A controlled trial of a school-based internet program for reducing depressive symptoms in adolescent girls

Background: This study evaluates the benefits of a self-directed Internet intervention for depression (MoodGYM) delivered as a part ofthe high school curriculum. Method: One hundred and fifty-seven girls, aged 15 and 16 years, were allocated to undertak

Moderators and predictors of response to cognitive behaviour therapy for pediatric obsessive-compulsive disorder: A systematic review

We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations

Reduced willingness to approach genuine smilers in social anxiety explained by potential for social evaluation, not misperception of smile authenticity

We investigate perception of, and responses to, facial expression authenticity for the first time in social anxiety, testing genuine and polite smiles. Experiment 1 (N = 141) found perception of smile authenticity was unaffected, but that approach ratings, which are known to be reduced in social anxiety for happy faces, are more strongly reduced for genuine than polite smiles. Moreover, we found an independent contribution of social anxiety to approach ratings, over and above general negative affect (state/trait anxiety, depression), only for genuine smiles, and not for polite ones. We argue this pattern of results can be explained by genuine smilers signalling greater potential for interaction – and thus greater potential for the scrutiny that is feared in social anxiety – than polite smiles. Experiment 2 established that, relative to polite smilers, genuine smilers are indeed perceived as friendlier and likely to want to talk for longer if approached. Critically, the degree to which individual face items were perceived as wanting to interact correlated strongly with the amount that social anxiety reduced willingness to approach in Experiment 1. We conclude it is the potential for social evaluation and scrutiny signalled by happy expressions, rather than their positive valence, that is important in social anxiety.This work was supported by the Australian Research Council (DP110100850; CE110001021, see ARC Centre of Excellence for Cognition and Its Disorders at www.ccd.edu.au)

Emotional Abilities in Children with Oppositional Defiant Disorder (ODD): Impairments in Perspective-Taking and Understanding Mixed Emotions are Associated with High Callous-Unemotional Traits

Most studies of emotion abilities in disruptive children focus on emotion expression recognition. This study compared 74 children aged 4-8 years with ODD to 45 comparison children (33 healthy; 12 with an anxiety disorder) on behaviourally assessed measures of emotion perception, emotion perspective-taking, knowledge of emotions causes and understanding ambivalent emotions and on parent-reported cognitive and affective empathy. Adjusting for child's sex, age and expressive language ODD children showed a paucity in attributing causes to emotions but no other deficits relative to the comparison groups. ODD boys with high levels of callous-unemotional traits (CU) (n = 22) showed deficits relative to low CU ODD boys (n = 25) in emotion perspective-taking and in understanding ambivalent emotions. Low CU ODD boys did not differ from the healthy typically developing boys (n = 12). Impairments in emotion perceptive-taking and understanding mixed emotions in ODD boys are associated with the presence of a high level of CU

Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents (review)

Background: While behavioural or cognitive-behavioural therapy (BT/CBT) is recommended as the psychotherapeutic treatment of choice for children and adolescents with obsessive-compulsive disorder (OCD), the application of BT/CBT to paediatric OCD may no

Mental health first aid training of the public in a rural area: a cluster randomized trial [ISRCTN53887541]

BACKGROUND: A Mental Health First Aid course has been developed which trains members of the public in how to give initial help in mental health crisis situations and to support people developing mental health problems. This course has previously been evaluated in a randomized controlled trial in a workplace setting and found to produce a number of positive effects. However, this was an efficacy trial under relatively ideal conditions. Here we report the results of an effectiveness trial in which the course is given under more typical conditions. METHODS: The course was taught to members of the public in a large rural area in Australia by staff of an area health service. The 16 Local Government Areas that made up the area were grouped into pairs matched for size, geography and socio-economic level. One of each Local Government Area pair was randomised to receive immediate training while one served as a wait-list control. There were 753 participants in the trial: 416 in the 8 trained areas and 337 in the 8 control areas. Outcomes measured before the course started and 4 months after it ended were knowledge of mental disorders, confidence in providing help, actual help provided, and social distance towards people with mental disorders. The data were analysed taking account of the clustered design and using an intention-to-treat approach. RESULTS: Training was found to produce significantly greater recognition of the disorders, increased agreement with health professionals about which interventions are likely to be helpful, decreased social distance, increased confidence in providing help to others, and an increase in help actually provided. There was no change in the number of people with mental health problems that trainees had contact with nor in the percentage advising someone to seek professional help. CONCLUSIONS: Mental Health First Aid training produces positive changes in knowledge, attitudes and behaviour when the course is given to members of the public by instructors from the local health service

Standards of care for obsessive–compulsive disorder centres

In recent years, many assessment and care units for obsessive–compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive- Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a stand- ards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries

Individual Differences in the Ability to Recognise Facial Identity Are Associated with Social Anxiety

Previous research has been concerned with the relationship between social anxiety and the recognition of face expression but the question of whether there is a relationship between social anxiety and the recognition of face identity has been neglected. Here, we report the first evidence that social anxiety is associated with recognition of face identity, across the population range of individual differences in recognition abilities. Results showed poorer face identity recognition (on the Cambridge Face Memory Test) was correlated with a small but significant increase in social anxiety (Social Interaction Anxiety Scale) but not general anxiety (State-Trait Anxiety Inventory). The correlation was also independent of general visual memory (Cambridge Car Memory Test) and IQ. Theoretically, the correlation could arise because correct identification of people, typically achieved via faces, is important for successful social interactions, extending evidence that individuals with clinical-level deficits in face identity recognition (prosopagnosia) often report social stress due to their inability to recognise others. Equally, the relationship could arise if social anxiety causes reduced exposure or attention to people's faces, and thus to poor development of face recognition mechanisms

Benefits of cognitive-behavioural therapy for children and youth with obsessive-compulsive disorder: re-examination of the evidence

The aim of the present paper was to critically examine evidence about the benefits of cognitive-behavioural therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) from controlled and single group studies, including its benefits relative to medication are critically reviewed. Selected studies were categorized by study type and by risk of bias classification. Standardized mean differences (Hedges' g or Cohen d) and, where appropriate, weighted mean difference (WMD) were calculated. All five comparison and 14 one-group studies showed a significant benefit for CBT within a wide range (ES = .78 to 4.38). Low risk of bias studies produced the lower adjusted effect sizes. The best available estimate of CBT efficacy relative to no treatment is about 1 standardized mean difference, equivalent to a treatment effect of 8 points on the Children's Yale-Brown Obsessive-Compulsive Scale. This represents a reduction in the risk of continuing to have OCD post-treatment of about 37% (95% CI 14% to 54%). Evidence from 3 studies indicates that the efficacy of CBT and medication do not differ significantly. CBT combined with medication is significantly more efficacious than non-active controls or medication alone but not relative to CBT alone. CBT should be regarded as a first line equivalent to anti-OCD medication with the potential to lead to better outcomes when combined with medication than medication alone can provide. Additional studies are needed to further clarify CBT's benefits and to investigate how it can be made more available as a treatment option for children and youth who suffer from OCD

Comparative physiological reactivity during script-driven recall in depression and posttraumatic stress disorder

Increased physiological responsiveness to trauma memories is common in posttraumatic stress disorder (PTSD) and is related to higher felt memory intrusiveness. Physiological reactivity to remembering of distressing personal events in depression and its association with memory quality have not been examined. Heart rate (HR) and skin conductance (SC) reactivity during script-driven recall were assessed in participants with a depressive episode without PTSD (n = 24), participants with PTSD (n = 24), and nondisordered controls (n = 24). Participants reported on event impact and memory quality. PTSD participants showed higher HR and SC reactivity during trauma recall compared with recall of other events and compared with depressed participants for HR and SC reactivity and compared with nondisordered participants for HR reactivity. Although reactivity between depressed and nondisordered participants was not significantly different, the findings indicated a consistent trend toward an attenuation of reactivity to memories of events subjectively associated with symptom onset for those with depression. There was no evidence that the presence of depression impacted the increased physiological responsiveness observed in PTSD. Higher avoidance was associated with lower HR reactivity to the event memory for depressed participants, whereas higher avoidance was associated with higher HR reactivity to the trauma memory for PTSD participants. Trauma remembering in PTSD is distinctive from comparable remembering in depression in triggering high physiological reactivity. Avoidance of remembering the event predicts attenuated physiological reactivity to critical event recall in depression