Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment

Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (β = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (β = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety.publishedVersio

Parental early life maltreatment and related experiences in treatment of youth anxiety disorder

The role of parents’ early life maltreatment (ELM) (e.g. physical, sexual abuse) and related experiences, in relation to offspring anxiety is not well understood. The current study investigated the association between self-reported depression and ELM and related experiences in mothers (n = 79) and fathers (n = 50), and mother-, father-, and youth-reported symptoms of youth anxiety (n = 90). Outcomes were assessed at pre,- and posttreatment and 3-, 6-, and 12-months follow-up. Parental ELM were not associated with pre-treatment differences or differences in outcome of treatment. However ELM related experiences were associated with increased mother-, father-, and youth-rated youth anxiety at pretreatment. Fathers depressive symptoms were found to mediate the relationship between father ELM related experiences and father-rated youth anxiety symptoms. Future research is warranted on parental ELM and depression as factors affecting outcomes of treatment of youth anxiety. Trial registered at: helseforskning.etikkom.no (reg. nr. 2017/1367).publishedVersio

Change and stability : Within-person life satisfaction over a 20-year period using data from the HUNT survey

publishedVersionPaid Open AccessUNIT agreemen

Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder

Although cognitive-behavioral therapy (CBT) is an effective treatment for adolescents with anxiety disorders, the majority remain impaired following treatment. We developed a group CBT program (RISK) with high degrees of exposure practice and family and school involvement delivered in a community-based setting and investigated its effectiveness. The treatment involved adolescents (N = 90), with a primary diagnosis of anxiety disorder (82%) or obsessive-compulsive disorder (18%), and their families who received 38 hours of group treatment over 10 weeks. Diagnostic status and symptom severity were assessed at pre- and post-treatment, and a 12-month follow-up and benchmarked against previous effectiveness studies. Our results showed that, at post-treatment, the RISK-treatment was comparably effective as benchmarks on measures of diagnostic status, parent-rated measures, adolescent-rated measures, and clinician-rated measures. At 12-month follow-up all outcomes were superior to benchmarks, including the proportion of participants in remission (79.5%, 95% Highest Posterior Density Interval [74.7, 84.2]), indicating that the RISK-treatment enhanced effectiveness over time. The combination of group format, a high degree of exposure practice, and school and family involvement is a promising format for real-world settings that may help sustain and increase treatment effectiveness. Trial registered at helseforskning.etikkom.no (reg. nr. 2017/1367).publishedVersio

Physical couple and family violence among clients seeking therapy: identifiers and predictors

publishedVersio

Bayes Factor Benefits for Clinical Psychology

Deposit for supplemental material and data for article on benefits of Bayes Factor

Multifamily Group Cognitive Behavioral Therapy for Child and Adolescent Anxiety Disorders : An investigation into the effectiveness and role of family accommodation and parental early life maltreatment

Angstlidelser er vanlig hos ungdom (12–18 år), og har skadelige effekter for individet og samfunnet både på kort og lang sikt. Dessverre er mange ungdommer fortsatt plaget av angst etter regulær poliklinisk behandling (i.e., BUP). Derfor er det behov for mer effektiv behandling for ungdom med angstlidelser gitt i spesialisthelsetjenesten. I denne avhandlingen evalueres en flerfamilie kognitiv atferdsterapi intervensjon (RISK), som hadde som formål å forbedre effekten av behandling for angst i spesialisthelsetjenesten. Foreldrefaktorer som kan forbedre eller hemme utfall av behandling blir også undersøkt. Metoder Studien ble utført som en observasjonsstudie med resultater “benchmarked” mot eksisterende studier på effekten av kognitiv atferdsterapi i regulær poliklinikk for barn og ungdommer med angst. Nitti ungdommer og deres foreldre ble rekruttert ved BUP mellom 2017 og 2019, og diagnostiske intervjuer og foreldre-, ungdoms- og klinikervurderte vurderinger av ungdomsangst ble samlet inn før, etter, og ved 12 måneders oppfølging. I tillegg ble det fylt ut spørreskjemaer etter hver terapi-session om grad av angstsymptomer og grad av uhensiktmessig foreldretilpasning. Artikkel I vurderte effektiviteten av RISK behandlingen sammenlignet med resultater fra en metaanalyse av kognitiv atferdsterapi regulær poliklinisk behandling for barn og ungdom. Artikkel II vurderte hvordan foreldres uhensiktsmessige tilpasning og ungdommens angst påvirket hverandre fra uke til uke under behandlingen. Artikkel III vurderte sammenhengen mellom foreldrenes egen erfaring med mishandling i barndommen (Early Life Maltreatment; ELM) og ungdommens symptomtrykk før behandling. Artikkel III vurderte også om foreldres depresjon og egen erfaring med mishandling i barndommen påvirket ungdommens utbytte av RISK behandlingen. Resultat I artikkel I ble det funnet at RISK var sammenlignbar med benchmark ret etter behandling i forhold til diagnostisk status og ungdoms-, foreldre- og klinikervurderte ungdomsangstsymptomer og klinisk funksjonsnivå. Etter et år var resultatene bedre enn forventet ut ifra benchmark og 79,5 %, 95 % HPD [74,7, 84,2] av ungdommene oppfylte ikke lenger diagnostiske kriterier for en angstlidelse. I artikkel II ble forholdet mellom det funnet et gjensidig forhold mellom foreldres uhensiktsmessig tilpasning og ungdommenes angst. Uhensiktsmessig tilpasning i forrige terapi-session økte ungdommens angstsymptomer i den nåværende, β = 0,23, 95 % KI [0,08, 0,38]. Samtidig påvirket ungdommens angstsymptomer i forrige terapi-session foreldrenes tilpasning i den nåværende, β = 0,11, 95 % KI [0,06, 0,17]. Dette indikere at ungdommers angstsymptomer har større innflytelse på foreldres tilpasning enn foreldres tilpasning har på ungdommens angst. I papir III var mors ELM positivt assosiert med mor- og ungdoms-vurdert ungdomsangst før behandling. Fars ELM var positivt assosiert med ungdoms angstsymptomer før behandling. Hvis mor hadde opplevd ELM påvirket dette negativt behandlingens effekt på ungdommens angstsymptomer. Mødres depressive symptomer medierte forholdet mellom ungdommens angstsymptomer og mors ELM. Fedres depressive symptomer medierte forholdet mellom far-vurderte ungdomsangstsymptomer og far ELM. Konklusjon Funnene i denne avhandlingen indikerer at RISK er effektiv og gjennomførbar for ungdomsangstlidelser i regulær poliklinisk behandling. Funnene som omhandler uhensiktsmessig foreldretilpasning fremhever viktigheten av å involvere foreldre, men understreker at direkte arbeid med ungdommen (dvs. eksponeringterapi) må prioriteres). Funnene tyder også på at ELM og foreldredepresjon kan være viktige faktorer å vurdere når man behandler ungdom med angstlidelse i regulær poliklinik. Fremtidig forskning bør vurdere om effektiviteten kan opprettholdes med mindre ressurser.Anxiety disorders are prevalent among adolescents (ages 12–18 years), and they have a detrimental impact on individuals and society both in the short- and long-term. Unfortunately, many of those adolescents remain impaired after treatment in routine clinical care (i.e., Child and Adolescent Mental Health Services). Therefore, it is vital to improve treatment effectiveness for adolescents with anxiety in routine clinical care. The present thesis evaluated the effectiveness of a multifamily CBT intervention (RISK), intended to enhance outcomes for adolescents in routine clinical care. Methods This study was conducted as a single arm open-trial with outcomes benchmarked against existing studies regarding the effects of CBT for child and adolescent anxiety in routine clinical care settings. Ninety adolescents and their parent(s) were recruited from community care settings between 2017 and 2019, and diagnostic interviews and parent, adolescent, and clinician-rated assessments of adolescent anxiety were convened at pretreatment, posttreatment, 3-, 6-, and 12-month follow-ups. Additionally, research participants completed questionnaires after each session about the existence of anxiety symptoms and the quality of parental accommodation. Paper I assessed the effectiveness of the RISK treatment when compared with the results of a meta-analysis of CBT for child and adolescent routine clinical and community care. Paper II examined the directional relationship between family accommodation and adolescent anxiety during treatment. Paper III investigated the relationship between parental early life maltreatment (ELM) and adolescent anxiety and clinical impairment before treatment. It also sought to determine the effects parental ELM had on the treatment outcomes and whether parental depression acted as a potential mediator of treatment outcomes. Results Paper I found at posttreatment that the RISK treatment was comparably effective to benchmarks on measures of diagnostic status and adolescent-, parent-, and clinician-rated adolescent anxiety symptoms and clinical impairment. Between posttreatment and 12-month follow-up greater improvements occurred and 79.5%, 95% Highest Posterior Density interval [74.7, 84.2] of adolescents no longer met diagnostic criteria for an anxiety disorder. In Paper II, the relationship between family accommodation and adolescent anxiety was found to be bidirectional. The effect of previous sessions family accommodation on adolescent anxiety symptoms in the current session was β = 0.23, 95% CI [0.08, 0.38]. The effect of previous sessions adolescent anxiety symptoms on family accommodation in the current session was β = 0.11, 95% CI [0.06, 0.17]. These findings indicate that adolescent anxiety exerts a greater impact on family accommodation than family accommodation does on adolescent anxiety. In Paper III, mother ELM was positively associated with mother- and adolescent-rated adolescent anxiety at pretreatment. Along the same line, father ELM was found to be positively associated with adolescent anxiety symptoms at pretreatment. As anticipated, the outcomes of treatment for adolescent-rated anxiety symptoms were negatively impacted by mother ELM. Mothers depressive symptoms mediated the relationship between mother- and adolescent-rated adolescent anxiety symptoms and mother ELM. Fathers depressive symptoms mediated the relationship between father-rated adolescent anxiety symptoms and father ELM. Conclusion The findings of the present thesis indicate that multifamily CBT is effective for treating adolescent anxiety disorders in routine clinical care. The findings on parental accommodation highlight the importance of involving parents in the management of adolescent anxiety disorders, but they also underscore that direct work with the adolescent (i.e., exposure practice) must be prioritized in routine clinical care. The findings also suggest that ELM and parental depression may be important factors to consider when treating adolescents with anxiety disorder in routine clinical care. Future research should assess whether the effectiveness of multifamily CBT in the treatment of adolescent anxiety disorders can be maintained with less resourcesDoktorgradsavhandlin

Effectiveness of General Practitioner Delivered Interventions for Youth Anxiety: Systematic Review

Protocol for SR on the effect of GP delivered interventions for youth anxiet

Bidirectional Relationship Between Family Accommodation and Youth Anxiety During Cognitive-Behavioral Treatment

Family accommodation is associated with an increase in anxiety and has recently received attention as a target for intervention for youth anxiety. Existing theories posit that the increase in family accommodation increases youth anxiety and can attenuate the effect of psychotherapy. However, the directionality between family accommodation and youth anxiety has not been investigated. A cross-lagged cross-panel design was used to assess accommodation and anxiety for 10 sessions for 73 youths with an anxiety disorder, who were receiving cognitive-behavioral therapy. The analysis revealed a bidirectional relationship, such that to some extent previous session family accommodation increased youth anxiety symptoms (β = 0.11, 95% CI [0.06, 0.17]), but to an even greater extent previous session youth-rated anxiety symptoms increased family accommodation (β = 0.23, 95% CI [0.08, 0.38]). Family accommodation is an important target for reducing youth anxiety but should be addressed simultaneously as interventions directly targeting youth anxiety

Benchmarked effectiveness of family and school involvement in group exposure therapy for adolescent anxiety disorder

Although cognitive-behavioral therapy (CBT) is an effective treatment for adolescents with anxiety disorders, the majority remain impaired following treatment. We developed a group CBT program (RISK) with high degrees of exposure practice and family and school involvement delivered in a community-based setting and investigated its effectiveness. The treatment involved adolescents (N = 90), with a primary diagnosis of anxiety disorder (82%) or obsessive-compulsive disorder (18%), and their families who received 38 hours of group treatment over 10 weeks. Diagnostic status and symptom severity were assessed at pre- and post-treatment, and a 12-month follow-up and benchmarked against previous effectiveness studies. Our results showed that, at post-treatment, the RISK-treatment was comparably effective as benchmarks on measures of diagnostic status, parent-rated measures, adolescent-rated measures, and clinician-rated measures. At 12-month follow-up all outcomes were superior to benchmarks, including the proportion of participants in remission (79.5%, 95% Highest Posterior Density Interval [74.7, 84.2]), indicating that the RISK-treatment enhanced effectiveness over time. The combination of group format, a high degree of exposure practice, and school and family involvement is a promising format for real-world settings that may help sustain and increase treatment effectiveness. Trial registered at helseforskning.etikkom.no (reg. nr. 2017/1367)