Variability in clinician intentions to implement specific cognitive-behavioral therapy components.

BACKGROUND: CBT comprises many discrete components that vary in complexity, but implementation and training efforts often approach CBT as a single entity. We examined variability in clinician intentions to use different structural and interventional components of CBT for three different clinical groups: clients receiving CBT, clients with depression, and clients with anxiety. METHODS: Clinicians (n = 107) trained in CBT completed a one-time electronic survey. Clinicians' intentions were measured using established item stems from social psychology adapted to examine intentions to use six specific CBT components: exposure therapy, cognitive restructuring, behavioral activation, planning homework, reviewing homework, and agenda-setting. RESULTS: Intentions were weakest, on average, for exposure. They were strongest, on average, for reviewing homework. A series of ANOVAs with Tukey's post-hoc tests revealed that participants intended to use exposure with clients receiving CBT (p = .015) and clients with anxiety (p < .001) significantly more than for clients with depression. Participants intended to use behavioral activation with clients with depression (p = .01) significantly more than for clients with anxiety. No other intentions to use CBT components differed among these three clinical populations. CONCLUSIONS: When studying determinants of CBT use and designing interventions to increase use, implementers should consider that different CBT components may require different implementation strategies. TRIAL REGISTRATION: Not applicable.

Community violence and posttraumatic stress disorder symptoms in urban youth: The moderating influence of friend and parent support.

Separate lines of research have demonstrated that community violence predicts posttraumatic stress disorder (PTSD) symptoms in youth and that social support is one protective factor against the development of PTSD symptoms. The current study sought to examine the associations between primary and secondary exposure to community violence and the moderating role of parent and friend support on these relations. Participants were 96 urban youths (aged 6-17 years; 58.4% racial/ethnic minority; 51% female) and a caregiver recruited from a university mental health clinic. Results indicated that both primary and secondary exposure to community violence predicted PTSD symptoms. Friend support, but not parent support, moderated the association between primary, but not secondary, exposure to community violence and PTSD symptoms. The findings suggest that friend support is a salient protective factor for urban youth who may be at risk of PTSD symptoms due to exposure to community violence.

Emotional Control Mediates the Association Between Dimensions of Perfectionism and Worry in Children.

Previous research has shown that perfectionism predicts for increased worry in children. Theoretically, children with high levels of perfectionism may show a decreased ability to control their emotions during times of perceived failure. Children may then worry as a maladaptive attempt to cope with intense emotions. The current study sought to test the mediating role of emotional control on the relation between perfectionism dimensions and worry in children. Participants were 66 parent-child dyads. Children were 7-13 years (50 % male; 77.3 % Caucasian, 9.1 % African American). Overall the model fit the data well. Results indicated that perfectionism domains predicted for emotional control deficits and increased worry. Emotional control also partially mediated the relation between perfectionism dimensions and worry. These results suggest that emotional control may be one mechanism through which perfectionism exerts its effect on worry and perfectionistic children may worry due to difficulty controlling their emotional responses.

Negative Affect and Child Internalizing Symptoms: The Mediating Role of Perfectionism.

Separate lines of research have linked the temperament factor negative affect and perfectionism with internalizing disorders. Despite theory, no previous studies have connected these lines of research to examine internalizing pathology. The current study tested a path model to investigate the mediating effect of perfectionism domains on the relation between negative affect and child anxiety, worry, and depression symptoms. Participants were 61 parent-child dyads recruited from the community. Children were 7-13 years old (54.1 % male; 88.2 % Caucasian). Overall the model fit the data well. Analyses indicated that separate domains of perfectionism mediated separate relations between negative affect and child anxiety, worry, and depression symptoms. The findings suggest that domains of perfectionism may be implicated in specific paths between negative affect and child anxiety, depression, and worry. Implications and future directions are discussed.

The effect of maternal psychopathology on parent-child agreement of child anxiety symptoms: A hierarchical linear modeling approach.

The current study examined the effects of maternal anxiety, worry, depression, child age and gender on mother and child reports of child anxiety using hierarchical linear modeling. Participants were 73 mother-child dyads with children between the ages of 7 and 10 years. Reports of child anxiety symptoms, including symptoms of specific disorders (e.g., social phobia) were obtained using concordant versions of the Screen for Anxiety and Related Emotional Disorders (SCARED). Children reported significantly higher levels of anxiety symptoms relative to their mothers. Maternal worry and depression predicted for significantly lower levels of maternal-reported child anxiety and increasing discrepant reports. Maternal anxiety predicted for higher levels of maternal-reported child anxiety and decreasing discrepant reports. Maternal depression was associated with increased child-reported child anxiety symptoms. No significant effect of child age or gender was observed. Findings may inform inconsistencies in previous studies on reporter discrepancies. Implications and future directions are discussed.

Language of perfectionistic parents predicting child anxiety diagnostic status.

Previous research has identified parental perfectionism as a risk factor for child anxiety. Yet few studies investigated why parental perfectionism may play such a role. Based on research suggesting parental verbal information and language use are associated with increased child fear beliefs and anxiety, the current study investigated the linguistic style of perfectionistic mothers and its relation to child anxiety. Participants were 71 mother-child dyads. Children were 3-12 years old, 57.7% female, and 30 were diagnosed with an anxiety disorder. Analyses showed that parental perfectionism was associated with increased second person pronouns, decreased adverbs, negative emotion words, and anger words. Second person pronouns and negative emotion words predicted child anxiety diagnostic status and mediated the relation between maternal perfectionism and child anxiety. These findings suggest that parental perfectionism may be associated with a specific language style that is related to child anxiety. Implications and future directions are discussed.

Parental perfectionism and overcontrol: examining mechanisms in the development of child anxiety.

It has been theorized that perfectionistic parents will engage in behaviors characterized by overcontrol, which then increase child anxiety. Previous research has yet to test this theory within a single study. The current study investigated the proposed theory in a single model, examining the mediational roles of parent perfectionism and overcontrol in the association between parent and child anxiety. Participants were 77 parent-child dyads, with 46 parents and 40 children diagnosed with an anxiety disorder. Children were between 3 and 12 years old (57.1% female, 76.6% Caucasian, 22.1% African American). Path analysis indicated that the overall model fit the data well. Analyses showed that parental overcontrol mediated the relation between parental perfectionism and child anxiety and parental perfectionism mediated the relation between parental anxiety and parental overcontrol. Further, parental perfectionism and overcontrol sequentially mediated the parent to child anxiety relation. However, when parental perfectionism was accounted for in the model, parental overcontrol did not mediate the relation between parent and child anxiety. The findings suggest that parent perfectionism and overcontrol, together, may represent a specific pathway of risk for the development of anxiety disorders in children. The implications of these findings are reviewed in the context of previous theory on parental perfectionism, overcontrol, and the development of child anxiety. The clinical importance of the findings and future directions are also discussed.

Perfectionism in pediatric anxiety and depressive disorders.

Although perfectionism has been identified as a factor in many psychiatric disorders across the life span, it is relatively understudied in pediatric anxiety and depressive disorders. Furthermore, there exists little cohesion among previous research, restricting the conclusions that can be made across studies. In this review, research associating perfectionism with pediatric anxiety and depression is examined and a framework is presented synthesizing research to date. We focus on detailing the current understanding of how perfectionism develops and interacts with other developmental features characteristic of anxiety and depression in children and potential pathways that result in anxiety and depressive disorders. This includes: how perfectionism is measured in children, comparisons with relevant adult literature, the development of perfectionism in children and adolescents, mediators and moderators of the link between perfectionism and anxiety and depression, and the role of perfectionism in treatment and prevention of these disorders. We also present research detailing perfectionism across cultures. Findings from these studies are beginning to implicate perfectionism as an underlying process that may contribute broadly to the development of anxiety and depression in a pediatric population. Throughout the review, difficulties, limitations, and gaps in the current understanding are presented while offering suggestions for future research.

Temperament, peer victimization, and nurturing parenting in child anxiety: a moderated mediation model.

Research has linked fearful temperament and childhood anxiety. Yet there remain numerous factors that moderate and mediate this relation. Two specific factors, identified in separate lines of research, are peer victimization and parenting. The current study tested a moderated mediational model to investigate the respective effects of peer victimization and nurturing parenting on the relation between fearful temperament and child anxiety. Participants were 124 parent-child dyads recruited from the community. Children were between the ages of 7 and 12 (56.5% male, 93.5% Caucasian) and most parents were mothers. Overall the data fit the model well. Analyses indicated that peer victimization was a mediator of the temperament to child anxiety relation, while nurturing parenting moderated this mediated effect. Nurturing parenting did not mediate the temperament to child anxiety relation directly. The findings suggest that nurturing parenting may be a specific, rather than global, protective factor for peer victimization in child anxiety.

Maternal overcontrol and child anxiety: the mediating role of perceived competence.

Previous research has shown that maternal overcontrol is related to higher levels of child anxiety. It has been theorized, though not empirically tested, that maternal overcontrol decreases child perceived competence and mastery, which increases child anxiety. The present study investigated this theory using a sample of 89 mother-child dyads (children aged 6-13, 84.3% Caucasian, 6.7% African American, and 51.7% male). After statistically controlling for maternal anxiety level, child perceived competence was shown to partially mediate the relationship between maternal overcontrol and child anxiety. Though current findings are based on cross sectional data, they suggest multiple pathways through which maternal overcontrol impacts child anxiety. One pathway, described in theoretical models, posits that greater levels of parental control reduce children's opportunities to acquire appropriate developmental skills, lowering their perceived competence, and thus increasing their anxiety. Implications of these findings and directions for future research are discussed.

Exploring Parental Predictors of Child Anxiety: The Mediating Role of Child Interpretation Bias.

BACKGROUND: Separate lines of research have shown that higher levels of parental overcontrol and parental anxiety are related to higher levels of child anxiety. The mechanisms of transmission, however, are poorly understood. OBJECTIVE: It has been theorized, though not empirically tested, that parental overcontrol and anxiety increase children's interpretation bias by signaling to the child that the environment is threatening (e.g. through modeling or restriction of autonomy), thus increasing the child's anxiety level. METHODS: The present study investigated this theory using 75 parent-child dyads (parents aged 27-52, 82 % female; children aged 7-12, 52 % female, 80 % Caucasian). All parents were diagnosed with a primary anxiety disorder, while no child was diagnosed with an anxiety disorder. RESULTS: Children's interpretation bias, measured using ambiguous stories, was shown to partially mediate the relation between parental overcontrol and child anxiety and completely mediate the relation between parental anxiety and child anxiety. There was no significant relation between parental overcontrol and parental anxiety. CONCLUSIONS: Findings partially support theoretical models, which posit that higher levels of overcontrol and parental anxiety signal to children that their environment is threatening, perhaps increasing their threat appraisal of ambiguous situations and increasing their anxiety. Implications and directions for future research are discussed.