New therapy for decreasing anxiety and improving psychological well-being in children

A group of investigators of the University of Bologna suggest a new way of approaching emotional disturbances in children by improving their psychological well-being. The study is published in the current issue of Psychotherapy and Psychosomatics.

Anxiety, mood disorders and somatoform disorders are among the most prevalent forms of psychological suffering during childhood and adolescence. A specific psychotherapeutic strategy for enhancing well-being (well-being therapy; WBT) has been developed from the multidimensional model of psychological well-being by Ryff. The aim of this study was to apply a modified form of WBT to a child population of patients with mood, anxiety and conduct disorders, and to test its effects in reducing symptoms and in improving new skills and competencies in children.

Four male subjects, referred to a tertiary neuropsychiatric clinic, and aged from 8 to 11 years with different diagnoses according to DSM-IV criteria (1 oppositional-defiant disorder, 1 ADHD, 1 major depressive disorder and 1 generalized anxiety disorder; GAD) were enrolled in this study. The child with GAD also manifested comorbidity with a learning disorder (dyslexia). None of these children were receiving pharmacological treatment, but 2 of them had a special tutor for helping them in school activities (the one with dyslexia and the one with ADHD). Intake diagnoses were established by 2 clinical psychologists using the Schedule for Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime Version (K-SADS-PL). WBT intervention was performed by 2 clinical psychologists. At the end of the WBT child intervention and at follow-up, each patient's clinical status was evaluated by the 2 clinical psychologists who established the intake diagnoses (and who were not involved in the treatment) using Kellner's global rating scale of improvement and again using the K-SADS-PL.

Case 1: At the end of the treatment, the child was rated 'much better' according to Kellner's global rating scale of improvement, with a partial remission of GAD symptoms, particularly somatic complaints and avoidant behaviors. At follow-up, the improvements were maintained and school performance improved so much that teachers decided to dismiss the child's tutor. Case 2: At the end of the treatment, the child was rated 'better' according to Kellner's global rating scale of improvement, particularly when considering mood, apathy and isolation. He improved in his autonomy and passive behaviors, according to his teachers. At follow-up, the child still presented depressive symptoms, but the positive results were maintained and somatic symptoms dramatically decreased. Case 3: At the end of the protocol, the child was rated as 'much better', according to Kellner's global rating scale of improvement, with a partial remission of ADHD symptoms, particularly in the hyperactivity/impulsiveness component. These improvements were noticed and reported also by his mother and teachers. The child also improved in his interpersonal relationships, and was more willing to participate in social and extra-curricula activities. At follow-up, these results were maintained and his ADHD diagnosis was changed into ADHD - predominantly inattentive subtype. His performances at school greatly improved. Case 4: At the end of the treatment, the child was rated 'much better' according to Kellner's global rating scale of improvement, with a partial remission of his oppositional-defiant disorder. This was also confirmed by teachers' reports. The child, however, had to repeat the school year. This triggered a very negative reaction in the child's parents who were very angry with him, and decided to punish him during the summer holidays. At follow-up, the child manifested some depressive symptoms (low mood and guilt) connected to this school failure. However, aggressive behaviour did not ensue and the oppositional-defiant disorder remitted.

In the present open clinical trial, child WBT was effective in decreasing anxiety (especially physical anxiety and somatization) and in improving psychological well-being. Recent findings showed that somatic complaints and anxiety in children predicted poor academic performance. Importantly, in 2 of the 4 patients enrolled in this study, WBT was associated with improvements in school performance, probably because of the improvements in somatic and anxiety symptomatology.Child WBT could thus have important clinical implications in view of the documented high prevalence of somatic symptoms in children and adolescents. Its innovative ingredient is the focus on promoting psychological well-being and optimal functioning in children. This is in line with a recent trend in child psychiatry, which suggests focusing on the child's competencies and enhancing growth in psychological domains, as well as the development of traits that may provide a buffer against adversity and build resilience in youth. Further research with larger samples and a controlled design is needed to investigate the role of well-being enhancing psychotherapeutic strategies in the treatment of child and adolescent mental disturbances.