Brady and Kendall (1992) concluded that although anxiety and depression in youths are meaningfully linked, there are important distinctions, and additional research is needed. Since then, studies of ...anxiety-depression comorbidity in youths have increased exponentially. Following a discussion of comorbidity, we review existing conceptual models and propose a multiple pathways model to anxiety-depression comorbidity. Pathway 1 describes youths with a diathesis for anxiety, with subsequent comorbid depression resulting from anxiety-related impairment. Pathway 2 refers to youths with a shared diathesis for anxiety and depression, who may experience both disorders simultaneously. Pathway 3 describes youths with a diathesis for depression, with subsequent comorbid anxiety resulting from depression-related impairment. Additionally, shared and stratified risk factors contribute to the development of the comorbid disorder, either by interacting with disorder-related impairment or by predicting the simultaneous development of the disorders. Our review addresses descriptive and developmental factors, gender differences, suicidality, assessments, and treatment-outcome research as they relate to comorbid anxiety and depression and to our proposed pathways. Research since 1992 indicates that comorbidity varies depending on the specific anxiety disorder, with Pathway 1 describing youths with either social phobia or separation anxiety disorder and subsequent depression, Pathway 2 applying to youths with coprimary generalized anxiety disorder and depression, and Pathway 3 including depressed youths with subsequent social phobia. The need to test the proposed multiple pathways model and to examine (a) developmental change and (b) specific anxiety disorders is highlighted.
A lack of effective therapist training is a major barrier to evidence-based intervention (EBI) delivery in the community. Systematic reviews published nearly a decade ago suggested that traditional ...EBI training leads to higher knowledge but not more EBI use, indicating that more work is needed to optimize EBI training and implementation. This systematic review synthesizes the training literature published since 2010 to evaluate how different training models (workshop, workshop with consultation, online training, train-the-trainer, and intensive training) affect therapists' knowledge, beliefs, and behaviors. Results and limitations for each approach are discussed. Findings show that training has advanced beyond provision of manuals and brief workshops; more intensive training models show promise for changing therapist behavior. However, methodological issues persist, limiting conclusions and pointing to important areas for future research.
Public Health Significance
Therapist training plays a critical role in the implementation of evidence-based interventions. This review provides an update of the past decade of literature related to therapist training in evidence-based interventions and examines five approaches to therapist training: workshops alone, workshops followed by consultation, online training, train-the-trainer, and intensive training. Results suggest that more intensive training models are most likely to facilitate clinician behavior change, although optimal dosage and training content remains unclear. Future work is needed to identify key elements of training to optimize the success of implementation efforts and ensure that treatment-seeking individuals receive effective care.
Clin Psychol Sci Prac 17: 1–30, 2010
Evidence‐based practice (EBP), a preferred psychological treatment approach, requires training of community providers. The systems‐contextual (SC) perspective, a ...model for dissemination and implementation efforts, underscores the importance of the therapist, client, and organizational variables that influence training and consequent therapist uptake and adoption of EBP. This review critiques the extant research on training in EBP from an SC perspective. Findings suggest that therapist knowledge improves and attitudinal change occurs following training. However, change in therapist behaviors (e.g., adherence, competence, and skill) and client outcomes only occurs when training interventions address each level of the SC model and include active learning. Limitations as well as areas for future research are discussed.
Anxiety disorders are prevalent and associated with functional impairments. Outcome research has focused on symptom reduction, rather than positive factors such as life satisfaction and improved ...functioning. We review the impact of youth anxiety disorders and elevated anxiety symptoms on academic, occupational, family, social, and legal functioning. Emphasis is placed on the degree to which developmental trajectories differ for youth with and without anxiety disorders. In some areas, psychopathology generally, rather than anxiety specifically, is associated with functional impairment. Other studies support youth anxiety as a unique predictor of functional impairment. In particular, social anxiety is associated with impairments in social functioning throughout development. The short- and long-term impacts of anxiety treatment in youth are discussed. Last, research directions are suggested.
Disasters and Youth Furr, Jami M; Comer, Jonathan S; Edmunds, Julie M ...
Journal of consulting and clinical psychology,
12/2010, Volume:
78, Issue:
6
Journal Article
Peer reviewed
Open access
Objective:
Meta-analyze the literature on posttraumatic stress (PTS) symptoms in youths post-disaster.
Method:
Meta-analytic synthesis of the literature (
k
= 96 studies;
N
total
= 74,154) ...summarizing the magnitude of associations between disasters and youth PTS, and key factors associated with variations in the magnitude of these associations. We included peer-reviewed studies published prior to 1/1/2009 that quantitatively examined youth PTS (≤18 years at event) after a distinct and identifiable disaster.
Results:
Despite variability across studies, disasters had a significant effect on youth PTS (small-to-medium magnitude;
r
pooled
= .19,
SE
r
= .03;
d
= 0.4). Female gender (
r
pooled
= .14), higher death toll (disasters of death toll ≤25:
r
pooled
= .09; vs. disasters with ≥1,000 deaths:
r
pooled
= .22), child proximity (
r
pooled
= .33), personal loss (
r
pooled
= .16), perceived threat (
r
pooled
= .34), and distress (
r
pooled
= .38) at time of event were each associated with increased PTS. Studies conducted within 1 year post-disaster, studies that used established measures, and studies that relied on child-report data identified a significant effect.
Conclusion:
Youths are vulnerable to appreciable PTS after disaster, with pre-existing child characteristics, aspects of the disaster experience, and study methodology each associated with variations in the effect magnitude. Findings underscore the importance of measurement considerations in post-disaster research. Areas in need of research include the long-term impact of disasters, disaster-related media exposure, prior trauma and psychopathology, social support, ethnicity/race, prejudice, parental psychopathology, and the effects of disasters in developing regions of the world. Policy and clinical implications are discussed.
Research on the expression and prevalence of co‐occurring anxiety disorders and autism spectrum disorders (ASDs) has produced variable results, in part due to the diversity in sample ascertainment ...and composition, methodology, and the operationalization of anxiety across studies. The present review organizes these findings to consider whether anxiety symptoms reported in ASD are better categorized as (a) a part of ASD or (b) a comorbid disorder. Although there is some support for the presence of co‐occurring, potentially comorbid anxiety disorders in ASD, a shift toward measurement validation and dimensional approaches in future research is needed to determine the role of anxiety in ASD, particularly regarding its “typical” and “atypical” presentation in this population.
Efficacious psychological treatments exist for a variety of mental health conditions, but many who could benefit from these treatments do not receive them. Increasing efforts have been made to ...disseminate effective protocols, and several approaches for implementing such treatments have been proposed, including the use of protocols, principles, practices, and policies. We discuss the relative merits of disseminating protocols and highlight the importance of employing flexibility within fidelity. We describe the benefits of using protocols, including their empirical support, guidance for decision‐making, and structure to facilitate training and enhance treatment integrity. We also address several criticisms that have been offered against protocols, citing data that indicate that many of the criticisms are not warranted.
Objective: To improve outcomes and create more personalized interventions, the field has sought to identify moderators of treatment response (variables that specify which treatments work for whom and ...under what conditions).
Method: The current review examines moderators of youth anxiety treatments.
Results: The majority of studies to date have examined variables of convenience, including demographics (age, sex, race, ethnicity, socioeconomic status), pretreatment youth clinical characteristics (anxiety severity, principal diagnosis, comorbidity) and pretreatment parent variables (parent psychopathology, parenting). Findings indicate few consistent moderators.
Conclusions: Future directions are discussed, including (a) group to individual generalizability, (b) power considerations, and (c) updates to study design and measure selection.
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