Current Research Projects
Ageing Wisely
Group Treatment Program for Anxiety and Depression in Older Adults
Funding: Macquarie University Research Development Grant 2007-2009
In 2004, the Australian Bureau of Statistics (ABS) estimated that 13% (or 2.6 million) of the Australian population were over the age of 65years. This figure is projected to rise to 26% in 2051. Given that older adults will make up a quarter of the population in the near future, specific health interventions need to be developed to service this population.
One area of need in aging Australians is the development of effective treatment of anxiety and depression in older adults. Estimates of comorid anxiety and depression in the elderly range up to 47% and the costs associated with clinical and subclinical levels of depression and anxiety in the elderly are huge. Depression and anxiety increases the risk for life dissatisfaction, illness and mortality, dementia, use of medication, use of health care services and completed suicide 2005. With the worst outcomes for older adults with comorbid anxiety and depression.
Treatment of anxiety and depression in older adults is therefore of primary importance. Typically mental health problems in older adults are managed by primary health care physicians with medication offered as the first line treatment. However, due to increased health problems in this age group, the demand on primary care resources means that mental health issues are often untreated. Psychosocial interventions may be preferable to reduce demand at the primary care level and also because older adults have an increased risk of medication side effects or drug-drug interaction effects. To date, little research has been conducted on the development of effective psychological interventions for older adults, and of that research, it has tended to focus on the treatment of one disorder i.e. Anxiety or Depression.
The current research project aims to develop and evaluate a psychological group program for the treatment of comorbid anxiety and depression in older adults. We are currently trialing the group program compared to waitlist. For more information about the project please contact Dr Viviana Wuthrich on 02 9850 9433.
The Child Anxiety Rural Outreach Program (CAROP)
Funding: National Health and Medical Research Council, 2008 - 2011
For further information on CAROP please click here
Adult Social Phobia
Enhanced treatment for social phobia through the incorporation of attentional re-training.
Funding: National Health & Medical Research Council; 2007-2009.
Many years of research into the treatment of social phobia has seen the development of some effective psychological treatments. While these developments provide a promising picture for the management of social phobia, research needs to continually work toward further improvements.
One exciting possibility for new ways to treat social phobia has come from recent developments in experimental investigations into anxiety. Research has shown that people with social phobia unconsciously focus their attention onto possible evaluation from other people. Therefore training anxious people to refocus their attention away from possible evaluation should reduce anxious feelings.
In 2007 we are starting a new study to try and increase the effectiveness of our standard treatment for social phobia. The new treatment will combine our usual 12-week program with re-training of attention. People will meet in small groups for 12 weeks during which they are taught ways to help control their anxiety. At the same time, they will use their home computers to re-train the ways in which they unconsciously focus on other people’s evaluations of them. A control group of people will receive the same group treatment for social phobia but their re-training will not shift their focus of attention. In this way, we will be able to see whether re-training in attention can increase the effects we get from standard treatment for social phobia.
The results of this study will help us to understand more about ways of treating social phobia even more effectively. If the results show positive effects, they will also provide one of the most unique developments in the management of emotional health in decades.
Adolescent Depression
Under construction
Child and Family
Enhancing efficacy of cognitive behavioural treatment for children with anxiety disorders: Treating parent anxiety.
Funding: NationalHealth & Medical Research Council; 2006-2008.
We know that anxiety disorders are a widespread problem in our youth. We also know that anxiety, if left untreated, will persist through the child's life and cause significant disruption to their life. The good news is that there has been an increased interest in these disorders and as a result treatments that work have been developed. However, a recent review of the best psychological treatments for anxiety in children showed that on average studies are reporting remission rates of 64%. Clearly we need to develop more effective treatments for anxious children. One possible approach to improve outcomes for children with anxiety is to provide additional treatment for the parents. We know that anxiety runs in families: anxious children are more likely than non-anxious children to have anxious parents. A number of theories have suggested that parental anxiety plays an important role in the development of anxiety in children: An anxious parent may model anxious behaviour, encourage avoidance of anxious situations and reinforce anxious behaviour in their child. The results of this study will determine whether it is possible to improve the efficacy of treatments for anxiety in children by addressing anxiety in their parents. If the data show no additional benefit of the modified treatment, therapists can be more efficient in their treatment of anxious children by focusing only on the child's and not the parent's anxiety. However, if as expected the modified treatment proves to be more efficacious, then we will have identified an important strategy to increase the efficacy of intervention for this highly prevalent and debilitating childhood problem.
Other related research projects
In addition to the main treatment outcome study we are also conducting numerous other research projects investigating the nature, cause, assessment and treatment of anxiety disorders in children.
Anxiety and sleep problems in children and adolescents
This research project is being conducted in collaboration with Dr Michael Gradisar at Flinders University and is one of the first of its kind to examine sleep problems in children and adolescents seeking treatment for anxiety disorders. To improve the quality of information collected on sleep habits, we are using an innovative online sleep diary. The data collected will contribute to a better understanding of the sleep problems in children with anxiety disorders.
The role of parent-child interactions in the development of anxiety
(Funded by the Australian Research Council 2003-2006). We have recently completed a 2 year longitudinal study exploring the role of temperament, parent-child attachment, parent behaviour and parental anxiety in the development of anxiety disorders. In this study we followed 200 four year old children who were either shy or confident and tracked the development of anxiety. This study explored the interactions between temperament and parenting in the development of anxiety disorders and will help us to develop more effective treatment and prevention programs. By knowing which combinations of temperament and environment produce the poorest outcomes for children, we can attempt to prevent anxiety by removing harmful environments. We have also asked families to provide genetic information to help us examine the interaction between genes and environment.
Development of an assessment interview to guide treatment of Anxious Children
This project aims to develop and evaluate a novel assessment tool that would improve the match between a child's presenting problems and the treatment they are offered. Accurate matching should increase the number of children who respond to treatment, improve the use of empirically supported treatments in the community and provide cost savings by reducing treatment time and enhancing the potential of an anxious child to contribute to the social and economic future of Australia.
Genes, anxiety and treatment outcome
In collaboration with Assoc. Prof. Donald (CEH) and Dr Thalia Eley (Institute of Psychiatry, College of London) we are examining whether children's genetic makeup predicts their response to our treatment programs. This research may help to identify which children are most likely to benefit from our treatment.
CD Study
Self-Help CD-ROM Program for Adolescents with Anxiety Disorders
Funding: Australian Rotary Health Research Fund (ARHRF) 2006-2009
Macquarie University Vice-Chancellor's Development Grant
Cognitive behavioral therapy (CBT) is an empirically supported approach to treating young people with anxiety disorders. There is strong support for the effectiveness of CBT interventions delivered in individual or group face-to-face formats. There is also some support for the delivery of CBT via bibliotherapy or telephone sessions in adolescent populations.
Future options for delivery of CBT include computer-based delivery methods. The benefits of this approach are that it is economical, self-help, and can be widely disseminated to users including those in remote or rural areas. Further, surveys suggest that computer-based interventions are particularly favourable to adolescence populations. Whilst effective computer-based programs have been developed for the treatment of anxiety in adult populations, there is a clear absence of programs for adolescents.
A team at the Centre for Emotional Health have developed a self-help CD-ROM program for the treatment of anxiety in adolescents. The program is based on the well established "Cool Kids" anxiety treatment program and contains eight CBT modules. The CD-ROM has been developed with the help of programmers and designers and is very interactive. It includes: cartoons, audio, worksheets and case studies including video footage.
We are currently trialling the effectiveness of this CD-ROM in adolescents with anxiety disorders from around Australia. Suitable adolescents are randomly allocated to either receive use of the CD-ROM straight away, or to wait for 12 weeks. During the use of the program, adolescents receive support from research psychologists via regular email contact.
Project Publications to date:
Cunningham, M.J., Donovan, C.L., & March, S. (in press). Developing and Delivering Computer-based CBT for Anxiety Disorders in Young People. In D. Einstein, (Ed). Innovations and Advances in Cognitive Behaviour Therapy. Sydney: Australian Academic Press.
Cunningham, M.J., Rapee, R.M., & Lyneham, H.J. (2006). The Cool Teens CD-ROM: A multimedia self-help program for adolescents with anxiety. Youth Studies Australia, 25, 50-56.
Cunningham, M.J., Rapee, R.M., & Lyneham, H.J. (2006). Feedback to a prototype self-help computer program for anxiety disorders in adolescents. Australian e-Journal for the Advancement of Mental Health, 5(3).
Age at First Birth, Mode of Conception and Adjustment to Early Parenthood.
Funding: ARC Linkage
Investigators McMahon, Gibson, Fisher, Boivin and Saunders, 2007 - 2009
The trend to delayed childbearing is well-established, multiply determined and unlikely to change in the short term. This study will provide contemporary Australian evidence on the experience of becoming a parent at different ages, naturally and through assisted conception, for Australian men and women. Both risk and protective factors for older first-time parents will be identified, thus informing policy and services that can better support Australian families with planning and rearing children. Older parents are more likely to need assisted reproductive technology (ART) to achieve a pregnancy which incurs significant financial and emotional costs to individuals and the community. There has been a 9% increase in the number of ART treatment cycles from 2002 to 2003 and a three-fold increase in the number of ART pregnancies and deliveries since 1994. Given recent evidence that mothering after assisted conception may be associated with higher rates of postpartum distress and admission to residential parentcraft hospitals, a key contribution of the proposed study is the inclusion of both fertile and previously infertile first-time parents of different ages to allow us to disaggregate separate and combined effects of age and infertility on adjustment during the transition to parenthood. A key outcome will be a Parenting Decision-Aid to provide evidence-based reader-friendly information about the positives and negatives of first-time parenthood at different ages.