Treatment of internalizing disorders in children and adolescents

Question 1

internalizing symptoms =

Answer 1

“Internalizing symptoms refer to problems of withdrawal, somatic complaints, and anxiety/depression while externalizing symptoms exhibit themselves in delinquent and aggressive behavior.”

Question 2

CBT works for …% of people

Answer 2

50%

Question 3

in both internalizing and externalizing thought and behaviour are affected, but you only notice it better.

Answer 3

oke

Question 4

the internalizing and externalizing framework….

Answer 4

Not a formal DSM diagnosis, but a framework used to describe etiology, classification, comorbidity, treatment of child and adolescent mental health problems.

Question 5

prevalence of internalising disorders

Answer 5

20%

Question 6

gender ratio internalizing

Answer 6

boys 1: girls 2/3

Question 7

gender barriere in internalizing disorders

Answer 7

difficult to diagnose internalizing in boys and externalzing in girls, because they are researched most often in the other gender. therefore we compare to those standards.

we dont know what the symptoms look like in the other gender, because of socialisation (girls dont climb in trees, boys do not cry).

Question 8

op welke leeftijd kunnen kinderen al behandeld worden

Answer 8

vanaf 3 jaar

Question 9

internalising = (3 groepen)

Answer 9

• anxiety
• depression
• stress-relating

Question 10

Internalizing disorders: anxiety disorders

Answer 10

• social anxiety
• panic disorder
• separation anxiety disorder
• specific phobia
• agoraphobia
• generalized anxiety disorder

Question 11

separation anxiety DSM

Answer 11

• Excessive anxiety concerning separation from home/parents, 3 or more symptoms:
• Recurrent distress or physical symptoms when separated or when anticipating
• Worry or nightmares
• Fearful or reluctant to be alone or without parents
• Reluctance to go to sleep without being near a parent
• The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder

Question 12

depressive disorders DSM

Answer 12

• Depressed (and irritable?) mood, most of the day, nearly every day
• Reduced interest or pleasure: anhedonia
• Significant weight loss or increase
• Insomnia or hypersomnia
• Psychomotor agitation or retardation
• Fatigue
• Feelings of worthlessness, guilt
• Reduced ability to think, concentrate
• Recurrent thoughts on death

Question 13

stress-related disorders

Answer 13

• obsessive compulsive disorder
• posttraumatic stress disorder

Question 14

core symptoms of internalizing disorders

Answer 14

• Emotional response: fear, sadness, anger, shame, guilt
• Cognitive response: negative cognitions (self, world, future, attention, interpretation, memory problems)
• Physiological response: trembling, palpitations, sweating hands, tension, headache, abdominal pain
• Behavioural response: avoidance, loss of interest in activities

Question 15

CBT is focused on

Answer 15

do-think-feel triangle (thoughts, feelings, behaviours)

Question 16

CBT kenmerken

Answer 16

• Treatment protocol
• Fixed steps
• Fixed amount of sessions
• Many different protocols
• Difference with adult CBT: more generic for kids than for adults (adults more specific per disorder)
• Parent involvement very important

Question 17

CBT components

Answer 17

• Cognitive therapy/ cognitive restructuring
• Behavioral therapy: exposure / behavioral activation
• Modelling
• Relaxation
• Social skills training
• Problem solving skills
• Goal setting
• Parent involvement

Question 18

cognitive therapy/cognitive restructuring steps

Answer 18

• Tracing negative thoughts: ’It’s my fault my group didn’t pass the test’
• Challenge negative thoughts: ‘What could be other explanations for not passing the test?’
• Formulating alternative, more neutral/realistic thoughts: ‘All group members have a responsibility’

Question 19

Behaviour therapy types

Answer 19

• Exposure: for anxiety, stress-related disorders → Exposure to feared stimuli/ situations/
  sensations
• Behavioral activation: depression → Increasing pleasant activaties, doing even if you do not feel like it

Question 20

Parent involvement is important when…

Answer 20

• Young kids
• Comorbid externalizing disorders
• Engagement homework
• Systemic nature
• Parents involved in maintaing disorder → family accommodation

Question 21

percentages of benefits from CBT

Answer 21

• 45-55% benefits
• so half of the kids don’t respond
• high relapse rates in the kids that do respond

Question 22

wat is de uitleg voor CBT non-efficacy rates

Answer 22

RCTs treatment protocols are tested as a whole: not on the component level. therefore we dont know

Question 23

RCTs kenmerken en waarom het niet handig is

Answer 23

• Standardized questionnaires (e.g., CBCL, CDI, SCARED) at pre-, post-, and follow up assessment.
• Total group scores (treatment vs. control group) compared to each other at post- and follow-up.
• Averaging of scores across the group means loss of information!
• RCTs treatment protocols are tested as a whole: not on the component level
• Individual differences: large heterogeneity
• Comorbidity

→ So ‘one-size-fits all’ doesn’t fit any more

Question 24

CBT protocols for children one-on-one translation from adult CBT programs
* Many different formats tested; with/without parental involvement, parental training, group/individual, add-ons….
* Many different treatments tested
→ Results have not improved

Answer 24

oke

Question 25

current research directions

Answer 25

1. Individual differences → individual approach, personalizing research/treatment
2. Modular treatment
3. Working mechanisms
4. Transdiagnostic approach

Question 26

individual differences research

Answer 26

• Experience sampling approach
• Idiographic approach vs. Nomothetic approach (i.e. individual vs. group approach)
• Changes over time
• Tracking during treatment: processes/working mechanisms
• Possibility personalized questions
• within-subject designs
• change in one or two variables over time

Question 27

SPACE =

Answer 27

parental programme, to make sure that parents dont accomodate the symptoms of the child. works with post-treatment assessments and an app

Question 28

modular treatment

Answer 28

modular treatment refers to a flexible and individualized approach to therapy where interventions are broken down into discrete, smaller units or “modules.” Each module focuses on a specific problem, skill, or therapeutic technique. These modules can be combined or customized to fit the unique needs of a patient, depending on their symptoms or issues.

Question 29

Studying Modularized CBT protocol (van Steensel et al., 2022)
* RCT with single-case components
* N=106 children aged 7-17 years with anxiety disorder/ problems in
the clinical range, and their (both) parents
* Therapists choose treatment content

Answer 29

werkte beter, anxiety van parents and child nam af

Question 30

working mechanisms in research

Answer 30

• how does the treatment work?
• theory driven

Question 31

social anxiety study van Mobach resultaten

Answer 31

• A change in dysfunctional beliefs mediated the change in anxiety
• A change in interpretation bias mediated the change in anxiety

Question 32

transdiagnostic treatment

Answer 32

• high comorbidity
• shared, underlying mechanisms of internalizing disorders: avoidance, emotion regulation, repetitive negative thinking (worrying, rumination, intrusions etc).
• 50% efficacy