Andrew Giles Guzick

Obsessive-compulsive disorder (OCD) is a chronic and often debilitating psychiatric condition affecting approximately 2–3% of the population (Ruscio et al., 2010). OCD is associated with substantia...

The relationship between misophonia and sleep‐related problems (SRPs) in youth is underexplored. This paucity of research is concerning because SRPs might be elevated among youth with misophonia. If left untreated, SRPs can contribute to long‐term health consequences. Thus, in this study we examined the link between misophonia and SRPs in youth aged 8 to 17. In this study, we compared SRPs in 102 children and adolescents with clinically significant misophonia to SRPs in a normative youth sample and a sample of 94 youth with anxiety disorders. We also examined the extent to which SRPs were associated with misophonia severity. Approximately 30% of youth with misophonia endorsed clinical levels of SRPs. SRPs were more prevalent in youth with misophonia compared to normative data from the general youth population ( d = 1.22) and similar to SRPs in youth with anxiety disorders ( d = 0.13). Youth with more severe misophonia symptoms had greater difficulties with SRPs and this association was attenuated but still significant when adjusting for gender, age, and internalizing and externalizing symptoms. In this study, we provided the first evidence of substantial issues with SRPs in youth with misophonia. Importantly, there was a moderate association between misophonia severity and SRPs, indicating that SRPs should be carefully assessed and potentially addressed in treatment for youth with misophonia. We discussed suggestions for clinical practice and future research.

Purpose: Anxiety disorders are widespread and significantly impair the mental health and daily functioning of autistic children and adolescents. Internet-delivered cognitive behavioral therapy (iCBT) has emerged as a widespread, low-cost alternative to traditional CBT, helping to reduce demands on therapists without sacrificing efficacy. However, the predictors of treatment outcomes in iCBT for this population remain understudied. This study used data from a randomized clinical trial evaluating parent-led, therapist-supported iCBT among 57 autistic youth with anxiety disorders to examine whether repetitive behaviors and restricted interests, pretreatment anxiety severity, parent-rated externalizing symptoms, verbal intellectual ability, and Hispanic/Latino ethnicity predicted treatment outcomes. Methods: Hierarchical linear modeling was used to test the impact of these predictors on changes in evaluator-rated and parent-reported anxiety severity. Results: Higher baseline anxiety severity was associated with greater improvement in evaluator- and parent-rated anxiety scores across the trial, while fewer externalizing behavior problems predicted more improvement in parent-reported anxiety and trended towards predicting greater improvement in evaluator-rated anxiety. The other predictor variables did not significantly influence rates of change in anxiety across the trial. Conclusion: These findings suggest that youth with varying levels of anxiety can benefit from a light-touch therapeutic approach, challenging the general notion that low-intensity interventions are only viable for individuals with mild anxiety. These findings also suggest that additional considerations are needed for youth with more severe disruptive behavior problems. Replication of these findings in larger samples with comparison groups (e.g., an inert comparator or a comparison to standard intensity treatment) is highlighted for future work.

Depression and suicidality are prevalent mental health issues among adolescents in the United States. There are multiple evidence‐based practices (EBPs) for depression and/or suicidality, including cognitive behavioural therapy (CBT), dialectical behavioural therapy (DBT) and interpersonal therapy for adolescents (IPT‐A), though youth seeking psychotherapeutic treatment in community settings may not consistently receive these EBPs. This study aims to characterize therapy experiences among youth aged 8–20 years with depression and/or suicidal behaviour who were in treatment using the Depression Treatment Experiences Questionnaire (DTEQ), as well as to provide initial construct validity and test–retest reliability of this new measure. Of the first 1000 participants in the Texas Youth Depression and Suicide Research Network (TX‐YDSRN), 585 were currently receiving psychotherapy for their depression and/or suicidality. Almost half of the participants engaged in therapy reported receiving some form of CBT ( n = 237, 42.4%). The DTEQ showed a two‐factor structure, including a 12‐item ‘Evidence‐Based Practice’ factor that demonstrated strong internal consistency and test–retest reliability and a two‐item ‘Parental Involvement’ factor that showed acceptable internal consistency and test–retest reliability. Participants receiving psychotherapy generally endorsed being exposed to techniques aligned with EBPs. Additional non‐therapeutic elements, such as exercise ( n = 276, 47.1%) and changing sleep habits ( n = 191, 32.6%), were frequently endorsed as being received by participants in psychotherapy. These results describe the therapy experiences of youth engaged in psychotherapy for depression and/or suicidality and propose a new assessment tool that can be used to characterize these experiences. Key Practitioner Messages: Youth in psychotherapy for depression or suicidality frequently engage in evidence‐based techniques (e.g., problem‐solving, cognitive restructuring), yet nearly half are unaware of the type of therapy they are receiving—highlighting a gap in patient‐provider communication and psychoeducation. The DTEQ is a promising tool for assessing therapy content and structure and may help practitioners assess that evidence‐based components are being implemented and understood by clients. Many adolescents supplement treatment with lifestyle changes like exercise and sleep adjustments—indicating the importance of integrating behavioural health recommendations into therapy for holistic care.

Anxiety disorders are among the most common and impairing mental health conditions in children and adolescents. Although exposure-focused cognitive behavioral therapy (CBT) is a well-established treatment for this population based on decades of psychological science, many available psychosocial interventions are not based on this strong empirical foundation. In some cases, interventions for youth with anxiety disorders have the potential to maintain anxiety in the long run. Grounded in a well-developed cognitive-behavioral theoretical frame, this commentary aimed to discuss popular and emerging psychosocial interventions for anxious youth that may inadvertently prolong anxiety. We argue that (1) although the availability of gold-standard CBT (with an adequate focus on exposure therapy) appears to be increasing, it continues to be difficult to access for many youth, (2) several available interventions prescribe avoidance-based strategies that do not enable a child to experience self-efficacy building and corrective learning experiences related to their fears or anxieties, thereby potentially maintaining anxiety in the long-run, and (3) several available interventions are not based in any clear, empirically-supported theoretical frame or evidence base, and thus have unclear benefits for anxiety. In a time when there is increasing alarm about anxiety disorders among youth, building systems that can support tried-and-true interventions based on strong science is of utmost importance. Future research, intervention deployment, and policy efforts should pay more attention to the harms that could arise from psychosocial interventions.

Introduction: Misophonia is an increasingly recognized disorder characterized by negative emotional and sensory reactions to specific noises. Although misophonia most often begins in childhood, there has been minimal research on its clinical presentation in youth. This qualitative study explored cognitive behavioral processes that are involved in misophonia and its associated functional impairment in young people and their families. Methods: Focused interviews were conducted with 20 youth with misophonia (ages 10–17) and their parents. Thematic analyses of these interviews using a cognitive behavioral theoretical framework were conducted. Results: A number of themes were identified, which included internalizing and externalizing cognitive behavioral processes at the individual level (e.g., hypervigilance, anticipatory anxiety, escape, automatic negative attributions), secondary emotional and functional consequences (e.g., negative perception of self, guilt, anxiety, depression, emotional exhaustion, concentration difficulties at school), as well as significant impacts to school, social life, and particularly to family life (e.g., conflict/tension, anger and resentment, family accommodation). These themes are integrated in a proposed theoretical model. Discussion: Misophonia is characterized by several transdiagnostic cognitive behavioral processes, including avoidance, maladaptive cognitions, emotional reactivity, and family communication difficulties, as well as significant functional impairment. Developing treatments that target these processes has the potential to help youth overcome misophonia and improve the quality of life of youth and their families.