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Biomedical subjects

R M Rapee

Publications and source records attributed to R M Rapee.

At least 19 recordsLinked to original sources
PubMed2003

The influence of comorbidity on treatment outcome for children and adolescents with anxiety disorders.

There have been a growing number of studies showing that cognitive behavioural treatment packages for children with anxiety disorders are highly effective. Clinically, it is often assumed that treatment outcome is less successful, or that treatment needs to be altered when faced with the existence of comorbid conditions. To date, only one study has directly addressed this question in the child anxiety literature. The present study compared the treatment outcome and maintenance following a brief, group program for the reduction of child and adolescent anxiety disorders in anxious children with versus without comorbid disorders. There was no significant difference in response to treatment at the end of the program and few differences at 12-month follow-up. The only indication of an impact of comorbidity was a suggestion that children with a comorbid condition did not do as well at follow-up. However, this result was only shown on some parent-report measures and not on self-report measures. Overall, the results indicate that treatment for child and adolescent anxiety disorders produces broadly comparable results regardless of the existence of comorbid disorders.

Adolescent↗
PubMed2002

Development and validation of a measure of children's automatic thoughts: the children's automatic thoughts scale.

The aim of this study was to describe the history, factor structure and psychometric properties of the Children's Automatic Thoughts Scale (CATS). The CATS is a self-report measure designed to assess a wide range of negative self-statements in children and adolescents. The results of confirmatory factor analyses supported four distinct but strongly correlated factors relating to automatic thoughts on physical threat, social threat, personal failure and hostility. The internal consistency of the total score and subscales was high and test-retest reliability at 1 and 3 months was acceptable. The CATS effectively discriminated between control children and adolescents, and clinically anxious, depressed, or behavior disorder children and adolescents, and showed good discriminant validity across clinical subgroups on the subscales. Results suggest that the CATS is a promising instrument in the assessment of a range of negative automatic thoughts across both internalizing and externalizing problems in young people.

Adolescent↗
PubMed2001

Parent-child interactions and anxiety disorders: an observational study.

Past research has indicated a potential link between anxiety and parenting styles that are characterised by control and rejection. However, few studies have utilised observational methods to support these findings. In the current study, mother-child interactions were observed while the child completed two difficult cognitive tasks. The sample consisted of clinically anxious children (n=43), oppositional defiant children (n=20) and non-clinical children (n=32). After adjusting for the age and sex of the child, mothers of anxious children and mothers of oppositional children displayed greater and more intrusive involvement than mothers of non-clinical children. Mothers of anxious children were also more negative during the interactions than mothers of non-clinical children. The differences between anxious and non-clinical interactions were equivalent across three separate age groups. The results support the relationship between an overinvolved parenting style and anxiety but question the specificity of this relationship.

Adolescent↗
PubMed2001

Anxiety sensitivity, panic, and depressed mood: a reanalysis teasing apart the contributions of the two levels in the hierarchial structure of the Anxiety Sensitivity Index.

Anxiety sensitivity (AS) has been defined as the fear of anxiety and anxiety-related sensations, and evidence suggests that AS plays an important role in the psychopathology of panic. It is entirely unclear whether the relation between AS and panic should be attributed to one (or more) of the AS group factors, the general AS factor, or to factors at both levels of the AS hierarchy. The authors reanalyzed data presented earlier by R. M. Rapee, T. A. Brown, M. A. Antony, and D. H. Barlow (1992) to tease apart the contributions of the different levels of the AS hierarchy to fear responses to hyperventilation and 5.5% carbon dioxide challenges. The results demonstrated that AS-Physical Concerns is the only one of the three AS group factors that contributes to relations with fear responses to these two challenges. However, AS-Mental Incapacitation Concerns had a stronger positive linear association with depressed mood than did AS-Physical Concerns.

Adult↗
PubMed2001

Cognitive-behavioral treatment of anxiety disorders in children: long-term (6-year) follow-up.

Authors evaluated the long-term effectiveness of cognitive-behavioral therapy (CBT) for childhood anxiety disorders. Fifty-two clients (aged 14 to 21 years) who had completed treatment an average of 6.17 years earlier were reassessed using diagnostic interviews, clinician ratings, and self- and parent-report measures. Results indicated that 85.7% no longer fulfilled the diagnostic criteria for any anxiety disorder. On a majority of other measures, gains made at 12-month follow-up were maintained. Furthermore, CBT and CBT plus family management were equally effective at long-term follow-up. These findings support the long-term clinical utility of CBT in treating children and adolescents suffering from anxiety disorders.

Adolescent↗
PubMed2000

Social anxiety and self-impression: cognitive preparation enhances the beneficial effects of video feedback following a stressful social task.

Negative and distorted images of the observable self are important in the development and maintenance of social phobia. Previous research has shown that video feedback has potential to correct the distorted self-perception [Rapee, R. M. & Hayman, K. (1996). The effects of video feedback on the self-evaluation of performance in socially anxious subjects. Behaviour Research and Therapy, 34, 315-322]. The present experiment investigated whether the construction of a self-image prior to viewing the video may enhance the therapeutic effects of video feedback. High and low socially anxious individuals gave a speech and then viewed the video of their performance. Half of the sample were given cognitive preparation prior to viewing the video. Cognitive preparation involved asking participants to (1) predict in detail what they will see in the video, (2) form an image of themselves giving the speech and (3) watch the video as though they were watching a stranger. Participants who received cognitive preparation prior to the video feedback made higher ratings of their overall performance and of specific aspects of their performance compared to those who were not given cognitive preparation and compared to the same ratings made prior to the video feedback. These results suggest that the therapeutic effects of video feedback can be enhanced by careful cognitive preparation which maximises the perceived discrepancy between self and video images.

Adolescent↗
PubMed2000

Issues in the diagnosis and assessment of anxiety disorders in children and adolescents.

Accurate diagnosis and assessment of anxiety disorders in children and adolescents is important for both treatment and research. In this paper, we review research related to the discriminant validity of the childhood anxiety disorders, and outline methods of assessment for children, including diagnostic interviews, self-report instruments, and behavioural, cognitive, and psychophysiological measures. Particular attention is given to psychometric and developmental issues, and their influence on assessment. The evidence provides support for the validity of the anxiety disorders as a whole, but only partial support for differentiation between specific anxiety disorders in children. Similarly, assessment methods used with anxious children provide reasonably accurate information on anxious symptoms, however are limited by poor discriminant validity and lack of sensitivity to developmental levels.

Adolescent↗
PubMed2000

The origins of social phobia.

A greater understanding of the origins of social phobia is much needed. The research to date is limited by the relatively small number of studies that sample clinical populations of individuals with social phobia. There is, however, research derived from related areas such as shyness, social anxiety, self-consciousness, peer neglect, and social withdrawal that contributes to a richer understanding of the etiology of social fears. Combining these areas of research, this review addresses four main factors that may be important to the origins of social phobia: (a) genetic factors; (b) family factors; (c) other environmental factors; and (d) developmental factors.

Adult↗
PubMed1998

Detection of negative and positive audience behaviours by socially anxious subjects.

Nineteen subjects high in social anxiety and 20 subjects low in social anxiety were asked to give a 5-min speech in front of three audience members. Audience members were trained to provide indicators of positive evaluation (e.g., smiles) and negative evaluation (e.g. frowns) at irregular intervals during the speech. Subjects were instructed to indicate, by depressing one of two buttons, when they detected either positive or negative behaviours. Results indicated that subjects high in social anxiety were both more accurate at, and had a more liberal criterion for, detecting negative audience behaviours while subjects low in social anxiety were more accurate at detecting positive audience behaviours.

Adolescent↗
PubMed1997

Recall of family factors in social phobia and panic disorder: comparison of mother and offspring reports.

Previous research has indicated that adults with various anxiety disorders, especially social phobia, recall their parents as excessively protective and controlling and as low in socialization. However, it is not clear whether such results would be supported by parents. In the present study subjects with social phobia, panic disorder, and nonclinical subjects and their mothers were given parallel measures of maternal control, socialization, and offspring early introverted behaviors as well as several questions relating to two early major life events and family size. Anxious offspring reported the usual high maternal control and low paternal socialization and mother supported the data on socialization. On control, mothers provided mixed results, disagreeing on a more standard measure, but showing agreement on a more operationalized measure. The data were more consistent for social phobia than for panic disorder. In terms of early life factors, both anxiety disorders were associated with fewer friends and more introverted behaviors, while family size and two major life events did not differentiate groups.

Adult↗
PubMed1997

Covariation bias for phylogenetic versus ontogenetic fear-relevant stimuli.

In the present study, two groups of 21 subjects with either high or low fear of both snakes (or spiders) and damaged electrical outlets/appliances participated in a two phase experiment. After reading a description of an illusory correlation experiment, subjects were asked to imagine themselves participating in it. They rated their expectations for the number of occasions on which slides of snakes, electrical outlets, and flowers would be followed by either a shock, tone, or nothing. As predicted, both high and low-fear subjects reported an expectancy bias for both phylogenetic and ontogenetic fear-relevant stimuli and shock. In the second phase subjects were actually exposed to the random slide/outcome presentation. Only high-fear subjects demonstrated a covariation bias which was specific to phylogenetic fear-relevant slides and shock, indicating all other biases were effectively attenuated.

Analysis of Variance↗
PubMed1997

A cognitive-behavioral model of anxiety in social phobia.

The current paper presents a model of the experience of anxiety in social/evaluative situations in people with social phobia. The model describes the manner in which people with social phobia perceive and process information related to potential evaluation and the way in which these processes differ between people high and low in social anxiety. It is argued that distortions and biases in the processing of social/evaluative information lead to heightened anxiety in social situations and, in turn, help to maintain social phobia. Potential etiological factors as well as treatment implications are also discussed.

Anxiety↗
PubMed1997

Potential role of childrearing practices in the development of anxiety and depression.

There is a vast literature describing the importance of childrearing factors in the development of anxiety and depression. Unfortunately, much of this work comes from diverse areas, has variable theoretical bases, and makes use of a variety of methods, each with its own limitations. Thus, conclusions about the state of the research are difficult to draw. This review pulls together literature related to childrearing factors and anxiety and depression from a wide variety of areas. Many of the studies are methodologically limited and results have been variable. Nevertheless, there is surprising consistency that suggests that rejection and control by parents may be positively related to later anxiety and depression. There is also more limited evidence to indicate that rejection may be more strongly associated with depression, whereas control is more specifically associated with anxiety. Limitations of the research are highlighted and specific suggestions for future research directions are discussed.

Anxiety↗
PubMed1996

Family enhancement of cognitive style in anxious and aggressive children.

Previous research has shown that anxious adults provide more threat interpretations of ambiguous stimuli than other clinic and nonclinic persons. We were interested in investigating if the same bias occurs in anxious children and how family processes impact on these children's interpretations of ambiguity. Anxious, oppositional, and nonclinical children and their parents were asked separately to interpret and provide plans of action to ambiguous scenarios. Afterwards, each family was asked to discuss two of these situations as a family and for the child to provide a final response. The results showed that anxious and oppositional children were both more likely to interpret ambiguous scenarios in a threatening manner. However, the two clinic groups differed in that the anxious children predominantly chose avoidant solutions whereas the oppositional children chose aggressive solutions. After family discussions, both the anxious children's avoidant plans of action and the oppositional children's aggressive plans increased. Thus, this study provides the first evidence of family enhancement of avoidant and aggressive responses in children. These results support a model of anxiety that emphasizes the development of an anxious cognitive style in the context of anxiety-supporting family processes.

Adolescent↗
PubMed1996

Family process and child anxiety and aggression: an observational analysis.

Barrett, Rapee, Dadds, and Ryan (1996) described a phenomenon whereby family discussions magnified the style of children's problem solving in a way characteristic of their particular clinical diagnosis. That is, anxious children became more avoidant, aggressive children more aggressive, and nonclinic children more prosocial, after discussing ambiguous hypothetical situations with their parents. This study examined specific sequences of communications exchanged between parents and children hypothesized to underlie this family exacerbation of child cognitive style. Family discussions were videotaped and categorized for groups of anxious, aggressive, and nonclinic children and their parents. Results revealed differences between groups of parents in frequency of agreeing with and listening to their child and the frequency of pointing out positive consequences. Conditional probability analyses showed that parents of anxious children were more likely to reciprocate avoidance, while parents of nonclinic children were more likely to agree with and listen to prosocial plans from their child. Differences in parent behaviors observed during the family discussions were reliably associated with the child's response to the ambiguous situation proposed after the family discussion. Results support a model of developmental anxiety and aggression that emphasizes the interaction of family processes and social-cognitive development in the child.

Adolescent↗
PubMed1996

The effects of video feedback on the self-evaluation of performance in socially anxious subjects.

Previous research has demonstrated that socially anxious subjects appraise their own social performance as worse than it is seen by independent observers, but are able to appraise the performance of others accurately. Three studies are reported in which socially anxious subjects evaluated their own social performance after viewing it via video. In each study, ratings made following video were closer to those made by independent observers than were ratings made without the benefit of video. In addition, this effect was similar in both socially anxious and nonanxious people. A model is proposed in which self evaluation of one's social performance is based on a mental representation of one's external appearance which receives input from long term memory, internal cues, and external cues.

Adolescent↗
PubMed1996

Family treatment of childhood anxiety: a controlled trial.

A family-based treatment for childhood anxiety was evaluated. Children (n = 79) aged 7 to 14 who fulfilled diagnostic criteria for separation anxiety, overanxious disorder, or social phobia were randomly allocated to 3 treatment conditions: cognitive-behavioral therapy (CBT), CBT plus family management (CBT + FAM), and waiting list. The effectiveness of the interventions was evaluated at posttreatment and at 6 and 12 months follow-up. The results indicated that across treatment conditions, 69.8% of the children no longer fulfilled diagnostic criteria for an anxiety disorder, compared with 26% of the waiting-list children. At the 12-month follow-up, 70.3% of the children in the CBT group and 95.6% of the children in the CBT + FAM group did not meet criteria. Comparisons of children receiving CBT with those receiving CBT + FAM on self-report measures and clinician ratings indicated added benefits from CBT + FAM treatment. Age and gender interacted with treatment condition, with younger children and female participants responding better to the CBT + FAM condition.

Adolescent↗