Parent–child interactions and adolescent anxiety: a systematic review

Abstract Parental behaviours have been implicated in the development and maintenance of anxiety in children and young people; however the degree to which findings apply to adolescents specifically remains unclear. We conducted a systematic review of studies examining the evidence for an association between parental behaviours and adolescent anxiety. Twenty two studies were identified. The results of this systematic review provide fairly consistent preliminary evidence for an association between anxiety and perceived parental control and anxious rearing in adolescence. The findings relating to an association between adolescent anxiety and perceived parental rejection and lack of warmth are somewhat less consistent. Methodological shortcomings in the studies mean that these results should be interpreted with caution. Future research should be conducted using observational and experimental design with adolescents from referred, clinical populations to help identify the critical parental processes and clarify the direction of effects

Secondary school teachers' experiences of supporting mental health

Teachers are often the first contact for students with mental health difficulties. They are in an ideal position to identify students who are struggling and frequently support them using different approaches and techniques. This qualitative study aims to investigate secondary school teachers' experiences of supporting the mental health of their students. 7 secondary school teachers from state-funded schools in the UK participated in face-to-face semi structured interviews. Interpretative phenomenological analysis was used to understand and structure the data into themes. Five superordinate themes emerged from the data analysis: Perceived role of teacher, nature of relationship, barriers to helping the child, amount of training and resource, and helplessness and satisfaction. Participants described the lack of training, resource and clarity about their role to be causes of frustration. Internal and environmental factors often influenced participants' feelings of helplessness. The findings from this study cannot be readily generalised to the wider population due to the nature of qualitative interviews. This study has led to a greater understanding of the experiences of teachers within a school setting. It is crucial that mental health training for teachers directly meets their needs and abilities. This paper finds value in recognising the lived experience and difficulties faced by teachers supporting students' mental health problems. A theoretical model is presented based on this analysis that can help inform best practice for schools

Protocol for a randomised controlled feasibility study examining the efficacy of brief cognitive therapy for the treatment of panic disorder in adolescents (PANDA)

Background: Panic disorder occurs in between 1-3% of adolescents, is associated with high levels of co-morbidity, and without treatment, appears to have a chronic course. To improve access to effective psychological interventions, briefer versions of cognitive behaviour therapy (CBT) have been developed and evaluated for pre-adolescent children with anxiety disorders. However, there are currently no brief evidence-based CBT interventions for adolescents with anxiety disorders that can be delivered in less than eight sessions. Given that a brief version of cognitive therapy has been shown to be effective in adults with panic disorder, it is possible that an adapted version could be effective for adolescents with panic disorder. Methods: The study will examine whether a definitive trial can be conducted, based on a single centre feasibility randomised controlled trial using several well-defined criteria. Between 30-48 young people (age 11-18 years) who meet diagnostic criteria for panic disorder, attending a routine clinical service, will be randomly allocated to receive either (i) brief cognitive therapy, or (ii) a general form of CBT treatment that is more commonly used for adolescents with anxiety disorders. Both will be delivered 1:1 by a therapist and involve five treatment sessions and two booster sessions. Young people’s outcomes will be assessed at the end of treatment and at 3 month follow up, and qualitative interviews will be conducted to examine acceptability. We will also explore outcomes 1-year after the completion of treatment. Discussion: This study will test the feasibility of a randomised controlled trial to compare brief cognitive therapy to a general form of CBT for adolescents with panic disorder in the UK. The outputs from the study will provide a clear indication of the feasibility of a future definitive trial and, if indicated, the critical resources that will be required and key information to inform the design and maximise the successful completion of the trial. This has the potential to bring direct benefits to young people and their families, as well as services and society more broadly

A randomized controlled trial of internet-delivered cognitive behaviour therapy for adolescent anxiety disorders in a routine clinical care setting with and without parent sessions

Background: Computerized treatments have been shown to be effective in young people with anxiety disorders within research settings. The aims of this study were to evaluate a self-completed, therapist-supported online treatment for adolescent anxiety disorders in a routine clinical care setting, and examine whether additional sessions for parents improved treatment outcome. Method: 60 adolescents (13-18 years) referred by primary and secondary care services for treatment of an anxiety disorder and their parent(s) were randomly allocated to begin treatment immediately or after a 16-week waitlist. Half the parents (receiving treatment immediately or after a waitlist) were allocated to receive sessions themselves. Assessments were conducted pre- and post-treatment and at 6-month follow-up. Results: There was no significant difference post-treatment between the immediate treatment and waitlist groups in remission of primary anxiety disorder (Odds Ratio (OR) = 2.19, 95% CI 0.72-6.70). Parent sessions did not significantly improve adolescent outcomes immediately or at 6-month follow-up (OR = 0.75, 95% CI 0.26-2.15; OR = 1.14, 95% CI 0.42-3.15). Conclusions: Within a routine clinical care setting, a therapist-supported online treatment failed to deliver significantly better outcomes for adolescents with anxiety disorders than a waitlist. Further research is needed to develop more effective treatments for this population

Why do children and adolescents (not) seek and access professional help for their mental health problems? A systematic review of quantitative and qualitative studies

Mental health disorders in children and adolescents are highly prevalent yet undertreated. A detailed understanding of the reasons for not seeking or accessing help as perceived by young people is crucial to address this gap. We conducted a systematic review (PROSPERO 42018088591) of quantitative and qualitative studies reporting barriers and facilitators to children and adolescents seeking and accessing professional help for mental health problems. We identified 53 eligible studies; 22 provided quantitative data, 30 provided qualitative data, and one provided both. Four main barrier/facilitator themes were identified. Almost all studies (96%) reported barriers related to young people’s individual factors, such as limited mental health knowledge and broader perceptions of help-seeking. The second most commonly (92%) reported theme related to social factors, for example, perceived social stigma and embarrassment. The third theme captured young people’s perceptions of the therapeutic relationship with professionals (68%) including perceived confidentiality and the ability to trust an unknown person. The fourth theme related to systemic and structural barriers and facilitators (58%), such as financial costs associated with mental health services, logistical barriers, and the availability of professional help. The findings highlight the complex array of internal and external factors that determine whether young people seek and access help for mental health difficulties. In addition to making effective support more available, targeted evidence-based interventions are required to reduce perceived public stigma and improve young people’s knowledge of mental health problems and available support, including what to expect from professionals and services

The relationship between dissociation and panic symptoms in adolescence and the exploration of potential mediators

Background: Dissociative experiences have been linked to panic symptoms in adolescents, yet the nature of the association remains unclear. Methods: In the present study, we investigated the longitudinal relationship between dissociative experiences (focusing on the felt sense of anomaly subtype) and panic, as well as the potential mediating roles of emotion regulation strategies (expressive suppression and cognitive reappraisal), alexithymia, and cognitive appraisals of dissociation. Four thousand five hundred one adolescents aged 13–18 years were recruited via social media advertising to take part in an online survey at two timepoints, 1 month apart. Results: Analysis of 421 datasets found a significant positive relationship between initial dissociative experiences and panic symptoms reported 1 month later. This was mediated by the emotion regulation strategy of cognitive reappraisal, and cognitive appraisals of dissociation. These two variables were no longer significant mediators when controlling for panic symptoms at the first time point, likely due to the stability of panic symptoms across both assessments. Neither alexithymia nor expressive suppression were significant mediators. Conclusions: Thus, dissociative experiences that are persistently misinterpreted in a catastrophic manner may lead to escalating anxiety and panic symptoms, which could in turn heighten and maintain the feared dissociation sensation. These results indicate that dissociative experiences are associated with panic symptoms in adolescence, with cognitive appraisals of dissociation and cognitive reappraisal playing a role in this relationship

Secondary school educational practitioners' experiences of school attendance problems and interventions to address them: a qualitative study

School attendance problems are associated with a range of adverse consequences, and educational practitioners play a role in identifying and responding to attendance problems. This qualitative study explored educational practitioners’ experiences of working with students with attendance problems and interventions to address them. Focus groups were conducted with sixteen practitioners across three secondary schools. Data were analysed using thematic analysis. Attendance problems were considered resource-intensive and emotionally challenging. Practitioners expressed difficulty understanding causes, although individual/family factors were emphasised over school factors. A range of interventions were described, including adaptations to school context and providing emotional support. Views on punitive approaches were mixed. Individualised interventions implemented at the first sign of problems, and a team approach, were considered important. Findings highlight the important role of educational practitioners in identifying attendance problems and implementing interventions. Recommendations include early intervention, team-work, and emotional support for students with, and staff responding to, attendance problems

Supporting students’ mental health in schools: what do teachers want and need?

There is a growing expectation in the UK for teachers to have an understanding of common mental health problems in young people. This study aims to identify the training needs of secondary school teachers to enable them to adequately support and educate their students around mental health. Nine focus groups, each with between four to eight participants, were conducted with secondary school teachers in the UK. Discussions were centred on the needs and wants of teachers in terms of mental health training, provision and advice. Participants were also shown three online resources as an example of existing training. Thematic analysis was used to structure the data. Participants wanted training on how to identify and provide early support for students who are struggling, without taking on the perceived role of a therapist. Participants also emphasised the strong need for practical, interactive and expert-led training that provides resources that can be adapted to individual settings. Implications and recommendations are discussed