Empirical Relationships among Trauma Exposure, Anxiety Sensitivity, and Post Traumatic Stress Disorder

This review synthesized and critically reviewed empirical studies that assessed relationships among trauma exposure, anxiety sensitivity (AS), and Post Traumatic Stress Disorder (PTSD). Across the literature, the prominent theory conceptualized anxiety sensitivity as a causal risk factor within two competing models. One model posited that individuals with dispositionally high AS prior to experiencing a potentially traumatizing event (PTE) have a greater likelihood of developing PTSD after trauma exposure. The second model theorized that the introduction of a PTE raises an individual’s baseline level of AS, leading to the development and maintenance of PTSD symptoms. Emerging research highlighted the possibility of reciprocal relationships, as well as moderating and mediating variables (e.g., age, gender) that cause differential relationships among the variables of interest. The majority of studies to date used a cross-sectional study design, and primarily relied on a descriptive approach that solely highlighted correlations between AS and PTSD. Consequently, the current state of the literature is still unable to authoritatively discern whether AS causes PTSD, PTSD increases AS, or if the two variables have a bidirectional relationship. Accordingly, extant evidence has only demonstrated that AS is a variable risk factor for the development and maintenance of PTSD symptoms. Current limitations within the literature, clinical implications, and suggestions for future research are discussed.https://scholarscompass.vcu.edu/gradposters/1063/thumbnail.jp

Examining outcome variability: Correlates of treatment response in a child and adolescent anxiety clinic

Examined correlates of treatment response in a clinic providing cognitive-behavioral therapy for children with anxiety disorders. Youth (ages 7 to 15) with a primary Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev., or 4th ed.; American Psychiatric Association, 198

Retention and Mentoring (RAM) Initiative

National and local surveys (e.g., COACHE, 2010; VCU Great Place Initiative, 2013) suggest that a primary reason for workplace dissatisfaction among faculty and staff is lack of adequate mentorship. Evidence also suggests that mentoring programs improve recruitment and retention of underrepresented faculty and staff (e.g., Daley, Wingard, & Reznik, 2006). VCU and VCU Health currently have decentralized and isolated mentoring programs across campuses: a centralized mentoring program accessible to all employees does not exist to address faculty and staff professional development and networking needs. Our project sought to fill this gap. Specifically, we proposed to develop an online database designed to match mentors with mentees based on multiple criteria. Our goal was to address faculty and staff mentoring and professional development needs as a means to build a culture of connection to promote retention of employees

Treatment of child anxiety. an exploratory study of the role of maternal anxiety and behaviours in treatment outcome

Anxiety disorders are common among parents of anxious children and have been found to impede child treatment outcomes, yet it is unclear whether it is parental anxiety that needs to be targeted in therapy or associated parental behaviours. Twenty-two children (6-12 years) with a current anxiety disorder and their mothers received cognitive-behavioural treatment (CBT) for child anxiety. In addition, of the 12 mothers who met criteria for a current anxiety disorder, 6 received CBT for their own disorder. Assessments were made of the mother-child interaction. The main findings were: (1) children did less well from treatment where their mothers had a current anxiety disorder; (2) treatment of maternal anxiety disorder did not improve child treatment outcome; and (3) maternal overinvolvement and expression of fear was associated with child treatment outcome. The results suggest that in the context of maternal anxiety disorder, child treatment outcome may be improved by specifically targeting parenting behaviours. Copyright (C) 2008 John Wiley & Sons, Ltd

Does Cognitive Behavioral Therapy for Youth Anxiety Outperform Usual Care in Community Clinics? An Initial Effectiveness Test

Objective: Most tests of cognitive behavioral therapy (CBT) for youth anxiety disorders have shown beneficial effects, but these have been efficacy trials with recruited youths treated by researcher-employed therapists. One previous (nonrandomized) trial in community clinics found that CBT did not outperform usual care (UC). The present study used a more stringent effectiveness design to test CBT versus UC in youths referred to community clinics, with all treatment provided by therapists employed in the clinics. Method: A randomized controlled trial methodology was used. Therapists were randomized to training and supervision in the Coping Cat CBT program or UC. Forty-eight youths (56% girls, 8 to 15 years of age, 38% Caucasian, 33% Latino, 15% African-American) diagnosed with DSM-IV anxiety disorders were randomized to CBT or UC. Results: At the end of treatment more than half the youths no longer met criteria for their primary anxiety disorder, but the groups did not differ significantly on symptom (e.g., parent report, eta-square = 0.0001; child report, eta-square = 0.09; both differences favoring UC) or diagnostic (CBT, 66.7% without primary diagnosis; UC, 73.7%; odds ratio 0.71) outcomes. No differences were found with regard to outcomes of comorbid conditions, treatment duration, or costs. However, youths receiving CBT used fewer additional services than UC youths (χ21 = 8.82, p = .006). Conclusions: CBT did not produce better clinical outcomes than usual community clinic care. This initial test involved a relatively modest sample size; more research is needed to clarify whether there are conditions under which CBT can produce better clinical outcomes than usual clinical care.Psycholog

Physiological regulation of stress in referred adolescents: The role of the parent-adolescent relationship

Background: Psychopathology in youth appears to be linked to deficits in regulating affective responses to stressful situations. In children, high-quality parental support facilitates affect regulation. However, in adolescence, the role of parent-child interaction in the regulation of affect is unclear. This study examined physiological reactivity to and recovery from stress in adolescents at risk for psychopathology, and their associations with internalising and externalising problems and parent-adolescent interactions. Methods: A total of 99 adolescents (M = 13.57 years, SD= 1.83) with a history of mental health problems underwent the Alarm Stress Task and were reunited with their primary caregiver after the stressor, while the physiological responses of the parasympathetic (respiratory sinus arrhythmia) and sympathetic (pre-ejection period) systems were measured. The quality of parent-adolescent interaction was determined from observations of secure-base seeking and providing during the task. Affect regulation was measured as physiological reactivity and recovery after the stressor. Results: Adolescents with high levels of externalising problems and low levels of secure-base support showed weaker parasympathetic reactivity and recovery. Higher level of adolescent secure-base seeking was associated with stronger sympathetic reactivity and recovery. Conclusions: Secure-base interactions between parents and adolescents facilitate physiological regulation of stress, especially for adolescents with externalising symptomatology. © 2009 Association for Child and Adolescent Mental Health

Physiological reactivity to stress and parental support: Comparison of clinical and non-clinical adolescents

An Alarm Stress Task was developed to study affect regulation in the context of parent-child interactions in adolescents (mean age = 12.72, standard deviation = 2.06) with (n = 20) and without (n = 20) mental health problems. Changes in heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA) were used as indicators of affect regulation. HR increased, and PEP and RSA decreased significantly in reaction to a suggested failure on a simple task, indicating that this procedure induced affective arousal in adolescents. During reunion with the parent, RSA increased significantly. Support seeking on reunion was associated with stronger parasympathetic reactivity during stress and reunion, consistent with the model that the parasympathetic system is involved when affect is regulated by social engagement. Quality of parent-adolescent interactive behaviour was overall lower in the clinical sample. Individual and relationship-based processes of affect regulation may be simultaneously assessed, highlighting the continuing importance of the parent-child relationship in adolescence for affect regulation and mental health. Copyright © 2008 John Wiley & Sons, Ltd

Children and adolescents referred for treatment of anxiety disorders: differences in clinical characteristics

Background: Reports of the clinical characteristics of children and adolescents with anxiety disorders are typically based on community populations or from clinical samples with exclusion criterion applied. Little is known about the clinical characteristics of children and adolescents routinely referred for treatment for anxiety disorders. Furthermore, children and adolescents are typically treated as one homogeneous group although they may differ in ways that are clinically meaningful. Methods: A consecutive series of children (n = 100, aged 6-12 years) and adolescents (n = 100, aged 13-18 years), referred to a routine clinical service, were assessed for anxiety and comorbid disorders, school refusal and parental symptoms of psychopathology. Results: Children were significantly more likely to be diagnosed with separation anxiety disorder than adolescents. Adolescents with a primary anxiety disorder had significantly higher self and clinician rated anxiety symptoms and had more frequent primary diagnoses of social anxiety disorder, diagnoses and symptoms of mood disorders, and irregular school attendance. Limitations: Childhood and adolescence were considered categorically as distinct, developmental periods; in reality changes would be unlikely to occur in such a discrete manner. Conclusions: The finding that children and adolescents with anxiety disorders have distinct clinical characteristics has clear implications for treatment. Simply adapting treatments designed for children to make the materials more ‘adolescent-friendly’ is unlikely to sufficiently meet the needs of adolescents

Clinician and Parent Perspectives on Parent and Family Contextual Factors that Impact Community Mental Health Services for Children with Behavior Problems

The present study employed qualitative methods to examine multiple stakeholder perspectives regarding the role of parent and family contextual factors on community child mental health treatment for children with behavior problems. Findings suggest agreement between clinicians and parents on the number, types and importance of parent and family factors in children’s mental health services; however, stakeholders differed in reports of which factors were most salient. Specifically, clinicians endorsed most factors as being equally salient, while parents described a few salient factors, with parental stress and inadequate social support being the most frequently discussed. These qualitative data further elucidate the context of community services and have implications for evidence-based practice implementation and improving community care

Symptoms of social anxiety, depression and stress in parents of children with social anxiety disorder

Objectives: It has been suggested that elevated maternal social anxiety may play a disorder specific role in maintaining childhood Social Anxiety Disorder (SAD), but few studies have examined whether mothers of children with SAD are more socially anxious than mothers of children with other anxiety disorders (ANX). This study set out to examine whether symptoms of social anxiety were more severe amongst mothers of 7-12 year old children presenting for treatment with SAD (n=260) compared to those presenting with ANX (n=138). In addition, we examined whether there were differences between these two groups in terms of maternal and paternal general anxiety, depression and stress. Method: Parents of 7-12 year old children referred for treatment of SAD or ANX completed self-report questionnaire measures of emotional symptoms. Results: Compared to mothers of children with ANX, mothers of children with SAD reported significantly higher levels of social anxiety, general anxiety, and depression. In addition, fathers of children with SAD reported significantly higher levels of anxiety, stress and depression than fathers of children with ANX. Conclusions: This study is one of the few existing studies that have examined mothers’ and fathers’ psychopathology across different childhood anxiety disorders. Compared to parents of children with ANX, parents of children with SAD may have poorer mental health which may inhibit optimum child treatment outcomes for children with SAD. Thus, targeting parental psychopathology may be particularly important in the treatment of childhood SAD