Self-Efficacy As a Target for Neuroscience Research on Moderators of Treatment Outcomes in Pediatric Anxiety

Krystal M Lewis, Chika Matsumoto, Elise Cardinale, Emily L Jones, Andrea L Gold, Argyris Stringaris, Ellen Leibenluft, Daniel S Pine, Melissa A Brotman, Krystal M Lewis, Chika Matsumoto, Elise Cardinale, Emily L Jones, Andrea L Gold, Argyris Stringaris, Ellen Leibenluft, Daniel S Pine, Melissa A Brotman

Abstract

Objective: Despite the advances in the field of neuroscience, many questions remain regarding the mechanisms of anxiety, as well as moderators of treatment outcome. Long-term adverse outcomes for anxious youth may relate to pathophysiologically based information processing patterns and self-referential beliefs, such as self-efficacy. In fact, there are no studies highlighting the relationship between self-efficacy and neurocircuitry in youth. The purpose of this study was to explore the relationships between self-efficacy, brain morphometry, and youth anxiety. Methods: Parent, child, and clinician ratings of anxiety symptoms and child-reported self-efficacy were analyzed in a sample of 8- to 17-year-old youth (n = 51). Measures were collected from all youth at baseline and during and after treatment for the patients. Anxious patients (n = 26) received 12 sessions of cognitive behavioral therapy (CBT). Moreover, imaging data obtained from all participants before treatment were utilized in analyses. Results: Patients reported lower self-efficacy than healthy volunteers. Across the entire sample, anxiety was negatively related to total, social, and emotional efficacy. Both social and emotional efficacy predicted anxiety posttreatment. In addition, social efficacy predicted social anxiety symptoms posttreatment and social efficacy increased across treatment. There were no significant relations between self-efficacy and neurocircuitry. Conclusions: Self-efficacy is an important treatment target for anxious youth. Although self-efficacy was not related to brain morphometry, self-efficacy beliefs may constitute an important mechanism through which CBT and psychopharmacological interventions decrease fear and anxiety symptoms in youth.

Trial registration: ClinicalTrials.gov NCT03283930.

Keywords: child anxiety; cognitive behavioral therapy; neuroscience; self-efficacy; treatment.

Figures

FIG. 1.
FIG. 1.
Change in social and emotional efficacy across treatment. *t(22) = −2.21, p = 0.038.

References

    1. Ambrosini PJ: Historical development and present status of the schedule for affective disorders and schizophrenia for school-age children (K-SADS). J Am Acad Child Adolesc Psychiatry 39:49–58, 2000
    1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association; 1994
    1. Bacchini D, Magliulo F: Self-image and perceived self-efficacy during adolescence. J Youth Adolesc 32:337–350, 2003
    1. Bandura A. Self-efficacy: Toward a unifying theory of behavior change. Psychol Rev 84:191–215, 1977
    1. Birmaher B, Khetarpal S, Brent D, Cully M, Balach L, Kaufman J, Neer SM: The screen for child anxiety related emotional disorders (SCARED): Scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36:545–553, 1997
    1. Bittner A, Egger HL, Erkanli A, Costello EJ, Foley DL, Angold A: What do childhood anxiety disorders predict? J Child Psychol Psychiatry 48:1174–1183, 2007
    1. Blackford JU, Pine DP: Neural substrates of childhood anxiety disorders: A review of neuroimaging findings. Child Adolesc Psychiatr Clin N Am 21:501–525, 2012
    1. Brown LA, Wiley JF, Wolitzky-Taylor K, Roy-Byrne P, Sherbourne C, Stein MB, Craske MG: Changes in self-efficacy and outcome expectancy as predictors of anxiety outcomes from the calm study. Depress Anxiety 31: 678–689, 2014
    1. Cardinale EM, Kircanski K, Brooks J, Gold AL, Towbin KE, Pine DS, Brotman MA: Parsing neurodevelopmental features of irritability and anxiety: Replication and validation of a latent variable approach. Dev Psychopathol 31: 1–13, 2019
    1. Chaplin TM, Cole PM, Zahn-Waxler C: Parental socialization of emotion expression: Gender differences and relations to child adjustment. Emotion 5:80–88, 2005
    1. Clark DA, Beck AT: Cognitive theory and therapy of anxiety and depression: Convergence with neurobiological findings. Trends Cogn Sci 14:418–424, 2010
    1. Clark DM: Anxiety disorders: Why they persist and how to treat them. Behav Res Ther 37:S5–S27, 1999
    1. Coleman PK: Perceptions of parent-child attachment, social self-efficacy, and peer relationships in middle childhood. Infant Child Dev 12:351–368, 2003
    1. Corwyn RF, Bradley RH: Fathers' autonomy support and social competence of sons and daughters. Merrill-Palmer Q 62:359–387, 2016
    1. Cox BJ, Swinson RP, Endler NS: A review of the psychopharmacology of panic disorder: Individual differences and non specific factors. Can J Psychiatry 36:130–138, 1991
    1. Craske MG, Treanor M, Conway CC, Zbozinek T, Vervliet B: Maximizing exposure therapy: An inhibitory learning approach. Behav Res Ther 58:10–23, 2014
    1. D'Argembeau A, Ruby P, Collette F, Degueldre C, Balteau E, Luxen A, Salmon E: Distinct regions of the medial prefrontal cortex are associated with self-referential processing and perspective taking. J Cogn Neurosci 19:935–944, 2007
    1. Dale AM, Fischl B, Sereno MI: Cortical surface-based analysis. I. Segmentation and surface reconstruction. NeuroImage 9:179–194, 1999
    1. De Bellis MD, Casey BJ, Dahl RE, Birmaher B, Williamson DE, Thomas KM, Ryan ND: A pilot study of amygdala volumes in pediatric generalized anxiety disorder. Biol Psychiatry 48:51–57, 2000
    1. De Las Cuevas C, de Leon J, Peñate W, Betancort M: Factors influencing adherence to psychopharmacological medications in psychiatric patients: A structural equation modeling approach. Patient Prefer Adher 11:681, 2017
    1. De Nadai AS, Karver MS, Murphy TK, Cavitt MA, Alvaro JL, Bengtson M, Storch EA: Common factors in pediatric psychiatry: A review of essential and adjunctive mechanisms of treatment outcome. J Child Adolesc Psychopharmacol 27:10–18, 2017
    1. Eisenberg N, Cumberland A, Spinrad TL: Parental socialization of emotion. Psychol Inq 9:241–273, 1998
    1. Ehrenreich JT, Gross AM: Biased attentional behavior in childhood anxiety: A review of theory and current empirical investigation. Clin Psychol Rev 22:991–1008, 2002
    1. Fischl B: Automatically parcellating the human cerebral cortex. Cereb Cortex 14:11–22, 2004
    1. Fischl B, Salat DH, Busa E, Albert M, Dieterich M, Haselgrove C, Dale AM: Whole brain segmentation. Neuron 33:341–355, 2002
    1. Galla BM, Wood JJ: Emotional self-efficacy moderates anxiety-related impairments in math performance in elementary school-age youth. Person Indiv Diff 52:118–122, 2012
    1. Gaudiano BA, Herbert JD: Self-efficacy for social situations in adolescents with generalized social anxiety disorder. Behav Cogn Psychother 35:209–223, 2007
    1. Gee DG, Gabard-Durnam LJ, Flannery J, Goff B, Humphreys KL, Telzer EH, Tottenham N: Early developmental emergence of human amygdala–prefrontal connectivity after maternal deprivation. Proc Natl Acad Sci U S A 110:15638–15643, 2013
    1. Ghandour RM, Sherman LJ, Vladutiu CJ, Ali MM, Lynch SE, Bitsko RH, Blumberg SJ: Prevalence and treatment of depression, anxiety, and conduct problems in US children. J Pediatr 206:256–267, 2019
    1. Gold AL, Steuber ER, White LK, Pacheco J, Sachs JF, Pagliaccio D, Pine DS: Cortical thickness and subcortical gray matter volume in pediatric anxiety disorders. Neuropsychopharmacology 42:2423–2433, 2017
    1. Gusnard DA, Akbudak E, Shulman GL, Raichle ME: Medial prefrontal cortex and self-referential mental activity: Relation to a default mode of brain function. Proc Natl Acad Sci U S A 98:4259–4264, 2001
    1. Habibi M, Tahmasian K, Ferrer-Wreder L: Self-efficacy in Persian adolescents: Psychometric properties of a Persian version of the Self-Efficacy Questionnaire for Children (SEQ-C). Int Perspect Psychol Res Pract Consult 3:93–105, 2014
    1. Hannesdóttir DK, Ollendick TH: Social cognition and social anxiety among Icelandic schoolchildren. Child Fam Behav Ther 29:43–58, 2007
    1. Hofmann SG: Cognitive processes during fear acquisition and extinction in animals and humans: Implications for exposure therapy of anxiety disorders. Clin Psychol Rev 28:199–210, 2008
    1. Kaufman J, Birmaher B, Brent DA, Ryan ND, Rao U: K-SADS-PL. J Am Acad Child Adolesc Psychiatry 39:1208, 2000
    1. Keenan JP, Wheeler MA, Gallup GG, Pascual-Leone A: Self-recognition and the right prefrontal cortex. Trends Cogn Sci 4:338–344, 2000
    1. Kendall PC, Cummings CM, Villabø MA, Narayanan MK, Treadwell K, Birmaher B, Gosch E: Mediators of change in the child/adolescent anxiety multimodal treatment study. J Consult Clin Psychol 84:1–14, 2016
    1. Kendall PC, Hudson JL, Gosch E, Flannery-Schroeder E, Suveg C: Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. J Consult Clin Psychol 76:282–297, 2008
    1. Kent G, Gibbons R: Self-efficacy and the control of anxious cognitions. J Behav Ther Exp Psychiatry 18:33–40, 1987
    1. Landon TM, Ehrenreich JT, Pincus DB: Self-efficacy: A comparison between clinically anxious and non-referred youth. Child Psychiatry Hum Dev 38:31–45, 2007
    1. Lau WY, Chan CKY, Li JCH, Au TKF: Effectiveness of group cognitive-behavioral treatment for childhood anxiety in community clinics. Behav Res Ther 48:1067–1077, 2010
    1. LeDoux JE, Pine DS: Using neuroscience to help understand fear and anxiety: A two-system framework. Am J Psychiatry 173:1083–1093, 2016
    1. Maric M, Heyne DA, MacKinnon DP, van Widenfelt BM, Westenberg PM: Cognitive mediation of cognitive-behavioural therapy outcomes for anxiety-based school refusal. Behav Cogn Psychother 41:549–564, 2013
    1. Maslowsky J, Mogg K, Bradley BP, McClure-Tone E, Ernst M, Pine DS, Monk CS: A preliminary investigation of neural correlates of treatment in adolescents with generalized anxiety disorder. J Child Adolesc Psychopharmacol 20:105–111, 2010
    1. Masouleh SK, Eickhoff SB, Hoffstaedter F, Genon S, Alzheimer's disease neuroimaging initiative: Empirical examination of the replicability of associations between brain structure and psychological variables. eLife 8:e43464, 2019
    1. McClure EB, Monk CS, Nelson EE, Parrish JM, Adler A, Blair RJR, Pine DS: Abnormal attention modulation of fear circuit function in pediatric generalized anxiety disorder. Arch Gen Psychiatry 64:97–106, 2007
    1. Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Swendsen J: Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry 49:980–989, 2010
    1. Mitchell JP, Banaji MR, MacRae CN: The link between social cognition and self-referential thought in the medial prefrontal cortex. J Cogn Neurosci 17:1306–1315, 2005
    1. Mogg K, Bradley BP: A cognitive-motivational analysis of anxiety. Behav Res Ther 36:809–848, 1998
    1. Monk CS, Nelson EE, McClure EB, Mogg K, Bradley BP, Leibenluft E, Pine DS: Ventrolateral prefrontal cortex activation and attentional bias in response to angry faces in adolescents with generalized anxiety disorder. Am J Psychiatry 163:1091–1097, 2006
    1. Mueller SC, Aouidad A, Gorodetsky E, Goldman D, Pine DS, Ernst M: Gray matter volume in adolescent anxiety: An impact of the brain-derived neurotrophic factor Val66Met polymorphism? J Am Acad Child Adolesc Psychiatry 52:184–195, 2013
    1. Muris P: A brief questionnaire for measuring self-efficacy in youths. J Psychopathol Behav Assess 23:145–149, 2001
    1. Muris P: Relationships between self-efficacy and symptoms of anxiety disorders and depression in a normal adolescent sample. Pers Individ Diff 32:337–348, 2002
    1. Northoff G, Heinzel A, De Greck M, Bermpohl F, Dobrowolny H, Panksepp J: Self-referential processing in our brain—a meta-analysis of imaging studies on the self. Neuroimage 31:440–457, 2006
    1. Ollendick TH, Halldorsdottir T, Fraire MG, Austin KE, Noguchi RJ, Lewis KM, Whitmore MJ: Specific phobias in youth: A randomized controlled trial comparing one-session treatment to a parent-augmented one-session treatment. Behav Ther 46:141–155, 2015
    1. Ollendick TH, Öst LG, Ryan SM, Capriola NN, Reuterskiöld L: Harm beliefs and coping expectancies in youth with specific phobias. Behav Res Ther 91:51–57, 2017
    1. Pfeifer JH, Lieberman MD, Dapretto M: “I know you are but what am I?!”: Neural bases of self-and social knowledge retrieval in children and adults. J Cogn Neurosci 19:1323–1337, 2007
    1. Pine DS, Cohen P, Gurley D, Brook J, Ma Y: The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 55:56–64, 1998
    1. Prins PJ, Ollendick TH: Cognitive change and enhanced coping: Missing mediational links in cognitive behavior therapy with anxiety-disordered children. Clin Child Fam Psychol Rev 6:87–105, 2003
    1. Qin S, Young CB, Duan X, Chen T, Supekar K, Menon V: Amygdala subregional structure and intrinsic functional connectivity predicts individual differences in anxiety during early childhood. Biol Psychiatry 75:892–900, 2014
    1. Quirk GJ, Mueller D: Neural mechanisms of extinction learning and retrieval. Neuropsychopharmacology 33:56, 2008
    1. Rappaport BI, Pagliaccio D, Pine DS, Klein DN, Jarcho JM: Discriminant validity, diagnostic utility, and parent-child agreement on the Screen for Child Anxiety Related Emotional Disorders (SCARED) in treatment-and non-treatment-seeking youth. J Anxiety Disord 51:22–31, 2017
    1. Raval VV, Luebbe AM, Sathiyaseelan A: Parent socialization of positive affect, adolescent positive affect regulation, and adolescent girls' depression in India. Soc Dev Res 28:1–16, 2019
    1. Research Units on Pediatric Psychopharmacology Anxiety Study Group: The pediatric anxiety rating scale (PARS): Development and psychometric properties. J Am Acad Child Adolesc Psychiatry 41:1061–1069, 2002
    1. Rudy BM, Davis III TE, Matthews RA: The relationship among self-efficacy, negative self-referent cognitions, and social anxiety in children: A multiple mediator model. Behav Ther 43:619–628, 2012
    1. Saunders J, Davis L, Williams T, Williams JH: Gender differences in self-perceptions and academic outcomes: A study of African American high school students. J Youth Adolesc 33:81–90, 2004
    1. Sebastian C, Burnett S, Blakemore SJ: Development of the self-concept during adolescence. Trends Cogn Sci 12:441–446, 2008
    1. Shechner T, Hong M, Britton JC, Pine DS, Fox NA: Fear conditioning and extinction across development: Evidence from human studies and animal models. Biol Psychol 100:1–12, 2014
    1. Silk JS, Forbes EE, Whalen DJ, Jakubcak JL, Thompson WK, Ryan ND, Dahl RE: Daily emotional dynamics in depressed youth: A cell phone ecological momentary assessment study. J Exp Child Psychol 110:241–257, 2011
    1. Silk JS, Tan PZ, Ladouceur CD, Meller S, Siegle GJ, McMakin DL, Ryan ND: A randomized clinical trial comparing individual cognitive behavioral therapy and child-centered therapy for child anxiety disorders. J Clin Child Adolesc Psychol 47:542–554, 2018
    1. Silverman WK, Albano AM: Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions. San Antonio (Texas), Psychological Corporation, 1996
    1. Silverman WK, Saavedra LM, Pina AA: Test-retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: Child and parent versions. J Am Acad Child Adolesc Psychiatry 40:937–944, 2001
    1. Smith S, Nichols T: Threshold-free cluster enhancement: Addressing problems of smoothing, threshold dependence and localization in cluster inference. NeuroImage 44:83–98, 2009
    1. Sotres-Bayon F, Cain CK, LeDoux JE: Brain mechanisms of fear extinction: Historical perspectives on the contribution of prefrontal cortex. Biol Psychiatry 60:329–336, 2006
    1. Southam-Gerow MA, Weisz JR, Chu BC, McLeod BD, Gordis EB, Connor-Smith JK: Does cognitive behavioral therapy for youth anxiety outperform usual care in community clinics? An initial effectiveness test. J Am Acad Child Adolesc Psychiatry 49:1043–1052, 2010
    1. Strawn JR, Chu W-J, Whitsel RM, Weber WA, Norris MM, Adler CM, DelBello MP: A pilot study of anterior cingulate cortex neurochemistry in adolescents with generalized anxiety disorder. Neuropsychobiology 67:224–229, 2013
    1. Strawn JR, Hamm L, Fitzgerald DA, Fitzgerald KD, Monk CS, Phan KL: Neurostructural abnormalities in pediatric anxiety disorders. J Anxiety Disord 32:81–88, 2015
    1. Strawn JR, John Wegman C, Dominick KC, Swartz MS, Wehry AM, Patino LR, DelBello MP: Cortical surface anatomy in pediatric patients with generalized anxiety disorder. J Anxiety Disord 28:717–723, 2014
    1. Suveg C, Sood E, Comer JS, Kendall PC: Changes in emotional regulation following cognitive-behavioral therapy for anxious youth. J Clin Child Adolesc Psychol 38:390–401, 2009
    1. Tan PZ, Forbes EE, Dahl RE, Ryan ND, Siegle GJ, Ladouceur CD, Silk JS: Emotional reactivity and regulation in anxious and nonanxious youth: A cell-phone ecological momentary assessment study. J Child Psychol Psychiatry 53:197–206, 2012
    1. Vasey MW, MacLeod C: Information-processing factors in childhood anxiety: A review and developmental perspective. In: The Developmental Psychopathology of Anxiety. Edited by Vasey MW, Dadds MR. New York, Oxford University Press, 2001, pp. 253–277
    1. Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, Kendall PC: Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359:2753–2766, 2008
    1. White LK, Sequeira S, Britton JC, Brotman MA, Gold AL, Berman E, Leibenluft E: Complementary features of attention bias modification therapy and cognitive-behavioral therapy in pediatric anxiety disorders. Am J Psychiatry 174:775–784, 2017
    1. Winkler AM, Greve DN, Bjuland KJ, Nichols TE, Sabuncu MR, Håberg AK, Rimol LM: Joint analysis of cortical area and thickness as a replacement for the analysis of the volume of the cerebral cortex. Cereb Cortex 28:738–749, 2018
    1. Winkler AM, Ridgway GR, Douaud G, Nichols TE, Smith SM: Faster permutation inference in brain imaging. NeuroImage 141:502–516, 2016
    1. Winkler AM, Ridgway GR, Webster MA, Smith SM, Nichols TE: Permutation inference for the general linear model. NeuroImage 92:381–397, 2014
    1. Zlomuzica A, Preusser F, Schneider S, Margraf J: Increased perceived self-efficacy facilitates the extinction of fear in healthy participants. Front Behav Neurosci 9:270, 2015

Source: PubMed

Sponsors et collaborateurs

Les conditions médicales

Interventions en matière de drogue

3
S'abonner