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While around one-fifth of UK secondary school pupils exhibit clinically significant eating pathology, in-school mental health provision does not include interventions to address such eating pathology.
Aims:
This preliminary qualitative study aimed to explore the views of staff, parents and pupils, on the idea of introducing a school-based brief cognitive behavioural therapy programme for non-underweight eating disorders.
Method:
31 pupils, 22 parents and 27 staff participated in 12 focus groups across four schools. The semi-structured interview guide covered topics around the practicalities of a potential eating disorders treatment programme, the acceptability of the intervention, and likelihood of future uptake.
Results:
Five over-arching themes and 12 subthemes emerged, reflecting the scale of eating and body image concerns, management limitations, and the importance of prioritising mental health over education. Advantages, challenges, considerations, and solutions were proposed for an in-school eating disorders treatment programme.
Conclusions:
These qualitative data show that there is support for an appropriately implemented in-school delivery of brief, evidence-based treatment, demonstrating the potential scope of such an approach to support children and adolescents to receive early help with their eating problems and body image concerns.
Internet-delivered parent-led interventions can be useful for treating anxiety in children and adolescents, and they also help increase access to services while reducing time and cost.
Aims
This review aimed to investigate the effects of internet-delivered parent-led interventions on reducing anxiety in children and adolescents.
Method
A search of PubMed, PsycArticles, Cochrane Library, and Google Scholar databases identified 13 studies published between 2013 and 2024, which examined internet-delivered, parent-led interventions targeting anxiety in children.
Results
Internet-delivered parent-led interventions had overall positive effects on reduced anxiety in children and adolescents that could be maintained through follow-up. Interventions directly targeting anxiety symptoms had significant treatment effects.
Discussion
Internet-delivered parent-led interventions may be effective in reducing anxiety symptoms in children and adolescents, particularly when the intervention directly targets anxiety rather than focusing solely on parenting approaches. Interventions supplemented with therapist support, such as telephone consultations, appear to enhance treatment outcomes and help maintain effects over time. Two-thirds of the included studies had a moderate risk of bias, and one-third had a serious risk of bias. Further studies using rigorous methodologies are needed to strengthen the evidence base.
Parent depression is a well-established prospective risk factor for adverse offspring mental health. Multiple lines of evidence suggest that improvements in parent depression predicts improved offspring mental health. However, no systematic review has examined the impact on offspring of psychological treatment of purely parent depression after the postnatal period.
Aims:
To systematically review the literature of randomised controlled trials examining the impact on offspring mental health outcomes of psychological interventions for parental depression after the postnatal period.
Method:
We pre-registered our systematic review on PROSPERO (CRD42023408953), and searched the METAPSY database in April 2023 and October 2024, for randomised controlled trials of psychological interventions for adults with depression, which also included a child mental health or wellbeing outcome. We double screened 938 studies for inclusion using the ‘Paper in a Day’ approach. All included studies would be rated using the Cochrane Risk of Bias tool.
Results:
We found no studies that met our inclusion criteria.
Conclusions:
Robust research into psychological therapy for depression in adults outside the postnatal period has failed to consider the potential benefits for the children of those adults. This is a missed clinical opportunity to evaluate the potential preventive benefits for those children at risk of adverse psychological outcomes, and a missed scientific opportunity to test mechanisms of intergenerational transmission of risk for psychopathology. Seizing the clinical and scientific opportunities would require adult-focused mental health researchers to make inexpensive additions of child mental health outcomes measures to their evaluation projects.
Health anxiety by proxy (HAP) refers to parents’ worries about their child’s health. Research into HAP is in its infancy, but it is known that the children of those with HAP and the broader family system are affected by these elevated health concerns.
Aims:
This study aimed to explore factors associated with HAP in parents of children with cancer, and parents of ‘well’ children, particularly parental health anxiety (HA), social support, and illness characteristics.
Method:
Cross-sectional online questionnaire design using social media and NHS paediatric oncology services to recruit parents of children with cancer (n=41) and parents of ‘well’ children (n=79).
Results:
HAP (but not HA) was significantly higher in parents of children with cancer than those with ‘well’ children (p < .001). HAP was negatively associated with social support in parents of ‘well’ children only (p=.002), but both groups demonstrated a positive association between social support and HA (p=.006). Both HA (B=.588; p < .001) and health status of child (B=–30.281; p < .001) were significant independent predictors of HAP (controlling for interactions between group and variables) in a hierarchical regression.
Conclusions:
Parents of children with cancer have higher rates of HAP (but not HA), with HAP associated with lower levels of social support in both groups. Parental HA and child health status are key to understanding HAP. Further research is needed to establish underlying mechanisms and vulnerability to HAP to inform development of effective interventions for this group.
The United Kingdom’s Talking Therapies for Anxiety and Depression (TTAD) programme provides standardised definitions for recovery-related outcomes, allowing transparent and comparable reporting. This study aimed to descriptively examine recovery-related outcomes following cognitive behavioural therapy (CBT) in a Japanese clinical sample using established TTAD definitions.
Method:
Data were drawn from patients who received CBT in routine clinical practice. Depressive and anxiety symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, respectively. Recovery, reliable improvement, and reliable recovery were classified according to the TTAD criteria.
Results:
The sample consisted of 241 participants, of whom 178 (73.9%) met the criteria for caseness at baseline. Among those with baseline caseness, 75 participants (42.1%) met the criteria for recovery at the end of treatment. Across the full sample, 103 participants (47.2%) demonstrated reliable improvement. Reliable recovery, defined as meeting the criteria for both recovery and reliable improvement, was observed in 65 participants (36.5% of those with baseline caseness).
Conclusions:
Using standardised TTAD definitions, this study provides a descriptive account of recovery-related outcomes following CBT in routine clinical practice in Japan. The findings show the distribution of recovery and improvement outcomes in this sample and highlight the importance of clearly distinguishing between recovery-related indicators when interpreting outcomes in real-world clinical settings.
Intrusive re-experiencing of traumatic events is a cornerstone of post-traumatic stress disorder (PTSD). Clinicians notice that clients also experience intrusive mental images of what they think might happen during a traumatic event. As mental imagery has a powerful impact on emotion, imagination-based imagery may be implicated in the peaks of distress (‘hotspots’) during a trauma.
Aims:
A data-only study was undertaken of cognitive therapy for PTSD ‘hotspot’ charts used by Grenfell Health and Wellbeing Service clinicians after the Grenfell fire disaster. The aim was to establish the prevalence and nature of peri-traumatic ‘imagination-based hotspots’ in this sample.
Method:
Hotspots are described as the worst moments within a trauma. Two clinicians independently rated anonymised hotspot charts (N=26) for the presence and content of ‘imagination-based hotspots’, defined as ‘a peak of emotion during a traumatic event that is related to something imagined “in the mind’s eye” as opposed to directly perceived with the senses’.
Results:
81% (N=21) of individuals reported an imagination-based hotspot; 38% of all hotspots (n=159) contained an imagination-based component. The most common was an image in which the person watching the fire imagined themselves in the ‘shoes’ of a tower resident.
Conclusions:
Imagination-based mental imagery appears to be linked to the ‘hotspots’ of a high proportion of people experiencing PTSD in this sample. Results underline the importance of enquiring about the presence of mental imagery during PTSD treatment. The presence of peri-traumatic mental images has implications for effective updating of ‘hotspots’ in PTSD treatment.
Despite its significant impact on parenting and child outcomes, postnatal anxiety receives less attention than postnatal depression. Intolerance of uncertainty (IU) and inflated responsibility (IR) may be vulnerability factors for postnatal anxiety and infant feeding outcomes. For this reason, we investigated the associations of postnatal anxiety and a range of factors including IR and IU.
Method:
Postnatal women (n=126), predominantly white Irish, completed an anonymous online survey assessing postnatal anxiety, IU and IR, and infant feeding. Hierarchical multiple regression analyses were tested for unique predictors of postnatal anxiety. Multivariate tests were used to assess variables associated with feeding outcomes.
Results:
Although both IR and IU were significantly correlated with postnatal anxiety, regression analyses found only IR accounted for a significant amount of unique variance in postnatal anxiety. In terms of feeding outcomes, IR and IU were associated with reduced likelihood to breastfeed.
Conclusions:
IU and IR may have different impacts on postnatal anxiety. IU and IR may explain the higher incidence of anxiety in postnatal women and impact on a mother’s decision to breastfeed her infant. Although important, these are results of a small cross-sectional study with some limitations. As such, they should be interpreted with caution. More investigation of these concepts would be beneficial.
Community crime against older people is of increasing concern but the relationship between safety-seeking behaviours and continued psychological distress has not been examined. As existing assessment tools have limited validity, we aimed to investigate this by designing a novel person-reported safety-seeking behaviour measure (PRSBM) and conducting preliminary evaluation of its wider applicability.
Method:
We collected mixed-methods data from n=100 initially distressed older victims at 3 months post-crime, using the PRSBM. This asked older victims how often they engaged in six behaviours (checking, reassurance-seeking, rumination, avoidance, rituals, hypervigilance), what these were, how often, and how much they had changed since the crime. We measured continued distress using the two-item General Anxiety Disorder and Patient Health Questionnaires. We analysed qualitative behaviour data using codebook thematic analysis, quantitative data on behaviour frequency and change using logistic regression adjusted for gender, age and crime type, and explored the PRSBM psychometric structure using unique variable analysis.
Results:
Older victims reported a wide range of safety-seeking behaviours conceptually consistent with their experiences. Some were highly restrictive; others may help maintain independence. The frequency of checking, avoidance, and hypervigilance, and a change in avoidance, were most strongly associated with continued distress. The PRSBM was acceptable, comprehensive, and captured differences and commonalities in safety-seeking.
Conclusions:
As older victims identified as avoidant appear at risk of losing their independence, referral for treatment is recommended. The PRSBM appears promising as a research and clinical tool in a range of settings, suggesting further testing in different populations would be worthwhile.