevention program.     

Accommodation in Youth With OCD and Anxiety

Accommodation refers to the ways in which family members act to alleviate a child's symptoms and distress. In the context of youth obsessive‐compulsive disorder (OCD) and anxiety, accommodation may contribute to the development and maintenance of the disorder. We review the theory and research literature on accommodation, including measures of accommodation. Findings support the idea that accommodation is not a preferred parenting strategy; the sequelae of accommodation are negative and are often associated with both parent and sibling distress. Accommodation should be assessed and targeted in treatment for youth OCD and anxiety. We conclude by identifying several areas for future research, including the development of interventions that specifically target accommodation, the evaluation of potential family factors implicated in accommodation, and the exploration of the construct of accommodation in other childhood disorders.     

Outcomes and process in genetic counselling

Although it may be simple to evaluate some elements of clinical genetics, it is difficult to evaluate genetic counselling. We review previous studies of the outcomes of genetic counselling; although the methods used may be valid in research studies, there are practical and ethical difficulties in applying them to the measurement of clinical effectiveness in standard practice. No simple measures of outcomes would be suitable. Research evidence will be helpful in deciding what services it is appropriate to offer, and the quality of a service can then be assured by assessing the quality of the clinical process in three ways: 1) adherence to agreed protocols and standards of care; 2) peer review and audit of clinical activity; and 3) ongoing review of the satisfaction of clients and referring physicians with the service. The assessment of client satisfaction will need to be a sophisticated form of retrospective satisfaction with the service provided, and such a scheme has yet to be fully developed.     

Cognitive‐Behavioral School‐Based Interventions for Anxious and Depressed Youth: A Meta‐Analysis of Outcomes

A meta‐analysis of school‐based interventions for anxious and depressed youth using QUORUM guidelines was conducted. Studies were located by searching electronic databases, manual effort, and contact with expert researchers. Analyses examined 63 studies with 8,225 participants receiving cognitive‐behavioral therapy (CBT) and 6,986 in comparison conditions. Mean pre–post effect sizes indicate that anxiety‐focused school‐based CBT was moderately effective in reducing anxiety (Hedge's g = 0.501) and depression‐focused school‐based CBT was mildly effective in reducing depression (Hedge's g = 0.298) for youth receiving interventions as compared to those in anxiety intervention control conditions (Hedge's g = 0.193) and depression intervention controls (Hedge's g = 0.091). Predictors of outcome were explored. School‐based CBT interventions for youth anxiety and for youth depression hold considerable promise, although investigation is still needed to identify features that optimize service delivery and outcome.     

射击射箭运动员功能性胃肠症状与状态-特质焦虑的相关性研究

目的探讨优秀射击射箭运动员功能性胃肠症状与状态-特质焦虑的相关性,考察功能性胃肠症状作为初步筛选焦虑运动员指标的可靠性。方法用症状自评量表(SCL-90)、功能性胃肠病罗马型诊断标准中功能性胃肠症状条目及焦虑状态-特质问卷(STAI)对上海市38名优秀射击射箭运动员测评并进行比较分析。结果 1运动员个体功能性胃肠道症状的数量与状态焦虑正相关(r=0.692,P0.01),与特质焦虑正相关(r=0.682,P0.01);2与运动员状态焦虑主要相关的功能性胃肠症状为反酸(t=2.118,P=0.042)、恶心(t=2.271,P=0.030)、腹泻(t=3.289,P=0.002);与运动员特质焦虑主要相关的功能性胃肠症状为反酸(t=2.678,P=0.011)、恶心(t=2.496,P=0.018)、呕吐(t=2.606,P=0.014)。结论在优秀射击射箭运动员中,反酸、恶心、呕吐、腹泻及功能性胃肠症状的数量可以作为初步筛选焦虑运动员的指标。     

大学生惧怕否定评价心理及其与演讲焦虑的关系

目的调查大学生惧怕否定评价(Fear of Negative Evaluation)的心理状况及其与演讲焦虑的关系。方法对英文版惧怕否定评价量表简本修订版(BFNE)进行初步修订,形成具有良好信效度的BFNE中文版量表。采用此量表和演讲者信心自评量表(PRCS)对541名大学生进行调查分析。结果 48.6%的大学生对他人否定评价的畏惧在平均水平(17分)以上。t检验和方差分析表明,不同性别、年级的大学生惧怕否定评价水平没有差异,但理科生显著高于文科生(t=-2.342,P0.05)。结论大学生惧怕否定评价心理比较普遍,惧怕否定评价与演讲焦虑显著相关。     

自尊、惧怕否定评价对公众演讲焦虑的影响

目的 探讨自尊、惧怕否定评价对公众演讲焦虑的影响.方法 采用自尊量表(SES)、演说者信心自评量表(PRCS)、惧怕否定评价量表简本(FNE),对227名大学生进行问卷调查.结果 ①自尊、惧怕否定评价可共同预测公众演讲焦虑(β<,1>=-0.393,β<,2>=0.242);②惧怕否定评价在自尊与公众演讲焦虑间的中介效...     

大学生负面评价恐惧和社交焦虑

目的:调查大学生负面评价恐惧和社交焦虑的现状及其关系。方法:采用简明负面评价恐惧量表(BFNES)和交往焦虑量表(IAS)对312名大学生进行问卷调查。结果:负面评价恐惧和社交焦虑在大学生群体中普遍存在,且以中等程度为主;大学生负面评价恐惧和社交焦虑在性别、专业和生源地维度上差异不显著(P0.05);负面评价恐惧和社交焦虑存在显著正相关(r=0.436,P0.01)。结论:降低负面评价恐惧水平有利于缓解社交焦虑状况。     

The Role of Parenting in Childhood Anxiety: Etiological Factors and Treatment Implications

Theoretical models of anxiety disorders suggest that family processes and parenting are important factors in the development, maintenance, and transmission of childhood anxiety. The direction of effects between parenting and childhood anxiety, however, remains unclear. This review article integrates theoretical, empirical, and applied knowledge regarding the association between parenting and childhood anxiety as a means to better understand the implications of involving parents in the treatment of their children's anxiety. The present article expands Rapee and colleagues' (2009) review on the main etiological factors related to childhood anxiety and parenting, drawing attention to the influence of parental behavior on treatment effectiveness for childhood anxiety. Limitations of empirical findings and future directions are discussed.     

Exploring the Nature and Function of Anxiety in Youth with Autism Spectrum Disorders

[Clin Psychol Sci Prac 17: 281–292, 2010] This article considers the nosology and pathogenesis of anxiety disorders in youth with autism. The comparability of anxiety in the autism spectrum disorder (ASD) population in relation to the typically developing population has been suggested by some recent findings, but conceptual and empirical ambiguities remain. It is suggested that anxiety may play at least three roles: (a) a downstream consequence of ASD symptoms (e.g., via stress generation through social rejection); (b) a moderator of ASD symptom severity, such that certain core autism symptoms like social skill deficits and repetitive behaviors may be exacerbated by anxiety; and (c) as a proxy of core ASD symptoms. Suggestions for clarifying the nature and function of anxiety in autism are made.     

Fear,anxiety, and their disorders from the perspective of psychophysiology

Psychophysiology is a central hub connecting neurobiological and behavioral domains with clinical science, thus providing ideal tools for increasing the understanding of mental disorders beyond the level of symptom reports. The present article provides an overview of how psychophysiological research can contribute toward efforts directed at an improved understanding of anxiety disorders. Starting with the behavioral domain, it is demonstrated that defensive behaviors are fundamental to anxiety disorders and that these behaviors are dynamically organized depending upon the proximity of a specific threat. The next section reviews neural networks that are activated during the encoding of threat-relevant information and during the organization of the cascade of defensive responses, including how passive avoidance might be conceptualized within a neurobehavioral framework. The last section addresses the translation of these behavioral and neuronal findings from experimental psychopathology research to clinical populations. Finally, evidence is presented to support how behavioral approaches may be helpful in predicting treatment outcomes.     

Exposure to Child Anxiety: Theory, Research, and Practice

This article provides a brief overview of cognitive-behavioral theory and its application in understanding and treating anxiety in youths. Research investigations have examined the outcomes of cognitive-behavioral intervention, treatment generalizability, diagnostic issues, cognitive processing, social competence, and familial and parental factors. Issues surrounding the transportability of empirically evaluated treatment to community-based clinics are considered.     

广泛性焦虑症心理与药物治疗效果研究

目的探讨广泛性焦虑症心理与药物治疗效果。方法将72例广泛性焦虑症患者随机分为研究组和对照组各36例。研究组使用心理治疗联合抗焦虑药物治疗,对照组单纯使用抗焦虑药物治疗。分别于治疗前和治疗第2、4、8周末采用汉密尔顿焦虑量表(HAMA)和焦虑自评量表(SAS)进行疗效评定,用副反应量表(TESS)评定不良反应。结果治疗8周后研究组有效率为94.4%,对照组有效率为72.2%,两组有效率比较有明显差异(P0.05)。治疗后两组汉密尔顿焦虑量表总分和焦虑自评量表评分较治疗前都有所降低,研究组在治疗第4、8周末HAMA、SAS评分下降更明显,与对照组比较差异显著(P0.01)。且研究组使用药物剂量明显低于对照组(P0.05),不良反应较少。结论与单纯药物治疗相比,心理联合抗焦虑药物治疗广泛性焦虑,有效率增加,能够减少服药剂量和药物副反应,是治疗广泛性焦虑的有效方法,对缩短病程、预防复发有积极意义。