Subthreshold Disorder Research Articles

The Effectiveness of Virtual Reality Exposure-Based Cognitive Behavioral Therapy for Severe Anxiety Disorders, Obsessive-Compulsive Disorder, and Posttraumatic Stress Disorder: Meta-analysis.

BackgroundIn recent years, virtual reality exposure–based cognitive behavioral therapy (VRE-CBT) has shown good treatment results in (subclinical) anxiety disorders and seems to be a good alternative to exposure in vivo in regular cognitive behavioral therapy (CBT). However, previous meta-analyses on the efficacy of VRE-CBT on anxiety disorders have included studies on specific phobias and subthreshold anxiety; therefore, these results may not be generalizable to patients with more severe and disabling anxiety disorders.ObjectiveThe objective of our study is to determine the efficacy of VRE-CBT on more severe anxiety disorders, excluding specific phobias and subthreshold anxiety disorders. Meta-analyses will be conducted to examine the efficacy of VRE-CBT versus waitlist and regular CBT. Our secondary objectives are to examine whether the efficacy differs according to the type of anxiety disorder, type of recruitment, and type of VRE-CBT (virtual reality exposure either with or without regular CBT). Furthermore, attrition in VRE-CBT and CBT will be compared.MethodsStudies published until August 20, 2020, were retrieved through systematic literature searches in PubMed, PsycINFO, and Embase. We calculated the effect sizes (Hedges g) for the difference between the conditions and their 95% CIs for posttest and follow-up measurements in a random effects model. A separate meta-analysis was performed to compare attrition between the VRE-CBT and CBT conditions.ResultsA total of 16 trials with 817 participants were included. We identified 10 comparisons between VRE-CBT and a waitlist condition and 13 comparisons between VRE-CBT and a CBT condition. With regard to risk of bias, information on random sequence generation, allocation concealment, and risk of bias for selective outcome reporting was often absent or unclear. The mean effect size of VRE-CBT compared with waitlist (nco=10) was medium and significant, favoring VRE-CBT (Hedges g=−0.490, 95% CI −0.82 to −0.16; P=.003). The mean effect size of VRE-CBT compared with CBT (nco=13) was small and nonsignificant, favoring CBT (Hedges g=0.083, 95% CI −0.13 to 0.30; P=.45). The dropout rates between VRE-CBT and CBT (nco=10) showed no significant difference (odds ratio 0.79, 95% CI 0.49-1.27; P=.32). There were no indications of small study effects or publication bias.ConclusionsThe results of our study show that VRE-CBT is more effective than waitlist and as effective as CBT in the treatment of more severe anxiety disorders. Therefore, VRE-CBT may be considered a promising alternative to CBT for patients with more severe anxiety disorders. Higher-quality randomized controlled trials are needed to verify the robustness of these findings.

Structure factorielle et qualités psychométriques du questionnaire d’auto-évaluation pour adolescents (Youth Self-Report) d’Achenbach et Rescorla

IntroductionRecent research on the prognostic significance of subthreshold comorbid disorders highlighted the need for instruments allowing for the comprehensive exploration of symptomatology of adolescents. ObjectiveTo verify the factor structure and psychometric properties of the Achenbach and Rescorla's Youth Self-Report French translation, which allows this investigation. MethodWe had 1450 adolescents 11–17- year old (747 girls) complete the YSR in secondary schools in the Paris metropolitan area. ResultsConfirmatory Factor Analyses and Exploratory Structural Equation Modeling supported the 8-syndrome structure. However, since ESEM allows cross-loadings, the number of indicators for each factor in the ESEM models is much higher than in the CFA models. Internal consistency and test-retest reliability were satisfactory, and multigroup analyses confirmed the metric and scalar invariance across age and gender of most of the items examined (70 out of 89). We can therefore affirm that girls score lower on Social problems than boys, 15–17-year-old adolescent score higher on Thought problems, Attention problems, and Rule-Breaking Behavior than the younger, and these differences are substantive and independent of differential item functioning. ConclusionThese results are likely to encourage the use of YSR in research and clinical practice with French-speaking adolescents.

Adjustment Disorder in U.S. Service Members: Factors Associated With Early Separation

ABSTRACT Introduction Adjustment disorder (AD) is a time-delimited disorder characterized by excessive emotional distress or impaired functioning in response to an identifiable stressor. Although it is commonly diagnosed in mental health settings, its impact on occupational, social and other areas of functioning is not well understood. As a subthreshold disorder that is frequently diagnosed in conjunction with other physical and mental health disorders, the extent of its contribution to functional impairment may be obscured. During military service, research suggests AD is frequently diagnosed in early-service trainees. To help elucidate the relationship between AD and functional outcome, we explored 2 factors that may be associated with the rate of separation from service in U.S. active duty service members (SMs) with an AD diagnosis: previous mental health diagnoses and time in service when SMs receive an incident AD diagnosis (IADx). Materials and Methods Twenty-thousand SMs with an IADx were grouped by whether or not this was their first mental health diagnosis received in the military. To assess functional impairment, the 2 groups were compared on rate of separation. Those without prior diagnoses were then stratified into 5 groups based on length of time from military entrance to receipt of IADx and were further analyzed for separation rates. The Cox model was used to determine hazard ratios and create survival curves. The study was determined to be “not human subjects research.” Results Nearly half (46.4%) of SMs with an IADx previously had received a mental health diagnosis and had an increased risk of separation [hazard ratio = 1.25 (95% confidence interval: 1.207-1.286)]. Of SMs with IADx as their first diagnosis, 19.3% were diagnosed during the first 6 months of service and had the highest risk of separating [hazard ratio = 1.48 (1.381-1.589)], with a 60% probability of separating within 2 years of diagnosis. Those receiving it during the second 6 months of service (16.2%), second year (20.1%), or third year (18.2%) had approximately a 47% probability of separating within 2 years. Conclusions Previous mental health diagnoses and time in service when diagnosed appear to be important factors associated with functional impairment for SMs with AD. Nearly half of those with an IADx had previously received diagnoses for mood, anxiety, and other disorders and were at higher risk of separation following IADx. Our findings are based on diagnoses entered in electronic health records, so we cannot identify the nature of the stressor that precipitated AD. Nonetheless, early IADx predicted the fastest rate of separation, and it may be an opportune time for interventions to reduce its impact on functional outcomes.

Exercise interventions to reduce anxiety in mid-life and late-life anxiety disorders and subthreshold anxiety disorder: a systematic review.

Background:Anxiety disorders are highly prevalent and cause significant distress, disability, and cost. Medication adverse effects and interactions increase in mid-life and late-life, highlighting the need for effective non-pharmacological interventions.Objectives:We aimed to evaluate the extent of evidence supporting exercise interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life.Design:Systematic review.Data Sources and Methods:We searched MEDLINE, PsycINFO, Embase, Emcare, Ovid Nursing, CINAHL Plus, Cochrane Library, Health Collection, Humanities & Social Sciences Collection, and https://clinicaltrials.gov databases for trials published January 1994–May 2019. Randomised controlled trials of exercise interventions involving aerobic exercise or resistance training for adults aged 40 years and above with anxiety or subthreshold anxiety disorders in residential or health settings were identified. The primary outcome was change in anxiety. We excluded trials including participants aged below 40 years, participants with diagnosis of separation anxiety, selective mutism, obsessive-compulsive disorder, acute stress disorder and post-traumatic stress disorder, and head-to-head comparisons of interventions. Trial quality was assessed using the Cochrane Risk of Bias Tool and evidence synthesised in narrative form.Results:Four trials totalling 132 participants met inclusion criteria, although some had methodological limitations. Interventions included a home-based resistance training intervention, supervised group-based aerobic intervention, Tai Chi intervention, and supervised group-based aerobic and strength intervention. Three trials included late-life participants and the fourth mid-life. Three trials demonstrated greater reductions in anxiety in the intervention group compared with control. The fourth trial showed pre–post reductions in anxiety in both groups, with between-group difference not reaching statistical significance.Conclusion:There is limited supportive evidence suggesting that exercise interventions have potential to be effective, feasible and safe non-pharmacological interventions for anxiety and subthreshold anxiety disorders in mid-life and late-life. The heterogeneity, limited number and high risk of bias of some trials meant that we were not able to conduct a meta-analysis. Tailoring of interventions may improve uptake and reduce dropout. The paucity of research in this area with only four included trials demonstrates the urgent need for future and larger trials to provide proof of concept, data about effective types and doses of exercise interventions, and guidance to community, clinical, and public health services.

The implementation of a digital group intervention for individuals with subthreshold borderline personality disorder

Context: Systems Training for Emotional Predictability and Problem Solving for Emotional Intensity (STEPPS-EI), a 13-week skills-based group intervention for individuals with subthreshold borderline personality disorder (BPD) has been deemed feasible and clinically effective in primary care [1] [2]. To modernize the service, STEPPS-EI lesson content has recently built onto an eHealth platform (Minddistrict). Due to Covid-19 restrictions, group sessions were additionally delivered remotely via Zoom. This project evaluates the implementation of this digitally blended version of STEPPS-EI within two Sussex Partnership NHS Foundation Trust (SPFT) primary care services.Methods: Service users and pracitioners who participated in the first two groups from March to July 2021 were invited to take part in a feasibility evaluation investigating recruitment, retention, and attendance rates, in addition to self-reported symptoms (BSL-23, QuEST), quality of life (ReQoL), system usability, and qualitative and quantitative measures designed to shed light on the experience and opinions of service users and practitioners during the intervention. Service users participating in following groups (from July to December 2021) were invited to share their symptom and quality of life outcome data only.Results: 14 service users and 5 practitioners agreed to take part in the primary evaluation. Results suggested that 86% of these service users attended at least 75% of the group sessions, and that service users completed on average 70% of the online material. Usability ratings revealed good gradings for Zoom from all participants, yet lower gradings for Minddistrict. Further analyses revealed a generally positive attitude towards digital STEPPS-EI from all parties and practical suggestions on how to improve the intervention. 11 service users from following groups agreed to share their data. Bayesian analyses were conducted for the data of service users who provided ratings at both timepoints. Evidence was found for a decrease in BSL-23 scores and an increase in ReQoL ratings from baseline to post-intervention. Incomplete self-report data-sets limits conclusions.Conclusions: It was found that the implementation of STEPPS-EI delivered in a blended digital format was feasible. The online delivery might increase service users' engagement with the material and group sessions. Yet more training and support on the use of Minddistrict may be required to increase usability.Implications: It may be possible to effectively implement digital interventions for individuals with subthreshold BPD. However, more research on the effect of these on symptom outcomes should follow.

Posttraumatic Stress among Pediatric Critical Care Physicians in the United States in Association with Coronavirus Disease 2019 Patient Care Experiences.

Posttraumatic stress among pediatric critical care physicians in the United States in association with coronavirus disease 2019 patient care experiences. Our objective was to assess the prevalence of posttraumatic stress (PTS) and its association with COVID-19 patient care experiences among pediatric critical care physicians. Our study was a cross-sectional study of pediatric critical care physicians in the United States. We measured PTS which included posttraumatic stress disorder (PTSD) and subthreshold posttraumatic stress disorder (SubPTSD) using validated PTSD Checklist- 5 survey tool. Association of PTS with COVID-19 patient care experiences was analyzed using regression analysis. Prevalence of PTS was noted in 120 among 294 pediatric critical care physicians (41%; 95% CI, 35-47%). The predominant symptoms were that of hyperarousal and feelings of negative cognition and mood. Among our physicians with PTS, 19% had PTSD and 81% had SubPTSD. Demographic and practice characteristics were not significant for increased PTS on regression analysis. Posttraumatic stress was significantly associated with physicians testing positive or taking time off for COVID-19 illness, self-isolation, fear of infecting their loved ones, families scared of being infected, feeling helpless, patients expressing fears of dying, having pre-existing depression, anxiety, or insomnia, working beyond comfort level of training and having thoughts of quitting (p < 0.05). Thoughts of quitting was associated with the highest significant increase in PTS scores (coefficient:11.643; 95% CI:8.551,14.735; P < 0.01) followed by feeling of helplessness (coefficient:11.055; 95% CI: 8.484,13.624; P < 0.01) and need for additional medications for depression, anxiety and insomnia (coefficient: 10.980; 95% CI: 4.970, 16.990; P < 0.01). Posttraumatic stress is high in pediatric critical care physicians and is associated with various COVID-19 patient care experiences. Thoughts of quitting was associated with highest increase in posttraumatic stress score which could have major implications for the workforce in the future. Subthreshold posttraumatic stress disorder should be recognized, and mental health issues of pediatric critical care physicians addressed.

Reducing Intrusive Memories of Childhood Trauma Using a Visuospatial Intervention: Case Study in Iceland.

BackgroundAdditional interventions are needed for survivors of psychological trauma because of several barriers to and limitations of existing treatment options (eg, need to talk about the trauma in detail). Case studies are an important step in exploring the development of novel interventions, allowing detailed examination of individual responses to treatment over time. Here, we present a case study that aims to test a novel intervention designed to disrupt memory reconsolidation, taking a single-symptom approach by focusing on intrusive memories of a traumatic event.ObjectiveThis study aims to examine a novel brief cognitive intervention to reduce the number of intrusive memories of trauma in an Icelandic setting and to extend previous studies by examining long-term effects for up to 3 months. The intervention was guided by a clinical psychologist and comprised a brief memory reminder, followed by Tetris gameplay with mental rotation, targeting one memory at a time in each session.MethodsThis was a single case study in Iceland with a woman in her 50s (drawn from an epidemiological study of trauma) with subthreshold posttraumatic stress disorder and a diagnosis of obsessive-compulsive disorder and social anxiety disorder. The participant had four different intrusive memories from a traumatic event that happened in her childhood. The primary outcome was the change in the number of intrusive memories from baseline to intervention phase and to follow-ups. The number of intrusions was monitored in a daily diary for 4 weeks preintervention, 8 weeks during the intervention, and 1 week at 1-month and 3-month follow-ups. Intrusions were targeted one by one over six intervention sessions, creating four repetitions of an AB design (ie, length of baseline A and intervention phase B varied for each memory). We examined changes in both the total number of intrusions (summed across all four memories) and individually for each memory. In addition, we explored whether having fewer intrusive memories would have an impact on functioning, posttraumatic stress, and depression or anxiety symptoms.ResultsThe total number of intrusions per week was 12.6 at baseline, 6.1 at the intervention phase (52% reduction from baseline), 3.0 at the 1-month follow-up (76% reduction), and 1.0 at the 3-month follow-up (92% reduction). Reductions in the symptoms of posttraumatic stress and depression were observed postintervention. Sleep, concentration, stress, and functioning improved. The participant considered the gameplay intervention acceptable and helpful in that she found that the memories disappeared while she was playing.ConclusionsThis guided brief cognitive intervention reduced the number of intrusive memories over the intervention phase and follow-ups. The brief memory reminder was well tolerated, removing the need to discuss trauma in detail. The next steps require an extension to more cases and exploring remote delivery of the intervention.

Post-traumatic Stress Disorder in Older U.S. Military Veterans: Prevalence, Characteristics, and Psychiatric and Functional Burden

To characterize the prevalence, characteristics, and comorbidities of subthreshold and full post-traumatic stress disorder (PTSD) in older U.S. military veterans. A nationally representative web-based survey of older U.S. military veterans who participated in the National Health and Resilience in Veterans Study (NHRVS) between November 18, 2019 and March 8, 2020. U.S. veterans aged 60 and older (n=3,001; mean age=73.2, SD: 7.9, range: 60-99). PTSD was assessed using the PTSD Checklist for DSM-5. Self-report measures assessed sociodemographic characteristics, trauma exposures, suicidal behaviors, psychiatric and substance use disorders, as well as mental, cognitive, and physical functioning. Multivariable analyses examined correlates of subthreshold and full PTSD. The vast majority of the sample (n=2,821; 92.7%) reported exposure to one or more potentially traumatic events. Of those exposed to such events, 262 (9.6%, 95% confidence interval [CI]: 8.4%-10.9%) and 68 (1.9%, 95% CI: 1.3%-2.6%) screened positive for subthreshold and full PTSD, respectively. The prevalence of subthreshold and full PTSD was significantly higher in female veterans and veterans who use VA as their primary healthcare. Subthreshold and full PTSD groups endorsed more adverse childhood experiences and total traumas than the no/minimal PTSD symptom group, the most common traumatic experiences endorsed were combat exposure, physical or sexual assault, and life-threatening illness or injury. Veterans with subthreshold and full PTSD were also more likely to screen positive for depression, substance use disorders, suicide attempts, nonsuicidal self-injury, and suicidal ideation, and reported lower mental, cognitive, and physical functioning. Subthreshold PTSD and full PTSD are prevalent and associated with substantial clinical burden in older U.S. veterans. Results underscore the importance of assessing both subthreshold and full PTSD in this population.

"Women as Troublemakers": The Hard Sociopolitical Context of Soft Bipolar Disorder in Iran.

Gender differences in the prevalence of psychiatric disorders, with higher prevalence of mood and anxiety disorders among women, have been the focus of much debate. In Iran, the adoption of the construct of Bipolar Spectrum Disorder (BSD) and of the concept of "soft bipolarity" has been associated with a large gender difference in rates of diagnosis. This paper discusses the gendered meanings of the diagnosis of BSD in Iran. In this qualitative study, we conducted 25 in-depth semi-structured interviews with prominent psychiatrists and university professors (7 female and 18 male) at six different universities in Iran and 37 in-depth semi-structured interviews with patients (23 female and 14 male, 18-55years of age) who had received bipolar spectrum disorder diagnosis and treatment, excluding Bipolar I. Findings suggest that the high rate of diagnosis of bipolar spectrum disorder (i.e., subthreshold orsoft bipolar disorder) among women in Iran is influenced by gender, sociocultural, political, and economic factors, as well as the diagnostic practices of biomedical psychiatry. The dominant biological psychiatry system in Iran has led many psychiatrists to frame sociopolitically and culturally rooted forms of distress in terms of biomedical categories like soft bipolarity and to limit their interventions to medication. This bioreductionist approach silences the voices of vulnerable groups, including those of women, and marginalizes discussions of problematic institutional and social power. To understand the preference for biomedical explanations, we need to consider not only the economic interests at play in the remaking of human identity in terms of biological being and the globalization of biological psychiatry, but also the resistance to addressing the sociocultural, political, and economic determinants of women's mental suffering in particular contexts.

Subthreshold psychiatric symptoms as potential predictors of postpartum depression

ABSTRACT The authors’ purpose in the present study is to examine the role of subthreshold mental disorders as predictors of Postpartum Depression (PPD). 110 pregnancy women were evaluated as follow: the General 5-Spectrum Measure at 26 weeks of gestation; the Edinburgh Postnatal Depression Scale at 3/6 months after delivery. Only 4.5% of the sample developed PPD at 3/6 months after delivery. Agoraphobia/panic, depressed mood, social anxiety and eating problems relate positively to PPD at 3/6 months. Early identification of symptoms that could indicate the development of future mood problems in the mother is of crucial importance for mental health and prevention.

Development and Validation of a Semi-Structured Clinical Interview for Nightmare Disorder

Objectives Nightmare disorder is highly prevalent in clinical settings and is highly comorbid with posttraumatic stress disorder (PTSD). In the current study, we aimed to develop and validate a semi-structured interview based on the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-fifth edition for diagnosing nightmare disorder. Methods We developed a Semi-Structured Clinical Interview for Nightmare Disorder (SCIN) in five steps: we interviewed 100 females (mean age, 24.6±5.88 years) using the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5); Structured Clinical Interview for DSM-IV Axis 1 Disorders, Research Version (SCID-I); and self-report questionnaires for nightmares (Disturbing Dream and Nightmare Severity Index, DDNSI), depression, state anxiety, trait anxiety, suicidal ideation, and insomnia. Two independent raters assessed the responses of the interviewees. The interrater reliability for the SCIN was calculated. Pearson’s correlation coefficient was used to assess convergent validity between SCIN and the DDNSI. Chi-square analyses were conducted to compare prevalence of PTSD based on nightmare disorder diagnosis. Results Among the participants, 42% were diagnosed with nightmare disorder, 15% had subthreshold nightmare disorder, and 43% did not have nightmare disorder. Interrater reliability was moderate (Kappa=0.707, p<0.001). The semi-structured clinical interview showed good convergent validity with the DDNSI (r=0.639, p<0.001). Additionally, individuals who were identified as having nightmare disorder had higher levels of depression, state anxiety, trait anxiety, suicidal ideation, and insomnia (p<0.001). Based on the PTSD diagnosis using CAPS-5, the nightmare group had a higher proportion of PTSD diagnoses than the no-nightmare group (26.2% vs. 8.6%, respectively; χ2=38.41, p<0.001). Conclusions The semi-structured clinical interview for nightmare disorder appears to have good reliability and validity and can be used in clinical settings. Keywords: Sleep, Parasomnias, Sleep wake disorders, Psychological interview, Nightmares

The cost of Medicare-funded medical and pharmaceutical services for mental disorders in children and adolescents in Australia.

ObjectiveTo examine the health care costs associated with mental disorders and subthreshold mental disorders within a nationally representative sample of children and adolescents in Australia.MethodData were derived from the Young Minds Matter Survey (N = 6,310). Mental disorders were classified using the Diagnostic Interview Schedule for Children Version IV. Participant data were linked to administrative data on health care costs. Adjusted generalized linear regression models and two-part models were used to estimate mean differences in costs between those with a mental disorder or subthreshold disorder and those without.ResultsCosts associated with health care attendances and medications were higher for children and adolescents with mental disorders and subthreshold mental disorders compared to those without a mental disorder. The additional population health care costs due to mental disorders amounted to AUD$234 million annually in children and adolescents, of which approximately 16% was attributed to out-of-pocket costs. Findings showed that those with subthreshold mental disorders or comorbid mental disorders have substantial additional costs of Medicare-funded medical and pharmaceutical services.Conclusion and implicationMental disorders in children and adolescents are associated with significant health care costs. Further research is needed to ensure that this population is receiving effective and efficient care.

Subthreshold post-traumatic stress disorder as a risk factor for post-traumatic stress disorder: results from a sample of USA veterans.

Subthreshold post-traumatic stress disorder (PTSD) is more prevalent than PTSD, yet its role as a potential risk factor for PTSD is unknown. To address this gap, we analysed data from a 7-year, prospective national cohort of USA veterans. Of veterans with subthreshold PTSD at wave 1, 34.3% developed PTSD compared with 7.6% of trauma-exposed veterans without subthreshold PTSD (relative risk ratio 6.4). Among veterans with subthreshold PTSD, specific PTSD symptoms, greater age, cognitive difficulties, lower dispositional optimism and new-onset traumas predicted incident PTSD. Results suggest that preventive interventions targeting subthreshold PTSD and associated factors may help mitigate risk for PTSD in USA veterans.

Predicting Depression Onset in Young People Based on Clinical, Cognitive, Environmental, and Neurobiological Data

BackgroundAdolescent onset of depression is associated with long-lasting negative consequences. Identifying adolescents at risk for developing depression would enable the monitoring of risk factors and the development of early intervention strategies. Using machine learning to combine several risk factors from multiple modalities might allow prediction of depression onset at the individual level. MethodsA subsample of a multisite longitudinal study in adolescents, the IMAGEN study, was used to predict future (subthreshold) major depressive disorder onset in healthy adolescents. Based on 2-year and 5-year follow-up data, participants were grouped into the following: 1) those developing a diagnosis of major depressive disorder or subthreshold major depressive disorder and 2) healthy control subjects. Baseline measurements of 145 variables from different modalities (clinical, cognitive, environmental, and structural magnetic resonance imaging) at age 14 years were used as input to penalized logistic regression (with different levels of penalization) to predict depression onset in a training dataset (n = 407). The features contributing the highest to the prediction were validated in an independent hold-out sample (three independent IMAGEN sites; n = 137). ResultsThe area under the receiver operating characteristic curve for predicting depression onset ranged between 0.70 and 0.72 in the training dataset. Baseline severity of depressive symptoms, female sex, neuroticism, stressful life events, and surface area of the supramarginal gyrus contributed most to the predictive model and predicted onset of depression, with an area under the receiver operating characteristic curve between 0.68 and 0.72 in the independent validation sample. ConclusionsThis study showed that depression onset in adolescents can be predicted based on a combination multimodal data of clinical characteristics, life events, personality traits, and brain structure variables.

Long-term effectiveness of eye movement desensitization and reprocessing in children and adolescents with medically related subthreshold post-traumatic stress disorder: a randomized controlled trial

Medical procedures and hospitalizations can be experienced as traumatic and can lead to post-traumatic stress reactions. Eye movement desensitization and reprocessing (EMDR) shows promising results but very few long-term studies have been published. Therefore, our aim was to test the long-term (8 months post-treatment) effectiveness of EMDR in children and adolescents with medically related subthreshold post-traumatic stress disorder (PTSD). Seventy-four children (including 39 with congenital or acquired heart disease) aged 4-15 (M = 9.6 years) with subthreshold PTSD after previous hospitalization were included into a parallel group randomized controlled trial. Participants were randomized to EMDR (n = 37) or care-as-usual (CAU) (n = 37; medical care only). The primary outcome was PTSD symptoms of the child. Secondary outcomes were symptoms of depression and blood-injection-injury (BII) phobia, sleep problems, and health-related quality of life (HrQoL) of the child. Assessments of all outcomes were planned at baseline and 8 weeks and 8 months after the start of EMDR/CAU. We hypothesized that the EMDR group would show significantly more improvements on all outcomes over time. Both groups showed improvements over time on child's symptoms of PTSD (only parent report), depression, BII phobia, sleep problems, and most HrQoL subscales. GEE analyses showed no significant differences between the EMDR group (nT2 = 33, nT3 = 30) and the CAU group (nT2 = 35, nT3 = 32) on the primary outcome. One superior effect of EMDR over time was found for reducing parent-reported BII phobia of the child. EMDR did not perform better than CAU in reducing subthreshold PTSD up to 8 months post-treatment in previously hospitalized children. Possible explanations and clinical implications are discussed.

Unifying treatment for mild anxiety and depression in preadolescence.

Anxiety disorders in children and adolescents are prevalent and, if left untreated, can lead to comorbid psychological disorders, substance use, poor socioemotional functioning, and academic and occupational underachievement. Subthreshold presentations of anxiety in youth could become problematic if overlooked, resulting in the aforementioned negative outcomes. Thus, it is important to treat such presentations, including with evidence-based treatments such as cognitive-behavioral therapy (CBT). However, because of not meeting the diagnostic criteria for which many CBT protocols were developed, subthreshold presentations of emotional problems could be an especially good match for transdiagnostic treatments like the Unified Protocol for Children (UP-C). Few studies have addressed this application of the UP-C to subthreshold emotion disorders; thus, this study aimed to preliminarily examine in a systemic case analysis (a) the efficacy of the UP-C for a preadolescent patient with mild anxiety/depression, and (b) the clinical utility of assessing both nomothetic and idiographic outcomes. Pre-post and time series outcome data demonstrated significant decreases in symptoms of depression, irritability, and negative reactions to events and significant increases in emotion identification and ownership of emotions. A network analysis of time series data described dynamics between parent and child ratings as well as the importance of child-rated anxiety and parent ratings of child's ownership of emotions. This case study provides evidence for the efficacy of the UP-C with a preadolescent who displayed subclinical symptoms of an emotional disorder. Furthermore, this case study demonstrates the usefulness of nomothetic and idiographic assessments for treating psychological disorders in youth. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Therapeutic effects of Silexan on somatic symptoms and physical health in patients with anxiety disorders: A meta-analysis.

A meta‐analysis was performed to examine therapeutic effects of Silexan on somatic symptoms, including insomnia/fatigue, and physical health in patients with anxiety disorders. Five randomized, placebo‐controlled trials were included in this analysis: The efficacy of Silexan (80 mg/day) was investigated in patients with subthreshold anxiety disorders (three trials) and in patients with generalized anxiety disorder (two trials). Silexan was superior to placebo in terms of the mean change from baseline in the Hamilton Anxiety Rating Scale (HAMA) subscore somatic anxiety at week 10 with a standardized mean difference of −0.31 [95% Cl: −0.52 to −0.10, p = .004]. Treatment effects of silexan on somatic anxiety were independent of gender and age. Statistically significant differences were also shown for single HAMA items somatic muscular, cardiovascular, respiratory, and genitourinary symptoms, indicating clinical relevance with small to medium effects of Silexan. Similar clinically meaningful effects of Silexan on SF‐36 physical health, including reduced bodily pain and improved general health, and on insomnia complaints and fatigue, were demonstrated. In this meta‐analysis including all placebo‐controlled clinical trials in patients with anxiety disorders to date, statistically significant and clinically meaningful advantages of Silexan over placebo treatment were found in improving somatic symptoms and physical health.

The Emerging Literature on Exposure-Based Writing Therapies for Subthreshold and Clinical Posttraumatic Stress Disorder: A Response to Thompson-Hollands etal.'s (2020) Commentary on Dawson etal. (2020).

Thompson-Hollands etal.'s (2020) commentary on our systematic review of exposure-based writing therapies for subthreshold and clinical posttraumatic stress symptoms (Dawson etal., 2020) emphasizes important questions about the impact of heterogeneity in drawing inferences from evidence reviews. In this reply, we discuss (a) our rationale for undertaking a systematic review that was broad rather than narrow in scope and (b) provide clarifications on how heterogeneity was considered in the meta-analyses that were conducted. We also strongly agree with Thompson-Hollands etal.'s recommendation that future research should focus on better understanding the mechanisms by which exposure-based writing therapies help reduce posttraumatic stress symptoms.

Subthreshold personality disorder: how feasible is treatment in primary care?

Abstract Individuals with subthreshold borderline personality disorder (BPD) are commonly encountered in primary care settings, yet the psychological treatments they receive are rarely tailored to their needs. In an effort to capture and treat this group of individuals in a targeted and meaningful way, some primary care settings offer Systems Training for Emotional Predictability and Problem Solving – Emotional Intensity (STEPPS-EI). This evaluation sought to assess the feasibility of STEPPS-EI within NHS primary care services. Employing an uncontrolled design, the evaluation examined recruitment, retention, effectiveness and group appraisal. Findings supported three out of four evaluation objectives for feasibility: uptake of the group was high at 74%, the group was well received by the group and significantly effective at reducing symptoms of BPD, depression and anxiety. However, retention rates were low, with only 43% classed as ‘completers’ of the programme. The results indicate preliminary evidence for STEPPS-EI as a potentially feasible intervention with possible modification to enhance retention and avenues for further study. Key learning aims After reading this paper, the reader will be aware of: (1) Recent developments in the classification and diagnosis of personality disorder leading to the conceptualisation of subthreshold presentations. (2) The feasibility of conducting a primary care intervention for individuals with emotional intensity difficulties. (3) The preliminary beneficial outcomes of utilising a primary care intervention for individuals with emotional intensity difficulties. (4) Potential issues for participants and providers of primary care programmes with future direction for improvement and implementation.

Children mental health in Bandung during COVID-19 pandemic: a cross-sectional study

A significant threat to mental health emerged in children during COVID-19. This study aims to identify the effects of COVID-19 on the mental health of children in Bandung while studying at home. The cross-sectional study was conducted online from August 28 to September 4, 2020, among 426 parents who had at least one child aged 5 to 15 years. Moreover, K-means clustering was used to group 4 categories based on mental health disturbances, and confirmation factors analysis was performed to identify the relationship between parenting behaviour and children's mental health, then assessed by the chi-square test. Children were divided into four groups, in which 52% had sub-threshold mental disorders (mean Major Depressive Disorder (MDD)-10; 2.45), 32% had a mild (mean MDD-10; 5.31), 13% had a moderate (mean MDD-10; 12.5), and 3% of the children had severe (mean MDD-10; 15.3). The percentage of mental disorders in children is higher in children with a higher educational level of the parents, families contracted COVID-19 and abnormal behaviour of the parents. This paper shows the low proportion of children suffering from mental disorders in Bandung during the pandemic. Applying psychological intervention strategies and improving household financial conditions, parenting literacy, childcare and job security can all help improve children's psychological status.