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Prevention of Anxiety Disorders

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Abstract

Research into the prevention of anxiety has increased dramatically in the past few years. Prevention programs have been directed at broad, nonspecific anxiety and at more specific anxiety types, such as panic disorder and post-traumatic stress disorder. Prevention of anxiety is still a relatively new field, but there has been a recent surge of literature reporting on different prevention programs. Universal prevention trials have shown modest but promising results, and school-based programs offered to all students also help to reduce stigmatization and common barriers to accessing treatment (eg, time, location, and cost). In contrast, targeted programs tend to show somewhat larger effects but rely on identification of relevant populations. Specific programs for the prevention of panic disorder and post-traumatic stress disorder have also demonstrated some preliminary success. This paper reviews the recent studies of prevention of anxiety and discusses several key issues, specifically (1) identification of at-risk participants for prevention programs, (2) motivation for participation, (3) optimal age for intervention, and (4) who should deliver the program.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Kessler RC, Berglund P, Demler O, et al. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.

    Article  PubMed  Google Scholar 

  2. Olatunji BO, Cisler JM, Tolin DF. Quality of life in the anxiety disorders: a meta-analytic review. Clin Psychol Rev. 2007;27(5):572–81.

    Article  PubMed  Google Scholar 

  3. Bruce SE, Yonkers KA, Otto MW, et al. Influence of psychiatric comorbidity on recovery and recurrence in generalized anxiety disorder, social phobia, and panic disorder: a 12-year prospective study. Am J Psychiatry. 2005;162:1179–87.

    Article  PubMed  Google Scholar 

  4. Beesdo K, Bittner A, Pine DS, et al. Incidence of social anxiety disorder and the consistent risk for secondary depression in the first three decades of life. Arch Gen Psychiatry. 2007;64:903–12.

    Article  PubMed  Google Scholar 

  5. Beesdo K, Pine DS, Lieb R, Wittchen HU. Incidence and risk patterns of anxiety and depressive disorders and categorization of generalized anxiety disorder. Arch Gen Psychiatry. 2010;67:47–57.

    Article  PubMed  Google Scholar 

  6. Norton GR, McLeod L, Guertin J, et al. Panic disorder or social phobia: which is worse? Behav Res Ther. 1996;34(3):273–6.

    Article  PubMed  CAS  Google Scholar 

  7. Roy-Byrne PP, Katon W. Generalized anxiety disorder in primary care: the precursor/modifier pathway to increased health care utilization. J Clin Psychiatry. 1997;58:34–40.

    Article  PubMed  Google Scholar 

  8. Last CG, Hansen C, Franco N. Anxious children in adulthood: a prospective study of adjustment. J Am Acad Child Adolesc Psychiatry. 1997;36:645–52.

    Article  PubMed  CAS  Google Scholar 

  9. Weissman MM, Wolk S, Wickramaratne P, et al. Children with prepubertal-onset major depressive disorder and anxiety grown up. Arch Gen Psychiatry. 1999;56(9):794–801.

    Article  PubMed  CAS  Google Scholar 

  10. Greenberg PE, Sisitsky T, Kessler RC, et al. The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry. 1999;60:427–35.

    Article  PubMed  CAS  Google Scholar 

  11. Canino G, Shrout PE, Rubio-Stipec M, et al. The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment. Arch Gen Psychiatry. 2004;61(1):85–93.

    Article  PubMed  Google Scholar 

  12. Issakidis C, Andrews G. Service utilisation for anxiety in an Australian community sample. Soc Psychiatry Psychiatr Epidemiol. 2002;37:153–63.

    Article  PubMed  Google Scholar 

  13. Cicchetti D, Toth SL. The development of depression in children and adolescents. Am Psychol. 1998;53:221–41.

    Article  PubMed  CAS  Google Scholar 

  14. Rapee RM, Spence SH. The etiology of social phobia: empirical evidence and an initial model. Clin Psychol Rev. 2004;24:737–67.

    Article  PubMed  Google Scholar 

  15. Rapee RM, Kennedy S, Ingram M, et al. Prevention and early intervention of anxiety disorders in inhibited preschool children. J Consult Clin Psychol. 2005;73:488–97.

    Article  PubMed  Google Scholar 

  16. Kennedy S, Rapee RM, Edwards S. A selective intervention program for inhibited preschool-aged children of parents with an anxiety disorder: effects on current anxiety disorders and temperament. J Am Acad Child Adolesc Psychiatry. 2009;48:602–9.

    Article  PubMed  Google Scholar 

  17. Andrews G, Issakidis C, Sanderson K, et al. Utilising survey data to inform public policy: comparison of the cost-effectiveness of treatment of ten mental disorders. Br J Psychiatry. 2004;184:526–33.

    Article  PubMed  Google Scholar 

  18. Feldner MT, Zvolensky MJ, Schmidt NB. Prevention of anxiety psychopathology: a critical review of the empirical literature. Clin Psychol Sci Pract. 2004;11:405–24.

    Article  Google Scholar 

  19. Rapee RM. Prevention of mental disorders: promises, limitations, and barriers. Cogn Behav Pract. 2008;15:47–52.

    Google Scholar 

  20. Mrazek PJ, Haggerty RJ. Reducing risks for mental disorders. Washington: National Academy Press; 1994.

    Google Scholar 

  21. Gordon R. An operational classification of disease prevention. Public Health Rep. 1983;98:107–9.

    PubMed  Google Scholar 

  22. Offord DR, Chmura Kraemer H, Kazdin AE, et al. Lowering the burden of suffering from child psychiatric disorder: trade-offs among clinical, targeted, and universal interventions. J Am Acad Child Adolesc Psych. 1998;37:686–94.

    Article  CAS  Google Scholar 

  23. Barrett P, Turner C. Prevention of anxiety symptoms in primary school children: preliminary results from a universal school-based trial. Br J Clin Psychol. 2001;40(4):399–410.

    Article  PubMed  CAS  Google Scholar 

  24. Lowry-Webster HM, Barrett P, Lock S. A universal prevention trial of anxiety symptomology during childhood: results at 1-year follow-up. Behav Change. 2003;20:25–43.

    Article  Google Scholar 

  25. Lock S, Barrett P. A longitudinal study of developmental differences in universal preventive intervention for child anxiety. Behav Change. 2003;20:183–99.

    Article  Google Scholar 

  26. Lowry-Webster HM, Barrett P, Dadds M. A universal prevention trial of anxiety and depressive symptomatology in childhood: preliminary data from an Australian study. Behav Change. 2001;18:36–50.

    Article  Google Scholar 

  27. Farrell LJ, Barrett P. Prevention of childhood emotional disorders: reducing the burden of suffering associated with anxiety and depression. Child Adolesc Ment Health. 2007;12:58–65.

    Article  Google Scholar 

  28. Kendall PC. Treating anxiety disorders in children: results of a randomized clinical trial. J Consult Clin Psychol. 1994;62(1):100–10.

    Article  PubMed  CAS  Google Scholar 

  29. Barrett PM, Locks S, Farrell LJ. Developmental differences in universal preventive intervention for child anxiety. Clin Child Psychol Psychiatry. 2005;10:539–55.

    Article  Google Scholar 

  30. Miller LD. Facing fears: the feasibility of anxiety universal prevention efforts with children and adolescents. Cogn Behav Pract. 2008;15(1):28–35.

    Google Scholar 

  31. Stallard P, Simpson N, Anderson S, et al. The FRIENDS emotional health programme: initial findings from a school-based project. Child Adolesc Ment Health. 2007;12(1):32–7.

    Article  Google Scholar 

  32. Stallard P, Simpson N, Anderson S, Goddard M. The FRIENDS emotional health prevention programme: 12 month follow-up of a universal UK school based trial. Eur Child Adolesc Psychiatry. 2008;17(5):283–9.

    Article  PubMed  Google Scholar 

  33. Barrett PM, Farrell LJ, Ollendick TH, Dadds M. Long-term outcomes of an Australian universal prevention trial of anxiety and depression symptoms in children and youth: an evaluation of the FRIENDS program. J Clin Child Adolesc Psychol. 2006;35(3):403–11.

    Article  PubMed  Google Scholar 

  34. Lyneham HJ, Rapee RM. Prevention of child and adolescent anxiety disorders. In: Silverman W, Field A, editors. Anxiety disorders in children and adolescents: research, assessment, and intervention. 2nd ed. Cambridge University Press; 2011, in press.

  35. Dadds M, Roth J. Prevention of anxiety disorders: results of a universal trial with young children. J Child Fam Stud. 2008;17(3):320–35.

    Article  Google Scholar 

  36. Aune T, Stiles TC. Universal-based prevention of syndromal and subsyndromal social anxiety: a randomized controlled study. J Consult Clin Psychol. 2009;77:867–79.

    Article  PubMed  Google Scholar 

  37. • Neil AL, Christensen H. Efficacy and effectiveness of school-based prevention and early intervention programs for anxiety. Clin Psychol Rev. 2009;29:208–15. This paper provides a systematic review of school-based anxiety prevention programs.

    Article  PubMed  Google Scholar 

  38. Rapee RM, Schniering CA, Hudson JL. Anxiety disorders during childhood and adolescence: origins and treatment. Annu Rev Clin Psychol. 2009;5:311–41.

    Article  PubMed  Google Scholar 

  39. Rapee RM, Kennedy S, Ingram M, et al. Altering the trajectory of anxiety in at-risk young children. Am J Psychiatry. 2010;167:1518–25.

    Article  PubMed  Google Scholar 

  40. Ginsburg GS. The Child Anxiety Prevention Study: intervention model and primary outcomes. J Consult Clin Psychol. 2009;77(3):580–7.

    Article  PubMed  Google Scholar 

  41. Balle M, Tortella-Feliu M. Efficacy of a brief school-based program for selective prevention of childhood anxiety. Anxiety Stress Coping. 2010;23:71–85.

    Article  PubMed  Google Scholar 

  42. Dadds MR, Holland DE, Laurens KR, et al. Early intervention and prevention of anxiety disorders in children: results at 2-year follow-up. J Consult Clin Psychol. 1999;67(1):145–50.

    Article  PubMed  CAS  Google Scholar 

  43. Dadds MR, Spence SH, Holland DE, et al. Prevention and early intervention for anxiety disorders: a controlled trial. J Consult Clin Psychol. 1997;65(4):627–35.

    Article  PubMed  CAS  Google Scholar 

  44. Bernstein GA, Bernat DH, Victor AM, Layne AE. School-based interventions for anxious children: 3-, 6-, and 12-month follow-ups. J Am Acad Child Adolesc Psychiatry. 2008;47(9):1039–47.

    PubMed  Google Scholar 

  45. Bernstein GA, Layne AE, Egan EA, Tennison DM. School-based interventions for anxious children. J Am Acad Child Adolesc Psychiatry. 2005;44(11):1118–27.

    Article  PubMed  Google Scholar 

  46. Hunt C, Andrews G, Crino R, et al. Randomized controlled trial of an early intervention programme for adolescent anxiety disorders. Aust N Z J Psychiatry. 2009;43:300–4.

    Article  PubMed  Google Scholar 

  47. Liddle I, Macmillan S. Evaluating the FRIENDS programme in a Scottish setting. Educ Psychol Pract. 2010;26:53–67.

    Article  Google Scholar 

  48. Mifsud C, Rapee RM. Early intervention for childhood anxiety in a school setting: outcomes for an economically disadvantaged population. J Am Acad Child Adolesc Psychiatry. 2005;44:996–1004.

    Article  PubMed  Google Scholar 

  49. Craske MG, Barlow DH. Panic disorder and agoraphobia. In: Barlow DH, editor. Clinical handbook of psychological disorders: a step-by-step treatment manual. 3rd ed. New York: Guilford; 2001. p. 1–59.

    Google Scholar 

  50. Ehlers A. A l-year prospective study of panic attacks: clinical course and factors associated with maintenance. J Abnorm Psychol. 1995;104:164–72.

    Article  PubMed  CAS  Google Scholar 

  51. Schmidt NB, Lerew DR, Jackson RJ. The role of anxiety sensitivity in the pathogenesis of panic: prospective evaluation of spontaneous panic attacks during acute stress. J Abnorm Psychol. 1997;106:355–64.

    Article  PubMed  CAS  Google Scholar 

  52. Schmidt NB, Lerew DR, Jackson RJ. Prospective evaluation of anxiety sensitivity in the pathogenesis of panic: replication and extension. J Abnorm Psychol. 1999;108:532–7.

    Article  PubMed  CAS  Google Scholar 

  53. Gardenswartz CA, Craske MG. Prevention of panic disorder. Behav Ther. 2001;32:725–37.

    Article  Google Scholar 

  54. Resnick H, Acierno R, Holmes M, et al. Prevention of post-rape psychopathology: preliminary findings of a controlled acute rape treatment study. J Anxiety Disord. 1999;13:359–70.

    Article  PubMed  CAS  Google Scholar 

  55. La Greca AM, Silverman WS. Treatment and prevention of posttraumatic stress reactions in children and adolescents exposed to disasters and terrorism: what is the evidence? Child Dev Perspect. 2009;3:4–10.

    Article  Google Scholar 

  56. Feldner MT, Monson CM, Friedman MJ. A critical analysis of approaches to targeted PTSD prevention: current status and theoretically derived future directions. Behav Modif. 2007;31:80–116.

    Article  PubMed  Google Scholar 

  57. Berger R, Pat-Horenczyk R, Gelkopf M. School-based intervention for prevention and treatment of elementary-students’ terror-related distress in Israel: a quasi-randomized controlled trial. J Trauma Stress. 2007;20(4):541–51.

    Article  PubMed  Google Scholar 

  58. Gelkopf M, Berger R. A school-based, teacher-mediated prevention program (ERASE-Stress) for reducing terror-related traumatic reactions in Israeli youth: a quasi-randomized controlled trial. J Child Psychol Psychiatry. 2009;50:962–71.

    Article  PubMed  Google Scholar 

  59. Schniering CA, Hudson JL, Rapee RM. Issues in the diagnosis and assessment of anxiety disorders in children and adolescents. Clin Psychol Rev. 2000;40:453–78.

    Article  Google Scholar 

  60. Silverman WK, Ollendick TH. Evidence-based assessment of anxiety and its disorders in children and adolescents. J Clin Child Adolesc Psychol. 2005;34:380–411.

    Article  PubMed  Google Scholar 

  61. Ashford J, Smit F, Van Lier PAC, et al. Early risk indicators of internalizing problems in late childhood: a 9-year longitudinal study. J Child Psychol Psychiatry. 2008;49:774–80.

    Article  PubMed  Google Scholar 

  62. Dozois DJA. Prevention of anxiety psychopathology: conceptual, methodological, and practical issues. Clin Psychol Sci Pract. 2004;11:425–9.

    Article  Google Scholar 

  63. Last CG, Perrin S, Hersen M, Kazdin AE. A prospective study of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. 1996;35:1502–10.

    Article  PubMed  CAS  Google Scholar 

  64. Hirshfeld-Becker DR, Biederman J. Rationale and principles for early intervention with young children at risk for anxiety disorders. Clin Child Fam Psychol Rev. 2002;5(3):161–72.

    Article  PubMed  Google Scholar 

  65. Calear AL, Christensen H, Mackinnon A, et al. The YouthMood Project: a cluster randomized controlled trial of an online cognitive behavioral program with adolescents. J Consult Clin Psychol. 2009;77:1021–32.

    Article  PubMed  Google Scholar 

  66. Masia-Warner C, Nangle DW, Hansen DJ. Bringing evidence-based child mental health services to the schools: general issues and specific populations. Educ Treat Child. 2006;29:165–72.

    Google Scholar 

  67. McLoone J, Hudson JL, Rapee RM. Treating anxiety disorders in a school setting. Educ Treat Child. 2006;29:219–42.

    Google Scholar 

  68. Andrews G, Szabo M, Burns J. Preventing major depression in young people. Br J Psychiatry. 2002;181:460–2.

    Article  PubMed  Google Scholar 

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Disclosure

Dr. Rapee has received research grant support from various sources, and the Centre for Emotional Health sells an anxiety prevention program described in this article.

Ms. Lau reported no potential conflicts of interest relevant to this article.

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Authors and Affiliations

  1. Centre for Emotional Health, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, New South Wales, 2109, Australia

    Elizabeth X. Lau & Ronald M. Rapee

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  1. Elizabeth X. Lau
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  2. Ronald M. Rapee
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Correspondence to Elizabeth X. Lau.

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Lau, E.X., Rapee, R.M. Prevention of Anxiety Disorders. Curr Psychiatry Rep 13, 258–266 (2011). https://doi.org/10.1007/s11920-011-0199-x

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