Cognitive behavioural therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children. However, the majority of studies conducted to date have included heterogeneous samples of children combining social anxiety disorder, generalized anxiety disorder and separation anxiety disorder (SAD) together. Few studies have examined the efficacy of CBT to specifically treat SAD. Moreover, research on the impact of CBT for SAD in children younger than 7 years old has been very limited. To address these issues, we examined the effects of a CBT parent training programme with six children with SAD aged between 4 and 7 years using a non-concurrent multiple baseline design. Parents completed semi-structured interviews, questionnaires and daily diaries to assess their child's anxiety symptoms, parental practices and parental stress. Results indicated that five of six children no longer met the criteria for SAD diagnosis after treatment and at 3-month follow-up. Moreover, the daily diaries showed that four of six children presented a systematic favourable change of the total weekly frequency of SAD symptoms. Finally, four mothers reported a decrease in overprotection, but we observed no changes in parental stress.

Cognitive behavioural therapy (CBT) with youth owns a solid and growing empirical literature base. CBT also recognizes the contribution a good therapeutic relationship makes to favourable treatment outcome. However, it is argued that the therapeutic relationship is insufficiently operationalized and the extant definitions neglect the role of therapeutic presence, immediacy, and transparency. Indeed, presence, immediacy, and transparency represent critical elements in creating the necessary therapeutic alchemy leading to propitious symptom change. Accordingly, therapeutic presence, immediacy, and transparency are defined and explained. Additionally, clinical parameters for using presence, immediacy, and transparency in clinical encounters with young patients are articulated. Finally, these crucial processes pervade cognitive behavioral modules such as self-monitoring, cognitive restructuring and behavioural experiments/exposures are explicated through specific examples and therapeutic dialogues.

Background: Little is known about the effect of case-formulation based cognitive behaviour therapy (CBT) for anxious children. Aim: The present study explores the feasibility of case-formulation driven CBT for anxious children. Parents were involved in treatment as either co-facilitators (involved only as the child's assistants, treatment being primarily directed at the child), or as co-clients (parents received therapy targeting theoretically established maintaining mechanisms; children received half of the sessions, parents the other half). Method: Feasibility of the case-formulation driven CBT was established by comparing the completion rate and the percentage of children free of anxiety after treatment, with manualized treatments reported in existing meta-analyses. Children aged 7–12 years and their parents participated (n = 54). Families were assessed at pre- and posttreatment and at 6-month follow-up. Results: All families completed treatment and the percentage of recovery in the case-formulation driven approach was comparable to results obtained in manualized treatments. Conclusion: The findings from this stage I study supports the notion that a case-formulation driven approach to CBT may be a feasible option when selecting treatment for anxious children; however, further studies must be conducted before firm conclusions can be drawn.

Background: Computer-assisted cognitive behavioral therapy (CCBT) programs for childhood anxiety are being developed, although research about factors that contribute to implementation of CCBT in community mental health centers (CMHC) is limited. Aim: The purpose of this mixed-methods study was to explore consumers’ and providers’ perceptions of utilizing a CCBT for childhood anxiety in CMHC in an effort to identify factors that may impact implementation of CCBT in CMHC. Method: Focus groups and interviews occurred with 7 parents, 6 children, 3 therapists, 3 project coordinators and 3 administrators who had participated in CCBT for childhood anxiety. Surveys of treatment satisfaction and treatment barriers were administered to consumers. Results: Results suggest that both consumers and providers were highly receptive to participation in and implementation of CCBT in CMHC. Implementation themes included positive receptiveness, factors related to therapists, treatment components, applicability of treatment, treatment content, initial implementation challenges, resources, dedicated staff, support, outreach, opportunities with the CMHC, payment, and treatment availability. Conclusion: As studies continue to demonstrate the effectiveness of CCBT for childhood anxiety, research needs to continue to examine factors that contribute to the successful implementation of such treatments in CMHC.

Background: Body dysmorphic disorder (BDD) is relatively common in adolescents and can have serious negative consequences. However, the treatment of BDD in young people has received virtually no empirical attention to date, and the evidence-base for cognitive behaviour therapy (CBT) in this population is limited to a small number of single case reports. Aims: This study aimed to investigate treatment outcomes associated with CBT, primarily consisting of exposure and response prevention, in a group of young people with BDD. Method: Six adolescents with a diagnosis of BDD received a course of developmentally appropriate CBT for BDD with parental involvement. BDD and depressive symptoms were evaluated at pre-treatment, post-treatment and at 3- or 6-month follow-up, using the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) and the Beck Depression Inventory-Youth, respectively. Results: Scores on the BDD-YBOCS indicated a 44% improvement in BDD symptoms at post-treatment and a 57% improvement at follow-up for the group. Considering response as a ≥30% reduction in BDD-YBOCS score, four of the six adolescents were classified as treatment responders. Improvements in depressive symptoms were observed among the treatment responders, but not the non-responders. Conclusions: These findings indicate the potential efficacy of CBT, including exposure and response prevention for adolescents with BDD, and highlight the need for further controlled trials.

Background: Children of parents with bipolar disorder are at increased risk of disturbance. Aims: This study examined relationships between parental mood, parenting, household organization and child emotional and behavioural adjustment in families with a parent with bipolar disorder to determine areas of specific need for parenting support. Method: 48 parents were recruited through advertisements via self-help organizations. The study was conducted online. Parental mood and activity was assessed by self-report questionnaires (CES-D, ISS, MDQ and SRM); parenting was assessed using the Parenting Scale (PS). The SDQ was used to assess the parent's view of their child's emotional and behavioural difficulties. The Confusion, Hubbub and Order Scale (CHAOS) assessed household organization. Results: Parents reported high levels of difficulties across all measures and scores were above clinical cut-offs on most scales. Children were reported as showing high levels of disturbance on the SDQ, including all sub-scales. Parenting and depression scores were significantly positively correlated, as were depression, parenting and CHAOS score. Regression analyses indicated that CHAOS was the strongest predictor of Total Difficulties and Emotional Symptoms on the SDQ. Conclusions: Families are likely to benefit from interventions tailored to meet their parenting needs.

Anxiety is the most pervasive childhood mental health disorder today. This study examined the parent component of a school-based universal prevention and early intervention program. Participating parents (N = 122) completed four measures on anxiety, the Anxiety Sensitivity Index, the Center for Epidemiological Studies-Depression, the Penn State Worry Questionnaire, and the Screen for Child Anxiety Related Emotional Disorders, before and after the parent program. The effectiveness of the program was investigated by analysing mean scores of the parent self-reported anxiety symptoms and parent reports of child anxiety symptoms. The main analyses conducted were 2 × 2 between-within ANOVAs for each measure. The hypothesis that parents who participated in the program (n = 20) would report reduced anxiety symptoms for themselves and for their children when compared to parents who did not attend (n = 120) was not confirmed. The parent's satisfaction level with the program was also studied, with high acceptability ratings providing strong social validity for this program. Implications of the findings, strengths, limitations and suggestions for further research are discussed.

Four anxiety disordered 8- to 11-year-old children and their parents participated in a shortened version of an efficacious cognitive–behavioural program for anxiety in children, designed to reflect therapy conditions found in usual clinical practice. A modified multiple-baseline design was used that combined clinic setting pragmatics with a necessary level of methodological protection. For ongoing evaluation, weekly measures of the child's trait anxiety and coping ability were obtained from the child and parents. In addition, a battery of measures was used to evaluate outcomes following treatment and at two follow-up intervals. Emphasising increased parent involvement and earlier exposure sessions, the program was found to lead to marked changes in child functioning. In particular, all children showed improvement on self-report, parent report, and independent clinician's ratings over the course of treatment. Moreover, scores on relevant indices were all within a nondeviant range following intervention, and all four children no longer qualified for an anxiety diagnosis at posttreatment and at 3- and 12-month followup. Findings are discussed in terms of implementation and evaluation in practice settings (e.g., critical components of treatment, use of pragmatic single case designs). Suggestions for future research include testing the effectiveness of this brief program on a large and diverse sample of children. Additional research is also required to find out to what extent increased parent involvement and earlier exposure sessions enhance the impact of treatment in the larger context of addressing features of the research-practice gap. Overall, findings provide preliminary support for the effectiveness of a brief cognitive–behavioural program for treating anxiety disorders in children, along with an evaluation strategy, compatible with some of the needs of service delivery settings.

Background: Subjective Units of Distress Scale (SUDS) ratings are commonly used during exposure tasks in cognitive behavioral treatment (CBT) for anxiety. Aims: The present study examined patterns and predictors of SUDS in a sample of anxiety-disordered youth. Method: Youth (N = 99) aged 7 to 14 (M = 10.4, SD = 1.8) were treated with CBT for social phobia (SP), generalized anxiety disorder (GAD), and/or separation anxiety disorder (SAD). Analyses were conducted using hierarchical linear modeling. Results: Child's peak SUDS and magnitude of change in SUDS significantly increased between sessions. Higher child self-reported pretreatment total Multidimensional Anxiety Scale for Children (MASC) score predicted greater change in SUDS within the first exposure session. Primary GAD diagnosis predicted less increase in change in SUDS between sessions. Conclusions: Results suggest that higher pretreatment total MASC scores are associated with increased first exposure within-session habituation. Additionally, youth with a principal diagnosis of GAD experienced less between-session habituation, perhaps because they may have required more imaginal than in-vivo exposures.

Social phobia (SP) is characterized by a fear of one or more social or performance situations. Studies of comorbidity in SP youth find anxiety and affective disorders co-occurring. The present study examined children with primary SP and compared them to children with primary Separation Anxiety Disorder (SAD) or Generalized Anxiety Disorder (GAD) prior to treatment and in response to treatment. The groups differed significantly on self-, parent- and teacher-rated pretreatment measures. Additionally, the two groups showed differential treatment outcomes. When the SP youth with comorbid Affective Disorder were excluded in treatment outcome analyses, there were non significant differences, indicating that comorbid affective disorders likely contributed to differential treatment outcome. Results are discussed in terms of treatment recommendations for socially phobic youth.

Parenting styles and the parent-child bond are associated with anxiety in children. Despite this association, little is known about the mechanism through which parenting has its effect. One possibility is that parenting interacts with other known pathways to fear. Two experiments are reported that look at the interaction between parenting styles and parent-child relationships and the verbal information pathway to fear. In Experiment 1, a punitive maternal parenting style was found to interact with the effect of threat information about a novel animal in 6–9-year-old children. Maternal warmth, neglect, overprotection and accurate monitoring were not found to have a significant effect. Experiment 2 showed that children reporting a greater number of negative interactions with their fathers had greater increases in fear beliefs about novel animals after both threat and no information. The quality of mother-child relationships did not significantly interact with the verbal information pathway. These experiments offer preliminary evidence that parenting practices influence how children react to negative information, which offers some insight into the potential causes of the association between parenting and anxiety in children.