Cognitieve bias modificatie en CGT als vroege interventie voor jongeren met sociale angst en faalangst

Sociale angst en faalangst komen veel voor onder jongeren, en kunnen op termijn grote gevolgen hebben. Zowel cognitieve gedragstherapie (CGT) als cognitieve bias modificatie (CBM) richten zich op processen die een rol lijken te spelen bij de ontwikkeling van angststoornissen. Door vroegtijdige interventies zouden kinderen met een verhoogd niveau van sociale angst of faalangst minder kwetsbaar worden voor het ontwikkelen van een angststoornis

Cognitive bias modification and CBT as early interventions for adolescent social and test anxiety:Two-year follow-up of a randomized controlled trial

BACKGROUND AND OBJECTIVESThis two-year follow-up study evaluated the long-term outcomes of two early interventions that aimed at reducing social and test anxiety in young adolescents at risk for developing social anxiety disorder. METHODSIn this RCT, moderately socially anxious adolescents (N=240, mean age 13.6 years) were randomly assigned to a 10-week internet-based multifaceted cognitive bias modification training (CBM), a 10-week school-based cognitive behavioral group training (CBT), or a no-intervention control condition. Using multiple imputation, this study examined the changes in primary and secondary outcome measures from pretest to follow-up in a repeated measures design. RESULTSPrimary outcome: Self-reported social and test anxiety generally decreased from pre-test to two-year follow-up, regardless of treatment condition. The percentage of adolescents who developed a social anxiety disorder was very low (6%) and similar across conditions. Secondary outcome: There were beneficial changes in self-esteem, self-reported prosocial behaviors, and fear of negative evaluation, but none of these were related to treatment condition. Automatic social-threat associations did not significantly change. The CBM intervention was effective in changing interpretative bias as indexed by the Recognition Task but this long-term effect did not transfer to the Adolescent Interpretation and Belief Questionnaire. LIMITATIONSThere was a substantial (50%) though seemingly non-selective attrition at follow-up. CONCLUSIONSThis RCT does not support the longer-term efficacy of school-based CBT or CBM as an early intervention for social and test anxiety. Rather, it emphasizes the positive 'natural' course of highly socially anxious adolescents over two years

Behavioral Inhibition and Attentional Control in Adolescents: Robust Relationships with Anxiety and Depression

Behavioral inhibition (BI) has been associated with the development of internalizing disorders in children and adolescents. It has further been shown that attentional control (AC) is negatively associated with internalizing problems. The combination of high BI and low AC may particularly lead to elevated symptomatology of internalizing behavior. This study broadens existing knowledge by investigating the additive and interacting effects of BI and AC on the various DSM-IV based internalizing dimensions. A sample of non-clinical adolescents (N = 1806, age M = 13.6 years), completed the Behavioral Inhibition System/Behavioral Activation System Scales (BIS/BAS), the attentional control subscale of the Adult Temperament Questionnaire (ATQ) and the Revised Child Anxiety and Depression Scale (RCADS). As expected, BI was positively, and AC was negatively related to internalizing dimensions, with stronger associations of BI than of AC with anxiety symptoms, and a stronger association of AC than of BI with depressive symptoms. AC moderated the association between BI and all measured internalizing dimensions (i.e., symptoms of generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder, obsessive–compulsive disorder, and major depressive disorder). Since high AC may reduce the impact of high BI on the generation of internalizing symptoms, an intervention focused on changing AC may have potential for prevention and treatment of internalizing disorders

The Youth Anxiety Measure for DSM-5 (YAM-5):Development and First Psychometric Evidence of a New Scale for Assessing Anxiety Disorders Symptoms of Children and Adolescents

The Youth Anxiety Measure for DSM-5 (YAM-5) is a new self- and parent-report questionnaire to assess anxiety disorder symptoms in children and adolescents in terms of the contemporary classification system. International panels of childhood anxiety researchers and clinicians were used to construct a scale consisting of two parts: part one consists of 28 items and measures the major anxiety disorders including separation anxiety disorder, selective mutism, social anxiety disorder, panic disorder, and generalized anxiety disorder, whereas part two contains 22 items that focus on specific phobias and (given its overlap with situational phobias) agoraphobia. In general, the face validity of the new scale was good; most of its items were successfully linked to the intended anxiety disorders. Notable exceptions were the selective mutism items, which were frequently considered as symptoms of social anxiety disorder, and some specific phobia items especially of the natural environment, situational and other type, that were regularly assigned to an incorrect category. A preliminary investigation of the YAM-5 in non-clinical (N = 132) and clinically referred (N = 64) children and adolescents indicated that the measure was easy to complete by youngsters. In addition, support was found for the psychometric qualities of the measure: that is, the internal consistency was good for both parts, as well as for most of the subscales, the parent-child agreement appeared satisfactory, and there was also evidence for the validity of the scale. The YAM-5 holds promise as a tool for assessing anxiety disorder symptoms in children and adolescents

Threat is in the eye of the beholder : cognitive bias modification in the prevention of adolescent social anxiety

Veel jongeren hebben last van sociale angst en zijn bang dat anderen negatief over hen zullen denken, vooral in sociale situaties of situaties waarin je moet presteren. Eerder onderzoek heeft laten zien dat angstige mensen vooral te letten op informatie die hun angst bevestigt; waarbij ze de neiging hebben om ambigue informatie (bv. iemand die zonder te groeten langsloopt) eerder negatief dan positief te interpreteren. Zo’n selectieve manier van informatieverwerking houdt logischerwijs de angst in stand of maakt de angst nog intenser. In samenwerking met Esther Sportel onderzocht Eva de Hullu of een internettraining die specifiek deze vertekeningen aanpakt (Cognitieve Bias Modificatie; CBM) in staat is om sociale angst en faalangst te verminderen en het ontstaan van ernstiger klachten zoals angststoornissen te voorkomen (zie www.projectpasta.nl). Van de ruim 1800 scholieren (12-14 jaar) die meededen aan een screening op 25 scholen selecteerden zij 240 scholieren die last hadden van faalangst of sociale angst. Zij kregen de CBM training, een cognitieve gedragstraining (CGT) in een groep op school, of geen training. Zoals verwacht lieten de angstige adolescenten voor de training een vertekende (dreiging-bevestigende) informatieverwerking zien: zij hadden relatief negatieve automatische associaties met sociale situaties en interpreteerden ambigue sociale situaties op een relatief negatieve manier. Zowel de CBM als de CGT had op korte termijn een gunstig –maar klein- effect op sociale angst; na twee jaar bleek de meerwaarde van de training echter verdwenen en lieten de scholieren zonder training een vergelijkbare daling zien in sociale angst. Op de lange termijn zorgde de CBM training wel voor een relatief sterke afname van faalangst en negatieve automatische associaties. Mede gezien de relatief lage kosten van CBM lijkt het daarom zinvol om verder onderzoek te doen naar mogelijke toepassingen van CBM om faalangst te verminderen en te voorkomen. Social anxiety is a common mental disorder that is characterized by increased fear of negative evaluation, in social situations and in performance situations. The persistence of social anxiety may partially be explained by biased information processing: socially anxious people view the world as threatening, and react with fear and avoidance in relatively harmless situations. In collaboration with Esther Sportel, Eva de Hullu studied information processing biases in adolescents with a subclinical level of social anxiety and tested whether an intervention specifically designed to modify these biases (Cognitive Bias Modification; CBM) was able to decrease or prevent social anxiety in a randomized controlled trial. Results of these studies indicate that adolescents with a subclinical level of social anxiety are indeed characterized by biased information processing: they display dysfunctional (relatively negative) automatic associations to social situations and interpret ambiguous social situations in relatively negative way. Direct modification of these biases has some small short-term effects on social anxiety symptoms, but in the long term, the no-intervention control group showed an equally strong decrease in symptoms of social anxiety. However, in the CBM group, test anxiety and negative automatic associations decreased over a period of two years, suggesting that CBM could be applied in the treatment of test anxiety. Although our results suggest that CBM is not (yet) ready to be applied in the prevention of social anxiety, the relatively low cost of the implementation of CBM makes the application of CBM in treatment of test anxiety worth considering.