Maaike Nauta | University of Groningen (original) (raw)

Papers by Maaike Nauta

Journal of Consulting and Clinical Psychology, 2014

Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CB... more Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.

Depression and Anxiety, 2013

Bennett et al.

Aims The aim of this study was to examine whether non-verbal therapies are effective in treating... more Aims

The aim of this study was to examine whether non-verbal therapies are effective in treating depressive symptoms in psychotic disorders.

Material and Methods

A systematic literature search was performed in PubMed, Psychinfo, Picarta, Embase and ISI Web of Science, up to January 2015. Randomized controlled trials (RCTs) comparing a non-verbal intervention to a control condition in patients with psychotic disorders, whilst measuring depressive symptoms as a primary or secondary outcome, were included. The quality of studies was assessed using the ‘Clinical Trials Assessment Measure for psychological treatments’ (CTAM) scale. Cohen’s d was calculated as a measure of effect size. Using a Network Meta-analysis, both direct and indirect evidence was investigated.

Results

10 RCTs were included, of which three were of high quality according to the CTAM. The direct evidence demonstrated a significant effect on the reduction in depressive symptoms relative to treatment as usual (TAU), in favor of overall non-verbal therapy (ES: -0.66, 95% C.I. = -0.88, -0.44) and music therapy (ES: -0.59, 95% C.I. = -0.85, -0.33). Combining both direct and indirect evidence, yoga therapy (ES: -0.79, 95% C.I. = -1.24, -0.35) had a significant effect on depressive symptoms, and occupational therapy (ES: 1.81, 95% C.I. = 0.81, 2.81) was less effective, relative to TAU. Exercise therapy did not show a significant effect on depressive symptoms in comparison to TAU (ES: -0.02 95% C.I. = -0.67, 0.62). Due to inconsistency of study evidence, the indirect effects should be interpreted cautiously.

Conclusions

Non-verbal therapies appear to be effective in reducing depressive symptomatology in psychotic disorders, in particular music therapy and yoga therapy.

The British journal of psychiatry : the journal of mental science, Jan 20, 2015

BackgroundWe previously reported an association between 5HTTLPR genotype and outcome following co... more BackgroundWe 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.AimsTo replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829).MethodLogistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed.ResultsThere 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.ConclusionsThe association between 5HTTLPR genotype...

Tijdschrift voor Psychotherapie, 2014

GETOETST Cognitieve gedragstherapie bij kinderen en jongeren met een angststoornis: waarom werkt ... more GETOETST Cognitieve gedragstherapie bij kinderen en jongeren met een angststoornis: waarom werkt het? Cognitie, ervaren controle en coping als mediatoren Sanne Hogendoorn, Pier Prins, Frits Boer, Leentje Vervoort, Lidewij Wolters, Harma Moorlag, Maaike Nauta, Harry Garst, Catharina Hartman en Else de Haan

Samenvatting Hoewel de effectiviteit van cognitieve gedragstherapie (CGT) bij angstige kinderen r... more Samenvatting Hoewel de effectiviteit van cognitieve gedragstherapie (CGT) bij angstige kinderen reeds in een aantal studies is aangetoond, werden de resultaten ervan niet eerder in de reguliere praktijkinstellingen getoetst. Bovendien was het de vraag of het noodzakelijk is om naast een behandeling van het kind ook intensieve oudertraining te geven. In deze studie onderzochten wij de effectiviteit van 12 sessies CGT bij angstige kinderen + 2 sessies psychoeducatie voor ouders en de mogelijke meerwaarde van een cognitieve oudertraining (COT) van 7 sessies. Aan deze studie namen 79 kinderen en jongeren (7 tot 18 jaar) met angststoornissen deel. Het ging om kinderen die waren verwezen naar zowel reguliere praktijkinstellingen als een universitair centrum. Over het algemeen hadden de kinderen meer baat bij CGT dan bij een wachtlijst. Na CGT (met of zonder COT) was er een aanzienlijke verbetering op zelfgerapporteerde angst en depressie en op ouderrapportages van angst en internaliserend gedrag. Deze verbetering hield stand tot drie en twaalf maanden na behandeling. CGT bleek even effectief in de reguliere pratijkinstellingen als in het universitaire centrum. Tegen de verwachting in had de cognitieve oudertraining geen meerwaarde boven de individuele behandeling van het kind. Concluderend kunnen de meeste angstige kinderen in praktijkinstellingen effectief behandeld worden met 12 sessies individuele CGT en 2 sessies psycho-educatie voor ouders. Intensieve cognitieve oudertraining voegt hier niets aan toe.

Depression and Anxiety, 2013

Bennett et al.

Journal of Personality and Social Psychology, 2003

The effectiveness of a treatment protocol with individual CBT for children with anxiety disorders... more The effectiveness of a treatment protocol with individual CBT for children with anxiety disorders was evaluated in a clinical setting, i.e. an outpatient clinic for child and adolescent psychiatry. In addition, the surplus value of a cognitive parent-training program above the individual CBT was determined. Eighteen children with anxiety disorders were treated at an outpatient clinic for child and adolescent psychiatry. All children received 12 weekly sessions of individual cognitive behaviour therapy and all parents had 2 sessions in which the treatment method was explained. In addition, the families were randomly assigned to one of the following conditions: 1) no extra treatment, or 2) additional cognitive training for the parents, consisting of 7 two-weekly sessions, parallel to the individual treatment of the child. Results were studied at post-treatment, at 3-months follow-up, and at 15 months follow-up. Both child and parent reports showed significant decline of anxiety of the child, reaching the level of normal controls at 3 months follow-up. According to parent reports, many children improved between the post-test and the 3 months follow-up. Additional cognitive parent training did not add to the results of individual cognitive behaviour therapy for the children. At 15 months follow-up, data for the total group revealed a general increase in anxiety symptoms in child reports but not in parental reports. Five children showed severe psychopathology, whereas the other 12 children reported no anxiety disorders and high levels of general functioning. Again, no differences between the treatments were found.

Objective To investigate predictors and moderators of outcome of behavioral parent training (BPT)... more Objective To investigate predictors and moderators of outcome of behavioral parent training (BPT) as adjunct to ongoing routine clinical care (RCC), versus RCC alone. Methods We randomly assigned 94 referred children (4–12 years) with attention-deficit/hyperactivity disorder (ADHD) to BPT plus RCC or RCC alone. Outcome was based on parent-reported behavioral problems and ADHD symptoms. Predictor/moderator variables included children's IQ, age, and comorbidity profile,

Journal of the American Academy of Child & Adolescent Psychiatry, 2015

Journal of consulting and clinical psychology, 2014

Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CB... more Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing...

Journal of Personality Disorders, 2014

The development of borderline personality disorder (BPD) has been associated with parenting style... more The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress has not been examined in this group. The current study examined 101 adolescents (14-19 years old) with BPD symptoms and their mothers. Assessments were made on severity of BPD symptoms, youth-perceived maternal rearing styles, and psychopathology and parenting stress in mothers. Multiple regression analyses were used to examine potential predictors of borderline severity. No correlation was found between severity of BPD symptoms in adolescents and parenting stress. Only youth-perceived maternal overprotection was significantly related to BPD severity. The combination of perceived maternal rejection with cluster B traits in mothers was significantly related to BPD severity in adolescents. This study provides a contribution to the disentanglement of the developmental pathways that lead to BPD.

European Child & Adolescent Psychiatry, 2014

This study aims to explore the influence of paternal variables on outcome of behavioral parent tr... more This study aims to explore the influence of paternal variables on outcome of behavioral parent training (BPT) in children with attention-deficit/hyperactivity disorder (ADHD). 83 referred, school-aged children with ADHD were randomly assigned to BPT plus ongoing routine clinical care (RCC) or RCC alone. Treatment outcome was based on parent-reported ADHD symptoms and behavioral problems. Moderator variables included paternal ADHD symptoms, depressive symptoms, and parenting self-efficacy. We conducted repeated measures analyses of variance (ANOVA) for all variables, and then analyzed the direction of interaction effects by repeated measures ANOVA in high and low scoring subgroups. Paternal ADHD symptoms and parenting self-efficacy played a moderating role in decreasing behavioral problems, but not in decreasing ADHD symptoms. Paternal depressive symptoms did not moderate either treatment outcome. BPT is most beneficial in reducing children's behavioral problems when their fathers have high levels of ADHD symptoms or high-parenting self-efficacy.

To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group tra... more To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group training for adolescents with borderline personality disorder (BPD) symptoms. One hundred nine adolescents with borderline traits (73% meeting the full criteria for BPD) were randomized to treatment as usual only (TAU) or ERT + TAU. Outcome measurements included severity of BPD symptoms, general psychopathology, and quality of life. Multilevel analyses were conducted on an intent-to-treat basis. Clinical significant change was determined by normative comparisons on a primary outcome measurement. Independent of treatment condition, the two groups improved equally on the severity of BPD symptoms, general psychopathology, and quality of life. Nineteen percent of the ERT group was remitted according to the cutoff score after treatment (at 6 months) versus 12% of the control group. Follow-up assessments in the ERT group at 12 months showed some further improvement (33% remittance). With regard to predictors of outcomes, adolescents with higher levels of depression or attention-deficit/hyperactivity disorder or oppositional-defiant disorder at baseline and who reported a history of abuse had worse outcomes, regardless of treatment condition. The attrition rate for the ERT sessions was remarkably low (19%). Early interventions for BPD symptoms in adolescence are feasible and necessary. No additional effect of ERT over TAU could be demonstrated in the present study. There is a clear need for developing effective interventions for adolescents with persistent BPD symptomatology. Clinical trial registration information-Evaluation of Group Training for Adolescents (Emotion Regulation Training) with Emotion Regulation Problems: A Randomized Controlled Clinical Trial; http://trailregister.nl/; ISRCTN97589104.

Journal of the American Academy of Child & Adolescent Psychiatry, 2008

Objective: The efficacy and partial effectiveness of child-focused versus family-focused cognitiv... more Objective: The efficacy and partial effectiveness of child-focused versus family-focused cognitive<behavioral therapy (CBT) for clinically anxious youths was evaluated, in particular in relation to parental anxiety disorders and child's age.

Journal of the American Academy of Child & Adolescent Psychiatry, 2007

Objective: To investigate the effectiveness of behavioral parent training (BPT) as adjunct to rou... more Objective: To investigate the effectiveness of behavioral parent training (BPT) as adjunct to routine clinical care (RCC).

Journal of the American Academy of Child & Adolescent Psychiatry, 2003

To evaluate a 12-week cognitive-behavioral treatment program for children with anxiety disorders ... more To evaluate a 12-week cognitive-behavioral treatment program for children with anxiety disorders and the additional value of a seven-session cognitive parent training program. Seventy-nine children with an anxiety disorder (aged 7-18 years) were randomly assigned to a cognitive behavioral treatment condition or a wait-list control condition. Families in the active treatment condition were randomly assigned to an additional seven-session cognitive parent training program. Semistructured diagnostic interviews were conducted with parents and children separately, before and after treatment and at 3 months follow-up. Questionnaires included child self-reports on anxiety and depression and parent reports on child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anxiety and behavioral problems. Children with anxiety disorders showed more treatment gains from cognitive-behavioral therapy than from a wait-list control condition. These results were substantial and significant in parent measures and with regard to diagnostic status, but not in child self-reports. In the active treatment condition, children improved on self-reported anxiety and depression, as well as on parent reports on their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anxiety problems. These results were equal for clinically referred and recruited children. Child self-reports decreased to the normal mean, whereas parents reported scores that were lower than before treatment but were still elevated from the normal means. No significant outcome differences were found between families with or without additional parent training. Children with anxiety disorders profited from cognitive-behavioral therapy. Children improved equally whether or not additional parent training was offered.

Journal of Personality Disorders, 2012

The Borderline Personality Disorder Severity Index-IV-adolescent and parent versions (BPDSI-IV-ad... more The Borderline Personality Disorder Severity Index-IV-adolescent and parent versions (BPDSI-IV-ado/p) are DSM-IV based semi-structured interviews for the assessment of the severity of symptoms of borderline personality disorder (BPD) in adolescents. The present study evaluates the psychometric properties of the BPDSI-IV-ado/p. The interviews were administered to 122 adolescents, aged 14-19 years and their parents/caretakers who were referred to mental health centres for emotion regulation problems, and to 45 healthy controls. The interrater reliability and internal consistency of all nine subscales (following the nine BPD symptoms in DSM-IV) proved to be good to excellent. Discriminant, concurrent, and construct validity were satisfactory. Cut-off scores that optimize sensitivity and specificity were derived. Informant agreement between adolescents and parents/caretakers was modest. The results of this study suggest that the BPDSI-IV adolescent and parent versions are valid and reliable instruments for the assessment of BPD symptom severity in adolescents.

Journal of Consulting and Clinical Psychology, 2014

Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CB... more Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. RESULTS should be replicated as additional RCTs are published.

Depression and Anxiety, 2013

Bennett et al.

Aims The aim of this study was to examine whether non-verbal therapies are effective in treating... more Aims

The aim of this study was to examine whether non-verbal therapies are effective in treating depressive symptoms in psychotic disorders.

Material and Methods

A systematic literature search was performed in PubMed, Psychinfo, Picarta, Embase and ISI Web of Science, up to January 2015. Randomized controlled trials (RCTs) comparing a non-verbal intervention to a control condition in patients with psychotic disorders, whilst measuring depressive symptoms as a primary or secondary outcome, were included. The quality of studies was assessed using the ‘Clinical Trials Assessment Measure for psychological treatments’ (CTAM) scale. Cohen’s d was calculated as a measure of effect size. Using a Network Meta-analysis, both direct and indirect evidence was investigated.

Results

10 RCTs were included, of which three were of high quality according to the CTAM. The direct evidence demonstrated a significant effect on the reduction in depressive symptoms relative to treatment as usual (TAU), in favor of overall non-verbal therapy (ES: -0.66, 95% C.I. = -0.88, -0.44) and music therapy (ES: -0.59, 95% C.I. = -0.85, -0.33). Combining both direct and indirect evidence, yoga therapy (ES: -0.79, 95% C.I. = -1.24, -0.35) had a significant effect on depressive symptoms, and occupational therapy (ES: 1.81, 95% C.I. = 0.81, 2.81) was less effective, relative to TAU. Exercise therapy did not show a significant effect on depressive symptoms in comparison to TAU (ES: -0.02 95% C.I. = -0.67, 0.62). Due to inconsistency of study evidence, the indirect effects should be interpreted cautiously.

Conclusions

Non-verbal therapies appear to be effective in reducing depressive symptomatology in psychotic disorders, in particular music therapy and yoga therapy.

The British journal of psychiatry : the journal of mental science, Jan 20, 2015

BackgroundWe previously reported an association between 5HTTLPR genotype and outcome following co... more BackgroundWe 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.AimsTo replicate the association between 5HTTLPR and CBT outcome in child anxiety from the Genes for Treatment study (GxT Cohort 2, n = 829).MethodLogistic and linear mixed effects models were used to examine the relationship between 5HTTLPR and CBT outcomes. Mega-analyses using both cohorts were performed.ResultsThere 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.ConclusionsThe association between 5HTTLPR genotype...

Tijdschrift voor Psychotherapie, 2014

GETOETST Cognitieve gedragstherapie bij kinderen en jongeren met een angststoornis: waarom werkt ... more GETOETST Cognitieve gedragstherapie bij kinderen en jongeren met een angststoornis: waarom werkt het? Cognitie, ervaren controle en coping als mediatoren Sanne Hogendoorn, Pier Prins, Frits Boer, Leentje Vervoort, Lidewij Wolters, Harma Moorlag, Maaike Nauta, Harry Garst, Catharina Hartman en Else de Haan

Samenvatting Hoewel de effectiviteit van cognitieve gedragstherapie (CGT) bij angstige kinderen r... more Samenvatting Hoewel de effectiviteit van cognitieve gedragstherapie (CGT) bij angstige kinderen reeds in een aantal studies is aangetoond, werden de resultaten ervan niet eerder in de reguliere praktijkinstellingen getoetst. Bovendien was het de vraag of het noodzakelijk is om naast een behandeling van het kind ook intensieve oudertraining te geven. In deze studie onderzochten wij de effectiviteit van 12 sessies CGT bij angstige kinderen + 2 sessies psychoeducatie voor ouders en de mogelijke meerwaarde van een cognitieve oudertraining (COT) van 7 sessies. Aan deze studie namen 79 kinderen en jongeren (7 tot 18 jaar) met angststoornissen deel. Het ging om kinderen die waren verwezen naar zowel reguliere praktijkinstellingen als een universitair centrum. Over het algemeen hadden de kinderen meer baat bij CGT dan bij een wachtlijst. Na CGT (met of zonder COT) was er een aanzienlijke verbetering op zelfgerapporteerde angst en depressie en op ouderrapportages van angst en internaliserend gedrag. Deze verbetering hield stand tot drie en twaalf maanden na behandeling. CGT bleek even effectief in de reguliere pratijkinstellingen als in het universitaire centrum. Tegen de verwachting in had de cognitieve oudertraining geen meerwaarde boven de individuele behandeling van het kind. Concluderend kunnen de meeste angstige kinderen in praktijkinstellingen effectief behandeld worden met 12 sessies individuele CGT en 2 sessies psycho-educatie voor ouders. Intensieve cognitieve oudertraining voegt hier niets aan toe.

Depression and Anxiety, 2013

Bennett et al.

Journal of Personality and Social Psychology, 2003

The effectiveness of a treatment protocol with individual CBT for children with anxiety disorders... more The effectiveness of a treatment protocol with individual CBT for children with anxiety disorders was evaluated in a clinical setting, i.e. an outpatient clinic for child and adolescent psychiatry. In addition, the surplus value of a cognitive parent-training program above the individual CBT was determined. Eighteen children with anxiety disorders were treated at an outpatient clinic for child and adolescent psychiatry. All children received 12 weekly sessions of individual cognitive behaviour therapy and all parents had 2 sessions in which the treatment method was explained. In addition, the families were randomly assigned to one of the following conditions: 1) no extra treatment, or 2) additional cognitive training for the parents, consisting of 7 two-weekly sessions, parallel to the individual treatment of the child. Results were studied at post-treatment, at 3-months follow-up, and at 15 months follow-up. Both child and parent reports showed significant decline of anxiety of the child, reaching the level of normal controls at 3 months follow-up. According to parent reports, many children improved between the post-test and the 3 months follow-up. Additional cognitive parent training did not add to the results of individual cognitive behaviour therapy for the children. At 15 months follow-up, data for the total group revealed a general increase in anxiety symptoms in child reports but not in parental reports. Five children showed severe psychopathology, whereas the other 12 children reported no anxiety disorders and high levels of general functioning. Again, no differences between the treatments were found.

Objective To investigate predictors and moderators of outcome of behavioral parent training (BPT)... more Objective To investigate predictors and moderators of outcome of behavioral parent training (BPT) as adjunct to ongoing routine clinical care (RCC), versus RCC alone. Methods We randomly assigned 94 referred children (4–12 years) with attention-deficit/hyperactivity disorder (ADHD) to BPT plus RCC or RCC alone. Outcome was based on parent-reported behavioral problems and ADHD symptoms. Predictor/moderator variables included children's IQ, age, and comorbidity profile,

Journal of the American Academy of Child & Adolescent Psychiatry, 2015

Journal of consulting and clinical psychology, 2014

Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CB... more Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing...

Journal of Personality Disorders, 2014

The development of borderline personality disorder (BPD) has been associated with parenting style... more The development of borderline personality disorder (BPD) has been associated with parenting styles and parental psychopathology. Only a few studies have examined current parental rearing styles and parental psychopathology in relationship to BPD symptoms in adolescents. Moreover, parenting stress has not been examined in this group. The current study examined 101 adolescents (14-19 years old) with BPD symptoms and their mothers. Assessments were made on severity of BPD symptoms, youth-perceived maternal rearing styles, and psychopathology and parenting stress in mothers. Multiple regression analyses were used to examine potential predictors of borderline severity. No correlation was found between severity of BPD symptoms in adolescents and parenting stress. Only youth-perceived maternal overprotection was significantly related to BPD severity. The combination of perceived maternal rejection with cluster B traits in mothers was significantly related to BPD severity in adolescents. This study provides a contribution to the disentanglement of the developmental pathways that lead to BPD.

European Child & Adolescent Psychiatry, 2014

This study aims to explore the influence of paternal variables on outcome of behavioral parent tr... more This study aims to explore the influence of paternal variables on outcome of behavioral parent training (BPT) in children with attention-deficit/hyperactivity disorder (ADHD). 83 referred, school-aged children with ADHD were randomly assigned to BPT plus ongoing routine clinical care (RCC) or RCC alone. Treatment outcome was based on parent-reported ADHD symptoms and behavioral problems. Moderator variables included paternal ADHD symptoms, depressive symptoms, and parenting self-efficacy. We conducted repeated measures analyses of variance (ANOVA) for all variables, and then analyzed the direction of interaction effects by repeated measures ANOVA in high and low scoring subgroups. Paternal ADHD symptoms and parenting self-efficacy played a moderating role in decreasing behavioral problems, but not in decreasing ADHD symptoms. Paternal depressive symptoms did not moderate either treatment outcome. BPT is most beneficial in reducing children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s behavioral problems when their fathers have high levels of ADHD symptoms or high-parenting self-efficacy.

To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group tra... more To evaluate the effectiveness of Emotion Regulation Training (ERT), a 17-session weekly group training for adolescents with borderline personality disorder (BPD) symptoms. One hundred nine adolescents with borderline traits (73% meeting the full criteria for BPD) were randomized to treatment as usual only (TAU) or ERT + TAU. Outcome measurements included severity of BPD symptoms, general psychopathology, and quality of life. Multilevel analyses were conducted on an intent-to-treat basis. Clinical significant change was determined by normative comparisons on a primary outcome measurement. Independent of treatment condition, the two groups improved equally on the severity of BPD symptoms, general psychopathology, and quality of life. Nineteen percent of the ERT group was remitted according to the cutoff score after treatment (at 6 months) versus 12% of the control group. Follow-up assessments in the ERT group at 12 months showed some further improvement (33% remittance). With regard to predictors of outcomes, adolescents with higher levels of depression or attention-deficit/hyperactivity disorder or oppositional-defiant disorder at baseline and who reported a history of abuse had worse outcomes, regardless of treatment condition. The attrition rate for the ERT sessions was remarkably low (19%). Early interventions for BPD symptoms in adolescence are feasible and necessary. No additional effect of ERT over TAU could be demonstrated in the present study. There is a clear need for developing effective interventions for adolescents with persistent BPD symptomatology. Clinical trial registration information-Evaluation of Group Training for Adolescents (Emotion Regulation Training) with Emotion Regulation Problems: A Randomized Controlled Clinical Trial; http://trailregister.nl/; ISRCTN97589104.

Journal of the American Academy of Child & Adolescent Psychiatry, 2008

Objective: The efficacy and partial effectiveness of child-focused versus family-focused cognitiv... more Objective: The efficacy and partial effectiveness of child-focused versus family-focused cognitive<behavioral therapy (CBT) for clinically anxious youths was evaluated, in particular in relation to parental anxiety disorders and child's age.

Journal of the American Academy of Child & Adolescent Psychiatry, 2007

Objective: To investigate the effectiveness of behavioral parent training (BPT) as adjunct to rou... more Objective: To investigate the effectiveness of behavioral parent training (BPT) as adjunct to routine clinical care (RCC).

Journal of the American Academy of Child & Adolescent Psychiatry, 2003

To evaluate a 12-week cognitive-behavioral treatment program for children with anxiety disorders ... more To evaluate a 12-week cognitive-behavioral treatment program for children with anxiety disorders and the additional value of a seven-session cognitive parent training program. Seventy-nine children with an anxiety disorder (aged 7-18 years) were randomly assigned to a cognitive behavioral treatment condition or a wait-list control condition. Families in the active treatment condition were randomly assigned to an additional seven-session cognitive parent training program. Semistructured diagnostic interviews were conducted with parents and children separately, before and after treatment and at 3 months follow-up. Questionnaires included child self-reports on anxiety and depression and parent reports on child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anxiety and behavioral problems. Children with anxiety disorders showed more treatment gains from cognitive-behavioral therapy than from a wait-list control condition. These results were substantial and significant in parent measures and with regard to diagnostic status, but not in child self-reports. In the active treatment condition, children improved on self-reported anxiety and depression, as well as on parent reports on their child&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s anxiety problems. These results were equal for clinically referred and recruited children. Child self-reports decreased to the normal mean, whereas parents reported scores that were lower than before treatment but were still elevated from the normal means. No significant outcome differences were found between families with or without additional parent training. Children with anxiety disorders profited from cognitive-behavioral therapy. Children improved equally whether or not additional parent training was offered.

Journal of Personality Disorders, 2012

The Borderline Personality Disorder Severity Index-IV-adolescent and parent versions (BPDSI-IV-ad... more The Borderline Personality Disorder Severity Index-IV-adolescent and parent versions (BPDSI-IV-ado/p) are DSM-IV based semi-structured interviews for the assessment of the severity of symptoms of borderline personality disorder (BPD) in adolescents. The present study evaluates the psychometric properties of the BPDSI-IV-ado/p. The interviews were administered to 122 adolescents, aged 14-19 years and their parents/caretakers who were referred to mental health centres for emotion regulation problems, and to 45 healthy controls. The interrater reliability and internal consistency of all nine subscales (following the nine BPD symptoms in DSM-IV) proved to be good to excellent. Discriminant, concurrent, and construct validity were satisfactory. Cut-off scores that optimize sensitivity and specificity were derived. Informant agreement between adolescents and parents/caretakers was modest. The results of this study suggest that the BPDSI-IV adolescent and parent versions are valid and reliable instruments for the assessment of BPD symptom severity in adolescents.