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Predictors of treatment dropout
S160
IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S140–S196
Mo-P-1092
Predictors of outcome in CBT for youth anxiety disorders K.W. Fjermestad a,∗ , G.J.H. Wergeland b , O.E. Havik b , E.R. Heiervang b Clinical Psychology, University of Bergen, Bergen, Norway b Bergen, Norway ∗ Corresponding author.
a
The presentation focuses on predictors of effect in a randomized controlled trial of manual-based cognitive behavioral therapy for youth anxiety disorders. Participants (n = 182, Mean age = 12.01, SD = 3.04, 49.5% boys) were treated in community clinics by regular clinicians. They were randomized to group or individual CBT treatment, or a wailist condition. Both anxiety and depression symptoms were significantly reduced at post-treatment. Around half the participants lost one or more anxiety diagnoses. Multiple regression models showed that pre-treatment motivation, perceived treatment credibility, early therapeutic alliance and alliance increase from early to late in treatment significantly predicted the effect of CBT for youth anxiety disorders. The clinical implications are that enhancing pre-treatment motivation and treatment credibility, as well as building alliance, can be beneficial for treatment effects when CBT is delivered in regular community youth mental health clinics. http://dx.doi.org/10.1016/j.neurenf.2012.04.204 Mo-P-1093
Discrepancies between implicit and explicit self-esteem among adolescents with social anxiety disorder F. Schreiber a,∗ , C. Bohn a , I.M. Aderka b , U. Stangier a , R. Steil a Clincal Psychology and Psychotherapy, Institute of Psychology, Goethe-University, Frankfurt, Frankfurt, Germany b Psychotherapy and Emotion Research Laboratory, Boston University, Boston, USA ∗ Corresponding author.
a
Prior studies have examined self-esteem in socially anxious adults and found low explicit self-esteem (ESE) to prevail concurrently with positive implicit self-esteem (ISE). This indicates that self-esteem discrepancies are linked to social anxiety in adults. No study so far has investigated discrepant self-esteem in youths suffering from social anxiety disorder (SAD). In this study, we use two implicit measures (Affect Misattribution Procedure, Implicit Association Test) and one explicit measure (Rosenberg Self-Esteem Scale) to examine discrepant SE after social threat activation in 20 adolescents suffering from SAD, compared to 20 healthy adolescents who were matched for age and gender. Our results revealed discrepant self-esteem (high ISE, low ESE) in adolescents with SAD compared to congruent self-esteem (high ISE, high ESE) in healthy youths. Clinical and practical implications of our results regarding the role self-esteem in cognitive treatment protocols for SAD in adolescents will be discussed. http://dx.doi.org/10.1016/j.neurenf.2012.04.205 Mo-P-1094
Predictors of treatment dropout Wergeland a,∗ ,
Fjermestad b ,
Marin c ,
Silverman c ,
Havik b ,
G.J. K. C. W. O. E.R. Heiervang d a Institute of Clinical Medicine, University of Bergen, Norway, Bergen, Norway b Department of Clinical Psychology, University of Bergen, Bergen, Norway c Department of Psychology, CCF, Florida International University, Miami, USA d Institute of Clinical Medicine, University of Oslo, Oslo, Norway ∗ Corresponding author. Premature treatment termination is common in public child mental health clinics. Little is known about factors associated with premature termination among children with anxiety disorders. This study examines predictors of dropout from a 10 week randomized controlled effectiveness trial of a group (GCBT) versus individual (ICBT) cognitive behavior therapy program conducted in seven public mental health outpatient clinics in Norway. Participants were children (n = 182, age 8–15) with primary diagnosis of separation anxiety disorder, social
anxiety disorder or general anxiety disorder. There were altogether 26 dropouts (14.3%), with similar dropout rates ICBT and GCBT. Child and parent treatment credibility child self-concept, and parent-rated behavior inhibition differentiated significantly completers from non-completers. Only child treatment credibility significantly predicted dropout from treatment (OR: 0.845, CI: 0.77–0.93, P < 0.001). The most frequent reason given for dropout was lack of motivation. Implication of the findings for research and practice will be discussed. http://dx.doi.org/10.1016/j.neurenf.2012.04.206 Mo-P-1095
Detecting social anxiety symptoms in adolescents: Prevalence and comorbid symptoms in a community sample (the HUNT study) and a clinical sample (the CAP survey) I. Ranøyen a,∗ , J. Wallander b , M.S. Indredavik c , T. Jozefiak a The Regional Centre for Child and Adolescent Mental Health (RBUP) Mid-Norway, Norwegian University of Science and Technology (NTNU), Faculty of Medicine, Trondheim, Norway b School of Social Sciences, Humanities and Arts, University of California, Merced, CA, USA c Department of Neuroscience, The Regional Centre for Child and Adolescent Mental Health (RBUP), Trondheim, Norway ∗ Corresponding author.
a
Background.– Few individuals with social anxiety (SA) seek treatment, and those who do, often seek treatment for other disorders. We also suspect that therapists may not recognize SA among their patients. Despite the fact that 95% of all individuals developing SA do so before the age of 20, most research on SA thus far has focused on adults. Objectives/method.– To facilitate identification of SA, this study compares prevalence of social anxiety symptoms and comorbid symptoms among adolescents, ages 13 through 18, both in mental health clinics and in the community. Data from two Norwegian cross-sectional surveys are analyzed: the HUNT study (community sample, n = 7940) and the CAP survey, St. Olavs Hospital (clinical sample, n = 717). Results.– Data are now being analyzed, and results will be presented at the conference. We suspect that comorbid symptoms are different in the two samples, and that SA seldom is detected in the clinical sample. http://dx.doi.org/10.1016/j.neurenf.2012.04.207 Mo-P-1096
River-dust exposure in relation to the clinic visits of anxiety disorders among children and adolescents
H. Yang ∗ , C. Hsieh , C. Kuo , C. Hu , Y. Chiang Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan ∗ Corresponding author.
Background.– River dust consists of high levels of PM10, which has been found to have significant effects on a variety of physical conditions in children. Yet its effect on psychopathology is still obscure. We used 8-year data in a high river-dust exposure area to examine the relationship between riverdust exposure and daily clinic visits of anxiety disorders among children and adolescents. Methods.– All residents aged 6–18 in Yunlin County, Taiwan (n = 10,294) were selected from the Taiwan National Health Insurance Research Database (NHIRD), 2002–2009. The NHIRD comprises detailed medical data of over 98% residents in Taiwan. Diagnoses of anxiety disorders were based on ICD code of 300.0 and 300.2. PM10 data during the same period were derived from the Lunbei station (located at Yunlin County) of EPA, Taiwan. Linear regression models were performed to examine the effect of PM10 concentration on daily clinic visits of anxiety disorders. Results.– Daily clinic visits for anxiety disorders among children slightly, but not significantly, increased with PM10 levels when PM10 lower than 300 g/m3 .
IACAPAP 2012 – 20th World congress / Neuropsychiatrie de l’enfance et de l’adolescence 60S (2012) S140–S196
Mo-P-1092
Predictors of outcome in CBT for youth anxiety disorders K.W. Fjermestad a,∗ , G.J.H. Wergeland b , O.E. Havik b , E.R. Heiervang b Clinical Psychology, University of Bergen, Bergen, Norway b Bergen, Norway ∗ Corresponding author.
a
The presentation focuses on predictors of effect in a randomized controlled trial of manual-based cognitive behavioral therapy for youth anxiety disorders. Participants (n = 182, Mean age = 12.01, SD = 3.04, 49.5% boys) were treated in community clinics by regular clinicians. They were randomized to group or individual CBT treatment, or a wailist condition. Both anxiety and depression symptoms were significantly reduced at post-treatment. Around half the participants lost one or more anxiety diagnoses. Multiple regression models showed that pre-treatment motivation, perceived treatment credibility, early therapeutic alliance and alliance increase from early to late in treatment significantly predicted the effect of CBT for youth anxiety disorders. The clinical implications are that enhancing pre-treatment motivation and treatment credibility, as well as building alliance, can be beneficial for treatment effects when CBT is delivered in regular community youth mental health clinics. http://dx.doi.org/10.1016/j.neurenf.2012.04.204 Mo-P-1093
Discrepancies between implicit and explicit self-esteem among adolescents with social anxiety disorder F. Schreiber a,∗ , C. Bohn a , I.M. Aderka b , U. Stangier a , R. Steil a Clincal Psychology and Psychotherapy, Institute of Psychology, Goethe-University, Frankfurt, Frankfurt, Germany b Psychotherapy and Emotion Research Laboratory, Boston University, Boston, USA ∗ Corresponding author.
a
Prior studies have examined self-esteem in socially anxious adults and found low explicit self-esteem (ESE) to prevail concurrently with positive implicit self-esteem (ISE). This indicates that self-esteem discrepancies are linked to social anxiety in adults. No study so far has investigated discrepant self-esteem in youths suffering from social anxiety disorder (SAD). In this study, we use two implicit measures (Affect Misattribution Procedure, Implicit Association Test) and one explicit measure (Rosenberg Self-Esteem Scale) to examine discrepant SE after social threat activation in 20 adolescents suffering from SAD, compared to 20 healthy adolescents who were matched for age and gender. Our results revealed discrepant self-esteem (high ISE, low ESE) in adolescents with SAD compared to congruent self-esteem (high ISE, high ESE) in healthy youths. Clinical and practical implications of our results regarding the role self-esteem in cognitive treatment protocols for SAD in adolescents will be discussed. http://dx.doi.org/10.1016/j.neurenf.2012.04.205 Mo-P-1094
Predictors of treatment dropout Wergeland a,∗ ,
Fjermestad b ,
Marin c ,
Silverman c ,
Havik b ,
G.J. K. C. W. O. E.R. Heiervang d a Institute of Clinical Medicine, University of Bergen, Norway, Bergen, Norway b Department of Clinical Psychology, University of Bergen, Bergen, Norway c Department of Psychology, CCF, Florida International University, Miami, USA d Institute of Clinical Medicine, University of Oslo, Oslo, Norway ∗ Corresponding author. Premature treatment termination is common in public child mental health clinics. Little is known about factors associated with premature termination among children with anxiety disorders. This study examines predictors of dropout from a 10 week randomized controlled effectiveness trial of a group (GCBT) versus individual (ICBT) cognitive behavior therapy program conducted in seven public mental health outpatient clinics in Norway. Participants were children (n = 182, age 8–15) with primary diagnosis of separation anxiety disorder, social
anxiety disorder or general anxiety disorder. There were altogether 26 dropouts (14.3%), with similar dropout rates ICBT and GCBT. Child and parent treatment credibility child self-concept, and parent-rated behavior inhibition differentiated significantly completers from non-completers. Only child treatment credibility significantly predicted dropout from treatment (OR: 0.845, CI: 0.77–0.93, P < 0.001). The most frequent reason given for dropout was lack of motivation. Implication of the findings for research and practice will be discussed. http://dx.doi.org/10.1016/j.neurenf.2012.04.206 Mo-P-1095
Detecting social anxiety symptoms in adolescents: Prevalence and comorbid symptoms in a community sample (the HUNT study) and a clinical sample (the CAP survey) I. Ranøyen a,∗ , J. Wallander b , M.S. Indredavik c , T. Jozefiak a The Regional Centre for Child and Adolescent Mental Health (RBUP) Mid-Norway, Norwegian University of Science and Technology (NTNU), Faculty of Medicine, Trondheim, Norway b School of Social Sciences, Humanities and Arts, University of California, Merced, CA, USA c Department of Neuroscience, The Regional Centre for Child and Adolescent Mental Health (RBUP), Trondheim, Norway ∗ Corresponding author.
a
Background.– Few individuals with social anxiety (SA) seek treatment, and those who do, often seek treatment for other disorders. We also suspect that therapists may not recognize SA among their patients. Despite the fact that 95% of all individuals developing SA do so before the age of 20, most research on SA thus far has focused on adults. Objectives/method.– To facilitate identification of SA, this study compares prevalence of social anxiety symptoms and comorbid symptoms among adolescents, ages 13 through 18, both in mental health clinics and in the community. Data from two Norwegian cross-sectional surveys are analyzed: the HUNT study (community sample, n = 7940) and the CAP survey, St. Olavs Hospital (clinical sample, n = 717). Results.– Data are now being analyzed, and results will be presented at the conference. We suspect that comorbid symptoms are different in the two samples, and that SA seldom is detected in the clinical sample. http://dx.doi.org/10.1016/j.neurenf.2012.04.207 Mo-P-1096
River-dust exposure in relation to the clinic visits of anxiety disorders among children and adolescents
H. Yang ∗ , C. Hsieh , C. Kuo , C. Hu , Y. Chiang Department of Public Health, Chung Shan Medical University, Taichung City, Taiwan ∗ Corresponding author.
Background.– River dust consists of high levels of PM10, which has been found to have significant effects on a variety of physical conditions in children. Yet its effect on psychopathology is still obscure. We used 8-year data in a high river-dust exposure area to examine the relationship between riverdust exposure and daily clinic visits of anxiety disorders among children and adolescents. Methods.– All residents aged 6–18 in Yunlin County, Taiwan (n = 10,294) were selected from the Taiwan National Health Insurance Research Database (NHIRD), 2002–2009. The NHIRD comprises detailed medical data of over 98% residents in Taiwan. Diagnoses of anxiety disorders were based on ICD code of 300.0 and 300.2. PM10 data during the same period were derived from the Lunbei station (located at Yunlin County) of EPA, Taiwan. Linear regression models were performed to examine the effect of PM10 concentration on daily clinic visits of anxiety disorders. Results.– Daily clinic visits for anxiety disorders among children slightly, but not significantly, increased with PM10 levels when PM10 lower than 300 g/m3 .