Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests:
Research Interests: Psychology, Clinical Psychology, Anxiety Disorders, Adolescent, Medicine, and 15 moreAnxiety, Attendance, Humans, Child, African American, Female, Cognitive Therapy, Male, African Americans, Clinical Sciences, European Continental Ancestry Group, ANXIETY, Combined Modality Therapy, Phobic disorders, and Paediatrics and reproductive medicine
Research Interests: Clinical Psychology, Cognitive Behavioral Therapy, Anxiety Disorders, Cognition, Adolescent, and 15 moreMedicine, Anxiety, Humans, Child, Female, Cognitive Therapy, Male, Cognitive behavior therapy, New England, Randomized Controlled Trial, ANXIETY, Anxiety Disorder, Combined Modality Therapy, Combination Therapy, and Medical and Health Sciences
Research Interests:
Research Interests:
Research Interests:
Chapter 5 outlines the treatment for children whose anxiety in social, performance, and/or evaluative situations is so distressing that they cannot tolerate these situations. Instead, avoidance behavior takes over. Treatment for such... more
Chapter 5 outlines the treatment for children whose anxiety in social, performance, and/or evaluative situations is so distressing that they cannot tolerate these situations. Instead, avoidance behavior takes over. Treatment for such children involves teaching them to identify what they tell themselves in anxiety-provoking situations and then to use a method to change negative thoughts to coping, helpful statements. Treatment involves graduated exposure to anxiety-provoking social or evaluative situations in session with the therapist and gradually increasing school attendance. It is important for the child to practice coping skills in real-life social and evaluative situations.
Research Interests:
Abstract Recognition of the unique nature and importance of emerging adulthood as a discrete developmental period continues to gain momentum since first introduced by Arnett in 2000. As the literature on normative development during this... more
Abstract Recognition of the unique nature and importance of emerging adulthood as a discrete developmental period continues to gain momentum since first introduced by Arnett in 2000. As the literature on normative development during this time period proliferates, parents, teachers, clinicians, and researchers are also identifying a growing number of emerging adults who struggle to meet developmental milestones and transition into adulthood. Though the level of impairment and diagnostic presentation of these emerging adults can vary widely, anxiety often plays a central role in hindering their successful launch into adulthood. In this chapter, we discuss the prevalence and impact of anxiety disorders during emerging adulthood and the paucity of developmentally appropriate evidence-based interventions for anxiety during this period. In addition, we discuss a treatment model that was developed in our clinic to target anxiety within the developmental context of emerging adulthood, as well as a more in-depth discussion of one specific application of this treatment model to an intensive outpatient group.
Research Interests:
Abstract Adolescence and emerging adulthood are distinct developmental periods marked by significant changes in physical and social maturation, familial and societal expectations, and brain development, specifically with regard to emotion... more
Abstract Adolescence and emerging adulthood are distinct developmental periods marked by significant changes in physical and social maturation, familial and societal expectations, and brain development, specifically with regard to emotion and behavioral control. These stages of life carry significant risk for the development of psychopathology and related functional impairments that adversely impact the achievement of important academic, occupational, and social milestones. Exposure therapy with adolescents and young adults must involve contextually rich in vivo or simulated interactions with emotionally provocative stimuli and situations, and must address areas of functional impairment and/or missed developmental milestones. Involving parents in exposure therapy with adolescence and young adults should be a strategic and collaborative process with the youth and family to facilitate individuation, decrease accommodation, and support practice and mastery. The scientific support, specific recommendations, and illustrative examples for successful exposure therapy with adolescents and young adults are described in this chapter.
Research Interests:
Research Interests:
Research Interests:
Objective: This paper examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. Method: Participants (N = 488; age 7-17 years; 45% male;... more
Objective: This paper examined associations between change in youth and family characteristics during youth anxiety treatment and long-term anxiety severity and overall functioning. Method: Participants (N = 488; age 7-17 years; 45% male; 82% white) were randomized to 12 weeks of cognitive behavioral therapy (Coping Cat), medication (sertraline), their combination, or pill placebo in the Child/Adolescent Anxiety Multimodal Study (CAMS). A subset participated in the naturalistic follow-up Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS; n = 319; 3.70-11.83 years posttreatment). The current secondary analyses examined how change in anxiety severity (Child Global Impression-Severity), overall functioning (Children's Global Assessment Scale), caregiver psychopathology (Brief Symptom Inventory), caregiver strain (Family Burden Assessment Scale), and family dysfunction (Brief Family Assessment Measure) during CAMS was associated with anxiety severity and overall f...
Research Interests:
Social phobia is an exaggerated fear of a variety of social and performance situations due to the concern that one may become embarrassed or humiliated in front of others. Such fear is considered “normal” to some degree, especially during... more
Social phobia is an exaggerated fear of a variety of social and performance situations due to the concern that one may become embarrassed or humiliated in front of others. Such fear is considered “normal” to some degree, especially during the period of adolescence. However, for a significant proportion of youth, social fear and social phobia become pathological conditions impacting upon functioning across a variety of life domains (friendships, academics, family functioning, vocational functioning). Youth with social phobia report greater feelings of depression, estrangement from others, hopelessness, and loneliness. Moreover, research indicates that social phobia, if left untreated, can be a major pathway for more complex and destructive complications, such as suicidality and substance abuse. This paper reviews the research in the area of social anxiety and social phobia in adolescents. The phenomenology of the disorder, particularly within a developmental context, is presented. Cu...
Research Interests:
Research Interests: Psychology, Clinical Psychology, Anxiety Disorders, Psychotherapy, Psychopathology, and 15 moreTreatment, Adolescent, Medicine, Anxiety, Humans, Child, Female, Male, Psychological Intervention, Psychosocial, ANXIETY, Nino, Combined Modality Therapy, Psychology and Cognitive Sciences, and Medical and Health Sciences
Obsessive-compulsive disorder (OCD) comprises both cognitive and behavioral components. It is not surprising, therefore, that there has been a considerable emphasis on applying cognitive-behavioral techniques in the treatment of... more
Obsessive-compulsive disorder (OCD) comprises both cognitive and behavioral components. It is not surprising, therefore, that there has been a considerable emphasis on applying cognitive-behavioral techniques in the treatment of obsessive-compulsive disorder for the past 20 or so years. Although a great number of individuals afflicted with obsessive-compulsive disorder are suffering from cognitive symptoms, the success rate in using traditional cognitive-behavioral techniques in targeting these covert symptoms has unfortunately been somewhat low. This article provides a case study utilizing a cognitive-behavioral treatment used to successfully treat obsessive-compulsive disorder in a 10-year-old Caucasian male with severe “just right” cognitive compulsions. Treatment outcome is discussed in terms of various assessment measures administered at pre-treatment, post-treatment, and 3-month follow-up, as well as weekly monitoring forms.
Research Interests:
Initial internet-based cognitive behavioral therapy (iCBT) programs for anxiety disorders in children and young people (CYP) have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack... more
Initial internet-based cognitive behavioral therapy (iCBT) programs for anxiety disorders in children and young people (CYP) have been developed and evaluated, however these have not yet been widely adopted in routine practice. The lack of guidance and formalized approaches to the development and dissemination of iCBT has arguably contributed to the difficulty in developing iCBT that is scalable and sustainable beyond academic evaluation and that can ultimately be adopted by healthcare providers. This paper presents a consensus statement and recommendations from a workshop of international experts in CYP anxiety and iCBT (#iCBTLorentz Workshop Group) on the development, evaluation, engagement and dissemination of iCBT for anxiety in CYP.
Research Interests:
There has been growing clinical and research attention to the unique developmental stage of emerging adulthood. This stage is a time of significant change and growth for all individuals, as it includes identity exploration, emotional,... more
There has been growing clinical and research attention to the unique developmental stage of emerging adulthood. This stage is a time of significant change and growth for all individuals, as it includes identity exploration, emotional, behavioral, and financial independence from caregivers, and completion of educational or vocational requirements. Anxiety disorders are the most common mental health diagnoses among emerging adults, and individuals suffering from these disorders often experience compounding functional impairments across health, financial, and social domains. While evidence-based treatments exist for both child/adolescent anxiety disorders and adult anxiety disorders, no specialized assessment or treatment methods have been established for the unique period of emerging adulthood. Our review examines literature pertinent to anxiety disorders in emerging adulthood and describes a novel, specialized intervention to address the unique challenges faced by anxious emerging ad...
Research Interests:
To determine the percent reduction cutoffs on the Multidimensional Anxiety Scale for Children (MASC) that optimally predict treatment response and remission in youth with anxiety disorders. Youths and their parents completed the MASC-C/P... more
To determine the percent reduction cutoffs on the Multidimensional Anxiety Scale for Children (MASC) that optimally predict treatment response and remission in youth with anxiety disorders. Youths and their parents completed the MASC-C/P before and after treatment, and the Anxiety Disorders Interview Schedule for DSM-IV-Child and Parent Versions (ADIS-IV-C/P) and the Clinical Global Impression-Improvement Scale (CGI-I) were administered by independent evaluators. Treatment response and remission were defined by post-treatment ratings on the CGI-I and the ADIS-IV-C/P, respectively. Quality receiver operating characteristic methods determined the optimal cutoff on the MASC-P for predicting overall remission (loss of all study entry diagnoses) and optimal percent reductions on the MASC-P for predicting treatment response and remission of separation anxiety, social anxiety, and generalized anxiety. A post-treatment raw score of 42 optimally predicted remission. A reduction of 35% on the...
Research Interests:
Bioecological models of developmental psychopathology underscore the role of familial experiences of adversity and children's individual-level characteristics in heightening risk for pediatric anxiety through direct, combined, and... more
Bioecological models of developmental psychopathology underscore the role of familial experiences of adversity and children's individual-level characteristics in heightening risk for pediatric anxiety through direct, combined, and interactive effects. To date, much of the existing research dedicated to pediatric anxiety disorders has largely been examined in bioecological models of diathesis-stress using community samples. This study extends our understanding of children's differential responsiveness to familial adversity by examining the diathesis-stress interaction of cumulative risk and children's individual-level vulnerabilities (negative affectivity and coping efficacy) within a clinic-referred treatment study for pediatric anxiety disorders. A cumulative risk index assessing exposure to familial adversity (e.g., socioeconomic status [SES], parent psychiatric illness) and self-reported measures of children's negative affectivity and coping efficacy were each mea...
Research Interests:
To report anxiety outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). Rates of stable anxiety remission (defined rigorously as the absence of all DSM-IV TR anxiety disorders across all... more
To report anxiety outcomes from the multisite Child/Adolescent Anxiety Multimodal Extended Long-term Study (CAMELS). Rates of stable anxiety remission (defined rigorously as the absence of all DSM-IV TR anxiety disorders across all follow-up years) and predictors of anxiety remission across a 4-year period, beginning 4 to 12 years after randomization to 12 weeks of medication, cognitive-behavioral therapy (CBT), their combination, or pill placebo were examined. Examined predictors of remission included acute treatment response, treatment assignment, baseline child and family variables, and interim negative life events. Data were from 319 youths (age range 10.9-25.2 years; mean age 17.12 years) originally diagnosed with separation, social, and/or generalized anxiety disorders and enrolled in the multi-site Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were assessed annually by independent evaluators using the age-appropriate version of the Anxiety Disorders Interview...
Research Interests:
Exposure tasks are recognized widely as a key component of cognitive-behavioral therapy (CBT) for child and adolescent anxiety. However, little research has examined specific exposure characteristics that predict outcomes for youth with... more
Exposure tasks are recognized widely as a key component of cognitive-behavioral therapy (CBT) for child and adolescent anxiety. However, little research has examined specific exposure characteristics that predict outcomes for youth with anxiety and that may guide its application in therapy. This study draws on a sample of 279 children and adolescents (48.4% male; 79.6% white) with a principal anxiety disorder who received 14 sessions of CBT, either alone or in combination with medication, through the Child/adolescent Anxiety Multimodal treatment Study (CAMS). The present study examines therapist-reported quantity, difficulty level, compliance, and mastery of exposure tasks as they related to CBT response (i.e., Clinical Global Impressions-Improvement ratings). Secondary treatment outcomes included reduction in anxiety symptom severity on the Pediatric Anxiety Rating Scale, global impairment measured via the Children's Global Assessment Scale, and parent-report of anxiety-specifi...
Research Interests:
Anxiety disorders are among the most common mental health problems in youth, and faulty interpretation bias has been positively linked to anxiety severity, even within anxiety-disordered youth. Quick, reliable assessment of interpretation... more
Anxiety disorders are among the most common mental health problems in youth, and faulty interpretation bias has been positively linked to anxiety severity, even within anxiety-disordered youth. Quick, reliable assessment of interpretation bias may be useful in identifying youth with certain types of anxiety or assessing changes on cognitive bias during intervention. This study examined the factor structure, reliability, and validity of the Self-report of Ambiguous Social Situations for Youth (SASSY) scale, a self-report measure developed to assess interpretation bias in youth. Participants (N=488, age 7 to 17) met diagnostic criteria for Social Phobia, Generalized Anxiety Disorder, and/or Separation Anxiety Disorder. An exploratory factor analysis was performed on baseline data from youth participating in a large randomized clinical trial. Exploratory factor analysis yielded two factors (Accusation/Blame, Social Rejection). The SASSY full scale and Social Rejection factor demonstrat...
Research Interests:
Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics,... more
Cognitive behavioral therapy (CBT) for anxiety disorders is effective, but nonadherence with treatment may reduce the benefits of CBT. This study examined (a) four baseline domains (i.e., demographic, youth clinical characteristics, therapy related, family/parent factors) as predictors of youth adherence with treatment and (b) the associations between youth adherence and treatment outcomes. Data were from 279 youth (7-17 years of age, 51.6% female; 79.6% White, 9% African American), with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) diagnoses of separation anxiety disorder, generalized anxiety disorder, and/or social phobia, who participated in CBT in the Child/Adolescent Anxiety Multimodal Study. Adherence was defined in three ways (session attendance, therapist-rated compliance, and homework completion). Multiple regressions revealed several significant predictors of youth adherence with CBT, but predictors varied according to the definition of adheren...
Research Interests:
This is a feasibility study evaluating the safety, tolerability, and potential anxiolytic efficacy of the α2 agonist guanfacine extended-release (GXR) in children and adolescents with generalized anxiety disorder (GAD), separation anxiety... more
This is a feasibility study evaluating the safety, tolerability, and potential anxiolytic efficacy of the α2 agonist guanfacine extended-release (GXR) in children and adolescents with generalized anxiety disorder (GAD), separation anxiety disorder (SAD), or social phobia/social anxiety disorder. Youth aged 6-17 years with a primary diagnosis of GAD, SAD, and/or social anxiety disorder were treated with flexibly dosed GXR (1-6 mg daily, n = 62) or placebo (n = 21) for 12 weeks. The primary aim of this study was to determine the safety and tolerability of GXR in youth with anxiety disorders, which involved the analysis of treatment-emergent adverse events (TEAEs), the emergence of suicidal ideation and behaviors, vital signs, and electrocardiographic/laboratory parameters. Exploratory efficacy measures included dimensional anxiety scales (Pediatric Anxiety Rating Scale [PARS] and Screen for Child Anxiety Related Emotional Disorders [SCARED]), as well as the Clinical Global Impression-...
Research Interests: Psychology, Anxiety Disorders, Adolescent, Medicine, Anxiety, and 15 moreHumans, Child, Placebo, Generalized Anxiety Disorder, Blood Pressure, Female, Feasibility Studies, Male, Separation Anxiety, Social phobia, ANXIETY, Pilot Projects, Guanfacine, Psychiatric Status Rating Scales, and Pharmacology and pharmaceutical sciences
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors are effective treatments for pediatric anxiety disorders. However, the mechanisms of these treatments are unknown. Previous research indicated that somatic... more
Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors are effective treatments for pediatric anxiety disorders. However, the mechanisms of these treatments are unknown. Previous research indicated that somatic symptoms are reduced following treatment, but it is unclear if their reductions are merely a consequence of treatment gains. This study examined reductions in somatic symptoms as a potential mediator of the relationship between treatment and anxiety outcomes. Participants were 488 anxious youth ages 7-17 (M = 10.7), 50.4% male, 78.9% Caucasian, enrolled in Child/Adolescent Anxiety Multimodal Study, a large randomized control trial comparing 12-week treatments of CBT, sertraline, a combination of CBT and sertraline, and a pill placebo. Causal mediation models were tested in R using data from baseline, 8-, and 12-week evaluations. Somatic symptoms were assessed using the Panic/Somatic subscale from the Screen for Child Anxiety Related Emotional Disorders...
Research Interests:
Research Interests:
Research Interests: Clinical Psychology, Anxiety Disorders, Fear, Eating Disorders, Culture, and 15 moreBody Image, Medicine, Comorbidity, Anorexia Nervosa, Anxiety, Humans, Behavior Therapy, Female, Feeding Behavior, Eating, Body Weight, ANXIETY, Implosive therapy, Exposure and Response Prevention, and Combined Modality Therapy
Research Interests:
Chapter 7 describes treatment procedures for children who refuse school to pursue tangible rewards outside of school. Common behaviors in this functional group include secrecy to hide school absences, verbal and physical aggression,... more
Chapter 7 describes treatment procedures for children who refuse school to pursue tangible rewards outside of school. Common behaviors in this functional group include secrecy to hide school absences, verbal and physical aggression, running away, spending an excessive amount of time with friends, disruptive behavior to stay out of school, hostile attitude, refusal to talk, drug use, and excessive sleep. The major focus of treatment is relevant family members, most likely the parents and the child (more likely adolescent) refusing school. The major goal is to provide family members with a better way of solving problems, reducing conflict, increasing rewards for school attendance, and decreasing rewards for school absence. Ways of improving family communication, solving problems by establishing and sticking to contracts, and dealing with peers are discussed. Special topics covered are 504 plans and individualized education plans, alternative educational placements, the need to involve law enforcement, and problems getting out of bed.
Research Interests:
Chapter 4 outlines the treatment for children with school refusal behavior who are motivated by a desire to avoid emotions such as fear, dread, anxiety, panic, or depression that can become associated with certain school-related objects... more
Chapter 4 outlines the treatment for children with school refusal behavior who are motivated by a desire to avoid emotions such as fear, dread, anxiety, panic, or depression that can become associated with certain school-related objects or situations. For these children, the main goal of treatment is to change the child’s avoidance behavior and build coping and active school attendance behaviors. Detailed descriptions of each session are provided, along with homework assignments. The child is taught skills such as relaxation and deep breathing. Case vignettes and sample dialogues are included.
Research Interests:
Research Interests: Psychology, Clinical Psychology, Cognitive Science, Developmental Psychology, Social Anxiety, and 13 moreChild Development, Adolescent, Medicine, Anxiety, Humans, Child, Female, Male, Social phobia, ANXIETY, Guidance and Counseling Intervention Programs, Cross Sectional Studies, and Child and Adolescent Clinical Psychology
Research Interests: Psychology, Clinical Psychology, Psychiatry, Education, Adolescent Development, and 13 moreAdolescent Health, Adolescent, Medicine, Humans, Major Depressive Disorder, Cognitive Therapy, Psychological Intervention, Psychosocial, FLUOXETINE, Serotonin Uptake Inhibitors, Combined Modality Therapy, Psychology and Cognitive Sciences, and Medical and Health Sciences
Research Interests:
Research Interests:
Research Interests:
... Patty DiBartolo wishes to thank her husband and children, John, Jack, and Emily, and her sisters, Chris, Carolyn, and Jess, for their love ... the natural onset and resolution of social and evalua-tive fears at certain times during... more
... Patty DiBartolo wishes to thank her husband and children, John, Jack, and Emily, and her sisters, Chris, Carolyn, and Jess, for their love ... the natural onset and resolution of social and evalua-tive fears at certain times during the course of childhood (see Albano, Causey, & Carter ...
Research Interests:
Research Interests:
ABSTRACT
Research Interests:
... to find female role models representing the range of lifestyle and career choices before them, from Maya Angelou to Sally Ride, Madonna ... self-focus and self-deprecation and are accompanied by a range of autonomic symptoms and... more
... to find female role models representing the range of lifestyle and career choices before them, from Maya Angelou to Sally Ride, Madonna ... self-focus and self-deprecation and are accompanied by a range of autonomic symptoms and sensations (Albano, DiBartolo, Heimberg, & ...
Research Interests:
Research Interests: Psychology, Fear, Eating Disorders, Medicine, Anorexia Nervosa, and 15 moreAnxiety, Humans, Female, Cognitive Therapy, Feeding Behavior, Adult, Randomized Controlled Trial, Body Weight, ANXIETY, Meal, Pilot Projects, Energy Intake, Implosive therapy, Psychology and Cognitive Sciences, and Medical and Health Sciences
Social anxiety is a universal phenomenon that any individual can recall having experienced at repeated times during his or her life. If asked, most individuals can easily remember their most embarrassing moment, along with more minor... more
Social anxiety is a universal phenomenon that any individual can recall having experienced at repeated times during his or her life. If asked, most individuals can easily remember their most embarrassing moment, along with more minor social faux pas occurring more often than not. For many persons the physical and emotional discomfort experienced during such events are transitory and soon forgotten or later recalled with sidesplitting laughter. Unfortunately, a significant proportion of children and adolescents tend to experience social anxiety at extreme levels, on a continuous basis, with or without having any objective experience with an embarrassing event. For such individuals, everyday experiences such as attending school and interacting with peers are approached with painful anticipation of rejection, humiliation, embarrassment, and failure.
Research Interests:
In the present study involving children and adolescents with a principal diagnosis of social phobia, we measured parent–child agreement regarding social anxiety symptoms. Additionally, we examined variables related to the severity of the... more
In the present study involving children and adolescents with a principal diagnosis of social phobia, we measured parent–child agreement regarding social anxiety symptoms. Additionally, we examined variables related to the severity of the children's social phobia symptoms as reported by children and as rated by clinicians. Examination of cross-informant agreement indicated little difference between mean parent and children ratings of