A Unified,Transdiagnostic Treatment for Adolescents With Chronic Pain and Comorbid Anxiety and Depression

Chronic pain disorders represent a significant public health concern, particularly for children and adolescents. High rates of comorbid anxiety and unipolar mood disorders often complicate psychological interventions for chronic pain. Unified treatment approaches, based on emotion regulation skills, are applicable to a broad range of emotional disorders and suggest the possibility of extending these interventions to chronic pain and pain-related dysfunction. This case report describes the use of a unified protocol for treatment of an adolescent boy with chronic daily headache and social anxiety and an adolescent girl with whole body pain and depression. Following weekly, 50-minute individual treatment sessions, the boy demonstrated notable improvement in emotional symptoms, emotion regulation skills, somatization, and functional disability. The girl showed some improvement on measures of anxiety and depression, although there appeared to be a worsening of pain symptoms and somatization. However, both patients demonstrated improvement over follow-up. This case study illustrates the potential utility of a unified treatment approach targeting pain and emotional symptoms from an emotion regulation perspective in an adolescent population.     

Mindfulness-Based Approaches with Children and Adolescents: A Preliminary Review of Current Research in an Emergent Field

Interest in applications of mindfulness-based approaches with adults has grown rapidly in recent times, and there is an expanding research base that suggests these are efficacious approaches to promoting psychological health and well-being. Interest has spread to applications of mindfulness-based approaches with children and adolescents, yet the research is still in its infancy. I aim to provide a preliminary review of the current research base of mindfulness-based approaches with children and adolescents, focusing on MBSR/MBCT models, which place the regular practice of mindfulness meditation at the core of the intervention. Overall, the current research base provides support for the feasibility of mindfulness-based interventions with children and adolescents, however there is no generalized empirical evidence of the efficacy of these interventions. For the field to advance, I suggest that research needs to shift away from feasibility studies towards large, well-designed studies with robust methodologies, and adopt standardized formats for interventions, allowing for replication and comparison studies, to develop a firm research evidence base.     

Applying a Transdiagnostic Cognitive-Behavioral Treatment to Adolescents at High Risk for Serious Mental Illness: Rationale and Preliminary Findings

Given the chronic and deleterious course of serious mental illness (SMI; schizophrenia and bipolar disorder), significant efforts have been undertaken to improve prediction of SMI and provide treatment for adolescents in the early, putatively prodromal stage of these illnesses. While risk assessments and disorder-specific treatments for adolescents at risk for SMI have shown some efficacy, significant issues remain around disorder-specific treatments for these youth. There is substantial heterogeneity of psychopathology within adolescents at high risk for SMI that leads to many false-positives and varying diagnostic outcomes. As a result, initial treatment focusing on broad symptoms and skills has been proposed in place of disorder-specific treatments. We discuss the rationale for providing an already-developed and empirically supported transdiagnostic treatment for emotional disorders (termed the Unified Protocol) as a first-line staging of treatment for adolescents experiencing early SMI symptoms. Additionally, we outline the open trial we are piloting using this transdiagnostic treatment in adolescents between the ages of 13 – 17 who have begun experiencing distressing yet subsyndromal psychosis or bipolar mood symptoms. Preliminary findings suggest feasibility and acceptability as well as initial efficacy in improving psychiatric symptoms, quality of life, and difficulties regulating emotions. We also present case studies from our open trial. A unified, cognitive-behavioral treatment for early presentations of SMI has important clinical and public health benefits, including streamlining treatment and providing broad skills that are applicable to a wide range of psychopathology.     

Development and Implementation of a Transdiagnostic,Stepped-Care Approach to Treating Emotional Disorders in Children via Telehealth

Stepped-care interventions may increase the accessibility of evidence-based treatments but remain relatively underexplored in the child mental health literature. Further, while the feasibility and efficacy of stepped-care interventions have been examined for specific diagnoses or classes or disorders, transdiagnostic stepped-care interventions have not yet been developed. We discuss the development and initial implementation of a transdiagnostic approach to emotional disorders using the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C; Ehrenreich-May et al., 2018). A case series is presented to illustrate the delivery of UP-C stepped care (UPC-SC) via telehealth, using a collaborative decision-making process to inform step-up/step-down decisions. Lessons learned are discussed to guide refinements of UPC-SC and inform a larger trial.     

Correction to: A Family Socialization Model of Transdiagnostic Risk for Psychopathology in Preschool Children

Research on Child and Adolescent Psychopathology - A correction to this paper has been published: https://doi.org/10.1007/s10802-021-00812-1     

儿童功能性躯体化症状研究述评

功能性躯体化症状(Functional-somatic Symptoms, FSS)是指无法用医学知识解释, 或经医学治疗后无改善的躯体不适症状, 多发于儿童和青少年群体, 常伴随焦虑、抑郁等心理障碍共同发生。儿童FSS的发病受多方因素的影响, 包括社会文化、年龄、性别、家庭环境、生理易感性等。各个心理学流派从不同视角提出了儿童FSS的心理理论模型。心理干预, 尤其是认知行为疗法和放松–生物反馈疗法对治疗儿童FSS有较好的效果。     

Adaptation of Transdiagnostic CBT for Turkish Adolescents: Examples From Culturally Adapted Multiplex CBT

The present article illustrates how cognitive-behavioral therapy (CBT) was adapted for an adolescent Turkish population with mood and anxiety disorders. The resulting 10-session treatment—based on multiplex CBT—was efficacious in a treatment trial, showing large effect sizes (Acarturk et al., 2018). This paper discusses the cultural grounding of CBT, which increases effectiveness by such means as increasing acceptability and positive expectancy. We describe a culturally sensitive assessment measure of somatic complaints and cultural syndromes, the Turkish Symptom and Syndrome Addendum. We discuss how, in a culturally sensitive way, we normalized symptoms, conducted interoceptive exposure, and created positive reassociations to sensations. We describe how we used Turkish metaphors and religious ideas to teach CBT principles. We show how we adapted mindfulness and “loving kindness” for a Turkish population, and how we utilized transition “rituals” at the end of the treatment to give a sense of closure and a positive feeling of transformation. Two case examples are provided to further illustrate how we adapted multiplex CBT to a Turkish adolescent population.     

Defense Mechanisms Development in Children,Adolescents, and Late Adolescents

To replicate and extend Cramer's (1987) original cross-sectional study concerning the development of defense mechanisms, the Thematic Apperception Test responses of 148 students in Grades 2, 5, 8, 11, and college freshmen were collected and scored for denial, projection, and identification using Cramer's Defense Mechanisms Manual (1991). Our results supported the notion that the relative use of denial and projection decreases and identification increases as a function of grade level. The findings provide additional support for the psychoanalytic view (Freud, 1966) of an ontogenetic developmental line of defense.     

A Family Socialization Model of Transdiagnostic Risk for Psychopathology in Preschool Children

Research on Child and Adolescent Psychopathology - This longitudinal study examined the presence of general (P) and specific internalizing (INT) and externalizing (EXT) psychopathology factors in a...     

Introduction to the Special Issue on the Utility of Transdiagnostic Approaches for Developing Novel Interventions for Substance and Behavioural Addictions

Neuropsychology Review -     

Characteristics of Children and Adolescents Admitted to a Residential Treatment Center

Studies of youths in residential treatment that utilize systematic assessments and validated measures are rare. We examined psychopathology, family characteristics, occurrence of physical or sexual abuse, types of aggressive behavior, hyperactive/impulsive behavior, medical and neurological problems, and self-reported drug and alcohol use in 397 youth who were assessed using reliable measures and consecutively treated in a residential treatment center. Results indicate high rates of internalizing and externalizing psychopathology, aggressive behavior, and consistent gender differences, with girls having higher levels of internalizing and externalizing psychopathology and aggressive behavior. The sample was characterized by high rates of medical problems including asthma, seizures, and obesity, as well as evidence of extensive family dysfunction, including high rates of parental alcohol use, violence, and physical or sexual abuse. Residential treatment needs to progress beyond the one size fits all approach and develop more specific and empirically proven treatments for the specific needs of this population.     

An Inhibitory Learning Approach to Cognitive-Behavioral Therapy for Children and Adolescents

Although exposure-based cognitive-behavioral therapy (CBT) is efficacious for childhood anxiety and obsessive–compulsive disorder (OCD), many youth do not adequately respond to treatment. Extinction learning is an important process in exposure-based CBT. However, youth with anxiety disorders and OCD exhibit impairments in extinction processes that are best characterized by deficits in inhibitory learning. Therefore, the utilization of strategies to optimize inhibitory learning during exposures may compensate for these deficits, thereby maximizing extinction processes and producing more robust treatment outcomes for exposure-based CBT. This paper reviews several strategies to optimize inhibitory learning in youth with anxiety disorders and OCD, and presents practical examples for each strategy. This paper also highlights the difference between inhibitory learning-based exposures and prior conceptual approaches to exposure therapy in clinical practice. It concludes with a discussion of future directions for clinical research on inhibitory learning and exposure-based CBT in youth.     

Spirituality and Loss: Approaches for Counseling Grieving Adolescents

The death of a loved one has serious implications for adolescent growth and development. The authors review relevant research on the grief process and spirituality in adolescence, and they give a rationale for integrating spirituality into adolescent grief work. By way of a case illustration, they draw implications for counselors’ use of spirituality in addressing adolescent grief.     

Irritability in Children and Adolescents With OCD

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7–17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed.     

Brief Rorschach Records With Children and Adolescents

In order to determine the frequency with which children and adolescents give brief Rorschach ( R < 14) records and to test the hypothesis that brief records represent a resistance to testing, the psychological evaluations of 439 admissions to an inpatient unit were reviewed. Of the records reviewed, 16.6% were found to contain less than 14 responses. When the complete test protocols of those subjects who provided brief records were compared with those of a matched group, it was found that the group with brief records failed to complete the other parts of the evaluation significantly more often than did those subjects who did not give brief records. There was no significant difference between the two groups on IQ scores or on self-report scores of depression, anxiety, and social desirability. Results are interpreted as supporting Exner's (1988) hypothesis that brief records represent a form of resistance to being tested.