CACP Collection Revision

Question 1

Kessler et al. (2005)

Answer 1

Conducted diagnostic interviews of community samples across lifetimes and found that anxiety disorders are the most commonly experience MH disorder across the lifespan. Statistics indicate that 28.8% of people experience a level of anxiety that could be considered an anxiety disorder at some point in their lifetime, and that the median age of onset of anxiety was 11yo.

Question 2

Solmi et al. (2021)

Answer 2

Found that the median age of onset of anxiety disorders was around 17yo, but this varies for specific anxiety disorders. For example, separation anxiety and paranoias typically onset in childhood (median 8yo), while panic disorder and GAD typically onset in adulthood (26yo and 33yo, respectively)

Question 3

Copeland et al. (2014)

Answer 3

Studied the impacts of having anxiety disorders, by looking at the health, financial and interpersonal outcomes of people with different AD diagnoses at 16yo. When compared to controls with no AD, individuals with any of the included ADs (separation, social, GAD & overanxious) displayed worse outcomes in at least one of the domains, and GAD was associated with poor functioning in all the domains

Question 4

McCrone et al. (2008)

Answer 4

Focused on the economic impact of child anxiety disorders, by analysing UK costs of MH disorders and projections of these costs for 2026. Anxiety disorders were the most costly of the different MH disorders, due to its high prevalence.

Question 5

Caspi et al. (1998)

Answer 5

Early onset mental health disorders tend to be especially chronic or relapsing, and are predictive of a range of psychological and social impairments in the long-term

Question 6

Lawrence et al. (2019)

Answer 6

Conducted a systematic review and meta-analysis and found that offspring of parents with anxiety disorders are more likely to have anxiety and depressive disorders compared to those with parents who don’t have anxiety. However, while there is increased risk, they are still in the minority, as about 2/3 of children of parents with anxiety disorders don’t have an anxiety disorder

Question 7

Murray et al. (2009)

Answer 7

Proposed a model of different pathways to child anxiety, which can explain why individuals develop anxiety in the absence of parental anxiety disorder, but also why there is increased risk when parents do have an anxiety disorder. The model includes genetic vulnerability, life events, and anxiogenic modelling, all of which are influenced by parental anxiety and in turn influence anxious thinking styles, hyperarousal and avoidance.

Question 8

McLeod et al. (2007)

Answer 8

Conducted a meta-analysis to explore the extent to which different parent behaviours affect childhood anxiety disorders.

Question 9

Yap & Jorm (2015)

Answer 9

Conducted a systematic review of the existing data, specifically for pre-adolescents aged 5-11yo, and classified the studies into “sound”, “emerging” , and “equivocal”.

Question 10

Ginsberg (2009)

Answer 10

Explored the effects of a preventative program that targets parental over-involvement for child and adolescent anxiety. Children and their parents were randomly assigned to an 8-week CBT intervention (Coping & Promoting Strength Program) or a waitlist control. 30% of the waitlist children developed at AD by the 1y followup, while none of those in the treatment group did. There was also a decrease in parent-reported anxiety in the treatment group but not in the waitlist control

Question 11

Siegenthaler et al. (2012)

Answer 11

Conducted a systematic review and meta-analysis and found that preventative interventions for parents with MH issues might be effective in preventing new mental disorders and internalising symptoms in their children.

Question 12

Hudson et al. (2009)

Answer 12

Conducted a study to explore causal relationships between parental behaviours and child anxiety, with primary school aged children. They compared mother’s behaviours when helping a child complete a task, when they were doing so with an anxious child and with an un-anxious child. Regardless of whether their own child had anxiety, all mothers were coded as more involved when they interacted with a child with clinical anxiety. However, there was an interaction, as mothers of children with anxiety showed a smaller decrease in involvement behaviours when interacting with non-anxious children compared to anxious children.

Question 13

Hudson & Rapee (2004)

Answer 13

Suggested that parents of children with anxiety are more likely to become overinvolved in their child’s life to try and reduce their distress, but that this is actually a maladaptive pattern which reinforces a child’s vulnerability to anxiety. They propose that this is because it increases the child’s perception of threat and reduces the amount of control they have, and that they perceive to have, leading to increased avoidance, which perpetuates the anxieties, as they don’t learn that the feared situations are not actually a threat

Question 14

Rubin et al. (1999)

Answer 14

A child’s initial behaviours affect how parents interact with them. They found that a parent’s perception of how shy their child was at 2yo significantly predicted later maternal overprotection at 4yo

Question 15

Feinman et al. (1992) – social referencing

Answer 15

9-12mo infants use social referencing, as aware of agency of other individuals and modify their responses based on other people’s emotional response to it

Question 16

Murray et al. (2005)

Answer 16

Argued social referencing might be especially important in the development of social anxiety. They used a social referencing paradigm to examine the development of socially anxious responses to strangers in a large longitudinal study of community sample of mothers with social phobia and their infants. Infant first watched mother interact with a stranger, and then the stranger interacted with the infant while the mother was also able to interact with the child and demonstrate her own response. At 10mo, mothers with social phobia showed more signs of anxiety in both periods, and showed less encouragement of infant in the 2nd phase. At 14mo, children of anxious mothers were more avoidant of the stranger compared to infants of control mothers

Question 17

De Rosnay et al. (2006)

Answer 17

Investigated the role of anxiogenic modelling.

Question 18

Thirlwall & Creswell (2010)

Answer 18

Conducted a study to explore how autonomy granting is causally associated with child anxiety. Parents were trained to either be controlling in a task with the child, or to provide autonomy by just giving open suggestions and not being directive. When children had low level trait anxiety, parental manipulation didn’t affect observed child anxiety during the task. However, when children had high trait anxiety, they were rated as more anxious in controlling conditions compared to autonomy promoting conditions.

Question 19

Moore et al. (2004)

Answer 19

Found that when a mother and a child are both anxious, more catastrophising comments are made. However, there were no significant differences in autonomy promotion or warmth based on parent and child anxiety status

Question 20

Creswell et al. (2013)

Answer 20

Measured maternal anxiety behaviours when interacting with a child with an anxiety disorder on a range of difficult tasks. They compared mothers with and without anxiety disorders, and explored the relationship between the child’s level of anxiety and parent behaviours and anxiety. When children are anxious, parent behaviour differed based on the parent’s own anxiety status, with anxious mothers becoming more intrusive and having a less positive relationship compared to non-anxious mothers. The child’s level of anxiety also affected parental anxiety for anxious parents – as the child became more anxious, parents with anxiety disorders also appeared more anxious  so then even more likely to model anxiety behaviours to children when the children are anxious

Question 21

Thirlwall et al. (2013)

Answer 21

Evaluated the efficacy of low-intensity parent-delivered CBT treatments for children with anxiety disorder, comparing full parent-delivered CBT, brief parent-delivered CBT, waitlist control. For the intervention, parents were given a self-help book, and received some therapist support (weekly contact over 8 weeks for full programme, and fortnightly contact over 8 weeks for brief programme).

Question 22

Platt et al. (2016)

Answer 22

Examined the relationship between stressful life events and anxiety symptoms in children, focusing on the role of parenting stress, parental anxious rearing and dysfunctional parent-child interactions as mediators.

Question 23

Waite & Creswell (2015)

Answer 23

Compared observed behaviours of parents of children (7-10yo) and adolescents (13-16yo) with and without anxiety disorders, while doing mildly anxiety-provoking tasks.

Question 24

Ahmadzadeh et al. (2019)

Answer 24

Tested the role of genetic mechanisms in the association between parental and child anxiety, by looking at adoptive families.

Question 25

Solmi et al. (2022)

Answer 25

Conducted a very large meta-analysis on MH problems in adolescence and found that about 75% of all mental health problems have their onset in adolescence. 1/3 of MH illnesses will have had first onset by age 14, and ½ will have onset by 18yo

Question 26

Morales-Munoz et al. (2022)

Answer 26

Investigated how the balance of different ADs varies over age, using a community sample. They found a reduction in GAD from 8yo to 10yo and 13yo, and an increase in separation anxiety from 8yo to 10yo.

Question 27

Waite & Creswell (2014)

Answer 27

Investigated the split of ADs in a clinical sample. They found a significant decrease in separation anxiety from pre-adolescence to adolescence, but an increase in social anxiety. In general, adolescent anxiety was rated worse overall (by the child themselves and by the clinician), and adolescents were more likely to have a comorbid mood disorder, usually uni-polar depression.

Question 28

Larson & Ham (1993)

Answer 28

Suggestion that environment changes hugely in the shift to adolescents. In a large US sample of young people and their parents, they found that the number of negative and stressful events increases as they grew older (from 10yo to 15yo). A substantial amount of this increase was in peer relationships, some was in school stress, and some in family life. Also found a sex effect, where more negative events were reported among boys.

Question 29

Copeland et al. (2013)

Answer 29

Followed up with 1400 young people from ages 9 to 16, and found that those who were a victim of bullying were at higher risk of developing ADs and other MH difficulties. When they controlled for family environment and existing ADs in pre-adolescence, this relationship holds, indicating that the association isn’t just because those who are vulnerable are more likely to be bullied.

Question 30

Waite et al. (2014)

Answer 30

Conducted a meta-analysis on studies investigating the links between parenting behaviours and anxiety, focusing on adolescence. In adolescence, the most well-explored parenting construct is over-involvement. There was some indication of a positive association between more overcontrol in parents and AD in adolescence, though these findings are based on self-report, so there is relatively low confidence in the finding.

Question 31

Hudson & Rapee (2001)

Answer 31

Cross-sectional study of parenting behaviours and age and anxiety disorders, using children and adolescents with AD and a non-clinical community sample. Mothers of clinical children and adolescents were more involved and intrusive when completing difficult cognitive tasks. When participants were categorised according to age, with a separate category for 12-15yo, there was no significant age by group interaction  no significant age by group interaction, just mothers of clinical offspring more controlling than non-clinical

Question 32

Verhoeven et al. (2012)

Answer 32

Found a significant association between perceptions of father’s over-controlling behaviour and adolescent AD, but not for mothers. Indicates father could be more important in adolescence – maybe father should be involved in treatments?

Question 33

McClure et al. (2001)

Answer 33

Adolescents’ perceptions of their mother’s psychological control predicted AD, but maternal AD did not predict adolescent perceptions of maternal control

Question 34

Larson et al. (2002)

Answer 34

Following repeatedly measurements of children’s emotional states, they found that in early adolescence, there is a downward shift in self-reported emotional states which increases over time. Overall, there are more positive than negative emotions, but there is a heightened reactivity to both stressor and positive events compared to during adulthood

Question 35

Young et al. (2019)

Answer 35

As a child grows into adolescence, there is an ever-increasing demand to manage emotions independently. During childhood, parents often help to regulate emotions by re-appraising and by distracting etc., while during adolescence, they are expected to do this themselves. These emotion regulation abilities are underpinned by EFs, including good WM, ability to update and to inhibit thoughts and more. While these EFs start to mature in early adolescence, it takes time for these to develop throughout the period.

Question 36

Gardner & Steinberg (2005)

Answer 36

Compared adolescents, young adults, and adults’ risk tasking behaviours in a driving game, by measuring how they respond to an amber light. They manipulated whether the participant believed they were doing the task alone or with a peer of the same age. There was a dissociation between risk-taking behaviour in adolescents specifically – when they were alone, they had similar levels of risk as the adults, but they were significantly riskier when they were with peers of the same aged. Perhaps during adolescence, social exclusion is viewed as a great danger and affects behaviours despite them understanding what is the right thing to do.  EFs

Question 37

James et al. (2013)

Answer 37

Cochrane review including 88 studies. Compared to waitlist, there is moderate quality evidence that CBT leads to greater remission of primary anxiety disorder (and of all ADs) compared to passive control.

Question 38

Ginsberg et al. (2011) – CAMS trial

Answer 38

Including 500 children and adolescents. There was some indication that CBT outcomes were poorer for those who were older. Age was associated with ADIS and CGI scores, but not on remission. Adolescents were less likely than children to achieve remission, but these age differences weren’t tested by treatment condition – not just measuring CBT

Question 39

Bennett et al. (2013)

Answer 39

Conducted an individual patient data meta-analysis on age effects of CBT in child and adolescent anxiety. They found no interaction between age and CBT exposure, and adolescents who receive CBT in efficacy research studies show benefits comparable to those in young children. However, they also note that this might just be explained by modifications that expert trial therapists routinely apply to the CBT protocol, rather than because the existing protocols are effective themselves.

Question 40

Kendall & Peterman (2015)

Answer 40

Examined the efficacy of CBT for adolescents with anxiety. Outcomes suggest that 2/3 of youths respond well to CBT, with moderate to large effects such that it shows superiority over control/comparison conditions. There were no differential outcomes by age. Efficacy of CBT for anxiety in adolescence quite high, even when using more conservative measures (50-70%)

Question 41

Reynolds et al. (2012)

Answer 41

Evaluated 55 studies of treatments for adolescent anxiety. Participants were all under 19yo, had elevated anxiety or an anxiety diagnosis at pre-treatment and received anxiety-focused treatment. Saw medium to large effects for all age groups from 11yo to 15+

Question 42

Walkup et al. (2008)

Answer 42

CAMS – the largest RCT for anxiety treatment, using a separate treatment manual for adolescents. Participants were randomly assigned to: 12 weeks of CBT, sertraline, combo treatment, pill placebo. Combination treatment was associated with greater improvements compared to CBT alone and compared to medication alone. All the active treatments were more effective than placebo

Question 43

Chu et al. (2013)

Answer 43

Measured symptom trajectory using multilevel growth models. They found that adolescents showed elss symptom improvement in early stages compared to children, but didn’t differ in symptom measures at the end of treatment. So: adolescents can respond to treatment, but modifications should be made to induce engagement earlier on, to make it more efficient

Question 44

Steinberg (2005)

Answer 44

Adolescence is a period of heightened vulnerability because of disjunctions between the developing brain and behavioural and cognitive systems that mature along different timetables and under the control of common and independent processes.

Question 45

Sobesky (1983)

Answer 45

While adolescent thinking about moral dilemmas becomes more principled during adolescence, their reasoning about real-world problems problems is not as good as their reasoning about hypothetical dilemmas

Question 46

McLaughlin et al. (2015)

Answer 46

Defines adolescence as a time which begins with puberty and ends when one has assumed adult roles.

Question 47

Hare et al. (2008)

Answer 47

Adolescents exhibited initially exaggerated amygdala response to fearful facial expressions relative to child and adults, but the level of this exaggerated activity was dependent on age, with heightened emotional reactivity in adolescence. The extent to which this exaggerated response diminished over time was associated with anxiety measures, and enhanced amygdala activity was also inversely related to PFC activity

Question 48

Zimmermann & Iwanski (2014)

Answer 48

Examined age differences in 7 emotion regulation strategies for early adolescence from 11yo to 50yo for emotions of sadness, fear and anger. They found developmental changes in the use of emotional regulation strategies, with a tendency to increase adaptive emotion regulation with age, but middle adolescents showed the least use of emotional regulation strategies.

Question 49

Beesdo et al. (2010); Kessler et al. (2005)

Answer 49

Median age of onset of social anxiety disorder is 13yo, and 90% of cases of social anxiety disorder occur before 23yo.

Question 50

Stein et al (2001)

Answer 50

SAD is a predictor of later depression and suicidality

Question 51

Evans et al. (2021)

Answer 51

Re-analysed the outcomes of trials of broad-based CBT based on specific diagnoses. They found that these outcomes were more positive for those with a social anxiety disorder, and having SAD was a predictor of poorer outcomes in response to treatments. Post-CBT recovery rate from primary SAD was 35%, which is significantly lower than recovery rate from other primary ADs (54%)

Question 52

SAD-specific CBT

Answer 52

Albano et al. (1995) – Cognitive behavioural group therapy  mixture of cognitive techniques (e.g., cognitive restructuring) and graded exposure

Question 53

Bruce et al. (2005)

Answer 53

Community study in the US with adults, and found that SAD is unlikely to remit without treatment, as over the 12 years from the start of the study, only 37% recovered from social anxiety.

Question 54

Leary (2001)

Answer 54

Those with social anxiety how firm beliefs that it is very important to make a good impression on others, but also believe that they come across badly. This is related to the idea that negative broad unconditional beliefs lead to them making assumptions about themselves and their social environment.

Question 55

Clark & Wells (1995) – cognitive model of social anxiety disorder in adults

Answer 55

When we enter a new situation and are anxious, attention turns inwards and leads to scrutiny of themselves and how they’re coming across. Since they are attending to themselves and not others, they are unable to pick up on cues and social signals that people are giving off (which are usually positive), and attending to internal info (anxious feelings and anxious self-images), which means they think they are coming across as very anxious as well. Because they believe they are coming across negatively, they engage in safety seeking behaviours, including avoidance behaviours and impression management

Question 56

Leigh & Clark (2018)

Answer 56

Conducted a systematic review on how well the C&W model applies to adolescents. Most studies were supportive of the role of different aspects of the model in adolescent SAD, but these were all based on cross-sectional and observation studies. Negative social attitudes and cognitions were supported by 3 questionnaire studies. Also support for negative interpretation bias, enhanced self-attention, negative observer-perspective social images, use of internal information and of safety behaviours, and pre and post-event processing. Overall, some support for each of the components.

Question 57

Haller et al. (2015)

Answer 57

Adolescents with SAD are more likely to endorse negative interpretations of ambiguous social situations. Cognitive biases have been shown to manifest in differential engagement of fronto-limbic circuits during anticipation of, during, and post social-event processing

Question 58

Guyer et al. (2009)

Answer 58

Used a Chat Room Task. Participants were presented with photos of peers that participants either accepted or rejected for online interactions. When they were anticipating feedback from rejected peers, adolescents with social concerns showed greater amygdala activity compared to non-anxious adolescents

Question 59

Leigh et al. (2021)

Answer 59

Conducted an experimental study to investigate the role of internal focus and safety behaviours on social anxiety disorder in adolescents. Participants high and low in social anxiety had to have a conversation with someone they had never met before, and were instructed to turn focus inwards and use common safety behaviours, or to focus on the conversation partner and enjoy the situation. In both high and low social anxiety adolescents, internal attention led to higher ratings of anxiety and of realisation of their anxiety. Independent evaluator ratings of anxiety also increased.

Question 60

Leigh et al. (2020)

Answer 60

Conducted an experimental study to investigate the role of negative self-imagery on social anxiety. When participants were told to hold a negative image in mind, felt more anxious, and used more safety behaviours, which mediated the relationship between negative self-image and more critical rating of interaction. Therefore, a negative self-image motivates you to engage in more safety seeking behaviours, which generates less positive reactions from people.

Question 61

Chiu et al. (2022)

Answer 61

Longitudinal observational study with a prospective design with participants aged 11-14 who completed a range of measures on negative social cognitions, safety behaviours, self-focused attention, pre and post-event processing, social anxiety and depression. After controlling for age, gender, and baseline level of social anxiety, negative social cognitions, safety behaviours, self-focused attention and post-event processing all significantly predict social anxiety at time 2. Age, gender, and social anxiety at T1 accounted for 59% of the variance in SA at T2, and all the other significant predictors together accounted for an extra 4%.

Question 62

Chapman et al. (2020)

Answer 62

Reviewed studies looking at the association between mental imagery and social anxiety in children and young people, and found some evidence that children and young people with higher social anxiety report more negative observer-perspective images

Question 63

Cartwright-Hatton (2008)

Answer 63

Experimental study, assigned non-clinical adolescents to 3min speech task and told them they would be rated by peers. Higher SA symptoms at the end of the speech were associated with higher likelihood of reporting observer’s perspective when they were asked to visualise an image of themselves completing the speech.

Question 64

Ingul et al. (2014)

Answer 64

RCT comparing CBT and CT

Question 65

Leigh & Clark (2022)

Answer 65

Internet cognitive therapy for adolescent SAD.

Question 66

Turner et al. (1994)

Answer 66

Social effectiveness therapy

Question 67

Rapee et al. (2023)

Answer 67

200 children and adolescents with SAD as primary or additional disorder (with CSR 4+) randomly allocated to general CBT or modified SAD-specific treatment. The treatments didn’t significantly differ on remission of SAD at post-treatment or at follow-up, but close to significance at 6m follow-up. They didn’t differ at any time on secondary outcome measures like symptoms, life impairment etc. Remission of SAD around 40% for both treatments at end of treatment, and 50-68% for modified version.

Question 68

Spence et al. (2017)

Answer 68

125 youths aged 8-17 were allocated to either generic CBT (Cool Kids) or social anxiety specific CBT (extra focus on social skills, attention training) or waitlist control. At the end of the 12 weeks of treatment, all 3 groups showed surprisingly low remission (3-15%), with no significant difference between cognitions. This increased slightly at 6m follow-up, but still no significant differences between generic and specific CBT.

Question 69

Cognitive training to modify attention in social anxiety

Answer 69

Using dot probe task, learn to auto direct attention away from threatening target.

Question 70

Leigh & Clark (2016)

Answer 70

Delivered cognitive therapy to 5 adolescents with severe and chronic SAD and comorbid difficulties. 4 out of 5 of them had already had CBT with no response. By the end of treatment, symptoms had reduced to subclinical levels for anxiety and depression, and these gains were maintained at 3-6m follow-up. They also found improved functioning, social participation and 100% school attendance. The average change on primary outcome measure was 79%, which is even higher than the results of cognitive therapy for adult SAD

Question 71

Nordh et al. (2022)

Answer 71

Evaluated possible predictors and moderators of the effect of internet delivered CBT in an RCT (ICBT or ISUPPORT). Baseline depression symptoms moderated the outcome, with higher depression scores associated with greater reduction in SAD symptoms in ICBT compared to ISUPPORT. More difficulties at baseline with anticipatory anxiety, post-event processing, focus of attention and safety behaviours predicted greater reduction in SAD symptoms, regardless of treatment condition. Had 103 children and adolescents (10-17yo)

Question 72

Sadler et al. (2018)

Answer 72

Investigated prevalence rates of panic disorder in adolescents. In 11-16yo, prevalence is 1.1%, and in 17-19yo, prevalence is 3.4%. panic disorder was the most common anxiety disorder in the later adolescent group. Not seen in 5-10yo children at all, but not bc children do not have panic attacks, as adolescents usually report their first panic attack as occurring in childhood, but just not meeting the diagnosis criteria.

Question 73

Solmi et al. (2022)

Answer 73

Meta-analysis of 22 samples, found that 22.5% of adults reporting panic disorders said it started before the age of 18, with a peak onset of 15.5yo. The earlier it starts, the poorer the prognosis.

Question 74

Clark (1986) – cognitive model of panic disorder

Answer 74

Trigger (internal or external)  perceived threat  apprehension  bodily sensations  catastrophic interpretation (loop)

Question 75

Hewitt et al. (2021)

Answer 75

Interviewed adolescents who were high on the panic scale. Panic attacks were described as very intense, as a huge wave that is all-consuming. Mental images also enhanced the intensity of panic, and feelings of embarrassment and shame

Question 76

Baker et al. (2022)

Answer 76

Qualitative experiences of panic attacks in adolescence – report that they are overwhelming and unpleasant, with feelings of drowning in sensations, experiences largely fit with Clark’s cognitive model, social worries and unhelpful responses for others, feeling misunderstood, negative social interactions with teachers and peers in the school environment damaging.

Question 77

Kearney et al. (1997)

Answer 77

Measured anxiety sensitivity in clinical samples, comparing 2 groups of people (one with PD and one with other ADs). Young people in the panic disorder group had significantly higher levels of anxiety sensitivity compared to the other group. Most common symptoms of PD were somatic complaints like quicker HR, nausea, hot and cold flashes, shaking. Most severe symptoms included shortness of breath, feeling faint, quicker HR, choking. Those with PD showed greater comorbidity of depression than non-PD groups (with AD)

Question 78

Hayward et al. (2000)

Answer 78

Large scale study with high school studies, 4y longitudinal. Anxiety sensitivity showed specificity in predicting panic, even when they controlled for depression, but no longer when controlled for panic symptoms. Those high in anxiety sensitivity were 2* more likely to experience a panic attack than those without high anxiety sensitivity

Question 79

Ginsberg & Drake (2002)

Answer 79

107 African American adolescents  panic predicted later AS, and AS predicted later panic. But when panic symptoms at T1 were considered, anxiety sensitivity doesn’t make any contribution, so panic symptoms at baseline are the best predictor.

Question 80

Baker & Waite (2020)

Answer 80

Online survey with CAMHS clinicians in NHS, who delivered treatments to young people with anxiety disorders. Gave them a vignette which describes a young person who only met diagnostic criteria for PD (and no other ADs). Less than 50% identified panic symptoms or panic disorder as the main presenting problem. Most others identified other ADs, but not conceptualising panic disorder as the main problem. Clinicians the relatively unexperienced, with many of them (50%) not even having done any CBT training (even 1-day program), but most reported they would give CBT

Question 81

Clark et al. (1994)

Answer 81

Compared cognitive therapy, applied relaxation (active control), imipramine (med). At 3m post-treatment, 90% of the CT group was free of PD. 6m later, 75% of the CT group was free of PD, but imipramine looked better. But at 15m, CT maintains gains (just under 90%) but imipramine group success decreases (likely bc stopping the med). CT has better long-term results than meds, and relapse rates were low for CT, mid of relaxation, high for imipramine.

Question 82

Clark et al. (1999)

Answer 82

Took his prior successful treatment and halved it. Found that it was not significantly different from the full treatment arm, and was significant better than controls

Question 83

Klosko et al. (1990)

Answer 83

Panic Control Treatment with 57 ppts in RCT. Included 15 weekly sessions, including rational, psychoed, exposure to interoceptive cues, cognitive approaches, progressive relaxation training and respiration training + exposures, cognitive restructuring. About 90% post-treatment panic free in PCT. Was better than med, placebo and waitlist.

Question 84

Baker et al. (2021)

Answer 84

Only looked at adolescent anxiety disorders, at any psychological treatment. Of 16 studies, only 1 wasn’t CBT. 6 of the studies included adolescents with panic disorder

Question 85

Pincus et al. (2010)

Answer 85

Panic control treatment for adolescents – PCT-A

Question 86

Pincus et al. (2015)

Answer 86

RCT which found that the efficacy of intensive PCT-A relative to control. 63% of adolescents treated with intensive PCT-A no longer had PD diagnosis at post-treatment. Intensive PCT-A was also effective in reducing the severity of comorbid diagnosis, including depressive symptoms.

Question 87

Waite(2022)

Answer 87

Developed adolescent version of Clark’s brief treatment – PANDA, by adapting the workbooks and the treatment. Conducted a feasibility study, where randomly allocated to 1 of 2 conditions (no statistical comparison bc not powered). Compared brief CT, graded exposure  brief CT – all ppts improving, but in CBT some not improving.

Question 88

Angelosante et al. (2009)

Answer 88

Numerous studies have found that untreated PD is associated with additional problems later in life. Developed PCT-A for adolescents, a 11-week programme for PD in teens aged 12-17

Question 89

Berman et al. (2000)

Answer 89

Presence of depressive symptoms in young people predicts poorer responses to treatments for childhood ADs

Question 90

Hardway et al. (2015)

Answer 90

Investigated if an 8-day long intensive treatment for panic disorder (Pincus et al.’s (2008) Riding the Wave for adolescent PD) in adolescents also helps ameliorate depression symptoms. 57 adolescents aged 11-18 were randomly assigned to intensive panic treatment, half with parental involvement and half without. Depression scores decreased from baseline to 3m follow-up, and an interaction between age and parental involvement was a significant moderator in the decrease in depression. Younger participants benefitted more from treatment without parent involvement than older ppts (for depression symptoms).

Question 91

Elkins et al. (2016)

Answer 91

Adolescents with PD were randomised to intensive CBT treatment of waitlist control. Main effect of intensive CBT on post-treatment PD symptoms not uniform across ppts  those with lower baseline levels of fear and avoidance experienced greater treatment effects than those higher in baseline levels of fear and avoidance. Same ppts as Pincus et al. (2015) – 54 ppts aged 11-17.

Question 92

Leyfer et al. (2019)

Answer 92

DCS (partial NMDA agonist) might enhance the effects of exposure-based therapy for PD in adults. Tested the feasibility and acceptability of using DCS to increase the effects of intensive CBT for PD in adolescence, with 24 ppts aged 12-17. Compared CBT+DCS and CBT+placebo. Found no significant difference between the groups, but both showed sig improvement. Recovery of diagnosis 90% in placebo, 66.7% in DCS (not sig…). at 3m follow-up, DCS recovery rate went up, while placebos same  more LT effects? Also no diff in speed of improvement

Question 93

Nauphal et al. (2020)

Answer 93

24 ppts aged 12-17 with PD received 8-day intensive CBT. Higher levels of overall symptom interference at baseline and greater reductions in agoraphobic fear during treatment predicted greater treatment satisfaction at post-treatment. At 3m follow-up, satisfaction was only predicted by satisfaction post-treatment (initial satisfaction important in influencing LT perceptions of the treatment).

Question 94

Craske et al. (1995)

Answer 94

30 patients with PD randomly assigned to 4 weekly sessions of CBT or of non-directive supportive therapy. CBT led to sig reductions in worry and recurrence of panic, and overall ratings of phobia distress. Non-directive supportive did not produce any significant effects

Question 95

Gallo et al. (2014)

Answer 95

Examined rate and shape of change across an 8-day intensive CBT for adolescent PD, in ppts aged 12-17. Panic severity showed linear change, decreasing throughout treatment. Fear and avoidance showed cubic change, peaking at 1st session, decreasing at 2nd, and large gains continuing then plateauing in 4th session.

Question 96

Ale et al. (2015)

Answer 96

Exposure and response prevention was effective for OCD (with large effecr sizes), effectiveness of CBT for childhood adolescent disorders no different than attention placebo, but was more effective than waitlist control. ERP for OCD introduces exposure earlier and have it more, while CBT for childhood anxiety disorders use more relaxation techniques.

Question 97

Peris et al. (2015)

Answer 97

Combined med + CBT (Coping Cat Program) yielded highest response rates (80.7%), and CBT alone gave similar results to meds alone. Introduction of both cognitive restructuring and exposure tasks were followed by sig acceleration in rate of progress in treatment, across therapist ratings of overall symptom severity and global functioning. But introduction of relaxation training didn’t significantly alter the trajectory of improvement. Impact of exposure on treatment improvements moderated by age and treatment condition