Internet-delivered transdiagnostic and tailored cognitive behavioral therapy for anxiety and depression: a systematic review and meta-analysis of randomized controlled trials

Anxiety and depressive disorders are often comorbid. Transdiagnostic and tailored treatments seem to be promising approaches in dealing with comorbidity. Although several primary studies have examined the effects of Internet-delivered cognitive behavior therapy (iCBT) for anxiety and depression, no meta-analysis including different types of iCBT that address comorbidity has been conducted so far. We conducted systematic searches in databases up to 1 July 2016. Only randomized trials comparing transdiagnostic/tailored iCBT for adult anxiety and/or depression with control groups were included. Nineteen randomized trials with a total of 2952 participants that met inclusion criteria were analyzed. The quality of the studies was high, however the blinding criteria were not fulfilled. The uncontrolled effect size (Hedges’ g) of transdiagnostic/tailored iCBT on anxiety and depression outcomes was large and medium for quality of life. The controlled effect size for iCBT on anxiety and depression outcomes was medium to large (anxiety: g = .82, 95% CI: .58–1.05, depression: g = .79, 95% CI: .59–1.00) and medium on quality of life (g = .56, 95% CI: .37–.73). Heterogeneity was small (quality of life) to moderate (anxiety, depression). There was a large effect on generic outcome measures and a moderate effect on comorbidities. When compared to disorder-specific treatments there were no differences on anxiety and quality of life outcomes, however there were differences in depression outcomes. Transdiagnostic and tailored iCBT are effective interventions for anxiety disorders and depression. Future studies should investigate mechanisms of change and develop outcome measures for these interventions.     

Negative Halo Effects in Parent Ratings of ADHD and ODD

Parent ratings of ADHD and ODD symptoms depicted in written vignettes were examined for negative halo effects. Participants were 82 parents of children ages 6–12. Both unidirectional and bidirectional halo effects were found but to a lesser extent than in similar studies with teacher and college student raters. Specifically, parents were more likely to: (a) rate a child as inattentive in the presence of hyperactivity symptoms; (b) more likely to rate a child as oppositional in the presence of inattention and hyperactivity symptoms; and (c) more likely to rate a child as inattentive and hyperactive in the presence of oppositionality symptoms. Several specific symptoms were also found to be particularly susceptible to halo effects. Results suggest that parents may be more discerning raters of disruptive behavior disorders than teachers or college students and less prone to negative halo effects. Implications for clinical practice and future research directions are discussed.     

Understanding Strengths in Relation to Complex Trauma and Mental Health Symptoms within Child Welfare

Strengths can have a potent effect in mitigating the impact of trauma on mental health needs and functioning. Yet, evidence is limited on the role that strengths may have in ameliorating trauma-related or mental health symptoms over time. Providing a comprehensive assessment that includes strengths, as well as needs, is an important step in making appropriate service recommendations for youth in child welfare. This study assessed 7,483 children and adolescents entering an intensive stabilization program through the Illinois child welfare system. The interaction of individual, child strengths in relation to complex trauma exposure, traumatic stress symptoms, risk behaviors, and other mental health needs were examined. Results indicated strengths are relatively stable over time and inversely associated with several negative outcomes, including risk behaviors (?.32, p?<?.001), emotional/ behavioral needs (?.33, p?<?.001) and overall functioning (?.47, p?<?.001). Traumatic stress symptoms were also related to increases in these negative outcomes. Overall, strengths had a buffering effect on traumatic stress symptoms and outcomes over time. The role of strengths in relation to traumatic stress symptoms, however, was less consistent. Youth with histories of complex trauma exposure had significantly fewer useable strengths than youth without this exposure. However, strengths improved for both youth with and without complex trauma exposure over the course of stabilization services. These findings suggest that early identification and development of child strengths can mitigate risk-taking behaviors, mental health, and functional difficulties among youth in the child welfare system. Implications for more targeted trauma-informed and strengths-based assessment, and treatment/service planning are discussed.     

The role of treatment expectancy in youth receiving exposure-based CBT for obsessive compulsive disorder

The purpose of this investigation was to examine correlates of parent, child, and therapist treatment expectations and their role in the exposure-based treatment of childhood obsessive compulsive disorder (OCD). Treatment expectations were assessed among 49 youth with primary OCD, their parents, and therapists as part of the baseline evaluation and post-treatment clinical outcomes were determined by blind evaluators. Baseline depressive symptoms, child/parent-rated functional impairment, externalizing behavior problems, number of comorbid psychiatric disorders, and a lower perception of control were associated with lower pre-treatment expectations. Parent expectation was associated with parental OCD symptoms, child depressive symptoms and child-reported impairment. Therapist expectations inversely correlated with child depressive symptoms, externalizing problems, and child-rated impairment. Pre-treatment OCD severity and prior treatment history were not linked to expectancy. Finally, higher treatment expectations were linked to better treatment response, lower attrition, better homework compliance, and reduced impairment.     

Co-rumination predicts the onset of depressive disorders during adolescence

The tendency to co-ruminate, or frequently discuss and rehash problems with peers, may serve as one mechanism in the dramatic rise in depression observed during adolescence, particularly among adolescent girls. In the current study, our goal was (a) to test the hypothesis that adolescents' levels of co-rumination would predict the onset of clinically significant depressive episodes over a 2-year follow-up and (b) to determine whether levels of co-rumination would mediate gender differences in risk for depression onset. Both hypotheses were supported. Results of survival analysis revealed that adolescents with higher levels of co-rumination at the initial assessments exhibited a significantly shorter time to depression onset. Levels of co-rumination also mediated the gender difference in time to depression onset. These results were maintained even when adolescents' baseline levels of depressive symptoms and rumination were covaried statistically. Finally, co-rumination also predicted the course of illness in terms of episode severity and duration. Results suggest that co-rumination contributes a unique risk for the development of depression in adolescents.     

Mentoring Relationship Quality and Maltreated Children's Coping

Coping strategies are believed to protect against the harmful effects of maltreatment on children's psychosocial outcomes. Caregivers are thought to be critical in helping children develop adaptive coping strategies, yet many maltreated children have poor and/or insecure relationships with their parents. A quality relationship with a caring, non‐parental adult (e.g., a mentor), however, may be one strategy to promote healthy coping among maltreated children. Children (N = 154) in this study participated in a mentoring and skill‐based program for maltreated preadolescents placed in foster care. Hierarchical regression was used to assess the association between children's reports of their relationship with their mentor at the end of the intervention and four coping strategies (i.e., Active, Support‐seeking, Avoidance, and Distraction) 6 months following the intervention, while accounting for baseline coping strategies and other demographic factors. Above and beyond the covariates, better mentoring relationship quality was associated with children's greater use of Active and Distraction coping 6‐month post‐intervention. Mentoring relationship quality was not significantly associated with children's Avoidance or Support‐seeking coping. The findings suggest that mentoring programs may be a fruitful approach to improving vulnerable children's coping skills. Healthy coping is hypothesized to protect against the harmful effects of maltreatment and to promote resilience in the face of multiple stressors (Banyard & Williams, 2007 ; Boxer & Sloan‐Power, 2013; Cicchetti & Rogosch, 2009). It remains unclear, however, how best to promote positive coping among maltreated children, who are disproportionately exposed to numerous adverse childhood experiences (Raviv, Taussig, Culhane & Garrido, 2010). Theories of coping emphasize the importance of coping socialization through quality parent–child relationships (Kliewer et al., 2006; Skinner & Wellborn, 1994 ). Unfortunately, many maltreated children are exposed to poor quality and/or inadequate caregiving (Baer & Martinez, 2006), which may place them at risk for engaging in unhealthy or inappropriate forms of coping. It is reasonable to expect that positive relationships with other non‐parental adults (e.g., mentors) would affect coping behaviors given the positive impact that quality relationships have on a myriad of emotional and behavioral child outcomes (DuBois, Portillo, Rhodes, Silverthorn & Valentine, 2011; Keller & Pryce, 2012; Thomson & Zand, 2010 ). Because children in foster care often transition in and out of schools and home environments, a quality relationship with a mentor (a consistent presence in the child's life) may be well suited to promote healthy coping strategies.     

Using Behavioral Parent Training to Treat Disruptive Behavior Disorders in Young Children: A How-to Approach Using Video Clips

This article describes the application of a behavioral parent training program, Parent-Child Interaction Therapy (PCIT), in the treatment of behavior disorders in young children. PCIT is unique in that it works with both the child and parent in treatment and it focuses on improving the parent-child relationship as a means to improving parent and child behaviors and interactions with each other. A case illustration is provided and video components are included to highlight the procedures and concepts used in PCIT.     

Liar, liar: internet faking but not frequency of use affects social skills, self-esteem, social anxiety, and aggression.

Misuse of the Internet can affect various aspects of children's social lives. It was predicted that children who misrepresent themselves on the Internet would have less well-developed social skills, lower levels of self-esteem, and higher levels of social anxiety and aggression. The frequency of Internet use was also assessed. Students aged 11-16 years were recruited for the study from classes after obtaining consent. Questionnaires included a query of Internet behaviors, the Matson Evaluation of Social Skills with Youngsters Appropriate Social Skills and Inappropriate Assertiveness subscales, Rosenberg Self-esteem Scale, and the Social Anxiety Scale for Children-Revised. It was found that children who reported the most faking behavior on the Internet (e.g., pretending to be older) had poorer social skills, lower levels of self-esteem, higher levels of social anxiety, and higher levels of aggression. Frequency of use, however, did not affect these factors in the current study.     

Interracial contact and racial constancy: A multi-site study of racial intergroup bias in 3–5 year old Anglo-British children

This paper examined the influence of interracial contact and racial constancy on the racial intergroup bias of young Anglo-British children. This multi-site study was conducted in areas of Great Britain that varied in terms of racial diversity. The study also investigated whether preschool children express bias on positive, but not negative, valence attributions. Anglo-British children (N = 136) between 3 and 5 years of age with different levels of interracial contact undertook a racial stereotype attribution measure and three tasks to assess racial constancy. Significantly more racial bias was shown towards the African Caribbean-British compared to the Asian-British or Oriental-British racial out-groups. As predicted, only children in racially mixed areas failed to show discrimination in favor of the white in-group on both the positive and negative trait attributions. In addition, higher racial constancy was related significantly to greater racial intergroup bias. These findings suggest that racial intergroup bias amongst 3–5 year old children may be reduced through the promotion of interracial contact, because at this age children are already beginning to develop racial constancy.