E-Book, Englisch, 142 Seiten
Grills-Taquechel / Ollendick Phobic and Anxiety Disorders in Children and Adolescents
1. Auflage 2013
ISBN: 978-1-61334-339-5
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
E-Book, Englisch, 142 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61334-339-5
Verlag: Hogrefe Publishing
Format: EPUB
Kopierschutz: 6 - ePub Watermark
Compact, authoritative guidance to effective assessment and treatment of the most common psychological difficulties in children and adolescents - phobia and anxiety disorders
This authoritative but compact text addresses the psychopathology, assessment, and treatment of the anxiety disorders and phobias in childhood and adolescence. These perplexing conditions are the most prevalent psychological difficulties in young people and result in considerable impairment and distress, not only to the child but also to her or his family. Effective treatments exist, but unfortunately many of these interventions are either not known to the practicing professionals or not used by them. This volume aims to address this gap and to present these interventions in a clear and straightforward manner.
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2 Theories and Models of Phobic and Anxiety Disorders
Theoretical models of anxiety disorders have been continuously evolving over the last century. As a result, current theories tend to draw from several areas of research. For example, biopsychosocial and integrative models have evolved which commonly include the combination of biological, developmental, psychological, and social influences. Presenting the extensive research that has supported these theories is well beyond the scope of this chapter. Rather, brief mention will be given to each of these areas (see Table 6) and major areas of research focus within them, with references to pertinent work for interested readers. Greater focus is devoted to areas more directly relevant for assessment and treatment recommendations, and a final section provides a brief depiction of some of the contemporary integrated models of anxiety development. Table 6 Common Risk and Maintenance Factors for Childhood Anxiety Disorders 2.1 Genetic/Biological Contributions
Anxiety disorders comprised both heritable and nonheritable (psychosocial/ environmental) components Regarding biological contributions, it is now clear that anxiety disorders have a heritable component, as demonstrated by a growing body of genetic, familial, and twin research studies (see Arnold & Taillefer, 2011; Gregory & Eley, 2007; Hirshfeld-Becker, Micco, et al., 2008). From these studies, we know that higher concordance is found among identical versus fraternal twins, with reported heritability estimates typically in the range of .2 to .4. In addition, these studies have confirmed that there is a significantly greater risk of developing an anxiety disorder in children who have a parent with an anxiety disorder; though children are not predisposed to “inherit” the same disorder as their parent. Neurobiological research has also emerged, suggesting potentially important roles for the limbic and fear circuitry systems, especially the amygdala (e.g., De Bellis et al., 2000; Pine, 2009), frontal lobe asymmetry (see Forbes et al., 2006; Thibodeau, Jorgensen, & Kim, 2006), and neurotransmitter systems, such as those involving serotonin (see Arnold & Taillefer, 2011; Gregory & Eley, 2007). In short, findings from genetic and biologically oriented studies have provided substantial information regarding child anxiety disorders. However, this research only accounts for roughly one third to one half of cases, leaving a significant amount of influence to other areas. Of course even in those cases when genetics/biological contributions are present, they alone do not account for the development of anxiety disorders in young people, a fact that clearly illustrates the need to consider psychosocial/ environmental domains. Nonetheless, it is important to recognize that given strong heritability rates, parents presenting with their anxious child may also be experiencing significant anxiety difficulties. In addition to any family history of mental health concerns, clinicians should consider incorporating a brief parent anxiety screener into their assessment battery for determining this. In such cases, for example, the therapist may also need to address the parents’ anxiety (e.g., through referral for treatment or active participation in the child’s treatment) to best intervene for the child and potentially decrease the chance of relapse. 2.2 Child/Developmental Characteristics
2.2.1 Early Behavioral Indicators
Behavioral inhibition and negative affectivity, as well as poor attachment, are all strong predictors of later anxiety diagnoses Most families will not present for treatment until the child is much older than when these characteristics are observed Several behaviors or traits of infants/young children have been linked with the later diagnosis of anxiety disorders. Among these, temperament has emerged as a robust and stable predictor, with both behavioral inhibition and negative affectivity or emotionality showing the strongest associations (see Degnan, Almas, & Fox, 2010; Feng, Shaw, & Silk, 2008; Hirshfeld-Becker, Micco, et al., 2008; Karevold, Røysamb, Ystrom, & Mathiesen, 2009; Muris, van Brakel, Arntz, & Schouten, 2011). Behavioral inhibition is present in about 10–15% of infants (Fox, Henderson, Marshall, Nichols, & Ghera, 2005). These infants typically experience physiological arousal and withdraw or show fear when exposed to unfamiliar situations. With advances in child development, the expression and developmental processes involved with behavioral inhibition tend to vary. Negative affectivity or emotionality refers to a pattern of negative mood and emotional reactions along with increased irritability and difficulty being soothed or comforted. Whereas behavioral inhibition has been specifically associated with anxiety disorders, negative emotionality has been associated with anxiety, mood, and internalizing symptoms, including depression and irritability. Poor attachment patterns (insecure) with primary caregivers have also been linked with both behavioral inhibition and later anxiety disorders (e.g., Gar, Hudson, & Rapee, 2005; Manassis, 2001; Shamir-Essakow, Ungerer, & Rapee, 2005). Children with insecure attachments may show distress when separated from their primary caregiver or in new environments but also show little interest in receiving comfort from their caregiver. Insecure attachment is believed to influence the development of child anxiety, as the child may develop the sense of an unpredictable world and the lack of secure support from primary caregivers. Although temperament and attachment have been well linked with the onset of child anxiety disorders, most often children will not present for treatment until several years beyond the development of these early behavioral indicators. That is, these two domains develop in infancy, and most children will not be brought for treatment of anxiety disorders until they are several years older. Still these early precursors are important as they may set the stage for the development of anxiety, and may inform treatment approaches insomuch as there may be a continuing negative pattern of parent–child interaction. For example, researchers have found that a transaction may occur in which children with behavioral inhibition elicit greater overprotection from their parents (e.g., Mills & Rubin, 1993). In such cases, it would be relevant for the clinician to be aware of this continued pattern, as it may serve as an additional target for intervention. Importantly, these early indicators may also represent identifiable areas to be modified in an attempt to prevent the onset of later anxiety disorders. 2.2.2 Cognitive and Emotional Contributions
Cognitive Biases Common cognitive biases of anxious youth include attention, interpretation, judgment, and memory In terms of cognitive contributions, theorists have proposed several risk factors involving biases and misinterpretations, problem solving, and control. With regard to cognitive biases, four different areas are typically discussed (though varying terminology has been used), and these include attention bias, interpretation, judgment, and memory (Cowart & Ollendick, 2010; Vasey & MacLeod, 2001; Weems, Costa, Watts, Taylor, & Cannon, 2007). Anxious children often have an attention bias toward things viewed as threatening and misinterpret ambiguous things as threatening Numerous studies have shown that anxious children exhibit an attention bias toward perceived threatening stimuli, as well as an interpretation bias marked by misinterpretation of ambiguous aspects of their environment as threatening (e.g., Cannon & Weems, 2010; Creswell, Schniering, & Rapee, 2005; Hadwin & Field, 2010; Puliafico & Kendall, 2006). Attention bias toward threatening stimuli does not only appear to occur in anxious youths, however. Rather, this bias has been shown to occur in children more generally (e.g., Morren, Kindt, van den Hout, & van Kasteren, 2003; Waters, Lipp, & Spence, 2004) and to be present from early in infancy (Field & Lester, 2010). Interestingly, an attention bias has also been found to develop alongside increased fear in children who were given negative/fearful information about a novel stimulus (an unknown animal; Field, 2006). Thus, it may be that children with anxiety disorders have been provided fear information about a greater number of stimuli or have shown an increased tendency to generalize from specific fear stimuli to others, perhaps due to a predisposition for anxiety. Also remarkable, whereas in adults threat attention bias has been shown to dissipate following anxiety treatment using cognitive behavioral intervention (Mathews, Mogg, Kentish, & Eysenck, 1995; Mogg, Bradley, Millar, & White, 1995), this has not been replicated with children to date (Waters, Wharton, Zimmer-Gembeck, & Craske, 2008). Although replication of these findings is needed, it is likely the case that child anxiety treatments would benefit from more specifically addressing attention biases (Cowart & Ollendick, 2010; Puliafico & Kendall, 2006). Interpretation bias reflects the tendency to view ambiguous stimuli as threatening. An example we commonly use to depict this for young people is the school cafeteria phenomenon: It is lunchtime, and you walk into the cafeteria and see your friends already sitting together. As you approach the table, they start laughing. Now how you interpret the situation will certainly influence how you feel. For example, if...
