In a clinical sample of 116 children and adolescents we studied the relation between the course of an anxiety disorder during treatment and the concomitant changes in cortisol levels. Assessments... Show moreIn a clinical sample of 116 children and adolescents we studied the relation between the course of an anxiety disorder during treatment and the concomitant changes in cortisol levels. Assessments at base-line, after three months, and at one-year follow-up were performed with the Anxiety Disorders Interview Schedule. When we compared cortisol levels at baseline and one-year follow-up, persistence of the anxiety disorder was associated with both increased daytime cortisol production (F = 3.2, p = 0.04) and a trend towards a decreased cortisol morning rise (F = 2.4, p = 0.09). At one-year follow-up daytime cor-tisol production was lowest in the early remitters (109.7 ± 29.2 h mmol/l), higher in the late remitters (121.0 ± 40.0 h mmol/l) and highest in the non-remitters (131.1 ± 48.9 h mmol/l). Early remitters had the highest cortisol morning rise (1.1 ± 1.5 h mmol/l), followed by the late remitters (0.8 ± 1.8 h mmol/l), the non-remitters had the lowest cortisol morning rise (0.07 ± 1.7 h mmol/l). Persistence of an anxiety disorder may thus lead to changes in HPA-axis functioning, underscoring the importance adequate treatment of anxiety disorders. Show less
In a clinical sample of 116 children and adolescents we studied the relation between the course of ananxietydisorder during treatment and theconcomitantchangesincortisollevels. Assessments at... Show moreIn a clinical sample of 116 children and adolescents we studied the relation between the course of ananxietydisorder during treatment and theconcomitantchangesincortisollevels. Assessments at baseline, after three months, and at one-year follow-up were performed with theAnxietyDisordersInterview Schedule. When we comparedcortisollevels at baseline and one-year follow-up,persistenceof theanxietydisorder was associated with both increased daytimecortisolproduction (F=3.2, p=0.04) and a trend towards a decreasedcortisolmorning rise (F=2.4, p=0.09). At one-year follow-up daytimecortisolproduction was lowest in the early remitters (109.7±29.2 h mmol/l), higher in the late remitters (121.0±40.0 h mmol/l) and highest in the non-remitters (131.1±48.9 h mmol/l). Early remitters had the highestcortisolmorning rise (1.1±1.5 h mmol/l), followed by the late remitters (0.8±1.8 h mmol/l), the non-remitters had the lowestcortisolmorning rise (0.07±1.7 h mmol/l).Persistenceof ananxietydisorder may thus lead tochangesin HPA-axis functioning, underscoring the importance adequate treatment ofanxietydisorders. Show less
Background: This study examined whether treatment response to stepped-care cognitive-behavioural treatment (CBT) is associated with changes in threat-related selective attention and its specific... Show moreBackground: This study examined whether treatment response to stepped-care cognitive-behavioural treatment (CBT) is associated with changes in threat-related selective attention and its specific components in a large clinical sample of anxiety-disordered children. Methods: Ninety-one children with an anxiety disorder were included in the present study. Children received a standardized stepped-care CBT. Three treatment response groups were distinguished: initial responders (anxiety disorder free after phase one: child-focused CBT), secondary responders (anxiety disorder free after phase two: child-parent-focused CBT), and treatment non-responders. Treatment response was determined using a semi-structured clinical interview. Children performed a pictorial dot-probe task before and after stepped-care CBT (i.e., before phase one and after phase two CBT). Results: Changes in selective attention to severely threatening pictures, but not to mildly threatening pictures, were significantly associated with treatment success. At pre-treatment assessment, initial responders selectively attended away from severely threatening pictures, whereas secondary responders selectively attended toward severely threatening pictures. After stepped-care CBT, initial and secondary responders did not show any selectivity in the attentional processing of severely threatening pictures. Treatment non-responders did not show any changes in selective attention due to CBT. Conclusions: Initial and secondary treatment responders showed a reduction of their predisposition to selectively attend away or toward severely threatening pictures, respectively. Treatment non-responders did not show any changes in selective attention. The pictorial dot-probe task can be considered a potentially valuable tool in assigning children to appropriate treatment formats as well as for monitoring changes in selective attention during the course of CBT. Show less
