Improved understanding of the cognitive and behavioural processes underpinning panic disorder (PD) in adolescents could improve identification and treatment.

We investigated whether the processes outlined in Clark’s (1986) cognitive model of PD are observed in adolescents with PD, are specific to PD, and predict symptom severity.

We recruited three groups of adolescents (12–17 years): 34 with a PD diagnosis, 33 with another anxiety disorder excluding PD (‘clinical control’), and 34 scoring below the clinical cut-off on a measure of anxiety symptoms (‘community control’). Participants self-reported on measures of PD symptom severity, catastrophic cognitions, bodily sensation fear, and safety-seeking behaviours.

The PD group reported significantly higher levels of catastrophic cognitions and safety-seeking behaviours than both control groups. They reported significantly higher levels of bodily sensation fear compared with the community but not the clinical control group. All process measures positively predicted PD symptom severity across all groups.

We found evidence of catastrophic cognitions and safety-seeking behaviours as PD-specific processes in adolescents which predict symptom severity. Bodily sensation fear also predicted symptom severity. Findings support Clark’s cognitive model of PD in adolescents and suggest that catastrophic cognitions and safety behaviours may be targets for adolescent PD treatment.

The identification of predictors of treatment response is crucial for improving treatment outcome for children with anxiety disorders. Machine learning methods provide opportunities to identify combinations of factors that contribute to risk prediction models.

A machine learning approach was applied to predict anxiety disorder remission in a large sample of 2114 anxious youth (5–18 years). Potential predictors included demographic, clinical, parental, and treatment variables with data obtained pre-treatment, post-treatment, and at least one follow-up.

All machine learning models performed similarly for remission outcomes, with AUC between 0.67 and 0.69. There was significant alignment between the factors that contributed to the models predicting two target outcomes: remission of all anxiety disorders and the primary anxiety disorder. Children who were older, had multiple anxiety disorders, comorbid depression, comorbid externalising disorders, received group treatment and therapy delivered by a more experienced therapist, and who had a parent with higher anxiety and depression symptoms, were more likely than other children to still meet criteria for anxiety disorders at the completion of therapy. In both models, the absence of a social anxiety disorder and being treated by a therapist with less experience contributed to the model predicting a higher likelihood of remission.

These findings underscore the utility of prediction models that may indicate which children are more likely to remit or are more at risk of non-remission following CBT for childhood anxiety.

It is unclear whether treatment for an anxiety disorder improves sleep. This study examined baseline sleep characteristics of adolescents with an anxiety disorder, comparing weekdays and weekends, and whether there were significant improvements in sleep following cognitive behaviour therapy (CBT).

To improve our understanding of sleep problems in adolescents with an anxiety disorder and examine whether CBT for the treatment of the anxiety disorder improves sleep.

Data was gathered from 179 participants with an anxiety disorder (11–17 years old) who had previously engaged with the out-patient child and adolescent mental health service. Baseline self-report measures of anxiety and depression symptoms, sleep patterns and experiences of insomnia were examined. Of this group, 135 participants had baseline data. A subset (n=73) had outcome data, which was used to examine changes in sleep following CBT.

At baseline, adolescents reported significantly less total sleep and more night-time waking on weekdays than weekends. Following treatment for their anxiety disorder, adolescents’ weekday sleep patterns significantly improved for sleep onset latency and total sleep time, whereas weekend sleep patterns only showed improvements for sleep onset latency. No significant improvements were reported for symptoms of insomnia.

The study relied upon subjective measurement of sleep and there was no control group; however, the findings provide promising results that CBT for adolescent anxiety disorders can improve some sleep problems. Further research is needed to understand discrepancies between subjective and objective sleep, and to explore avenues for the delivery of support for sleep problems.

1. (1) To understand the issues surrounding the delivery of brief CBT to young people with OCD.

2. (2) To understand ways of reviewing, developing and improving the CBT materials with a range of young people, their parents, and clinicians.

3. (3) To understand how to consult with clinicians in relation to the implementation of the treatment.

4. (4) To consider how the process of this type of work can assist in the next steps of implementing a manualised intervention in routine CAMHS.

Dissociation may be important across many mental health disorders, but has been variously conceptualised and measured. We introduced a conceptualisation of a common type of dissociative experience, ‘felt sense of anomaly’ (FSA), and developed a corresponding measure, the Černis Felt Sense of Anomaly (ČEFSA) scale.

We aimed to develop a short-form version of the ČEFSA that is valid for adolescent and adult respondents.

Data were collected from 1031 adult NHS patients with psychosis and 932 adult and 1233 adolescent non-clinical online survey respondents. Local structural equation modelling (LSEM) was used to establish measurement invariance of items across the age range. Ant colony optimisation (ACO) was used to produce a 14-item short-form measure. Finally, the expected test score function derived from item response theory modelling guided the establishment of interpretive scoring ranges.

LSEM indicated 25 items of the original 35-item ČEFSA were age invariant. They were also invariant across gender and clinical status. ACO of these items produced a 14-item short-form (ČEFSA-14) with excellent psychometric properties (CFI=0.992; TLI=0.987; RMSEA=0.034; SRMR=0.017; Cronbach’s alpha=0.92). Score ranges were established based on the expected test scores at approximately 0.7, 1.25 and 2.0 theta (equivalent to standard deviations above the mean). Scores of 29 and above may indicate elevated levels of FSA-dissociation.

The ČEFSA-14 is a psychometrically valid measure of FSA-dissociation for adolescents and adults. It can be used with clinical and non-clinical respondents. It could be used by clinicians as an initial tool to explore dissociation with their clients.

Social anxiety disorder (SAD) is common. It usually starts in adolescence, and without treatment can disrupt key developmental milestones. Existing generic treatments are less effective for young people with SAD than with other anxiety disorders, but an adaptation of an effective adult therapy (CT-SAD-A) has shown promising results for adolescents.

The aim of this study was to conduct a qualitative exploration to contribute towards the evaluation of CT-SAD-A for adoption into Child and Adolescent Mental Health Services (CAMHS).

We used interpretative phenomenological analysis (IPA) to analyse the transcripts of interviews with a sample of six young people, six parents and seven clinicians who were learning the treatment.

Three cross-cutting themes were identified: (i) endorsing the treatment; (ii) finding therapy to be collaborative and active; challenging but helpful; and (iii) navigating change in a complex setting. Young people and parents found the treatment to be useful and acceptable, although simultaneously challenging. This was echoed by the clinicians, with particular reference to integrating CT-SAD-A within community CAMHS settings.

The acceptability of the treatment with young people, their parents and clinicians suggests further work is warranted in order to support its development and implementation within CAMHS settings.

Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed.

Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment?

CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training.

Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was £4047 (SD = £1003) per adolescent treated, of which £1861 (SD = £358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment.

This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults.

Anxiety disorders are common, and cognitive–behavioural therapy (CBT) is a first-line treatment. Candidate gene studies have suggested a genetic basis to treatment response, but findings have been inconsistent.

To perform the first genome-wide association study (GWAS) of psychological treatment response in children with anxiety disorders (n = 980).

Presence and severity of anxiety was assessed using semi-structured interview at baseline, on completion of treatment (post-treatment), and 3 to 12 months after treatment completion (follow-up). DNA was genotyped using the Illumina Human Core Exome-12v1.0 array. Linear mixed models were used to test associations between genetic variants and response (change in symptom severity) immediately post-treatment and at 6-month follow-up.

No variants passed a genome-wide significance threshold (P=5×10–8) in either analysis. Four variants met criteria for suggestive significance (P<5×10–6) in association with response post-treatment, and three variants in the 6-month follow-up analysis.

This is the first genome-wide therapygenetic study. It suggests no common variants of very high effect underlie response to CBT. Future investigations should maximise power to detect single-variant and polygenic effects by using larger, more homogeneous cohorts.

We previously reported an association between 5HTTLPR genotype and outcome following cognitive–behavioural therapy (CBT) in child anxiety (Cohort 1). Children homozygous for the low-expression short-allele showed more positive outcomes. Other similar studies have produced mixed results, with most reporting no association between genotype and CBT outcome.

To replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829).

Logistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed.

There was no significant effect of 5HTTLPR on CBT outcomes in Cohort 2. Mega-analyses identified a significant association between 5HTTLPR and remission from all anxiety disorders at follow-up (odds ratio 0.45, P = 0.014), but not primary anxiety disorder outcomes.

The association between 5HTTLPR genotype and CBT outcome did not replicate. Short-allele homozygotes showed more positive treatment outcomes, but with small, non-significant effects. Future studies would benefit from utilising whole genome approaches and large, homogenous samples.