51 research outputs found
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Performance-Based Cognitive Processing in Clinically Anxious Youths
Anxiety is distressing, impairing, and the most prevalent mental health problem in children and adolescents. Theoretical models implicate biases in cognitive processes as underlying the development and maintenance of anxiety disorders. Yet little work has been done to test theoretical models of information processing (IP) in clinically anxious youths. The present dissertation sought to examine relationships between youth anxiety and the basic cognitive processes of attention and interpretation using performance-based methodology. The aims of this investigation were to: 1) empirically test the IP model of youth anxiety, specifically whether biased interpretation statistically mediates the association between biased attention and anxiety symptoms, 2) unpack the components of interpretation (i.e., threat valence judgments, speed of responding) on a performance-based task of interpretation bias, and 3) probe the impact of comorbid depressive symptoms on these cognitive processes. Youths (N=26, ages 9 to 17) and their primary caregivers completed diagnostic interviews and a comprehensive self- report battery, and youths completed performance-based assessments of attention and interpretation. In this sample, attention bias towards threat was significantly associated with percentage of negative interpretations endorsed (r=.46, p=.019). However, attention was not significantly related to anxiety symptoms, and the indirect effect of attention on anxiety through interpretation was not statistically significant. Negative interpretations of ambiguous information strongly predicted youth anxiety symptom severity, accounting for 46% of variance in clinician-rated anxiety severity. Deconstructing interpretation into its components, youth response latencies on the interpretation task as measured by threat and benign reaction time indices were not significantly associated with attention. Percentage of negative interpretations endorsed (r=.68, p<.001) and response latencies on the interpretation threat reaction time index (r=.45, p=.022) were significantly related to anxiety severity. Conversely, response latencies on the benign interpretation reaction time index were not related to anxiety. Finally, depressive symptoms were not significantly related to attention or to any of the components of interpretation assessed in this sample of clinically anxious youths. These findings provide preliminary evidence for a relationship between attention and interpretation biases, and stronger evidence for a relationship between interpretation bias and anxiety. Clinical and theoretical implications of this study are discusse
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Attention Bias and Anxiety: The Moderating Effect of Sociocultural Variables in Rural Latinx Youth.
Attention bias confers risk for anxiety development, however, the influence of sociodemographic variables on the relationship between attention bias and anxiety remains unclear. We examined the association between attention bias and anxiety among rural Latinx youth and investigated potential moderators of this relationship. Clinical symptoms, demographic characteristics, and a performance-based measure of attention bias were collected from 66 rural Latinx youth with clinical levels of anxiety (33.3% female; Mage = 11.74; 92.4% Latinx, 7.6% Mixed Latinx). No moderating effects for age or gender were found. Youth below the poverty line displayed an attention bias away from threat in comparison to youth above the poverty line, who displayed an attention bias towards threat. Among youth below the poverty line, this bias away from threat was associated with increased anxiety. Findings highlight the importance of economic adversity in understanding the relationship between attention bias and anxiety
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Targeted Family Intervention for Complex Cases of Pediatric Obsessive-Compulsive Disorder: A Randomized Controlled Trial
ObjectiveAlthough evidence-based treatments for pediatric obsessive-compulsive disorder (OCD) exist, many youth fail to respond, and interventions tailored to the needs of specific subsets of patients are lacking. This study examines the efficacy of a family intervention module designed for cases of OCD complicated by poor family functioning.MethodParticipants were 62 youngsters aged 8 to 17 years (mean age = 12.71 years; 57% male; 65% white) with a primary diagnosis of OCD and at least 2 indicators of poor family functioning. They were randomized to receive 12 sessions of individual child cognitive-behavioral therapy (CBT) plus weekly parent psychoeducation and session review (standard treatment [ST]) or the same 12 child sessions plus 6 sessions of family therapy aimed at improving OCD-related emotion regulation and problem solving (positive family interaction therapy [PFIT]). Blinded raters evaluated outcomes and tracked responders to 3-month follow-up.ResultsCompared to ST, PFIT demonstrated better overall response rates on the Clinician Global Impression-Improvement scale (CGI-I; 68% versus 40%, p = .03, φ = 0.28) and rates of remission (58% PFIT versus 27% ST, p = .01, φ = 0.32). PFIT also produced significantly greater reductions in functional impairment, symptom accommodation, and family conflict, and improvements in family cohesion. As expected, these shifts in family functioning constitute an important treatment mechanism, with changes in accommodation mediating treatment response.ConclusionPFIT is efficacious for reducing OCD symptom severity and impairment and for improving family functioning. Findings are discussed in terms of personalized medicine and mechanisms of change in pediatric OCD treatment. Clinical trial registration information-Family Focused Treatment of Pediatric Obsessive Compulsive Disorder; http://clinicaltrials.gov/; NCT01409642
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Improvement in anxiety and depression symptoms following cognitive behavior therapy for pediatric obsessive compulsive disorder
Pediatric obsessive-compulsive disorder (OCD) co-occurs frequently with other mental health conditions, adding to the burden of disease and complexity of treatment. Cognitive behavioral therapy (CBT) is efficacious for both OCD and two of its most common comorbid conditions, anxiety and depression. Therefore, treating OCD may yield secondary benefits for anxiety and depressive symptomatology. This study examined whether anxiety and/or depression symptoms declined over the course of OCD treatment and, if so, whether improvements were secondary to reductions in OCD severity, impairment, and/or global treatment response. The sample consisted of 137 youths who received 12 sessions of manualized CBT and were assessed by independent evaluators. Mixed models analysis indicated that youth-reported anxiety and depression symptoms decreased in a linear fashion over the course of CBT, however these changes were not linked to specific improvements in OCD severity or impairment but to global ratings of treatment response. Results indicate that for youth with OCD, CBT may offer benefit for secondary anxiety and depression symptoms distinct from changes in primary symptoms. Understanding the mechanisms underlying carryover in CBT techniques is important for furthering transdiagnostic and/or treatment-sequencing strategies to address co-occurring anxiety and depression symptoms in pediatric OCD
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Disentangling Reward Processing in Trichotillomania: ‘Wanting’ and ‘Liking’ Hair Pulling Have Distinct Clinical Correlates
Trichotillomania (TTM; hair-pulling disorder) is characterized by an irresistible urge or desire to pull out one's own hair, and a sense of pleasure when hair is pulled out. Evidence from translational neuroscience has shown that 'wanting' (motivation to seek a reward) and 'liking' (enjoyment when reward is received) are each mediated by overlapping but distinct neural circuitry, and that 'wanting' contributes to addictive/compulsive behaviors more so than 'liking'. In the present study, we developed the Hair Pulling Reward Scale (HPRS), a self-report measure that consists of two subscales designed to assess (a) cue-triggered urges and appetitive motivation to pull hair (i.e., putative correlates of 'wanting'), and (b) momentary pleasure and gratification during pulling episodes (i.e., putative correlates of 'liking'). We administered the HPRS to 259 individuals with TTM and examined its psychometric properties. Confirmatory factor analysis supported a two-factor model reflecting correlated Wanting and Liking scales. Consistent with predictions, Wanting, much more than Liking, had robust correlations with TTM severity, impulsiveness, difficulties in emotion regulation, psychiatric symptoms, and sleep dysfunction. The results suggest that the HPRS is a psychometrically sound instrument that can be used as a symptom-level measure of reward processing in TTM
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