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University of Southampton Research Repository University of Southampton Research Repository Copyright © and Moral Rights for this thesis and, where applicable, any accompanying data are retained by the author and/or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This thesis and the accompanying data cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder/s. The content of the thesis and accompanying research data (where applicable) must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holder/s. When referring to this thesis and any accompanying data, full bibliographic details must be given, e.g. Thesis: Author (Year of Submission) "Full thesis title", University of Southampton, name of the University Faculty or School or Department, PhD Thesis, pagination. Data: Author (Year) Title. URI [dataset] UNIVERSITY OF SOUTHAMPTON FACULTY OF SOCIAL AND HUMAN SCIENCES School of Psychology Volume 1 of 1 Childhood Anxiety Disorders: Exploring Targeted Preventative Interventions and Spontaneous Recovery from Diagnosis By Sally M Rooke, BSc, PgDip. Thesis for the degree of Doctor of Clinical Psychology May 2017 Word Count: 17, 497 UNIVERSITY OF SOUTHAMPTON ABSTRACT FACULTY OF SOCIAL AND HUMAN SCIENCES School of Psychology Thesis for the degree of Doctor of Clinical Psychology Childhood Anxiety Disorders: Exploring Targeted Preventative Interventions and Spontaneous Recovery from Diagnosis Sally M. Rooke The first section of this thesis submission consists of a systematic literature review of randomised controlled trials evaluating intervention programmes aimed at preventing the onset of Anxiety Disorders in ‘at risk’ young people. A total of 16 studies (2545 young people) met inclusion criteria. Intervention characteristics were varied, although most often based on cognitive behavioural therapy. The range of risk factors used for inclusion in selective interventions was wide ranging. Evidence for effectiveness was mixed. Studies included in this review revealed a trend for a reduction of anxiety symptoms post intervention, but inconsistent findings regarding the significance of this decrease in comparison with control groups. The need for future research is discussed. The second part contains an empirical research paper investigating potential predictive factors of spontaneous recovery from childhood anxiety disorders. Sixty-three children, aged 7-12 years old, with a current anxiety disorder took part in the study. The main findings were that children’s spontaneous recovery from childhood anxiety disorders was higher among children with a single anxiety disorder than for children with comorbid anxiety disorders, and for those with parents who displayed lower levels of passivity, threat promotion, or vulnerability promotion. Clinical implications and suggestions for future research are discussed. Table of Contents Table of Contents .................................................................................................................. i List of Tables ........................................................................................................................ v List of Figures ..................................................................................................................... vii Declaration of Authorship .................................................................................................. ix Acknowledgements .............................................................................................................. xi Definitions and Abbreviations ........................................................................................ xiii Chapter 1: Systematic Literature Review. Preventative Interventions for the Onset of Anxiety Disorders in ‘At Risk’ Young People ................................. 15 1.1 Introduction ............................................................................................................ 15 1.1.1 Prevention programmes for childhood anxiety disorders............................. 16 1.1.2 Review objectives. ....................................................................................... 19 1.2 Method .................................................................................................................... 21 1.2.1 Protocol. ....................................................................................................... 21 1.2.2 Eligibility criteria. ........................................................................................ 21 1.2.3 Information sources and search terms. ......................................................... 22 1.2.4 Study Selection. ............................................................................................ 23 1.2.5 Data extraction. ............................................................................................ 25 1.2.6 Coding of study quality. ............................................................................... 25 1.2.7 Meta-analysis ............................................................................................... 25 1.3 Results .................................................................................................................... 27 1.3.1 Study and participant characteristics. ........................................................... 27 1.3.2 Assessment of risk. ....................................................................................... 28 1.3.3 Intervention characteristics........................................................................... 30 1.3.4 Diagnostic outcomes. ................................................................................... 32 1.3.5 Anxiety symptom outcomes. ........................................................................ 33 1.3.6 Changes in risk factors. ................................................................................ 35 1.3.7 Comparing selective and indicated interventions. ........................................ 36 1.3.8 Multiple risk factors versus one risk factor. ................................................. 36 1.3.9 Moderating factors. ...................................................................................... 36 1.3.10 Mediating factors. ....................................................................................... 37 1.3.11 Control type. ............................................................................................... 38 i Chapter 1 1.4 Discussion .............................................................................................................. 41 1.4.1 Critical review of the literature. ................................................................... 43 1.4.2 Limitations of the literature review.............................................................. 44 1.4.3 Implications and future directions. .............................................................. 44 1.4.4 Conclusion. .................................................................................................. 45 Chapter 2: Empirical Research Paper. Investigating Spontaneous Recovery in Children with Anxiety Disorders. .................................................................... 47 2.1 Introduction ............................................................................................................ 47 2.1.1 The natural course of anxiety in childhood.................................................. 47 2.1.2 Factors associated with the natural trajectory of childhood anxiety symptoms................................................................................................. 49 2.1.3 Factors associated with recovery from an anxiety disorder following intervention. ............................................................................................. 50 2.1.4 Parental factors associated with childhood anxiety disorders...................... 52 2.1.5 Aims and hypotheses. .................................................................................. 57 2.2 Method ................................................................................................................... 59 2.2.1 Participants and procedure. .......................................................................... 59 2.2.2 Measures ...................................................................................................... 63 2.2.3 Design .......................................................................................................... 64 2.2.4 Ethics............................................................................................................ 65 2.3 Results .................................................................................................................... 67 2.3.1 Associations with recovery from primary diagnosis. .................................. 68 2.3.2 Associations with recovery from all anxiety disorder diagnoses. ................ 69 2.3.3 Associations with clinical global improvement. .......................................... 70 2.4 Discussion .............................................................................................................. 73 2.4.1 Key findings. ................................................................................................ 73 2.4.2 Implications.................................................................................................
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