Verhaltenstherapie bei Kindern und Jugendlichen mit Angststörungen: Behandlungsbedarf und Behandlungsmöglichkeiten

Zusammenfassung: Angststörungen des Kindes- und Jugendalters wurden über lange Zeit in der Forschung vernachlässigt. Aktuelle empirische Arbeiten zur Prävalenz und zum Verlauf von Angststörungen des Kindes- und Jugendalters belegen eindrücklich, dass (1) Angststörungen die häufigsten psychischen Störungen des Kindes- und Jugendalters sind, und (2) dass sie bedeutsame Risikofaktoren für die Entwicklung v.a. von Angststörungen, Depressionen und Substanzabhängigkeit/-missbrauch im Erwachsenenalter darstellen. Die jüngsten Entwicklungen in der Verhaltenstherapie der Angststörungen bei Kindern und Jugendlichen werden zunächst vorgestellt und die Ergebnisse einer Metaanalyse verhaltenstherapeutischer Studien zusammengefasst. Die Ergebnisse der Metaanalyse zeigen, dass Angststörungen im Kindes- und Jugendalter erfolgreich mit Verhaltenstherapie behandelt werden können. Die Katamnesedaten dokumentieren darüber hinaus, dass die Therapieerfolge über mehrere Jahre stabil bleiben. Beim Vergleich von individueller und Gruppentherapie sowie von kind- und familienzentrierter Therapie ergaben sich keine bedeutsamen Unterschiede bezüglich des Therapieerfolg

Bullying history and mental health In university students : the mediator roles of social support, personal resilience, and self-efficacy

Bullying victimization by peers is highly prevalent in childhood and adolescence. There is convincing evidence that victimization is associated with adverse mental health consequences. In contrast, it has been found that perpetrators suffer no adverse mental health consequences. These findings originate from Western countries such as Germany but have rarely been investigated in collectivistic societies such as China. Furthermore, it has been rarely studied whether positive intrapersonal characteristics (e.g., personal resilience and self-efficacy) and interpersonal positive resources (e.g., social support) may mediate the impact of bullying on mental health. The current study used a path analytic model to examine, firstly, whether previous bullying experiences (both victimization and perpetration) are associated with current positive and negative mental health in university students and, secondly, whether these influences are mediated by social support, resilience, and self-efficacy. The model was tested in 5,912 Chinese and 1,935 German university students. It was found that in both countries, higher victimization frequency was associated with lower levels of social support, personal resilience, and self-efficacy, which in turn predicted poorer mental health. Moreover, and only in China, perpetration was negatively associated with social support and personal resilience but not self-efficacy. In contrast, in the German sample, perpetration experience was found to enhance one's self-efficacy, and the later was associated with better mental health. The results support a mediation model in which social support, personal resilience, and self-efficacy partially mediate the influence of victimization on mental health in both countries. For the relationship between perpetration and mental health, self-efficacy was the only full mediator in Germany, whereas in China, both social support and personal resilience were partial mediators. In conclusion, peer victimization has adverse effects on mental health in both Germany and China. Only in China, however, is perpetration also associated with adverse mental health outcomes. In contrast, getting ahead by bullying in an individualistic society such as Germany is associated with increased self-efficacy and mental health. The differences found between an individualistic country and a collectivistic country have important implications for understanding and planning interventions to reduce bullying

Fehldiagnose Aufmerksamkeitsdefizit- und Hyperaktivitätssyndrom?: Empirische Befunde zur Frage der Überdiagnostizierung

Zusammenfassung: Sowohl unter Experten als auch in der Öffentlichkeit wird oft vermutet, dass das Aufmerksamkeitsdefizit- und Hyperaktivitätssyndrom (ADHS) überdiagnostiziert wird. Dennoch gibt es hierzu kaum empirische Befunde. Aktuelle Ergebnisse der hier dargestellten repräsentativen Befragung von Kinder- und Jugendpsychotherapeuten und -psychiatern liefern jedoch erstmals empirische Belege dafür, dass ADHS zu häufig diagnostiziert wird. Die Befunde zeigen, dass Jungen bei identischem Symptombild häufiger eine ADHS-Diagnose gestellt bekommen als Mädchen. Eine fälschliche ADHS-Diagnose zieht zudem die Empfehlung einer medikamentösen und psychotherapeutischen Behandlung nach sich. Als Erklärung für diese diagnostischen Fehlurteile wird diskutiert, dass Therapeuten - wie bei anderen Alltagsentscheidungen auch - in der Diagnosesituation Heuristiken einsetzen. Verbreitet sind dabei die Repräsentativitäts- und die Verfügbarkeitsheuristik. Eine klare Orientierung an Diagnosekriterien und die Anwendung standardisierter Befragungsinstrumente helfen, solche Fehler zu vermeide

Does the Vigilance-Avoidance Gazing Behavior of Children with Separation Anxiety Disorder Change after Cognitive-Behavioral Therapy?

Cognitive biases are of interest in understanding the development of anxiety disorders. They also play a significant role during psychotherapy, where cognitive biases are modified in order to break the vicious cycle responsible for maintaining anxiety disorders. In a previous study, the vigilance-avoidance pattern was shown in children with separation anxiety disorder (In-Albon et al. Journal of Abnormal Child Psychology 38:225-235, 2010). The exhibited avoidance pattern may be essential for the maintenance of the anxiety disorder. Therefore, in the present study we used eye tracking methodology presenting disorder specific pictures to examine possible changes in the vigilance-avoidance pattern in 18 children with separation anxiety disorder after cognitive-behavioral treatment (CBT) and 13 healthy controls. Results indicated that following treatment, the vigilance pattern of children with separation anxiety disorder reduced significantly. Thus, the vigilance-avoidance pattern can be modified by CB

Vigilance and Avoidance of Threat in the Eye Movements of Children with Separation Anxiety Disorder

The vigilance-avoidance attention pattern is found in anxious adults, who initially gaze more at threatening pictures than nonanxious adults (vigilance), but subsequently gaze less at them than nonanxious adults (avoidance). The present research, using eye tracking methodology, tested whether anxious children show the same pattern. Children with separation anxiety disorder or no mental disorder viewed pairs of pictures, while the direction of their gaze was tracked. Each picture pair showed one picture of a woman separating from a child, the other picture of a woman reuniting with a child. The results supported the vigilance-avoidance model in children. Although the two groups' gaze direction did not differ during the first second of viewing, anxious children gazed significantly more at separating (threatening) pictures than nonanxious children after a period of 1s. But after 3s the pattern reversed: anxious children gazed significantly less at the separating pictures than nonanxious childre

Gravitational lensing as folds in the sky

We revisit the gravitational lensing phenomenon using a new visualization technique. It consists in projecting the observers sky into the source plane, what gives rise to a folded and stretched surface. This provides a clear graphical tool to visualize some interesting well-known effects, such as the development of multiple images of a source, the structure of the caustic curves, the parity of the images and their magnification as a function of the source position.Comment: 11 pages, 8 figure

Erfahrungen bei der Haltung horntragender Milchkühe im Laufstall – Probleme und Lösungsansätze in der Praxis

Loose housing systems are commonly designed for cows without horns. Farmers keeping horned herds are facing increased risks of injuries among the cows. Interviews were carried out on farms with 62 horned dairy herds in order to collect practical evidence on problems and suitable measures related to the keeping of loose housed horned cows. Most farmers see the feeding area, the cubicles and the waiting area before milking as problem areas. A possibility to securely lock all cows in the feeding rack and an easy retreat from the rack is regarded important. The cubicles should offer an exit to the front, which can be used by cows when attacked from behind. Generous space allowances in the waiting area as well as in the whole stable were recommended. Regarding management measures which help to improve conditions in an existing stable, especially a number of adequate measures to integrate new cows into the herd were described by the farmers

Effect of hypoxia and hyperoxia on exercise performance in healthy individuals and in patients with pulmonary hypertension: A systematic review

Exercise performance is determined by oxygen supply to working muscles and vital organs. In healthy individuals, exercise performance is limited in the hypoxic environment at altitude, when oxygen delivery is diminished due to the reduced alveolar and arterial oxygen partial pressures. In patients with pulmonary hypertension, exercise performance is already reduced near sea level due to impairments of the pulmonary circulation and gas exchange and, presumably, these limitations are more pronounced at altitude. In studies performed near sea level in healthy subjects as well as in patients with pulmonary hypertension (PH) maximal performance during progressive ramp exercise and endurance of submaximal constant load exercise were substantially enhanced by breathing oxygen-enriched air. Both in healthy individuals and in PH-patients these improvements were mediated by a better arterial, muscular and cerebral oxygenation along with a reduced sympathetic excitation, as suggested by the reduced heart rate and alveolar ventilation at submaximal isoloads, and an improved pulmonary gas exchange efficiency, especially in patients with PH. In summary, in healthy individuals and in patients with pulmonary hypertension, alterations in the inspiratory PO2 by exposure to hypobaric hypoxia or normobaric hyperoxia reduce or enhance exercise performance, respectively, by modifying oxygen delivery to the muscles and the brain, by effects on cardiovascular and respiratory control and by alterations in pulmonary gas exchange. The understanding of these physiologic mechanisms helps counselling individuals planning altitude or air travel and prescribing oxygen therapy to patients with pulmonary hypertension

Effect of maternal panic disorder on mother-child interaction and relation to child anxiety and child self-efficacy

To determine whether mothers with panic disorder with or without agoraphobia interacted differently with their children than normal control mothers, 86 mothers and their adolescents (aged between 13 and 23years) were observed during a structured play situation. Maternal as well as adolescent anxiety status was assessed according to a structured diagnostic interview. Results showed that mothers with panic disorder/agoraphobia showed more verbal control, were more criticizing and less sensitive during mother-child interaction than mothers without current mental disorders. Moreover, more conflicts were observed between mother and child dyadic interactions when the mother suffered from panic disorder. The comparison of parenting behaviors among anxious and non-anxious children did not reveal any significant differences. These findings support an association between parental over-control and rejection and maternal but not child anxiety and suggest that particularly mother anxiety status is an important determinant of parenting behavior. Finally, an association was found between children's perceived self-efficacy, parental control and child anxiety symptom