202 Chapter 4 research in CBT-based anxiety prevention programs for children has identified several potential baseline predictors, such as baseline anxiety, maternal mental health problems, and self-efficacy. Research investigating the effect of anxiety symptoms at baseline on the response to a prevention/intervention program is inconclusive. One study found that higher levels of baseline anxiety were related to greater decreases in anxiety after an indicated CBT-based program (Van Starrenburg et al., 2017). However, another study found that children with clinical anxiety show a more limited response to pain-focused CBT than children with subclinical levels of anxiety (Cunningham et al., 2016), suggesting that anxiety symptoms at baseline adversely impact the intervention response. Further, parents of children with mental health problems often have mental health issues themselves (Powdthavee & Vignoles 2008; Goodman et al., 2011). Research has shown that parental problems with mental health can be genetically transmitted (Lubke et al., 2016). Alternatively, parental problems can also impact children’s mental well-being through distortions in parenting, for example harsh discipline (Gershoff, 2002) or a controlling parenting style (Chorpita et al., 1998). For anxiety specifically, more controlling parents diminish children’s sense of personal control, thereby contributing to increases in anxiety (Chorpita et al., 1998). Last, parental modelling of anxious behaviours and cognitions may also contribute to children’s anxiety (Fisak & Grills-Taquechel 2007). Studies investigating the effect of maternal mental health problems on intervention effectiveness show inconsistent results. One study on the effect of maternal depression on posttraumatic stress treatment in children found that maternal depression was associated with increasing posttraumatic stress symptoms in children (Weems & Scheeringa 2013), especially for children with higher baseline levels of these symptoms (Nixon et al., 2012). However, another study showed that maternal psychopathology did not predict the effect of a depression and anxiety prevention program for adolescents with parents with mental health problems (Rasing et al., 2018). There are no studies that have directly examined the role of self-efficacy on anxiety prevention effects. Therefore, it is unclear whether children with high or low levels of self-efficacy respond differently to anxiety prevention programs. A recent meta-analysis of 155 experimental trials found, however, that self-efficacy has a causal effect on health-related intentions and behaviour (Sheeran et al., 2016), indicating that when people believe that they can execute the relevant action, they are more likely to change their health intention and behaviour.
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