Cathy Creswell

University of Oxford | OX · Department of Experimental Psychology

The cognitive theory of social anxiety disorder (SAD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, yet it remains unknown if, or to what extent, the same cognitive and behavioral maintenance mechanisms that occur in adult SAD also apply to SAD among pre-adolescent children. In contrast to the adult liter...

Background Half of all lifetime anxiety disorders emerge before age 12 years; however, access to evidence-based psychological therapies for affected children is poor. We aimed to compare the clinical outcomes and cost-effectiveness of two brief psychological treatments for children with anxiety referred to routine child mental health settings. We h...

Background: The tendency to interpret ambiguity as threat (negative interpretation) has been implicated in cognitive models of anxiety. A significant body of research has examined the association between anxiety and negative interpretation, and reviews suggest there is a robust positive association in adults. However, evidence with children and ad...

Background: Anxiety disorders have a median age of onset of 11 years and are the most common emotional disorders in childhood; however, a significant proportion of those affected do not access professional support. In the UK, GPs are often the first medical professional that families see so are in a prime position to support children with anxiety...

Background Intolerance of uncertainty (IU) has been implicated in the development and maintenance of worry and anxiety in adults and there is an increasing interest in the role that IU may play in anxiety and worry in children and adolescents. Method We conducted a systematic review and meta-analysis to summarize existing research on IU with regar...

To be able to develop effective policy and targeted support for children and young people, it is vital to develop and validate measures that enable us to understand what aspects of pandemics are associated with anxiety and stress across a wide age range. We examined the psychometric properties of the Pandemic Anxiety Scale– Parent-report (PAS-P), w...

The Parent Overprotection Measure (POM) is a promising scale to measure parent overprotection toward a child from the parent’s perspective. However, no Japanese translation of the scale has been developed, and whether the POM can be applied to a Japanese population is unknown. This study translated the POM into Japanese and examined its psychometri...

Background Difficulties identifying anxiety disorders in primary‐school aged children present significant barriers to timely access to support and intervention. This study aimed to develop a brief assessment tool that can identify children with anxiety disorders in community settings, with a high level of sensitivity and specificity. Methods Child...

Background Mental health difficulties are common for autistic people; however, almost no interventions have been co‐designed with the autistic community. Co‐design has the potential to add important insights from lived experience into intervention design, but there are currently limited examples of how rigorously to undertake this practice. This pa...

Introduction Children exposed to trauma are vulnerable to developing post-traumatic stress disorder (PTSD) and other adverse mental health outcomes. In low-and middle-income countries (LMICs), children are at increased risk of exposure to severe trauma and co-occurring adversities. However, relative to high-income countries, there is limited eviden...

The Preschool Anxiety Scale (PAS) is a parent-report scale measuring young children’s anxiety symptoms involving five specific anxiety symptoms (separation anxiety, physical injury fears, social phobia, obsessive–compulsive disorder, generalized anxiety) that load on a higher-order factor representing general anxiety shared by all specific anxiety...

Background Children and adolescents demonstrate diverse patterns of symptom change and disorder remission following cognitive behavioural therapy (CBT) for anxiety disorders. To better understand children who respond sub‐optimally to CBT, this study investigated youths (N = 1,483) who continued to meet criteria for one or more clinical anxiety diag...

Background It is estimated that 78% of children experience the death of a close friend or family member by 16 years of age, yet longitudinal research examining the mental health outcomes of wider experiences of bereavement is scarce. We conducted a longitudinal investigation of the association between maternal experienced bereavement before the age...

Background The Identifying Child Anxiety Through Schools-identification to intervention (iCATS-i2i) trial is being conducted to establish whether ‘screening and intervention’, consisting of usual school practice plus a pathway comprising screening, feedback and a brief parent-led online intervention (OSI: Online Support and Intervention for child a...

BACKGROUND A smartphone app, Parent Positive, was developed to help parents manage their children’s conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children’s emotional problems. However,...

Background A better understanding of the processes that maintain social anxiety disorder (SAD) in adolescents could improve treatment outcomes. This study aimed to establish whether cognitive and behavioural processes known to be important in the maintenance of adult SAD are observed in adolescent populations and whether they are specific to SAD....

Background: The Identifying Child Anxiety Through Schools – identification to intervention (iCATS-i2i) trial is being conducted to establish whether ‘screening and intervention’, consisting of usual school practice plus a pathway comprising screening, feedback and a brief parent-led online intervention (OSI: Online Support and Intervention for chil...

Background: Children's conduct and emotional problems increased during the COVID-19 pandemic. Objective: We tested whether a smartphone parenting support app, Parent Positive, developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content ada...

Background: Mental health difficulties are common for autistic people; however, few interventions have been co-produced with the autistic community. Mental health interventions constructed with a non-autistic lens likely miss key understandings from autistic experiences and priorities of the autistic community. Additionally, the style and aims of i...

Objective: To examine the risk of anxiety disorders in offspring of parents with mood disorders METHOD: We conducted a systematic review and meta-analysis. We searched four electronic databases- Medline, Embase, PsycINFO and Web of Science (core collection) to identify cross-sectional and cohort studies that examined the association between parent...

Considerable work has advanced understanding of the nature, causes, management, and prevention of anxiety disorders in children and adolescents over the past 30 years. Prior to this time the primary focus was on school refusal and specific phobias. It is now recognised that children and adolescents experience the full gamut of anxiety disorders in...

Objective Children’s experiences of peer victimization and peer aggression are strongly linked to their mental health. However, we do not know how this relationship is influenced by periods of restricted and unrestricted social interactions. In this study, we investigated the following: (1) the bidirectional association between children’s peer prob...

Background Over a quarter of people have an anxiety disorder at some point in their life, with many first experiencing difficulties during childhood or adolescence. Despite this, gaps still exist in the current evidence base of the multiple consequences of childhood anxiety problems and their costs. Methods A systematic review of Medline, PsycINFO...

Introduction It is increasingly accepted that young people need to be centrally involved in research on issues that affect them. The aim of this study was to explore young people's perceptions of the benefits for them of being involved in mental health research and the processes that enabled these benefits. Methods Qualitative interviews were cond...

Background The threats to health, associated restrictions and economic consequences of the COVID‐19 pandemic have been linked to increases in mental health difficulties for many. Parents, in particular, have experienced many challenges such as having to combine work with home‐schooling their children and other caring responsibilities. Yet, it remai...

Background A major concern throughout the COVID‐19 pandemic has been on young people's experiences with mental health. In this study we mapped children and adolescents' mental health trajectories over 13 months of the pandemic and examine whether family, peer, and individual‐level factors were associated with trajectory membership. Methods This st...

Background: Guided parent-delivered cognitive behavioural therapy (GPD-CBT) is an effective low-intensity treatment for childhood anxiety disorder in Western countries and can increase access to evidence-based psychological therapies. Aim: This study aimed to examine its feasibility in a Japanese sample. Method: Twelve children with anxiety di...

Anxiety problems are common in children and can have profound adverse effects on personal, social and academic life. Almost 40% of anxiety disorders emerge before age 14, making primary schools invaluable settings for prevention and early support of child anxiety. Research indicates that school‐based interventions can be costly and difficult to sch...

Background The Minimising Young Children’s Anxiety through Schools (MY-CATS) trial is being conducted to determine whether an online evidence-based parent-guided cognitive behavioural therapy intervention in addition to usual school practice is effective and cost-effective compared with usual school practice in reducing anxiety disorders in childre...

Background Anxiety problems are extremely common and have an early age of onset. We previously found, in a study in England, that fewer than 3% of children with an anxiety disorder identified in the community had accessed an evidence‐based treatment (Cognitive Behavioural Therapy; CBT). Key ways to increase access to CBT for primary school‐aged chi...

Background: Anxiety problems have a particularly early age of onset and are common among children. As we celebrate the anniversary of the BABCP, it is important to recognise the huge contribution that cognitive behavioural therapy (CBT) has made to the treatment of anxiety problems in children. CBT remains the only psychological intervention for c...

Background In the context of COVID-19, NHS Child and Adolescent Mental Health Services (CAMHS) and other children’s mental health services have faced major challenges in providing psychological treatments that (i) work when delivered remotely and (ii) can be delivered efficiently to manage increases in referrals as social distancing measures have b...

BACKGROUND Children’s conduct and emotional problems increased during the COVID-19 pandemic. OBJECTIVE We tested whether a smartphone parenting support app, Parent Positive , developed specifically for this purpose, reversed these effects in a cost-effective way. Parent Positive includes 3 zones. Parenting Boosters (zone 1) provided content adapte...

Background Systematically screening for child anxiety problems, and offering and delivering a brief, evidence-based intervention for children who are identified as likely to benefit would minimise common barriers that families experience in accessing treatment. We have developed a short parent-report child anxiety screening questionnaire, and proce...

Objectives: Childhood social anxiety disorder (SAD) is a common and disabling condition. General forms of cognitive behavioural treatments have demonstrated poorer efficacy for childhood SAD when compared to other childhood anxiety disorders and further understanding of the psychological factors that contribute to the maintenance of childhood SAD...

Schools may be well-placed to identify signs of mental health (MH) problems in children; however, there has been little research into how school-based screening and intervention initiatives should be delivered. One-to-one in-depth interviews were carried out with 15 practitioners that support children’s MH within primary school settings. Data were...

A major concern throughout the COVID-19 pandemic has been the impact on young people’s mental health. The objective of this study was to map children and adolescents’ mental health trajectories over thirteen months of the pandemic and examine whether family, peer, and individual-level factors were associated with different trajectories. The current...

Background Systematically screening for child anxiety problems, and offering and delivering a brief, evidence-based intervention for children who are identified as likely to benefit would minimise common barriers that families experience in accessing treatment. We have developed a short parent-report child anxiety screening questionnaire, and proce...

Background Anxiety disorders are common among primary-school aged children, but few affected children receive evidence-based treatment. Identifying and supporting children who experience anxiety problems through schools would address substantial treatment access barriers that families and school staff often face. We have worked with families and sc...

• Background: In the context of COVID-19, NHS Child and Adolescent Mental Health Services (CAMHS) and other children’s mental health services have faced major challenges in providing psychological treatments that (i) work when delivered remotely, and (ii) can be delivered efficiently to manage increases in referrals as social distancing measures ha...

Background The threats to health, associated restrictions and economic consequences of the COVID-19 pandemic have been linked to increases in mental health difficulties for many. Parents, in particular, have experienced many challenges such as having to combine work with home-schooling their children and other caring responsibilities. Yet, it remai...

Brief and low intensity (LI) interventions are a relatively new approach to delivering evidence-based psychological treatments for adults presenting with common mental health problems, and an even newer approach for working with children and young people. Over recent years, empirically validated brief and LI psychological treatments for children an...

Anxiety and depressive disorders are the most common mental health disorders in adolescents, yet only a minority of young people with these disorders access professional help. This study aims to address this treatment gap by improving our understanding of barriers and facilitators to seeking/accessing professional help as perceived by adolescents w...

Objectives A very small proportion of children with anxiety problems receive evidence-based treatment. Barriers to access include difficulties with problem identification, concerns about stigma and a lack of clarity about how to access specialist services and their limited availability. A school-based programme that integrates screening to identify...

Background: Cognitive Behavioural Therapy (CBT) is the gold standard intervention for anxiety and related mental health disorders among young people; however, the efficacy of individual elements of CBT (e.g., exposure to feared stimuli) have received little scrutiny. Aims: This scoping review, informed by three stakeholder groups and a scientifi...

Background Online treatments for child anxiety offer a potentially cost-effective and non-stigmatizing means to widen access to evidence-based treatments and meet the increasing demand on services; however, uptake in routine clinical practice remains a challenge. This study conducted an initial evaluation of the clinical effectiveness, feasibility...

Background Effective antibullying interventions may reduce the impact of bullying on young people’s mental health. Nevertheless, little is known about their effectiveness in reducing internalizing symptoms such as anxiety or depression, and what factors may influence intervention effects. The aim of this systematic review, meta‐analysis, and metare...

Anxiety disorders are the most common mental health disorders among children, however there is limited guidance on the process of assessing child anxiety disorders and sharing diagnostic outcomes with families. This study aimed to identify aspects of the diagnostic process that are helpful and/or unhelpful for families, and ways to mitigate any pot...

Background The Minimising Young Children’s Anxiety through Schools (MY-CATS) trial is being conducted to determine whether an online evidence-based parent-guided Cognitive Behavioural Therapy intervention in addition to usual school practice is effective and cost-effective compared with usual school practice in reducing anxiety disorders in childre...

Anxiety disorders are the most common psychiatric disorder in children and young people. They can be prevented in those at risk, but families do not always take up opportunities to participate in prevention programmes. This qualitative study aimed to understand what families with children who were at prospective risk of anxiety disorders perceived...

Background: identifying and supporting young children who are at-risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from pre...

Objectives The COVID-19 related lockdowns and distancing measures have presented families with unprecedented challenges. A UK-wide cohort study tracking changes in families’ mental health since early lockdown (Co-SPACE) found a significant rise in primary school-aged children’s behaviour problems and associated family-related stress. Three-quarters...

The widespread impacts of COVID-19 have affected both child and parent mental health worldwide. This study aimed to investigate the relationship between school closures due to COVID-19 and child and parent mental health in Japan. A sample of 1984 Japanese parents with children and adolescents aged 6–15 years participated. The parents responded to o...

Cognitive Behavioural Therapy (CBT) is the first line treatment for anxiety disorders in youth however many adolescents do not benefit. Behavioural exposure is believed to be the critical ingredient of CBT and research with adults has shown that labelling affect, but not positive coping statements, enhances exposure outcomes. However, many CBT prot...

Background Identifying and supporting young children who are at-risk of developing anxiety disorders would benefit children, families, and wider society. Elevated anxiety symptoms, inhibited temperament, and high parental anxiety are established risk factors for later anxiety disorders, but it remains unclear who is most likely to benefit from prev...

Informal (unpaid) carers are an integral part of all societies and the health and social care systems in the UK depend on them. Despite the valuable contributions and key worker status of informal carers, their lived experiences, wellbeing, and needs have been neglected during the COVID-19 pandemic. In this Health Policy, we bring together a broad...

Guidance is scarce on whether and how to involve parents in treatment for anxiety and depressive disorders in children and young people. We did a scoping review of randomised controlled trials of psychological interventions for anxiety and depressive disorders in children and young people, in which parents were involved in treatment, to identify ho...

Background Parental criticism is correlated with internalising symptoms in adolescent offspring. This correlation could in part reflect their genetic relatedness, if the same genes influence behaviours in both parents and offspring. We use a Children‐of‐Twins design to assess whether parent‐reported criticism and offspring internalising symptoms re...

Background The COVID‐19 pandemic has significantly changed the lives of children and adolescents, forcing them into periods of prolonged social isolation and time away from school. Understanding the psychological consequences of the UK’s lockdown for children and adolescents, the associated risk factors, and how trajectories may vary for children a...

Cognitive behavioral therapy (CBT) is an effective treatment for child anxiety disorders. Low-intensity forms of CBT, such as guided parent-delivered CBT (GPD-CBT), have been developed to increase access; however, it is unclear why some children benefit from this treatment and others do not. This qualitative study aimed to increase understanding of...

Background: Anxiety disorders are common among primary-school aged children, but few affected children receive evidence-based treatment. Identifying and supporting children who experience anxiety problems through schools would address substantial treatment access barriers that families and school staff often face. We have worked with families and s...

Cognitive behavioural therapy is an effective treatment for anxiety disorders in children and young people; however, many do not benefit. Behavioural exposure appears to be the critical ingredient in the treatment of anxiety disorders. Research with adults has identified innovative strategies to optimise exposure-based treatments, yet it is not cle...

Background: The COVID-19 pandemic has caused extensive disruption to the lives of children and young people. Understanding the psychological effects on children and young people, in the context of known risk factors is crucial to mitigate the effects of the pandemic. This study set out to explore how mental health symptoms in children and adolesce...

Background: Internet-based treatments for child anxiety may help to increase access to evidence-based therapies; however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximiz...

BACKGROUND Internet-based treatments for child anxiety may help to increase access to evidence-based therapies; however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizin...

There is limited guidance on whether and how to involve parents in treatment for anxiety and depressive disorders in children and young people (CYP). We conducted a scoping review of randomized controlled trials of psychological interventions for anxiety and depressive disorders in CYP, where parents were involved in treatment to identify how paren...