Mediators of change in the Child/Adolescent Anxiety Multimodal Treatment Study.

Abstract

Objective Test changes in (a) coping efficacy and (b) anxious self-talk as potential mediators of treatment gains at 3-month follow-up in the Child/Adolescent Anxiety Multimodal Treatment Study (CAMS). Method Participants were 488 youth (ages 7-17; 50.4% male) randomized to cognitive-behavioral therapy (CBT; Coping cat program), pharmacotherapy (sertraline), their combination, or pill placebo. Participants met DSM-IV criteria for generalized anxiety disorder, social phobia, and/or separation anxiety disorder. Coping efficacy (reported ability to manage anxiety provoking situations) was measured by youth and parent reports on the Coping Questionnaire, and anxious self-talk was measured by youth report on the Negative Affectivity Self-Statement Questionnaire. Outcome was measured using the Pediatric Anxiety Rating Scale (completed by Independent Evaluators blind to condition). For temporal precedence, residualized treatment gains were assessed at 3-month follow-up. Results Residualized gains in coping efficacy mediated gains in the CBT, sertraline, and combination conditions. In the combination condition, some unique effect of treatment remained. Treatment assignment was not associated with a reduction in anxious self-talk, nor did anxious self-talk predict changes in anxiety symptoms. Conclusions The findings suggest that improvements in coping efficacy are a mediator of treatment gains. Anxious self-talk did not emerge as a mediator.

Promocija mentalnog zdravlja i prevencija mentalnih poremećaja kod djece i adolescenata – sistematičan pregled literature

“…Također je dokazana povezanost između pušenja i konzumiranja alkohola u trudnoći s nastankom mentalnih poremećaja u ranoj dječjoj dobi. [17][18][19][20][21][22][23][24] Catania i suradnici navode da je važna suradnja između primarne zdravstvene zaštite i specijalista psihijatra i psihologa. Adekvatna suradnja omogućuje pripremu, osigurava dodatno vrijeme i pruža potporne strukture u programu prevencije.…”

Mediators in the randomized trial of Child- and Family-Focused Cognitive-Behavioral Therapy for pediatric bipolar disorder

“…Specifically, CBT for pediatric anxiety may affect change by: reducing children’s negative/anxious self-statements; increasing children’s perceived control, positive self-statements, and coping strategies; and improving family functioning and strain (Hogendoorn et al, 2014; Kendall et al, 2016; Kendall & Treadwell, 2007; Schleider et al, 2015; Treadwell & Kendall, 1996). Potential mediators of CBT for adolescent depression include: reducing youths’ cognitive distortions, automatic negative cognitions, and cognitive avoidance; and improving youths’ positive outlook and engagement in pleasant activities (Jacobs et al, 2014; Kaufman, Rhode, Seeley, Clarke, & Stice, 2005; Kolko, Brent, Baugher, Bridge, & Birmaher, 2000; Stice, Rhode, Seeley, & Gau, 2010).…”

Using Research-Informed Pedagogical Practices to Maximize Learning in Youth Cognitive Behavioral Therapy

“…Analogously in CBT, it is important to periodically give patients the opportunity to demonstrate what they have learned throughout treatment. This is done to ensure the quality with which the patient independently uses CBT skills (Hundt, Mignogna, Underhill, & Cully, 2013), with the ultimate goal of supporting patients in “becoming their own therapists.” Importantly, coping efficacy, or one’s belief that they have mastery of skill use, has been shown to play a role in treatment gains (Kendall, Cummings, Villabø, Narayanan, Treadwell, Birmaher, et al, 2016). This UDL principle reminds clinicians to provide multiple means of action and expression, which allows patients to demonstrate and use what they know in different ways (Meyer et al, 2014).…”

“…Clinicians can also measure target mechanisms (mediators) of change throughout treatment, such as coping efficacy (Kendall et al, 2016), in order to demonstrate how symptom reduction and/or functional improvement coincides with learning and implementation of skills.…”