Barbara Hoff Esbjørn

BACKGROUND Stress and anxiety among junior doctors working in emergency departments may negatively affect well-being, patient safety, and job retention. Evidence-based interventions to mitigate anxiety in this population are crucial but limited. OBJECTIVE The objective of this study was to investigate whether adaptive e-learning on acute patient conditions reduced anxiety levels in junior doctors when on call in emergency departments. METHODS This was a pragmatic, multicenter, open-label randomized controlled trial with parallel assignment. The study was conducted between January 1st and July 1st, 2025, across five emergency departments with 24/7 services in the Capital Region of Denmark. The participants were defined as foundation-year junior doctors or residents, with front- and middle-level shifts, and were recruited within the first 3 months of their employment. Participants were randomized to standard onboarding (control) or standard onboarding plus access to an adaptive e-learning program covering 13 acute medical conditions (intervention). The primary outcome was change in anxiety levels measured by the 6-item State–Trait Anxiety Inventory (STAI-6) from baseline to 6-week follow-up. RESULTS Of 550 eligible participants, 233 (42%) junior doctors, from 22 departments, were randomized, and 172 (74%) completed follow-up. The mean (95% CI) age of participants was 30.9 (30.4–31.5) years. At baseline, 71 of 233 participants (30%) had anxiety levels above the predefined threshold (STAI-6 > 15.5), indicating potential clinically relevant anxiety. Baseline anxiety was higher among female than male participants (13.9 [SD, 4.3] vs 12.1 [SD, 3.8]; P = .002) and among rotational doctors from internal medicine departments than doctors employed directly in the ED (adjusted difference, 1.76 [95% CI, 0.57-2.95]; P = .004). There was no significant difference in the reduction in anxiety from baseline to 6-week follow-up in the full cohort between the intervention group (mean change, −1.8; 95% CI, −2.5 to −1.1) and the control group (mean change, −1.2; 95% CI, −1.8 to −0.7). In the subgroup of junior doctors with elevated anxiety levels at baseline, a significant reduction was seen in the intervention group (mean change, −3.9; 95% CI, −5.1 to −2.7) compared to controls (mean change, −2.3; 95% CI, −3.4 to −1.3). CONCLUSIONS In this randomized controlled trial, adaptive e-learning did not reduce anxiety in the overall cohort but was associated with reduced anxiety among junior doctors with elevated baseline anxiety. This RCT demonstrates that targeted educational interventions can benefit high-risk subgroups of junior doctors with elevated anxiety levels. CLINICALTRIAL ClinicalTrials.gov NCT06842394; https://clinicaltrials.gov/study/NCT06842394

Background: Compassion fatigue is a significant problem in health care as higher degrees of compassion fatigue are associated with psychical, emotional, and work-related negative outcomes in professionals. Despite the significance of the problem, research has yet to establish how this problem can be ameliorated. Our study aimed at investigating if an educational program including a serious game, could be a feasible avenue to pursue. Method: We developed an educational program “The Compassion Equation: Find Your Formula”, inspired by theory and evidence on compassion fatigue and serious games. It consists of a short lecture, a serious board game, as well as group and individual reflections conducted in small groups with colleagues. We examined the feasibility of the educational program by obtaining reports from health care workers employed in psychiatric hospitals. They reported on levels of compassion fatigue, self-care beliefs and behaviors, as well as questions on feasibility of the game. Results: A total of 212 health care workers from 12 wards participated in the study. Of these 79% recommend the educational program as a way to prevent compassion fatigue. Less than 20% disagreed with the feasibility of the game being effective. Conclusion: Despite methodological issues, our study provides the first suggestion that an educational program with a persuasive game may be feasible to prevent compassion fatigue. Further studies are, however, needed to establish the mechanisms as well as the educational program’s effect on levels of compassion fatigue, and self-care beliefs and behaviors.

This systematic review summarizes the results of 43 studies that explored the potential role of fathers in emotion regulation (ER) development in children. Following a tripartite model, this review investigates the paternal modelling of ER strategies, emotion‐related paternal parenting practices, father–child emotional climate, and fathers' characteristics, by identifying 16 specific themes of paternal factors that could play a role in the child's ER development. Results show that while a large number of studies investigated father–child emotional climate and fathers' characteristics and their association with children's ER, the effects of paternal modelling and the father's emotion‐related parenting practices on children's ER are still understudied. This review reveals that several factors—fathers' modelling of ER strategies; positive reactions and support in responding to their child's expression of emotions; better quality of the father–child relationship; higher father–child attachment security; and positive parenting in terms of sensitivity, engagement, and expressiveness—had significant associations with children's higher ER skills. Conversely, fathers' psychopathology and harsh parenting were associated with poorer ER skills in children.Highlights: This study summarized existing literature that explored the association between paternal factors and ER in children. The review showed some evidence supporting the paternal role in children's ER development. Fathers' role in the development of child's ER is most prominent in infancy and toddlerhood. Most paternal factors significantly associated with a child's ER reflected previous findings examining maternal factors.

Background: Research suggests that the metacognitive model is applicable to clinical child populations. However, few measures related to the model are available for younger age groups. A key concept of the model is the cognitive attentional syndrome (CAS), which encompasses the individual’s worry and rumination, maladaptive coping strategies, and metacognitive beliefs. While the CAS has been successfully measured in adults, this has not yet been attempted in children.Aims: The aim of this study was to adapt a measure of the CAS for use with children and investigate the measure’s associations with anxiety, worry, depression and metacognitions.Methods: Our study included 127 children with anxiety disorders aged 7–13 years. The adult measure of CAS was adapted for use with children and administered at pre- and post-treatment. We examined the correlations between variables and the ability of the CAS measure to explain variance in anxious symptomatology, as well as the measure’s sensitivity to treatment change.Results: The adapted measure, CAS-1C, displayed strong associations with overall anxiety, depression, worry and metacognitions. The CAS-1C explained an additional small amount of variance in anxiety and worry symptoms after accounting for metacognitions, which may be due to the measure also assessing thinking styles and coping strategies. Furthermore, the measure displayed sensitivity to treatment change.Conclusions: The child measure of the CAS is a brief tool for collecting information on metacognitive beliefs and strategies that maintain psychopathology according to the metacognitive model, and it can be used to monitor treatment changes in these components.

Background: Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD. Aim: The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children. Method: We enrolled 122 clinically anxious children aged 7–13 years; of these, 33 had an SAD diagnosis. Results: SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis. Conclusions: Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.

The aim of this study was to specify the latent construct structure of the Friends and Family Interview (FFI: Steele & Steele, 2005) based on its dimensional scale coding protocol. The FFI is a semi‐structured interview measuring attachment in middle childhood. We analyzed data from 341 FFI interviews with children aged 7–12 years, recruited in the Scandinavian Öresund Region. Exploratory Factor Analysis revealed a three‐component model as best fitting the data. The first component, denoting attachment security, gathered all dimensional scales for evidence of secure base/safe haven regarding mother/father and coherence in the child’s narrative style, along with scales regarding reflective functioning, self‐perception, and social functioning. The second component comprised preoccupying feelings of anger, but also derogation. The third component gathered all scales coding idealization. Inter‐relations among the components were consistent with attachment theory, and respondents’ scores for all three components differed significantly across the four categorical attachment classifications. Affect regulation of negative emotion through anger and through derogation co‐occurred, and was distinct from regulation through maintaining a belief that things are better than they appear (idealization). These two affect regulation strategies appeared commonly when reflective functioning, and an organized self‐perception, and positive peer relations were less in evidence. The multi‐dimensional FFI coding system appears to measure successfully these diverse features of the child’s narrative provided in response to the interview. Overall, our findings support the construct validity of the FFI and provide further evidence of its usefulness for assessing attachment in middle childhood and early adolescence.

The ability to regulate one’s emotions is crucial to engaging successfully in social contexts. Difficulties in emotion regulation are seen in multiple psychiatric disorders, prompting an increased interest in the concept. Suitable methods for assessing emotion regulation, however, are lacking. In this study, we investigated the interrater and intrarater reliability, construct validity, and content validity of a new observational method for evaluating children’s emotion regulation abilities (a complex puzzle task) in a sample of 62 children without psychiatric disorders and 23 children with attention-deficit/hyperactivity disorder (ADHD) aged 7–12, using intra-class correlation coefficients for the reliability analyses and Spearman’s rank-order correlations for analyses of convergent and discriminant validity. A panel of experts examined the content validity of the test, and Mann–Whitney U-tests were used to investigate the ability of the test to differentiate the non-clinical group from the ADHD group. Results showed a high level of interrater and intrarater reliability of the test. There was mixed evidence for convergent and discriminant validity as expected due to the novelty and experimental nature of the test, making it difficult to compare with questionnaire-based measures. Content validity analysis was satisfactory, and the group comparison showed that the test differentiated the groups on the primary outcome measure. Overall, the measure demonstrated high feasibility and satisfactory psychometric properties. The generic nature of the test makes it suitable for use across psychiatric disorders and age groups with potential relevance in both research and clinical settings

In the metacognitive model, attentional control and metacognitive beliefs are key transdiagnostic mechanisms contributing to psychological disorder. The aim of the current study was to investigate the relative contribution of these mechanisms to symptoms of anxiety and depression in children with anxiety disorders and in non-clinical controls. In a cross-sectional design, 351 children (169 children diagnosed with a primary anxiety disorder and 182 community children) between 7 and 14 years of age completed self-report measures of symptoms, attention control and metacognitive beliefs. Clinically anxious children reported significantly higher levels of anxiety, lower levels of attention control and higher levels of maladaptive metacognitive beliefs than controls. Across groups, lower attention control and higher levels of maladaptive metacognitive beliefs were associated with stronger symptoms, and metacognitions were negatively associated with attention control. Domains of attention control and metacognitions explained unique variance in symptoms when these were entered in the same model within groups, and an interaction effect between metacognitions and attention control was found in the community group that explained additional variance in symptoms. In conclusion, the findings are consistent with predictions of the metacognitive model; metacognitive beliefs and individual differences in self-report attention control both contributed to psychological dysfunction in children and metacognitive beliefs appeared to be the strongest factor.