The Unified Protocols for Children and Adolescents in Partial Hospitalization: Using Implementation Science Frameworks to Guide Adaptation

Partial hospitalization programs (PHPs) and other acute mental health treatment programs, which are becoming increasingly common, may help divert children and adolescents from inpatient psychiatric care and provide a concentrated dose of intervention to individuals living in low-resource areas. However, there have been relatively few examinations of the effectiveness of PHPs in addressing emotional concerns (e.g., anxiety, depression, irritability) and functional impairment in youth. Further, evidence-based treatments originally designed for delivery in an outpatient weekly format may require significant adaptation to be appropriate for delivery in acute mental health settings, which differ significantly from weekly outpatient care in program structure, patient acuity, and staffing. In this intervention development and adaptation report, we present the rationale for adapting a transdiagnostic approach to treating emotional disorders—the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A)—for a hospital-based, general psychiatric partial hospitalization program. We use implementation science frameworks to describe our iterative approach to treatment adaptation and testing and to describe in detail proactive, planned adaptations to the UP-C/A for partial hospitalization that occurred prior to initial implementation and pilot testing. Three case examples (child, preadolescent, adolescent) are presented to illustrate how a transdiagnostic approach to care such as the UP-C/A can be used intensively in an acute mental health setting to address emotional and behavioral concerns, including safety.     

Childhood Trauma Predicts Positive Expressive Suppression During Social Affiliation in Adults With Anxiety and/or Depression: Implications for Social Functioning

Experiencing childhood trauma (CT) can create barriers for developing relationships and is a risk factor for anxiety and depression. Expressive suppression (ES; i.e., reducing expression associated with experiencing emotions) might explain the link between CT and relationship formation difficulties. We examined the association between (1) CT and ES during a dyadic paradigm intended to facilitate connectedness between unacquainted partners and (2) ES and desire for future interaction (DFI). Individuals with an anxiety or depressive disorder diagnosis (N = 77) interacted with a trained confederate; partners answered a series of increasingly intimate questions about themselves. Participant ES for positive and negative emotions, and participant and confederate DFI were collected during the task. Participants completed global anxiety, depression, and CT measures. CT correlated with positive (r = .35, p = .002), but not negative, ES (r = .13, p = .273). In a multiple linear regression model, CT predicted positive ES beyond symptom variables and gender, β = .318, t = 2.59, p = .012. Positive ES correlated with participant (r = ?.38, p = .001) and confederate DFI (r = ?.40, p<.01); and predicted participant DFI beyond symptom variables and ethnicity, β = ?.358, t = ?3.18, p = .002, and confederate DFI, β = ?.390, t = ?3.51, p = .001, beyond symptom variables. Mediation analyses suggested positive ES accounted for the relationship between greater CT severity and less desire for future interaction from participants, 95%CI [?0.26, ?0.02], and confederates, [?0.38, ?0.01]. Positive ES may be an important factor in the reduced capacity to form new social relationships for individuals with a history of CT, anxiety, and depression.     

The Head,the Heart,and the Community: Piloting a Brief Home-Based Mindfulness Intervention for Couples With Low Income

Although mindfulness is documented to reduce both individual and relationship stress and has the flexibility to be taught anywhere (e.g., at home, clinic setting, etc.), research examining mindfulness interventions among individuals with low income and economic marginalization (LIEM; APA, 2019), or persons whose economic position negatively impacts their health or well-being due to factors such as access to healthcare, is limited. To address this gap, the author and colleagues used Community Based Participatory Research methods to develop a brief, couple-based, mindfulness intervention tailored for communities with LIEM (see Lenger et al., 2022). The present study tested this newly developed brief, couple-based, mindfulness intervention's effectiveness in improving individual and relationship health through 1- and 2-months post-intervention. The intervention was piloted on a sample of 39 couples with an overrepresentation of couples with LIEM. To improve access to care, couples could participate in their home or a variety of local clinics. Thirty-nine couples received the intervention and completed assessments on mindfulness, depression, anxiety, stress, relationship satisfaction, and communication at baseline, 1-month, and 2-months post-intervention. Results revealed that mindfulness, depression, and relationship satisfaction improved from baseline to 1-month post-intervention. Mindfulness improved at a greater rate for couples with LIEM relative to couples with higher incomes. From baseline to 2-months post-intervention, depression and stress significantly improved at similar rates for couples with higher income and couples with LIEM. Thus, this study indicates that mindfulness can be taught in a brief, two-session format, and can have favorable outcomes on individual and relationship functioning.     

COVID-19 lockdown anxiety harms newcomers' job satisfaction: A cross-lagged panel analysis during snap lockdowns in China

The COVID-19 pandemic may have been a difficult time to join a new organization. Drawing on the feelings-as-information theory, this study explores how COVID-19 lockdown anxiety influenced newcomers' job satisfaction during their first few months of work. We tested 357 new employees working in 84 cities across China. We conducted a longitudinal study, and participants were invited to complete the same survey at two time points. Cross-lagged panel analysis was conducted to test our hypotheses. We confirmed that COVID-19 lockdown anxiety at Time 1 predicted less job satisfaction at Time 2, whereas the data did not support the idea of reverse causality. These findings suggest public health crises like the pandemic can impact newcomers' job satisfaction, especially during China's Zero-Covid Policy.     

Framing COVID-19 as an existential threat predicts prejudice towards Chinese people via anxious arousal

We tested the hypothesis that perceived existential threat stemming from COVID-19 elicits anxious arousal, which can manifest in prejudice toward the perceived source of the threat (Chinese people). Americans (n = 474) were randomly assigned to a condition in which COVID-19 was framed as a high existential threat to the United States or to a condition in which COVID-19 was framed as a low existential threat to the United States. They then completed self-report measures of anxious arousal as well as subtle and blatant prejudice towards Chinese people. As expected, participants in the high threat (vs. low threat) condition reported greater anxious arousal which, in turn, predicted greater subtle and blatant prejudice. The high threat (vs. low threat) condition also indirectly predicted greater subtle and blatant prejudice via greater anxious arousal. Results advance knowledge on the reactions people had to perceiving COVID-19 as an existential threat during the early phase of the pandemic.     

Social Anxiety Among Adolescents: Linkages with Peer Relations and Friendships

This study examined the utility of modifying the Social Anxiety Scale for Children—Revised (SASC-R) for use with adolescents, and examined associations between adolescents' social anxiety (SA) and their peer relations, friendships, and social functioning. Boys (n = 101) and girls (n = 149) in the 10th through 12th grades completed the Social Anxiety Scale for Adolescents (SAS-A) and measures of social support, perceived competence, and number and quality of their best friendships. Factor analysis of the SAS-A confirmed a three-factor structure: Fear of Negative Evaluation, Social Avoidance and Distress in General, and Social Avoidance Specific to New Situations or Unfamiliar Peers. Girls reported more SA than boys, and SA was more strongly linked to girls' social functioning than boys'. Specifically, adolescents with higher levels of SA reported poorer social functioning (less support from classmates, less social acceptance), and girls with higher levels of SA reported fewer friendships, and less intimacy, companionship, and support in their close friendships. These findings extend work on the SASC-R to adolescents, and suggest the importance of SA for understanding the social functioning and close friendships of adolescents, especially girls.     

Compulsive checking and anxiety in a nonclinical sample: Differences in cognition,behavior, personality,and affect

This study addresses the question of why some highly anxious individuals exhibit excessive levels of compulsive checking behavior while other do not. To this end, nonclinical samples of compulsive checkers (n=19), (nonchecking) anxious controls (n=16), and (nonchecking) nonanxious controls (n=12) were compared on a variety of cognitive, behavioral, personality, and affective measures hypothesized to differentiate checkers from anxious controls. Results indicated that checkers exhibited higher levels of perfectionism and worry, and demonstrated greater cognitive impairment on the Wisconsin Card Sorting Test. Furthermore, performance and subjective experiences of performance appeared to be mediated by perfectionism and worry. Findings suggest that both personality and cognitive variables are important correlates of the form of anxiety-related symptomatology.     

Specific fears as predictors of generalized anxiety

Three hundred thirty-seven female undergraduates completed the Trait Form of the State-Trait Anxiety Inventory (STAI) and the Fear Survey Schedule-II (FSS) to determine if any specific fear factor was significantly related to STAI score. All fear factor scores and the total FSS-II score were significantly correlated with the STAI score and with each other. A stepwise regression procedure indicated that Factor 1, Fear of Social Interaction, accounted for 25.2% of the variance in STAI scores (p <.001), while Factor 4, of Negative Social Evaluation, accounted for an additional 1.8% of the variance (p <.01). The implications for theory, assessment, and intervention are discussed.     

家庭功能与学前儿童行为问题的关系:依恋回避和社交焦虑的多重中介作用

采用纵向的研究设计,对上海市两所公办幼儿园192名学前儿童进行为期一年半的追踪调查,探讨了家庭功能与学前儿童行为问题之间的关系以及依恋回避和社交焦虑的中介作用。结果发现：（1）家庭功能、依恋回避、社交焦虑和儿童行为问题之间存在两两相关;（2）家庭功能能够显著负向预测儿童行为问题;（3）依恋回避和社交焦虑分别在家庭功能和行为问题之间起独立中介作用;（4）依恋回避和社交焦虑在家庭功能和行为问题之间起序列中介作用。研究结果进一步揭示了家庭功能对学前儿童行为问题影响的内在机制。