Journal of Experimental Psychopathology

Features of impulsivity and compulsivity are involved in PG phenomenology, and a large body of literature investigated these aspects primarily using clinical observations and self-report questionnaires. Moreover, cognitive measures of motor inhibition and decision-making abilities may represent promising endophenotypic indicators of behavioural regulation, and deficits in these functions are hypothesised to be implicated in PG. In light of the importance of integrating subjective and objective indicators in psychodiagnostic assessment, the present review will consider findings on phenotypic and endophenotypic indicators of impulsivity and compulsivity in PG. Furthermore, the two main theoretical models proposed for PG will be discussed. An in-depth understanding of the role played by impulsivity and compulsivity within PG is indeed necessary to address diagnostic and treatment issues.

In this paper, we review the area of anxiety in children under the age of 11 years. We explore the literature examining the continuity of anxiety symptoms and behavioral inhibition when they appear in children of this age, and show that when these are present, there is a high likelihood of significant anxiety in later childhood, adolescence, and beyond. We then focus on the growing area of treatment research. We show that there are a number of promising new avenues for managing anxiety disorders in this young age group. Many of these interventions involve a key role for parents in the treatment process, but others have demonstrated success employing modified cognitive behavior therapy directed at the child. Limitations to the conclusions, caused by the limited amounts research, small sample sizes and significant methodological difficulties, are discussed.

Parental behaviours have been implicated in the development and maintenance of anxiety in children and young people; however the degree to which findings apply to adolescents specifically remains unclear. We conducted a systematic review of studies examining the evidence for an association between parental behaviours and adolescent anxiety. Twenty two studies were identified. The results of this systematic review provide fairly consistent preliminary evidence for an association between anxiety and perceived parental control and anxious rearing in adolescence. The findings relating to an association between adolescent anxiety and perceived parental rejection and lack of warmth are somewhat less consistent. Methodological shortcomings in the studies mean that these results should be interpreted with caution. Future research should be conducted using observational and experimental design with adolescents from referred, clinical populations to help identify the critical parental processes and clarify the direction of effects.

Cognitive behaviour therapy (CBT) is an efficacious treatment for paediatric anxiety disorders, yet not all children improve following standard treatment protocols. Identifying pre-treatment predictors of poor treatment response is an important area of research to maximise outcomes for children with anxiety disorders. This paper presents a systematic review of pre-treatment predictors of child/adolescent anxiety treatment outcome, including child demographic, child diagnostic and parental factors. Results are based on 47 peer-reviewed articles and 4 dissertations. Results for each predictor are reported according to method of measuring outcome (e.g., endpoint or rate of change). No consistent and clear pre-treatment predictors of paediatric anxiety outcome were identified. Yet, it is worth noting that a number of trends emerged; some significant predictors were identified in more than one study including primary anxiety diagnosis, severity, comorbidity and parental anxiety/psychopathology. With regards to primary anxiety diagnosis, there was emerging evidence that Social Anxiety Disorder predicted poorer treatment response, while GAD predicted better outcome. Greater symptom severity and comorbid externalising symptoms/disorder were also associated with poorer treatment response but not dependably across studies. Some inconsistent evidence also emerged showing that presence of comorbidity, comorbid depression, parental psychopathology, parental anxiety and maternal anxiety were associated with poorer outcomes when outcome was assessed as an endpoint. There were a number of pre-treatment factors that were not related to treatment outcome: age, gender, ethnicity and socio-economic status. Based on a small number of studies, comorbid anxiety, maternal depression, paternal anxiety and paternal depression also failed to predict treatment outcome. Further methodologically strong research is needed to clarify the conclusions made in this review and to investigate a range of predictors considered under preliminary investigation.

The primary aim of this review was to determine whether computer-based treatment programs delivered asynchronously are able to produce a reduction in youth anxiety. Secondary aims were to examine the treatment components and level of therapist assistance inherent to these programs. Searches were conducted using the Web of Knowledge and manuscript quality was assessed using the Effective Public Health Practice Project (EPHPP) Tool. Eleven studies assessing six different computer-based anxiety treatment programs fulfilled the criteria. It was found that programs comprising a variety of CBT anxiety management strategies and which included exposure therapy (BRAVE, Cool Teens and Camp Cope-A-Lot), were able to produce reductions in diagnostic status, severity and self-reported anxiety symptoms. However, those programs being trialled in terms of their ability to reduce both anxiety and depression symptoms or which focused on a single CBT strategy (and which did not include exposure), were not as successful in reducing youth anxiety. Furthermore, higher levels of therapist assistance seemed to be associated with better treatment outcomes. In relation to other measures, computer-based programs were generally found to improve levels of overall functioning and internalising problems, but the results for self-rated depression and other measures were inconsistent. Computer-based treatment is an exciting and progressive area of research, with numerous avenues for extension and advancement.

This paper reviews evidence for using the “cognitive enhancer” D-Cycloserine (DCS) to treat anxious young people. Adult studies indicate DCS consolidates fear extinction learning into memory during exposure therapy, thereby increasing the speed of remission. This paper examines basic research indicating both fear extinction and DCS may work differently in younger animals compared to adults. It reviews trials using DCS to enhance treatment of obsessive compulsive disorder in youths. Given there is often ambivalence about using medication to treat young people, this paper also reviews current research examining parental attitudes to DCS. It considers specific challenges facing DCS research, particularly with regard to maintaining experimental control and managing negative perceptions associated with using medication. Finally, this paper considers current research underway, particularly with regard to using DCS to treat young people with specific phobias. Overall, findings indicate that DCS shows promise for enhancing the treatment of anxiety in young people, but further investigation is needed to determine whether it provides significant benefits over and above current therapies.

In this series of brief papers, high intensity (HI) cognitive behavior therapy (CBT) interventions are reviewed for use with the anxiety disorders in youth. HI CBT approaches are defined as those that deliver the treatment in fewer sessions or in a reduced period of time when compared to standard CBT interventions (delivered in 12 – 20 sessions). Support for HI CBT interventions is examined for specific phobias, obsessive-compulsive disorder, panic disorder, social anxiety disorder, separation anxiety disorder, and generalized anxiety disorder. To date, these interventions appear promising and to produce effects similar to those obtained with standard CBT interventions. Still more research is needed to determine if they are more cost-effective, when they might be used in contrast to standard CBT interventions, and if they can be enhanced to surpass the effects obtained with standard CBT interventions.

The one session treatment approach (Öst, 1989) incorporates cognitive behavioural techniques into a single 3-hour intensive session. This treatment approach has led the field in the development of more efficient and intensive approaches for treating childhood anxiety problems, and for childhood specific phobia is now considered a ‘well established’ treatment (Ollendick & Davis III, 2012). This review examines the clinical phenomenology of specific phobia in youth, provides a brief description of OST along with the evidence to support its efficacy, and provides suggestions for future research.

Preliminary evidence for the efficacy of intensive treatments for childhood OCD is promising. This is an important area of research as traditional weekly CBT for OCD is costly, time intensive and is often challenging for families to access. This review explores the evidence base for intensive treatments for childhood OCD and following this, provides a description of a novel intensive treatment approach that combines prolonged intensive ERP sessions, similar to the one-session treatment for specific phobia, with CBT delivered over the computer via webcam (W-CBT) for one-month maintenance. Future research directions are also discussed.

Panic disorder with agoraphobia (PDA) contributes to significant impairment and distress in adolescence, particularly when left untreated. Cognitive behavioral treatment of panic disorder in adolescents has now been developed and delivered in a traditional once per week format, and has also recently been adapted for delivery in an intensive format delivered over eight consecutive days. We provide a brief review of research efforts to date on the development and evaluation of intensive treatments for panic disorder in adolescence. Recent studies suggest that the intensive, eight-day treatment approach is associated with comparable reductions in PDA symptoms as compared to the once-weekly treatment and shows promise for reducing the impairing symptoms of PDA and its comorbid conditions. Ongoing research and future directions to further this body of work will be discussed.

Social Anxiety Disorder (SAD) is a prevalent disorder in youth that follows a chronic course if left untreated and is associated with a myriad of problematic short- and long-term consequences. Cognitive Behaviour Therapy (CBT) has been shown to be efficacious in treating SAD, however the majority of youth with SAD do not receive help for a number of reasons. Brief and/or intensive treatments for SAD might circumvent some of these barriers to treatment, yet only two studies to date have been conducted in this area. This paper provides an overview of SAD, the rationale and evidence for the use of brief/intensive therapy for the disorder, and suggestions for where research might be directed as we move into the future.

Childhood separation anxiety disorder (SepAD) has only recently been recognized as a highly frequent disorder, precursor of panic disorder, and pacemaker of anxiety and other mental disorders. Although cognitive-behavioral therapy (CBT) has proven effective for the treatment of anxiety disorders in children, including SepAD, intensive forms of treatments have been developed recently to further improve treatment efficacy. This brief article describes a rationale for the development of intensive, disorder-specific treatments for SepAD, focusing on extinction learning and parental involvement in the child's therapy. We further provide an overview of three cognitive-behavioral and one psychodynamic intensive treatment programs for SepAD and review the empirical evidence for each of these programs. In conclusion, one promising treatment-intensification strategy is to deliver exposure in high doses and in multiple contexts. Parents can be coached to conduct such exposure in-between treatment sessions. In the light of initial findings from RCTs, the involvement of parents seems to benefit younger children more so than older ones.

Worry is a normal part of child development. However, a significant proportion of young people experience excessive worry that causes distress and interference with daily functioning. Although worry is a common feature of all anxiety disorders, it is a defining feature of Generalized Anxiety Disorder (GAD). Cognitive-behavioural therapy is an efficacious treatment for GAD and other anxiety disorders that in recent years has been successfully adapted into short, time-limited formats for other childhood anxiety disorders including Specific Phobia, Social Phobia, Panic, Separation Anxiety and Obsessive Compulsive Disorder. However, intensive treatments for GAD specifically have not been examined to date. This paper provides a brief overview of the characteristics of youth with GAD, followed by a review of current intensive treatments for other anxiety disorders and evidence suggesting these approaches are effective in treating comorbid GAD. Potential benefits of an intensive treatment for GAD are outlined, and directions for future research on intensive treatments for GAD are discussed.