Biomedical subjects

Ronald M Rapee

Publications and source records attributed to Ronald M Rapee.

At least 19 recordsLinked to original sources

PubMed2006

Adolescents' reactions to universal and indicated prevention programs for depression: perceived stigma and consumer satisfaction.

There is a common view that one of the major considerations in selecting between universal and indicated interventions is the marked stigma produced by the latter. However, to date there has been no empirical examination of this assumption. The current study examined reported stigma and program satisfaction following two school-based interventions aimed at preventing depression in 532 middle adolescents. The interventions were conducted either across entire classes by classroom teachers (universal delivery) or in small high risk groups by mental health professionals (indicated delivery). The indicated delivery was associated with significantly greater levels of perceived stigma, but effect sizes were small and neither program was associated with marked stigma in absolute terms. Perceived stigma was more strongly associated with aspects of the individual including being male and showing greater externalizing symptomatology. In contrast, the indicated program was evaluated more positively by both participants and program leaders and effect sizes for these measures of satisfaction were moderate to large. The results point to the need for further empirical evaluation of both perceived stigma and program satisfaction in providing balanced considerations of the value of indicated and universal programs.

Adolescent↗

PubMed2006

Self-concept certainty in social phobia.

Two studies are reported which examined the content of beliefs about self-attributes in social phobia, and the level of certainty with which these beliefs are held. The results of both studies indicated that individuals with social phobia held less positive beliefs about their personality characteristics in comparison to non-anxious individuals. In addition, social anxiety was associated with reduced subjective confidence in self-descriptiveness ratings for personality attributes (Study 1), as well as longer reaction times in making self-descriptiveness decisions relative to general decisions about trait adjectives (Study 2). The association between social anxiety and reduced certainty in negative attribute ratings was evident after controlling for depression, general anxiety, stress, and the extent to which negative attributes were endorsed as being self-descriptive. Results are discussed in terms of the potential role that reduced self-concept certainty may play in social phobia.

Adult↗

PubMed2006

Evaluation of universal, indicated, and combined cognitive-behavioral approaches to the prevention of depression among adolescents.

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive- behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions.

Adolescent↗

PubMed2006

Bibliotherapy for children with anxiety disorders using written materials for parents: A randomized controlled trial.

The current trial examined the value of modifying empirically validated treatment for childhood anxiety for application via written materials for parents of anxious children. Two hundred sixty-seven clinically anxious children ages 6-12 years and their parents were randomly allocated to standard group treatment, waitlist, or a bibliotherapy version of treatment for childhood anxiety. In general, parent bibliotherapy demonstrated benefit for children relative to waitlist but was not as efficacious as standard group treatment. Relative to waitlist, use of written materials for parents with no therapist contact resulted in around 15% more children being free of an anxiety disorder diagnosis after 12 and 24 weeks. These results have implications for the dissemination and efficient delivery of empirically validated treatment for childhood anxiety.

Anxiety Disorders↗

PubMed2006

Do empirically supported treatments generalize to private practice? A benchmark study of a cognitive-behavioural group treatment programme for social phobia.

OBJECTIVES: There is much debate as to whether the treatment effects achieved in well-controlled studies such as randomized controlled trials (RCTs) are generalizable to more "naturalistic" clinical populations, such as that seen in private practice. The current study sought to examine this issue in relation to social phobia. DESIGN: A benchmarking strategy was used to compare the effectiveness of a cognitive-behaviour therapy group programme for social phobia that was developed and evaluated in a research unit, to that of a private practice population. METHODS: Fifty-eight participants from a university research unit and 54 participants from an independent private practice who met the principal diagnostic criteria for social phobia completed the 10-session group programme. Symptom severity was measured at pre-treatment, post-treatment, and 3 months after treatment. RESULTS: No significant treatment differences were found between the research unit and private practice groups. Both groups showed significant treatment effects that were maintained at 3-month follow-up. CONCLUSION: These findings suggest that treatments developed for RCTs are potentially transportable to private practice settings.

Adult↗

PubMed2005

Cultural differences in perceived social norms and social anxiety.

Cultural considerations in social anxiety are a rarely investigated topic although it seems likely that differences between countries in social norms may relate to the extent of social anxiety. The present study investigated individuals' personal and perceived cultural norms and their relation to social anxiety and fear of blushing. A total of 909 participants from eight countries completed vignettes describing social situations and evaluated the social acceptability of the behavior of the main actor both from their own, personal perspective as well as from a cultural viewpoint. Personal and cultural norms showed somewhat different patterns in comparison between types of countries (individualistic/collectivistic). According to reported cultural norms, collectivistic countries were more accepting toward socially reticent and withdrawn behaviors than was the case in individualistic countries. In contrast, there was no difference between individualistic and collectivistic countries on individuals' personal perspectives regarding socially withdrawn behavior. Collectivistic countries also reported greater levels of social anxiety and more fear of blushing than individualistic countries. Significant positive relations occurred between the extent to which attention-avoiding behaviors are accepted in a culture and the level of social anxiety or fear of blushing symptoms. These results provide initial evidence that social anxiety may be related to different cultural norms across countries.

Adolescent↗

PubMed2005

Evaluation of therapist-supported parent-implemented CBT for anxiety disorders in rural children.

Supplementing bibliotherapy with therapist-client communication has been shown to be an effective way of providing services to under-resourced and isolated communities. The current study examined the efficacy of supplementing bibliotherapy for child anxiety disorders with therapist-initiated telephone or email sessions, or with client-initiated contact in a randomised trial using a waitlist control. Participants were 100 anxiety-disordered children and their parents from rural and remote communities. All treatment conditions resulted in improvement on self-report measures and clinician rated severity. Telephone sessions produced superior outcomes with 79% of children being anxiety disorder free post-treatment compared with 33% of email and 31% of client-initiated participants. The results suggest that therapist supplemented bibliotherapy could provide an efficacious treatment option for families isolated from traditional treatment services.

Anxiety Disorders↗

PubMed2005

Adolescent mental health literacy: young people's knowledge of depression and help seeking.

This study examined the mental health literacy of a group of adolescents, with particular reference to their ability to recognize symptoms of depression in their peers. Respondents were 202 Australian adolescents (122 males, 80 females) aged 15-17 years. Their mental health literacy was examined through a questionnaire that presented them with five scenarios of young people. Respondents showed a mixed ability to correctly recognize and label depression, although they were able to differentiate depressed and non-depressed scenarios in terms of severity and expected recovery time. Results are discussed in light of findings from adult mental health literacy and clinical implications.

Adolescent↗

PubMed2005

Mental representation of observable attributes in people with social phobia.

Cognitive models of social phobia stress the importance of a negatively biased mental representation of ones social performance and appearance in maintenance of the disorder. People with social phobia (N=57) and non-clinical controls (N=41) engaged in a public speech and also completed several measures of perceived attributes including speech performance, physical attractiveness, and personal performance ability in several interpersonal areas. Independent observers also rated participants' speech performance and physical attractiveness. Relative to observers' ratings, individuals with social phobia reported significantly lower quality of speech performance and physical attractiveness than did non-clinical individuals. People with social phobia also reported significantly lower perceived ability in other areas of performance and appearance. These data held even after statistically controlling for levels of depression.

Adult↗

PubMed2005

Threat interpretation in anxious children and their mothers: comparison with nonclinical children and the effects of treatment.

Interpretation biases towards threat play a prominent role in cognitive theories of anxiety, and have been identified amongst highly anxious adults and children. Little is known, however, about the development of these cognitive biases although family processes have been implicated. The current study investigated the nature of threat interpretation of anxious children and their mothers through (i) comparison of a clinic and non-clinic population, (ii) analysis of individual differences; and (iii) pre- and post-treatment comparisons. Participants were 27 children with a primary anxiety disorder and 33 children from a non-clinic population and their mothers. Children and mothers completed self-report measures of anxiety and indicated their most likely interpretation of ambiguous scenarios. Clinic and non-clinical groups differed significantly on measures of threat interpretation. Furthermore, mothers' and children's threat interpretation correlated significantly. Following treatment for child anxiety, both children and their mothers reported a reduction in threat interpretation.

Adolescent↗

PubMed2005

Panic attacks as risk markers for mental disorders*.

OBJECTIVE: This paper extends previous epidemiological findings linking panic attacks with future episodes of depression and examines whether this relationship is independent of the effects of gender and neuroticism. METHODS: Composite International Diagnostic Interview (CIDI) DSM-IV diagnoses from a stratified multi-stage population survey of 10,641 Australian adults were analysed using logistic regression to examine the relationship between lifetime panic attacks, gender, neuroticism and mental disorders. RESULTS: People who experienced full CIDI DSM-IV panic attacks more than 12 months ago were 4 times more likely to meet criteria for current Depressive Disorder than those who reported no attacks. Those with panic attacks in the past 12 months were 13.3 times more likely to report current Depressive Disorders. A similar pattern was also present for non-panic Anxiety Disorders (odds ratio=7.5 for lifetime, but not 12-month panic attacks, and 21.46 for 12-month panic attacks) and for Substance Use Disorders (2.1 and 4.6, respectively) suggesting a broader relationship with psychopathology than previously reported. For each of these groupings of mental disorders, panic attacks accounted for significant variability over and above the effects of gender, neuroticism, and comorbid Anxiety Disorders. CONCLUSIONS: Panic attacks are associated with current and future Anxiety, Depressive, and Substance Use Disorders, and this relationship is not solely accounted for by differences in gender and neuroticism.

Adult↗

PubMed2005

Attachment, behavioral inhibition, and anxiety in preschool children.

This study examined the association between insecure attachment, behavioral inhibition, and anxiety in an at risk sample of preschool children. The relationship between maternal anxiety and child anxiety was also assessed. Participants were 104 children aged 3-4 years who were assessed for behavioral inhibition and mother-child attachment (using the Strange Situation procedure). DSM-IV criteria were used to assess childhood anxiety disorders. Insecure attachment and behavioral inhibition were both independently associated with child anxiety, even after controlling for the effect of maternal anxiety. Maternal anxiety was also associated with child anxiety. This study identified both constitutional and environmental factors associated with the expression of anxiety in young children. Furthermore, the highest levels of anxiety were shown by children who were behaviorally inhibited and insecurely attached and whose mothers were also anxious.

Adult↗

PubMed2005

The interpretation of negative social events in social phobia: changes during treatment and relationship to outcome.

Catastrophic interpretations of negative social events are considered to be an important factor underlying social phobia. This study investigated the extent to which these interpretative biases change during cognitive-behavioural treatment for social phobia, and examined whether within-treatment changes in different types of interpretations predict longer-term treatment outcome. Results showed that treatment was associated with decreases in various types of maladaptive interpretations of negative social events, but that social phobia symptoms 3 months after treatment were independently predicted only by within-treatment reductions in the degree to which individuals personally believed that negative social events were indicative of unfavourable self-characteristics. These findings are discussed in relation to cognitive models of the maintenance of social anxiety, and implications for treatment are considered.

Adaptation, Psychological↗

PubMed2005

Evaluation and treatment of anxiety disorders in the general pediatric population: a clinician's guide.

This article provides an overview of research on the recognition, assessment, and treatment of children and adolescents who have anxiety disorders and emphasizes practical issues facing clinicians. Discussion includes an overview of the prevalence and consequences of anxiety and reviews assessment tools, maintenance factors, and evidence-based approaches to treatment. Topics also include developmental considerations, approaches to informant discrepancy, predictors of treatment outcome, and recent innovative approaches to treatment that may potentially improve dissemination to the general pediatric population.

Adaptation, Psychological↗

PubMed2005

The interpretation of negative social events in social phobia with versus without comorbid mood disorder.

Two studies were conducted in order to examine biases in the interpretation of negative social events among socially anxious individuals. Results showed that social anxiety was associated with the tendency to believe that negative social events: would result in negative evaluation by other people; were actually indicative of negative personal characteristics; and would have adverse consequences in the long-term future. Although other types of anxiety were not independently associated with such beliefs, comorbid depression among individuals with social phobia was associated with further increases in these interpretative biases. The findings are consistent with theories suggesting that maladaptive interpretations of negative social events represent central cognitive biases in social phobia, but suggest that these interpretations are also associated with depression.

Adolescent↗

PubMed2005

Prevention and early intervention of anxiety disorders in inhibited preschool children.

This article reports results from an early intervention program aimed at preventing the development of anxiety in preschool children. Children were selected if they exhibited a high number of withdrawn/inhibited behaviors--one of the best identified risk factors for later anxiety disorders--and were randomly allocated to either a 6-session parent-education program or no intervention. The education program was group based and especially brief to allow the potential for public health application. Children whose parents were allocated to the education condition showed a significantly greater decrease in anxiety diagnoses at 12 months relative to those whose parents received no intervention. However, there were no significant effects demonstrated on measures of inhibition/withdrawal. The results demonstrate the value of (even brief) very early intervention for anxiety disorders, although these effects do not appear to be mediated through alterations of temperament.

Anxiety Disorders↗

PubMed2005

Agreement between telephone and in-person delivery of a structured interview for anxiety disorders in children.

OBJECTIVE: The current study determined the viability of using the telephone to facilitate assessment of children using the Anxiety Disorders Interview Schedule for children for DSM-IV (ADIS-C-IV). METHOD: Diagnoses established during telephone administration of the ADIS-C-IV-Parent version were compared with diagnoses obtained during standard administration of the ADIS-C-IV using both Child and Parent versions. Seventy-three children and their parents participated in counterbalanced, repeated assessments. RESULTS: The level of agreement between telephone and standard administration for principal diagnosis (kappa=0.86), individual anxiety disorders (kappa=0.63-0.86), and other disorders (kappa=0.79-0.91) were in the good to excellent range. Additionally, agreement on overall suitability for an anxiety treatment program was excellent (kappa=0.97). CONCLUSIONS: The data indicate that telephone administration of the ADIS-C-IV is a valid way to differentiate children who have anxiety disorders from those who have no disorder or other disorders, providing a less resource-demanding alternative to face-to-face assessment.

Anxiety Disorders↗

PubMed2005

Early intervention for childhood anxiety in a school setting: outcomes for an economically disadvantaged population.

OBJECTIVE: To evaluate a school-based early intervention program for the reduction of anxious symptoms in at-risk children from low socioeconomic status neighborhoods. METHOD: A total of 425 children (8-11 years old) from nine schools in low socioeconomic status areas were screened to identify children with high-level anxious symptoms. Ninety-one children were selected, and schools were assigned to either an eight-session active intervention or a waitlist control. Active intervention was conducted in small groups during school time by both school and health personnel. Parents of children in active intervention were offered two information sessions. RESULTS: Demographic data indicated a low socioeconomic status for the sample. Children assigned to active intervention demonstrated a significant reduction in symptoms of anxiety relative to children assigned to waitlist and differences were maintained 4 months after treatment according to both self-report (F287 = 6.73, p < 0.005, partial eta = 0.134) and teacher report (F 2,87 = 7.99, p = .001, partial eta = 0.155). Parents did not return sufficient data for meaningful statistical analysis. CONCLUSIONS: School-based early intervention appears to offer an effective means of reducing anxious symptomatology in economically disadvantaged populations. The school environment offers promise as a means of extending the reach of efficacious interventions for mental health to underserviced populations.

Anxiety↗