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Therapist-supported ICBT appears to be an efficacious treatment for anxiety in adults. The evidence comparing therapist-supported ICBT to waiting list, attention, information, or online discussion group only control was low to moderate quality, the evidence comparing therapist-supported ICBT to unguided ICBT was low to very low quality, and comparisons of therapist-supported ICBT to face-to-face CBT was low to moderate quality. Further research is needed to better define and measure any potential harms resulting from treatment. These findings suggest that therapist-supported ICBT is more efficacious than a waiting list, attention, information, or online discussion group only control, and that there may not be a significant difference in outcome between unguided CBT and therapist-supported ICBT; however, this latter finding must be interpreted with caution due to imprecision. The evidence suggests that therapist-supported ICBT may not be significantly different from face-to-face CBT in reducing anxiety. Future research should involve equivalence trials comparing ICBT and face-to-face CBT, examine the importance of the role of the therapist in ICBT, and include effectiveness trials of ICBT in real-world settings. A timely update to this review is needed given the fast pace of this area of research.

Epidemiological studies have focused on establishing comorbidity of posttraumatic stress disorder (PTSD) and substance use disorders (SUDs) in clinical and nonclinical samples (see chapter 1, this volume). These studies have established a statistical relationship between the presence of these two disorders among victims of a wide variety of potentially traumatic events, including combat, sexual assault, and disaster (see review by Stewart, 1996). In other words, having PTSD increases the risk of having an SUD, and vice versa. However, comorbidity research has merely established that these two disorders are statistically related to one another; it has not established whether any functional relationships exist between the two disorders (Rachman, 1991). Other types of research methods must supplement traditional epidemiological investigations of comorbidity rates to determine whether one disorder is causally related to the other and to gain insight into the mechanisms underlying causal relations between these disorders (i.e., functional relations). In this chapter we review studies using psychoso-cia1 research methods that shed light on functional relations that may explain this common form of comorbidity. Studies in which laboratorybased experimental methods are used to investigate biological and cognitive mechanisms underlying SUD-PTSD comorbidity are reviewed in chapter 3.We begin by reviewing some of the potential causal relations that have been suggested to underlie the high rates of comorbidity between PTSD and SUDs and some of the functional associations that might underlie such purported causal pathways (see also the review by Stewart, Pihl, Conrod,

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The Royal Canadian Mounted Police (RCMP), like all public safety personnel (PSP), are frequently exposed to potentially psychologically traumatic events that contribute to posttraumatic stress injuries (PTSI). Addressing PTSI is impeded by the limited available research. In this protocol paper, we describe the RCMP Study, part of the concerted efforts by the RCMP to reduce PTSI by improving access to evidence-based assessments, treatments and training as well as participant recruitment and RCMP Study developments to date. The RCMP Study has been designed to (1) develop, deploy and assess the impact of a system for ongoing annual, monthly and daily evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; (4) augment the RCMP Cadet Training Program with skills to proactively mitigate PTSI; and (5) assess the impact of the augmented training condition (ATC) versus the standard training condition (STC). Participants in the STC (n = 480) and ATC (n = 480) are assessed before and after training and annually for 5 years on their deployment date; they also complete brief monthly and daily surveys. The RCMP Study results are expected to benefit the mental health of all participants, RCMP and PSP by reducing PTSI among all who serve.

SUMMARY Over the past several decades, the field of pediatric pain has made impressive advances in our understanding of the pain experience of the developing child, as well as the devastating impact of inadequately managed pain early in life. It is now well recognized that, from infancy, children are capable of developing implicit memories of pain that can influence their subsequent reactions to pain. The present review provides a synthesis of selected studies that made a significant impact on this field of inquiry, with particular emphasis on recent clinical and laboratory-based experimental research examining children's explicit autobiographical memories for acute pain. Research has begun to move towards improving the precision with which children at risk for developing negatively estimated pain memories can be identified, given the adverse influence these memories can have on subsequent pain experiences. As such, several fear- and anxiety-related child and parent variables implicated in this process are discussed, and avenues for future research and clinical intervention are identified throughout. Finally, a preliminary empirically and theoretically derived model of acute pain memory development in childhood is presented to parsimoniously summarize the evidence accumulated to date and guide future investigation in this area.

The comorbidity of substance use disorders (SUDs) with anxiety and depression is the focus of substantial research attention and approached from myriad perspectives. This chapter focuses on the resultant complex research literature, first providing an overview of epidemiologic studies that have examined the prevalence of co-occurrence of SUDs (including alcohol and other drug use disorders) with anxiety and depressive disorders, as well as clinical correlates of these forms of comorbidity. Next, theoretical models of the onset and maintenance of emotional disorder–SUD comorbidity are considered, followed by a review of various types of studies evaluating these theoretical models (studies focusing on order-of-onset, the independent versus substance-induced disorder distinction, self-reported motives for use, genetic epidemiology, and experimental studies). Distinctions and commonalities between anxiety–SUD associations and depression–SUD associations are examined throughout. The chapter concludes by examining treatment implications of this comorbidity and suggests future directions for this burgeoning field.