Brief Cognitive-Behavioral Therapy for Anxious Youth: Feasibility and Initial Outcomes

We developed and evaluated a brief (8-session) version of cognitive-behavioral therapy (BCBT) for anxiety disorders in youth ages 6 to 13. This report describes the design and development of the BCBT program and intervention materials (therapist treatment manual and child treatment workbook) and an initial evaluation of child treatment outcomes. Twenty-six children who met diagnostic criteria for a principal anxiety diagnosis of separation anxiety disorder, generalized anxiety disorder, and/or social phobia were enrolled. Results suggest that BCBT is a feasible, acceptable, and beneficial treatment for anxious youth. Future research is needed to examine the relative efficacy of BCBT and CBT for child anxiety in a randomized controlled trial.     

Show-That-I-Can (Homework) in Cognitive-Behavioral Therapy for Anxious Youth: Individualizing Homework for Robert

Cognitive-behavioral therapy (CBT) has been reviewed and described as an empirically supported treatment for anxious youth. One component of CBT is the use of out-of-session “Show That I Can” tasks (STIC; i.e., homework tasks). STIC tasks vary in content and are to be completed between sessions. We discuss homework in CBT for Robert, a 13-year-old boy with social anxiety. Robert experienced distressing anxiety participating in and giving presentations at school and was fearful of open-ended questions. Robert had difficulty maintaining conversations with peers and reported being preoccupied with a concern that he would say something “weird” or “stupid.” Robert avoided numerous situations, and his social anxiety affected his grades, social interactions, family, and quality of life. Robert’s initial homework tasks entailed (a) journaling and self-monitoring anxious feelings and thoughts, and (b) practicing relaxation skills. During the second half of treatment, Robert’s STIC assignments were exposure tasks, including (a) opinion discussion assignments, (b) participating in class, and (c) initiating conversations with children at the bus stop. The present discussion focuses on how homework was individualized and presented so that it was palatable and sensitive. Issues regarding out-of-session exposure tasks that elicit sufficient anxiety, resistance to high-level exposure tasks, and parent involvement are explored.     

A Cognitive-Behavioral Approach to Family Therapy

Although cognitive behavioral spectrum approaches with individual children are plentiful and demonstrate effectiveness, cognitive behaviorally oriented clinicians are frequently left to their own devices when it comes to treating families. Cognitive behavioral family therapy is a relatively recent development and there are precious few reports of its clinical use. This article presents a conceptual foundation and clinical rubrics for the practice of cognitive behavioral family therapy. Basic theoretical background information is presented and places the therapeutic processes and procedures in a proper context. Session structure in cognitive behavioral therapy is illustrated and the way it propels therapeutic momentum and adds focus to each session is explained. Rudimentary processes of self-monitoring, self-instruction, rational analysis, and behavioral enactment are described and augmented with case material. Finally, the conclusion offers directions for further theory building, research, and clinical practice.     

Queer Youth in Family Therapy

Trends in popular belief about same‐sex relationships have undergone noteworthy change in the United States over the last decade. Yet this change has been marked by stark polarizations and has occurred at varying rates depending upon regional, community, racial, religious, and individual family context. For queer youth and their families, this cultural transformation has broadened opportunities and created a new set of risks and vulnerabilities. At the same time, youth's increasingly open and playful gender fluidity and sexual identity is complicated by unique intersections of class, race, religion, and immigration. Effective family therapy with queer youth requires practitioner's and treatment models that are sensitive to those who bear the burden of multiple oppressions and the hidden resilience embedded in their layered identities. We present case examples of our model of family therapy which addresses refuge, supports difficult dialogs, and nurtures queerness by looking for hidden resilience in the unique intersections of queer youths' lives. These intersections provide transformational potential for youth, their families and even for family therapists as we are all nurtured and challenged to think more complexly about intersectionality, sexuality, and gender.     

Cognitive-Behavioral Therapy With An East Indian Family*

This article discusses the use of the cognitive-behavioral approach to family therapy with an immigrant Indian family residing in the United States. Issues of acculturation and the emancipation of a young adolescent female are addressed as conflicts arise between her and her parents. The use of cognitive-behavior therapy (CBT) is presented as a flexible mode of treatment because it allows for the modification of schemas in a way that is respectful to cultural underpinnings and allows the family the freedom to change in a manner that does not compromise their cultural values. Further discussion is directed toward the cultural variables that may be accommodated by the CBT approach and the elements that make the approach adaptable, particularly in cases involving Indian culture.The authors thank Eric Frey of Lehigh University for his assistance with the literature review.     

Gender Stereotypes in the Family Context: Mothers, Fathers, and Siblings

Gender stereotypes of children and their parents were examined. Participants included 355 three-year-old children, their one-year-old siblings, and their mothers and fathers. Families were selected from the Western region of the Netherlands. Implicit gender stereotypes were assessed with computerized versions of the Action Inference Paradigm (AIP; both child and parents) and the Implicit Association Test (parent only). Parental explicit gender stereotypes were measured with the Child Rearing Sex-Role Attitude Scale. Findings revealed that mothers had stronger implicit gender stereotypes than fathers, whereas fathers had stronger explicit stereotypes than mothers. Fathers with same-gender children had stronger implicit gender stereotypes about adults than parents with mixed-gender children. For the children, girls’ implicit gender stereotypes were significantly predicted by their mother’s implicit gender stereotypes about children. This association could only be observed when the AIP was used to assess the stereotypes of both parent and child. A family systems model is applicable to the study of gender stereotypes.     

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.     

Differential Effectiveness of Behavioral Parent-Training and Cognitive-Behavioral Therapy for Antisocial Youth: A Meta-Analysis

Extended the findings from previous meta-analytic work by comparing the effectiveness of behavioral parent-training (BPT) and cognitive-behavioral therapy (CBT) for youth with antisocial behavior problems. Youth demographic variables were also examined as potential moderators of the effectiveness of these 2 types of interventions. Thirty BPT studies and 41 CBT studies met inclusion criteria for this meta-analysis. The weighted mean effect size (ES) for all interventions was 0.40. Youth age was found to moderate the outcome of the 2 interventions, with BPT having a stronger effect for preschool and school-aged youth and CBT having a stronger effect for adolescents. The results also indicate that there may be systematic differences in the outcomes associated with BPT and CBT when the setting of the intervention is considered, suggesting the need to carefully consider the effect of setting in future research. This study also highlights the need for outcome research dealing with more diverse populations and the better classification of research participants on different developmental trajectories of antisocial behavior.     

The Role of Mothers and Fathers

The development of personality characteristics appears to differ by sex of child and role of parent, with interpersonal concerns tending to characterize mothers and instrumental concerns describing fathers. Using a semi-structured interview protocol and paper-and-pencil questionnaires, we examined the effects of parenting, as reported by middle-class high school senior boys and girls, on the development of two aspects of personality. Ego development and self-esteem both have demonstrated sex differences, with girls displaying more advanced ego development and boys displaying higher self-esteem. We expected that mothers, because of their greater interpersonal orientation, would influence the development of ego development more than would fathers, and that, based on past findings, the opposite-sex parent would exert the primary influence on self-esteem. While ego development was found to relate to more encouraging, warmer mothering in boys, it related weakly to mothering in girls. Boys and girls who perceived their cross-sex parent to be warm and supportive were found to have higher self-esteem.     

Single Fathers and Noncustodial Mothers:

Private practitioners will increasingly be called upon to meet the needs of single fathers raising children alone. One articular challenne will be to und&stand the relatGnship these fathers have with their &- wives, the mothers of the children they are raising. Information from a sample of 1,136 single fathers provides needed baseline data about visitation'patterns and the dynamics-of the continuing relationship between the father. the children. and the noncustodial mother. The benefits to the father of having the mother stay involved with the family are highlighted.     

完美主义及其认知-行为治疗研究

完美主义是一种深刻影响人格的心理特征,与心理病理学现象有极为密切的联系。完美主义已经引起了心理界的关注。从完美主义的定义出发,提出完美主义认知和行为特征,总结了完美主义的评估方法及完美主义与心理障碍的关系研究,最后对完美主义的认知-行为治疗的方法和步骤进行了阐述。     

完美主义及其认知——行为治疗研究

完美主义是一种深刻影响人格的心理特征,与心理病理学现象有极为密切的联系.完美主义已经引起了心理界的关注.从完美主义的定义出发,提出完美主义认知和行为特征,总结了完美主义的评估方法及完美主义与心理障碍的关系研究,最后对完美主义的认知一行为治疗的方法和步骤进行了阐述.     

Role of Comorbid Depression and Co-occurring Depressive Symptoms in Outcomes for Anxiety-Disordered Youth Treated with Cognitive-Behavioral Therapy

This study examined the role of comorbid depressive disorders (major depressive disorder or dysthymic disorder) and co-occurring depressive symptoms in treatment outcome and maintenance for youth (N = 72, aged 7–14) treated with cognitive-behavioral therapy for a principal anxiety disorder (generalized anxiety disorder, separation anxiety disorder, or social phobia). Hierarchical linear modeling examined treatment outcome and maintenance in terms of severity of the principal anxiety disorder. Results indicated that higher levels of child-reported depressive symptoms predicted less favorable treatment outcome. Higher levels of mother-reported depressive symptoms predicted less favorable treatment maintenance at a 1-year follow-up. Results suggest that co-occurring depressive symptoms play a role in effective treatment for anxiety-disordered youth and support the merits of treatment adaptations for these youth.     

Attention-Deficit/Hyperactivity Disorder Symptoms in Mothers and Fathers: Family Level Interactions in Relation to Parenting

Previous studies linking parent ADHD symptoms to parenting have typically focused on each parent individually. To provide a broader understanding of family context, in this study, levels of inattention and hyperactivity-impulsivity in mothers and fathers were examined, both individually and in combination, in relation to negative parenting and child-rearing disagreements. Two-parent families of 5 to 13 year old boys (126 with ADHD and 53 typically developing) participated. Parents reported their own ADHD symptoms and their perceptions of child-rearing disagreements. Parenting was measured using self-, partner-, and child-reports as well as observations. Controlling for child ADHD symptoms, inattention symptoms in fathers predicted parenting difficulties. For mothers, inattention symptoms were linked to parenting problems only when fathers also had high levels of inattention. In contrast, parenting was most problematic for both mothers and fathers in families in which fathers had higher and mothers had lower levels hyperactivity-impulsivity symptoms. These results remained essentially unchanged when child externalizing behavior and mother depression and hostility were controlled, but father depression reduced the significance of some interactions. The results highlight the importance of the match between father and mother levels of symptoms, and point to differential relations of parenting to inattention and hyperactivity-impulsivity symptoms in parents.     

Family Therapy with Unmarried African American Mothers and Their Adolescents

Almost two-thirds of African American births are to unmarried mothers, and these single parents are among the most economically vulnerable in the United States. The effects of chronic stressors such as poverty can compromise the ability of these mothers to parent effectively, particularly during the developmental period of adolescence, typically a stressful phase of parenting. This article describes a multidimensional family therapy (MDFT) approach to working with African American adolescents who have drug and/or behavior problems. It is maintained that addressing the intrapersonal functioning of African American single mothers is vital if they are to re-establish the attachment bonds necessary for the maintenance of essential parental influence in the lives of their adolescents. Through systematic attention to the parent as an individual, leading to a balance between self-care and care for others, parental supervision is more easily achieved and relational impasses between parent and adolescent more equitably resolved.