Showing papers by "Michelle Rozenman published in 2020"
TL;DR: BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients and further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care.
Abstract: Objective To report on the 32-week outcome of the Brief Behavioral Therapy (BBT) for Pediatric Anxiety and Depression in Primary Care clinical trial. Method A total of 185 youths aged 8 to 17 years with anxiety and/or depression identified through 9 pediatric primary care (PPC) settings in San Diego and Pittsburgh were randomized to receive Assisted Referral to Care (ARC) or up to 12 sessions of BBT over 16 weeks. The primary outcome was clinical response across anxiety and depression, defined as a Clinical Global Impressions−Improvement Score of ≤2. Secondary outcomes included interview-rated functioning, depression, and anxiety. Here, we report on outcomes at 32 weeks after randomization. All analyses with primary outcomes are corrected for multiple comparisons using the false discovery rate procedure. Results At 32 weeks, BBT was superior to ARC with respect to response (67.5% versus 43.1%, q = 0.03, number needed to treat [NNT] = 5) and functioning (d = 0.49, q = 0.04). BBT was superior to ARC with respect to its impact on anxiety (f = 0.21) but not depressive symptoms (f = 0.05). These findings persisted after controlling for the number of sessions received. Ethnicity moderated the impact of BBT on outcome (NNT for Hispanic youths = 2), because of a much lower response rate to ARC in Hispanic than in non-Hispanic youths (16.7% versus 49.2%, p = 0.04). Conclusion BBT is a promising intervention that can be effectively delivered in PPC and may be particularly effective for Hispanic patients. Further work is indicated to improve its impact on depressive symptoms and to test BBT against other treatments delivered in pediatric primary care. Clinical trial registration information Brief Cognitive Behavioral Therapy (CBT) for Pediatric Anxiety and Depression in Primary Care; http://clinicaltrials.gov ; NCT01147614 .
18 citations
TL;DR: Emerging adults who reported higher maternal PC also reported higher anxiety symptoms and evidenced greater emotion regulation difficulties on both objective and subjective indices than those who reported lower maternal PC, and the association between PC and anxiety levels was statistically mediated by self-reported emotionregulation difficulties.
12 citations
TL;DR: Cognitive bias modification for interpretations (CBM‐I) is a computerized intervention that has received increasing attention in the last decade as a potential experimental intervention for anxiety but experiments have been conducted with unaffected samples, few training sessions, and have not examined transfer effects to anxiety‐related constructs such as stress reactivity.
Abstract: Background Cognitive bias modification for interpretations (CBM-I) is a computerized intervention that has received increasing attention in the last decade as a potential experimental intervention for anxiety. Initial CBM-I trials with clinical populations suggest the potential utility of this approach. However, most CBM-I experiments have been conducted with unaffected samples, few (one or two) training sessions, and have not examined transfer effects to anxiety-related constructs such as stress reactivity. Method This study compared a 12-session CBM-I intervention (n = 12) to an interpretation control condition (ICC; n = 12) in individuals (N = 24) with elevated trait anxiety on interpretation bias, anxiety symptom, and stress reactivity outcomes (electrodermal activity, heart rate, and respiratory sinus arrhythmia). Results Compared to the ICC group, participants assigned to CBM-I experienced significantly greater improvements in interpretation bias and anxiety symptoms by post-intervention 4 weeks later, with impact on anxiety maintained at 1-month follow-up. While CBM-I and ICC groups did not differ in stress reactivity during an acute stressor at pre-intervention, the CBM-I group evidenced improved stress reactivity at post-intervention compared to ICC on two psychophysiological indices, electrodermal activity and heart rate. Conclusions The results of this pilot study suggest that CBM-I may hold promise for reducing anxiety symptoms, as well as impact psychophysiological arousal during an acute stressor.
9 citations
TL;DR: Primary care providers reported that a substantial proportion of the patients they see struggle with anxiety, and a growing need for training in how to assess, treat, and refer anxious youth is reported.
Abstract: OBJECTIVE To assess pediatric primary care providers' (PCPs) knowledge, perceived barriers, and needs related to child and adolescent anxiety in their practice. METHODS Primary care providers licensed and practicing in the state of Colorado were invited to complete an online knowledge and needs assessment. The survey queried their knowledge of pediatric anxiety, experience in assessing and treating anxiety, perceived barriers in their practice setting to adequately addressing youth anxiety, and interest in additional training on this topic. RESULTS Survey completers included 115 PCPs (51 medical doctors and 64 nurses/nurse practitioners). PCPs had been practicing with their current medical license with pediatric patients for an average of 14 years (SD = 10.45), and 70% reported that they regularly discuss anxiety with patients and parents. Although PCPs had a basic knowledge of youth anxiety, there appeared to be significant gaps in PCP knowledge. Specifically, knowledge gaps included evidence-based assessment and treatment, how to differentiate between developmentally appropriate, transient episodes of anxiety versus anxiety disorders, and where and how to refer youth for specialty services. Nearly all (80%) PCPs indicated that they would be "extremely interested" in additional training in pediatric anxiety, particularly if it occurred in their organizational setting, at a nearby community setting, or online. CONCLUSION Primary care providers reported that a substantial proportion of the patients they see struggle with anxiety. PCPs also reported a growing need for training in how to assess, treat, and refer anxious youth. This needs assessment supports a need for the development of easily accessible training and resources for PCPs to better support their pediatric patients.
6 citations
24 Aug 2020
TL;DR: The UCLA Pediatric Obsessive-Compulsive Disorder Intensive Outpatient Program is described as an exemplary intervention setting for clinicians to adapt empirically supported treatment principles and clinical practices to address common treatment barriers in the real world.
Abstract: Intensive psychosocial treatment is presented as a specialized model of care to bridge the research-to-practice gap for evidence-based treatments (EBTs). In the present paper, we describe the UCLA ...
4 citations
TL;DR: Minority status predicts poorer response to standard CBT across disorders, suggesting the need for possible treatment adaptations and the value of family involvement in OCD treatment.
2 citations
01 Jan 2020
TL;DR: In this article, the authors provide a theoretical background, empirical data, and guidelines for practical application of transdiagnostic exposure-based approaches for internalizing youth with anxiety, depression, and somatic complaints.
Abstract: In the last decade, transdiagnostic interventions that target anxiety and common cooccurring problems (e.g., depression) as a cluster of symptoms that respond to the same core set of treatment techniques. In this chapter, we provide a theoretical background, extant empirical data, and guidelines for practical application of transdiagnostic exposure-based approaches for internalizing youth. The chapter begins with a brief description of transdiagnostic interventions, and provides a rationale for targeting anxiety, depression, and somatic complaints as an internalizing cluster in children and adolescents. We then review the current empirical support for transdiagnostic interventions in youth, including data from a recently completed two-site randomized clinical trial testing a brief behavioral therapy (BBT) for internalizing disorders in pediatric primary care. Finally, we present session-by-session treatment descriptions and a case example for implementing BBT with youth, along with general guidelines and considerations for delivering transdiagnostic interventions for youth with internalizing presentations (anxious, depressive, somatic symptoms).