Viviana M. Wuthrich

Objectives: Internet-delivered cognitive behavioural therapy (iCBT) shows promise for treating anxiety and depression in older adults; however, existing trials have relied on programs developed for younger users that require high-level technological proficiency. This study: (1) co-designed an iCBT intervention for anxiety/depression in older adults, based on an established program; and (2) evaluated its efficacy and acceptability in a randomised controlled trial (RCT).Methods: Study 1 (Co-design): Ageing Wisely Online (AW Online) was co-designed with older people (N = 6) and clinicians (N = 7) using an iterative participatory design with focus groups, followed by user testing and refinement of a prototype. Study 2 (RCT): In a parallel-group RCT, 68 older adults (aged 65–89 years) with a diagnosed anxiety and/or depressive disorder were randomly allocated to AW Online or waitlist control. Results: Compared to waitlist, participants receiving AW Online showed significantly greater reductions in primary disorder severity, anxiety and depression severity on diagnostic and self-report measures, diagnostic remission, as well as improvements in quality of life, psychosocial functioning and overall mental health. AW Online demonstrated high acceptability (completion rates and satisfaction ratings).Conclusions: Ageing Wisely Online is an effective and acceptable iCBT intervention for anxiety and depression in older adults.

Background: Predictors and moderators of treatment response to cognitive behavioural therapy (CBT) in older adults with anxiety and/or mood disorders are relatively unknown. Previous studies had small sample sizes and not included social factors, non-social activities, and frequency of negative automatic thoughts (NATs). Method: Pooled data from 220 participants aged 60–88 years ( M = 67.79, SD = 5.87) who received CBT or a Control in three clinical trials. Participants completed demographic questionnaires, diagnostic assessments, and self-report symptom measures pre- and post-treatment, with a subsample completing 6-month follow-up. Demographic, clinical, and process characteristics were examined for prediction and moderation of treatment outcomes across diagnostic severity, comorbidity, and symptom severity. Results: Few demographic characteristics predicted treatment outcomes. Greater severity of disorders and comorbidity were associated with greater symptom reduction across most measures, particularly for CBT. Social anxiety disorder was associated with greater symptom reduction. Fewer pre-treatment NATs predicted greater symptom reduction in Control but were otherwise linked to symptom change over time. More frequent social activities predicted greater symptom change in both conditions, with more frequent non-social activities also predicting greater symptom change in CBT. Social activity moderated treatment effects such that those with more social activities yielded more benefit from Control, whilst social activity did not influence the CBT outcomes. No other variables moderated treatment effects. Conclusions: Predictors of CBT response included disorder severity, comorbidity, frequency of NATs, social and non-social activities. Social activities moderate treatment effects. These findings provide new predictors and moderators of CBT response in older adults.

This paper reports on data from two trials about stakeholders’ attitudes to school-based mental health screening. Study 1 reports data from 6228 students from grades 4 to 12 while Study 2 reports data from 267 caregivers and 34 educators from a larger trial. All three groups of stakeholders reported broadly positive attitudes toward school-based screening. Few students reported distress from questions and most agreed that schools should screen. Caregivers and educators reported positive attitudes toward the use and implementation of screening and reported few concerns about harms. Educators who conducted screening reported mostly positive experiences, although they noted high resource burden and false positives and negatives.

These studies investigated whether the positivity effect in older adults results in positively valenced interpretations of ambiguous scenarios and whether personally relevant health content and induced positive and negative moods attenuate or moderate the effect. In two studies conducted in 2022 and 2023, older (n_Study1 = 31, M_ageStudy1 = 72.16, SD_ageStudy1 = 7.81, n_Study2 = 51, M_ageStudy2 = 71.64, SD_ageStudy2 = 6.39) and younger (n_Study1 = 25, M_ageStudy1 = 19.16, SD_ageStudy1 = 1.49, n_Study2 = 51, M_ageStudy2 = 20.20, SD_ageStudy2 = 1.88) adults underwent audiovisual mood inductions (positive, neutral, negative; within subjects) with baseline and postinduction affect measured and completed an ambiguous scenario interpretation task (health, social content; within subjects) and measures of depression and anxiety symptomology. Studies found that older versus younger adults provided significantly more positive interpretations of ambiguous scenarios, and this positivity effect was not significantly attenuated by health-related content. There was no significant evidence for age-based differences in mood-induced processing. Instead, negative mood congruence was found across age groups in Study 2 using improved methodology. In sum, older adults provided significantly more positive interpretations of ambiguous scenarios than younger adults, consistent with top-down emotion regulation processes used to increase well-being. The positivity effect was robust to health and social content, and both age groups demonstrated negative mood-induced processing, consistent with past findings. Most participants were born in Australia and had high levels of education and socioeconomic resources, and thus replication in more culturally and socioeconomically diverse participants is needed. Understanding the positivity effect has implications for how interventions may target mental health-related mechanisms. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Family accommodation (e.g. providing excessive reassurance, facilitating avoidance) is widespread and exacerbates anxiety in children and young adults, however has not been examined in older adults. There are reasons to expect that family accommodation may also exacerbate anxiety in later life. However, it is important to consider that age-related changes in physical or cognitive abilities may necessitate the need for functional assistance from others during assessment. This study aimed to examine the phenomenology and clinical correlates of family accommodation in older adults. Participants were 32 community-dwelling older adults, aged 60-88 (M = 69.78, SD = 8.62; 31% with a probable anxiety disorder) and their supporters. Dyads reported on supporter accommodation, mental health and functional ability and completed a behavioral stress task designed to elicit behavioral accommodation (intrusiveness, reassurance, and avoidance). 80% of supporters of older adults with anxiety engaged in accommodation.Accommodation was associated with greater anxiety severity, but not functional ability. Family accommodation is common from supporters of older adults with anxiety, and linked to increased anxiety. Assessment and modification of these environmental reinforcers may be important targets for treatment. Accommodation is an important environmental factor maintaining late-life anxiety, and should be reduced.

Purpose: Replacing irrational or unhelpful thoughts with more rationale and helpful ones is a core skill in Cognitive Behavioural Therapy, but there is limited research examining the neuropsychological mechanisms underpinning this process. This study examined age-differences in cognitive restructuring skill acquisition between children, younger adults and older adults; whether individual differences in cognitive flexibility influences the ability to learn cognitive restructuring across the lifespan; and whether cognitive flexibility explains age-differences in cognitive restructuring ability. Method: Participants were 114 individuals with anxiety disorders, including 35 children (aged 7–12, M = 9.14, SD = 1.44), 32 younger adults (aged 18–53, M = 23, SD = 7.84) and 47 older adults (aged 61–78, M = 66.81, SD = 4.43). Participants completed neuropsychological measures of cognitive flexibility and learned cognitive restructuring, which was coded for quality and efficacy. Results: More than half the participants of all ages showed good quality cognitive restructuring skill acquisition with only brief instruction. Older adults showed comparable cognitive restructuring skills to children, with slightly better skills among younger adults. However, after accounting for individual differences in cognitive flexibility, there were no age-differences in cognitive restructuring quality. Greater perseveration was associated with poorer cognitive restructuring skill acquisition in younger and older adults, and mediated age-differences in cognitive restructuring skill acquisition. Conclusions: Among younger and older adults, individual differences in perseveration, rather than chronological age, underpins the ability to learn cognitive restructuring. There is little evidence that cognitive flexibility plays a role in cognitive restructuring skill acquisition among children.

Background: The identification of predictors of treatment response is crucial for improving treatment outcome for children with anxiety disorders. Machine learning methods provide opportunities to identify combinations of factors that contribute to risk prediction models.Methods: A machine learning approach was applied to predict anxiety disorder remission in a large sample of 2114 anxious youth (5–18 years). Potential predictors included demographic, clinical, parental, and treatment variables with data obtained pre-treatment, post-treatment, and at least one follow-up.Results: All machine learning models performed similarly for remission outcomes, with AUC between 0.67 and 0.69. There was significant alignment between the factors that contributed to the models predicting two target outcomes: remission of all anxiety disorders and the primary anxiety disorder. Children who were older, had multiple anxiety disorders, comorbid depression, comorbid externalising disorders, received group treatment and therapy delivered by a more experienced therapist, and who had a parent with higher anxiety and depression symptoms, were more likely than other children to still meet criteria for anxiety disorders at the completion of therapy. In both models, the absence of a social anxiety disorder and being treated by a therapist with less experience contributed to the model predicting a higher likelihood of remission.Conclusions: These findings underscore the utility of prediction models that may indicate which children are more likely to remit or are more at risk of non-remission following CBT for childhood anxiety.

The Mini Social Phobia Inventory (Mini-SPIN) is a short 3-item measure of social anxiety disorder (SAD). Using existing data, the current study examined the psychometric properties of the Mini-SPIN using a large, treatment seeking sample of children aged 6-16 years with data available for youth (n = 695, 170) and their caregivers (n = 703, 177) at pre-treatment and follow-up, respectively. The ability of the Mini-SPIN to discriminate between those with and without SAD was examined at pre-treatment and 6-month follow-up, across caregiver and child report. The criterion group validity, internal consistency and construct validity of the measure was also examined. Results revealed that at pre-treatment the Mini-SPIN demonstrated good discriminant validity in detecting cases of SAD from non-SAD (with cut-off of 4 on child report, and 6 on caregiver report). At 6-month follow-up, the discriminant ability of the Mini-SPIN was found to be less than acceptable for child reported scores, but acceptable for caregiver reported scores. The Mini-SPIN further demonstrated good criterion group validity, internal consistency and construct validity across caregiver and child report. Overall, the findings from the current study lend further support for the use of the Mini-SPIN as a screening tool for SAD.