Anxious children who received treatment grow -up: An 8-to-13 year follow-up study

This dissertation examined the long-term efficacy (8-to-13 years, M = 9.54, SD = 1.689) of exposure-based cognitive-behavioral therapy (CBT) for phobic and anxiety disorders in youths. Long-term efficacy was examined in terms of diagnostic recovery, symptom reductions, and clinically significant change. This dissertation also examined predictors of long-term efficacy (e.g., age, gender, and other clinical characteristics) as well as the relative long-term efficacy of CBT for Hispanic/Latino and European American youth. ^ Participants consisted of 67 youth (age range 15–26 years; M = 19.43, SD = 3.02 years at time of follow-up assessment), (47.8% females, 37.3% Hispanic/Latino) who had participated in one of two clinical trials (Silverman et al., 1999a, b). After providing informed consent to participate in the long term follow-up, youths completed a diagnostic interview and a battery of questionnaires. Results indicated that treatment gains were maintained about 9.5 years after treatment was completed. Maintenance of treatment gains was evident in terms of diagnostic recovery, symptom reductions, and clinically significant change. Long-term treatment gains extended to both ethnic groups and the two ethnic groups were functionally equivalent along most indices examined. Analyses of predictors of long-term outcome showed that parent self-reported pre-treatment depression, youth-reported pre-treatment depression, and youths retrospective reports of negative life events were significantly associated with less favorable long-term gains in terms of total symptoms of anxiety at long-term follow-up. In terms of long-term sequelae, youths with less successful post-treatment outcomes reported seeking-out additional treatment as well as using/abused substances and substance dependence significantly more than youths with successful post-treatment outcomes. Results are discussed in terms of the contribution of the present study to knowledge base about the long-term efficacy of exposure-based CBT procedures for phobic and anxiety disorders in youth. Findings also are discussed in terms of the need to modify CBT procedures to target youths with less successful post-treatment outcomes. Limitations and future directions are presented. ^

The use of treatment process variables to differentiate between completers and dropouts for a guided self -change adolescent substance abuse intervention

This study documented differences between substance using adolescent participants who either completed or dropped out of a brief motivational intervention. Therapeutic alliance, working alliance and patient involvement were used to describe differences in treatment process ratings in a sample of majority Latino males who either (a) completed a adolescent substance abuse intervention called Alcohol Treatment Targeting Adolescents In Need (ATTAIN) or (b) dropped out after the first or second Guided Self-Change therapy session. Fifteen-minute segments were copied from the midpoint of previously recorded audio-tapes of Guided Self-Change therapy sessions. Raters were trained to a criterion level of interrater reliability for both the Working Alliance Inventory-Short and Vanderbilt Psychotherapy Process Scale. Correlations among Working Alliance Inventory- Short and Vanderbilt Psychotherapy Process Scale subscales reflected a general similarity in the assignment of ratings to client-therapist dyads. Findings underscore why these concepts are often used interchangeably in the treatment process literature. The Vanderbilt Psychotherapy Process Scale patient participation subscale demonstrated substantial empirical differentiation from overall therapeutic alliance. Discriminant function analysis demonstrated the Working Alliance Inventory-Short goal subscale and the Vanderbilt Psychotherapy Process Scale patient participation and therapist warmth and friendliness subscales as successful classifiers of groups of mostly Latino youth based on completion status. Follow-up logistic regression analyses confirmed major findings and successfully predicted group membership. Treatment process constructs can be used as clinical tools to identify participants who may be susceptible to dropping out of treatment services. Further investigation of treatment process may enhance understanding of the influence of alliance between clients and Guided Self-Change therapists. Investigating the role of treatment process as a critical component of brief motivational interventions for substance-using adolescents will inform both practitioners and researchers regarding the effectiveness of community-based substance abuse interventions for adolescents.

Ethnic and American identity development: A developmental systems approach

Given the role ethnic identity has as a protective factor against the effects of marginalization and discrimination (Umaña-Taylor, 2011), research longitudinally examining ethnic identity has become of increased importance. However, successful identity development must incorporate elements from both one's ethnic group and from the United States (Berry, 1980). Despite this, relatively few studies have jointly evaluated ethnic and American identity (Schwartz et al., 2012). The current dissertation, guided by three objectives, sought to address this and several other gaps in the literature. First, psychometric properties of the Multigroup Ethnic Identity Measure (MEIM) and the American Identity Measure (AIM) were evaluated. Secondly, the dissertation examined growth trends in recently immigrated Hispanic adolescents' and their caregivers' ethnic and American identity. Lastly, the relationship between adolescents' and caregivers' ethnic and American identity was evaluated. The study used an archival sample consisting of 301 recently immigrated Hispanic families collected from Miami (N = 151) and Los Angeles (N = 150). Consistent with previous research, results in Study 1 indicated a two-factor model reliably provided better fit than a one-factor model and established longitudinal invariance for the MEIM and the AIM. Results from Study 2 found significant growth in adolescents' American identity. While some differences were found across site and nationality, evidence suggested recently immigrated Hispanic adolescents were becoming more bicultural. Counterintuitively, results found a significant decline in caregivers' ethnic identity which future studies should further examine. Finally, results from Study 3, found several significant positive relationships between adolescents' and their caregivers' ethnic and American identity. Findings provided preliminary evidence for the importance of examining identity development within a systemic lens. Despite several limitations, these three studies represented a step forward in addressing the current gaps in the cultural identity literature. Implications for future investigation are discussed.

Cognitive behavior therapy for anxiety disorders in youth: Treatment specificity and mediation effects

The present study investigated the efficacies of Individual CBT (ICBT), Parent Relationship Skill Training (RLST, which targets increasing parental acceptance of youth and increasing autonomy granting) and Parent Reinforcement Skills Training (RLST, which targets increasing parental positive reinforcement and decreasing negative reinforcement). The specific aims were to examine treatment specificity and mediation effects of parenting variables. ICBT was used as a baseline comparison condition. The sample consisted of 253 youth (ages 5-16 years; M = 9.38; SD = 2.42) and their parents. To examine treatment outcome and specificity, the data were analyzed using analysis of variance within a structural equation modeling framework. Mediation was analyzed via structural equation modeling using MPlus. Results indicated that ICBT, RLST, and RFST produced positive treatment outcomes across all indices of change (i.e., clinically significant improvement, anxiety symptom reduction) and across all informants (i.e., youths and parents). RLST was associated with incremental reduction in youth anxiety symptoms beyond ICBT, as per youth report. Treatment specificity effects were found for participants in RFST in terms of parental reinforcement, as per parent report only. Treatment mediation was not found for any of the hypothesized parenting variables (i.e., parental acceptance, parental autonomy granting, parental reinforcement). The results support the use of CBT involving only the youth and the parent and youth together for treating youth anxiety. The findings’ implications are further discussed in terms of the need to conduct further meditational treatment outcome designs in order to continue to advance theory and research in youth anxiety treatment.

Development of Effortful Control as a Moderator of the Longitudinal Relations of Negative Reactivity and Symptoms in Preschool

Thesis (Ph.D.)--University of Washington, 2016-08

Childhood Attention Problems and the Development of Comorbid Symptoms at the Transition to High School: The Mediating Role of Parent and Peer Relationships

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) are at increased risk for the development of depression and delinquent behavior. Children and adolescents with ADHD also experience difficulty creating/maintaining high quality friendships and parent-child relationships, and these difficulties may contribute to the development of co-morbid internalizing and externalizing symptoms in adolescence. However, there is limited research examining whether high quality friendships and parent-child relationships mediate the relation between ADHD and the emergence of these co-morbid symptoms at the transition to high school. This study examines the mediating role of relationship quality in the association between ADHD and depressive symptoms/delinquent behaviors at this developmentally significant transition point. Results revealed significant indirect effects of grade 6 attention problems on grade 9 depressive symptoms through friendship quality and quality of the mother-child relationship in grade 8. Interventions targeting parent and peer relationships may be valuable for youth with ADHD to promote successful transitions to high school.

Developmental Neural Correlates of Social Interaction

Children develop in a sea of reciprocal social interaction, but their brain development is predominately studied in non-interactive contexts (e.g., viewing photographs of faces). This dissertation investigated how the developing brain supports social interaction. Specifically, novel paradigms were used to target two facets of social experience—social communication and social motivation—across three studies in children and adults. In Study 1, adults listened to short vignettes—which contained no social information—that they believed to be either prerecorded or presented over an audio-feed by a live social partner. Simply believing that speech was from a live social partner increased activation in the brain’s mentalizing network—a network involved in thinking about others’ thoughts. Study 2 extended this paradigm to middle childhood, a time of increasing social competence and social network complexity, as well as structural and functional social brain development. Results showed that, as in adults, regions of the mentalizing network were engaged by live speech. Taken together, these findings indicate that the mentalizing network may support the processing of interactive communicative cues across development. Given this established importance of social-interactive context, Study 3 examined children’s social motivation when they believed they were engaged in a computer-based chat with a peer. Children initiated interaction via sharing information about their likes and hobbies and received responses from the peer. Compared to a non-social control, in which children chatted with a computer, peer interaction increased activation in mentalizing regions and reward circuitry. Further, within mentalizing regions, responsivity to the peer increased with age. Thus, across all three studies, social cognitive regions associated with mentalizing supported real-time social interaction. In contrast, the specific social context appeared to influence both reward circuitry involvement and age-related changes in neural activity. Future studies should continue to examine how the brain supports interaction across varied real-world social contexts. In addition to illuminating typical development, understanding the neural bases of interaction will offer insight into social disabilities such as autism, where social difficulties are often most acute in interactive situations. Ultimately, to best capture human experience, social neuroscience ought to be embedded in the social world.

Social Influences of Error Monitoring

Adolescence is characterized by dramatic hormonal, physical, and psychological changes, and is a period of risk for affective and anxiety disorders. Pubertal development during adolescence plays a major role in the emergence of these disorders, particularly among girls. Thus, it is critical to identify early biomarkers of risk. One potential biomarker, the error-related negativity (ERN), is an event-related potential following an erroneous response. Individuals with an anxiety disorder demonstrate a greater ERN than healthy comparisons, an association which is stronger in adolescence, suggesting that pubertal development may play a role in the ERN as a predictor of anxiety. One form of anxiety often observed in adolescence, particularly among girls, is social anxiety, which is defined as anxiety elicited by social-evaluative contexts. In adults, enhancements of the ERN in social-evaluative contexts is positively related to social anxiety symptoms, suggesting that the ERN in social contexts may serve as a biomarker for social anxiety. This dissertation examined the ERN in and its relation with puberty and social anxiety among 76 adolescent girls. Adolescent girls completed a flanker task in two different

Individual Child Cognitive Behavioral Treatment versus Child-Parent Cognitive Behavioral Treatments for Anxiety Disorders in Children and Adolescents: Comparative Outcomes

Anxiety disorders; such as separation anxiety disorder, generalized anxiety disorder, social phobia and specific phobia, are widespread in children and adolescents. Cognitive behavioral therapy (CBT) has been shown to be effective in reducing excessive fears and anxieties in children and adolescents. Research has produced equivocal findings that involving parents in treatment of child anxiety enhances effects over individual CBT (ICBT). The present dissertation study examined whether parental involvement can enhance individual treatment effect if the parent conditions are streamlined by targeting specific parental variables. The first parent condition, Parent Reinforcement Skills Training (RFST), involved increasing mothers’ use of positive reinforcement and decreasing use of negative reinforcement. The second parent condition, Parent Relationship Skill Training (RLST), involved increasing maternal child acceptance and decreasing maternal control (or increasing autonomy granting). Results of the present dissertation findings support the use of all three treatment conditions (ICBT, RLST, RFST) for child anxiety; that is, significant reductions in anxiety were found in each of the three treatment conditions. No significant differences were found between treatment conditions with respect to diagnostic recovery rate, clinician rating, and parent rating of child anxiety. Significant differences between conditions were found on child self rating of anxiety, with some evidence to support the superiority of RLST and RFST to ICBT. These findings support the efficacy of individual, as well as parent involved CBT, and provide mixed evidence with respect to the superiority of parent involved CBT over ICBT. The conceptual, empirical, and clinical implications of the findings are discussed.

Memoria en publicidad y mercadeo

La psicología y la publicidad son dos disciplinas que desde hace algunos años se han venido complementando, la publicidad es la disciplina que se ha visto beneficiada con esta alianza, ya que el principal aporte que le hace la psicología a la publicidad es poder determinar aquellos factores o estrategias que generan en el consumidor; atención, asociación entre marca y producto, para luego almacenarse en la memoria y así generar una posible conducta de compra en el individuo. Los medios de comunicación cumplen un papel muy importante, ya que son los instrumentos utilizados para la transmisión de la información publicitaria, dependiendo del medio utilizado ya sea prensa, televisión o radio, las estrategias implementadas para dar a conocer la información deben ir dirigidas al campo perceptivo, que se utiliza para recibir la información y lograr una adecuada asociación y posterior almacenamiento en la memoria. La publicidad y el mercadeo hacen uso de una prueba de evaluación; top of mind, que muestra la jerarquía de recuerdo en la memoria de los individuos ante la mención de una categoría de servicio de un producto.

Corporeidade e ação nos processos de formação do eu

Parte-se da hipótese de que tanto os modos de constituição da subjetividade, quanto as teses epistemológicas sobre a formação do eu têm sofrido importantes mudanças nas últimas décadas. No plano das identidades pessoais, tal fato se expressa no atenuamento do ideário intimista, tradicionalmente centrado na idéia da vida mental como espaço privado e interior. No plano epistemológico, diferentes saberes vêm questionando a equivalência entre vida mental e interioridade psicológica e propondo descrições da origem do eu que incluam a dimensão da corporeidade e da ação. Considerando as noções de representação e de ação como eixos fundamentais para diferentes concepções da subjetividade, este artigo examina um modelo internalista do psiquismo, contrastando-o com outro que toma o eu como agente corporificado.