
Denise A ChaviraUniversity of California, Los Angeles | UCLA · Department of Psychology
Denise A Chavira
PhD
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129
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Publications (129)
Objective: The purpose of this randomized controlled trial was to test the effects of an online, coached mindfulness intervention on momentary negative affect (mNA) for youth with high levels of trait negative affectivity. Method: Participants were 111 youth ages 12 to 17 years old (M = 14.17, SD = 1.60). Youth self-identified as 68% female, 29% ma...
Objective:
Parent-Child Interaction Therapy (PCIT) is a parenting program in which caregivers must achieve "skill criteria" in using Do Skills and avoiding Don't Skills to complete treatment. Despite PCIT's emphasis on these skills, little is known about how Latinx caregivers acquire these Western-based parenting practices and whether cultural mis...
Pregnancy is a developmental period with distinct practical and attitudinal factors that affect mental health help-seeking. Within the Latine community, the inclusion of family values in therapy is associated with positive outcomes, suggesting that social relationships may contribute to help-seeking behavior for this population. This study aimed to...
BACKGROUND
Self-guided online interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression, anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such interv...
Background
Self-guided web-based interventions have the potential of addressing help-seeking barriers and symptoms common among university students, such as depression and anxiety. Unfortunately, self-guided interventions are also associated with less adherence, implicating motivation as a potential moderator for adherence and improvement for such...
Objective: Few online interventions targeting anxiety and depression in university students are designed for universal delivery, and none for group-level delivery. This randomized controlled trial (NCT No. 04361045) examined the effectiveness of such a prevention program. Method: StriveWeekly is a web-based intervention designed with weekly self-gu...
Disparities in treatment engagement and adherence based on ethnicity have been widely recognized but are inadequately understood. Few studies have examined treatment dropout among Latinx and non-Latinx White (NLW) individuals. Using Andersen's Behavioral Model of Health Service Use (A behavioral model of families' use of health services. 1968; J He...
Objective: Exposure therapy is the frontline treatment for anxiety among adults but is underutilized during pregnancy. We qualitatively assess the prospective acceptability of exposure therapy among pregnant Latinas with elevated anxiety, a group that experiences mental health disparities. Method: Pregnant Latinas (N = 25) with elevated anxiety wer...
Attention bias confers risk for anxiety development, however, the influence of sociodemographic variables on the relationship between attention bias and anxiety remains unclear. We examined the association between attention bias and anxiety among rural Latinx youth and investigated potential moderators of this relationship. Clinical symptoms, demog...
Previous research has implicated reductions in anxiety sensitivity (AS) – the dispositional tendency to fear anxiety-related sensations – as critical to change during cognitive behavioral therapy (CBT) for anxiety. However, the relationship of AS to anxiety symptom remittance following CBT remains largely unknown. To address this gap, the current s...
Objective: Few studies have tested cognitive behavioral therapy to reduce prenatal anxiety despite substantial empirical support among individuals seeking treatment for anxiety symptoms. We examined whether a brief cognitive behavioral intervention delivered to low-income pregnant women would be efficacious for reducing prenatal anxiety.
Method: A...
BACKGROUND
People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation (MM) may be especially well suited to help POC cope, given their emphasis on gaining awareness and acceptance of emotions associated with discriminator...
Background:
People of color (POC) who experience race-related stress are at risk of developing mental health problems, including high levels of stress, anxiety, and depression. Mindfulness meditation may be especially well suited to help POC cope, given its emphasis on gaining awareness and acceptance of emotions associated with discriminatory trea...
Social anxiety disproportionately impacts individuals from certain cultural and developmental groups, namely those from Latinx and Asian American cultures and adolescents. Neural sensitivity to social feedback has been shown to vary across individuals and could contribute to this disparity by further exacerbating differences; thus, his could be an...
Asegurar que las medidas de evaluación de ansiedad sean confiables y válidas para jóvenes latinos es un requisito previo fundamental para la investigación dirigida a abordar las disparidades relacionadas con la ansiedad que experimenta esta población. La Escala de Ansiedad Mulidimensional para Niños (MASC; March et al., 1997) es un cuestionario amp...
Background
Self-guided online interventions offer users the ability to participate in an intervention at their own pace and address some traditional service barriers (eg, attending in-person appointments, cost). However, these interventions suffer from high dropout rates, and current literature provides little guidance for defining and measuring on...
BACKGROUND
Self-guided online interventions offer users the ability to participate in an intervention at their own pace and address some traditional service barriers (eg, attending in-person appointments, cost). However, these interventions suffer from high dropout rates, and current literature provides little guidance for defining and measuring on...
The perceived salience of errors can be influenced by individual-level motivational factors. Specifically, those who endorse a high degree of collectivism, a cultural value that emphasizes prioritization of interpersonal relationships, may find errors occurring in a social context to be more aversive than individuals who endorse collectivism to a l...
Objective: There is a well-documented relationship between discrimination and increases in internalizing symptoms among rural Latinx youth. Among numerous assets in these adolescents’ lives, family resilience emerges as a culturally relevant and robust protective factor. However, it is still unclear whether family resilience is equally protective a...
Objective: To examine the feasibility of a self-guided, Web-based program for universal prevention of anxiety and depression in university students. Participants: University students (n = 651) enrolled in the tested program (March, 2016). Methods: The program delivered eight weeks of mental health skills (e.g., behavioral activation, mindfulness)....
Adolescents’ responses to negative social experiences can be influenced by parenting behaviors. This includes how parents react to their child’s expression of emotions, an aspect of parenting referred to as emotion socialization. Emotion socialization may intersect with cultural values, particularly collectivism, a socially-relevant attitude that e...
Previous research suggests that rural Latinx youth are more likely to experience traumatic events and are at higher risk for developing subsequent psychopathology compared to non-Latinx white youth. The aim of this study is to understand how family processes and values affect risk for internalizing and externalizing symptoms among rural Latinx yout...
Background:
This study aimed to clarify the predictive significance of youth perceptions of parental criticism assessed using a brief measure designed to enhance clinical utility. We hypothesized that high perceived parental criticism would be associated with more severe depression over 18-months of follow-up.
Methods:
The study involved seconda...
Promotores de salud (i.e., community health workers) have the potential to provide much-needed mental health services in Latinx communities, particularly in areas with provider shortages. This study used qualitative methods to explore promotor/a perspectives on mental health task shifting, with a focus on developing understanding of their definitio...
In this chapter, we discuss cultural and social aspects of anxiety disorders. DSM-5 characterizes culture as "systems of knowledge, concepts, rules and practices that are learned and transmitted across generations. Culture includes language, religion and spirituality, family structure, life-cycle stages, ceremonial rituals, and customs, as well as...
Objective: Using a conceptual model of postpartum depression risk in Latinas including both contextual and cultural stressors, we tested contributions to depressive symptom levels and trajectories over the course of 1 year following birth in a community sample of Latinas. Method: A multisite sample of low-income U.S.-born and foreign-born Latinas (...
Latinx youth report elevated internalizing symptomatology as compared to their non-Latinx White counterparts and are less likely to access mental health care for these problems. This qualitative study examined the knowledge, beliefs and perceptions that Latinx parents (86% foreign-born; 66.7% monolingual Spanish speakers) living in urban communitie...
Black women and Latinas have more symptoms of depression and anxiety during pregnancy than do their non‐Latina White counterparts. While effective interventions targeting internalizing disorders in pregnancy are available, they are primarily tested with White women. This article reviews randomized controlled trials and non‐randomized studies to bet...
Mental health disparities among racial and ethnic minorities (R&EM) are well documented. Some of the variables driving these disparities are limited care availability, difficulty accessing services, and attitudinal barriers. Although no single approach will eliminate all these obstacles, the use of technology to provide mental health services repre...
Objective: University students experience many help-seeking barriers, and thus not all students who could benefit from mental health services enroll in them. This study aimed to examine student enrollment in response to strategic marketing of an online prevention program for anxiety and depression. Method: Data were collected from students at two u...
Parental variables likely have important and bidirectional influences on the etiology of child anxiety. Although some child-focused cognitive-behavioral therapy (CCBT) anxiety trials have found vicarious improvements among parents who participated in their children's treatment, this is an understudied area. We hypothesized that parental variables (...
This comprehensive, 51-chapter handbook presents recent advances in the expression, etiology, assessment, and treatment of child and adolescent psychiatric disorders and related problems from a developmental psychopathology perspective. Following a broad conceptual overview of this area of clinical research and practice, assessment and treatment pr...
Introduction: Externalizing disorders are more prevalent in rural than urban settings and account for disproportionately high mental health service costs for rural adolescents. Although cultural stressors such as discrimination have been associated with externalizing problems in ethnic minority youth broadly, this relationship is understudied in La...
Evidence-based psychological interventions are growing in number but are not within reach of many individuals who could benefit from them. The recent revolution in digital technologies now makes it possible to reach people around the globe with digital interventions in the form of web sites, mobile applications, wearable devices, and so on. Althoug...
Cognitive behavioral therapies (CBT) for youth with anxiety, traumatic stress, and depression have demonstrated strong effects in individual studies and meta-analyses. Relatively more attention has been given to posttreatment effects, though, and assessment of follow-up effects has been limited at the meta-analytic level. The current meta-analysis...
Objective: In this study, we tailor a child anxiety cognitive–behavior therapy (CBT) program to fit the needs of rural Latino/a Spanish-speaking families and examine the feasibility, acceptability, tolerability, and safety of this intervention using 2 modes of service delivery. Method: Children (n = 31; age 8–13) with anxiety disorders were recruit...
This systematic review evaluates efforts to date to involve community health workers (CHWs) in delivering evidence-based mental health interventions to underserved communities in the United States and in low- and middle-income countries. Forty-three articles (39 trials) were reviewed to characterize the background characteristics of CHW, their role...
The present study examines how both between group (i.e., ethnic group membership) and within group cultural factors (i.e., nativity status, age of immigration, and perceived discrimination) may contribute to anxiety and related symptoms in Latinx with anxiety disorders. Baseline data were examined from patients who participated in one of the larges...
Brief overview of current research on evidence-based practices with Latino populations
Objectives: The objective of this study was to examine age differences in the likelihood of endorsing of death and suicidal ideation in primary care patients with anxiety disorders.
Method: Participants were drawn from the Coordinated Anxiety Learning and Management (CALM) Study, an effectiveness trial for primary care patients with panic disorder...
Objectives?:
Depression, a chronic and disabling condition, frequently has its first onset during adolescence, underscoring the value of early effective treatment and prevention. Integrated medical-behavioral health care provides one strategy for improving treatment access for adolescents and young adults (AYA). This study examined predictors of a...
This review included 136 published randomized controlled trials (RCTs) of youth cognitive behavioral therapy (CBT) treatments. We aimed to test the premise that evidence-based youth treatments can be better differentiated from each other by applying more nuanced standards of evidence. Accordingly, we applied three standards to this article sample t...
Mothers’ and fathers’ emotion socialization (ES) practices have been widely associated with child socioemotional outcomes. To extend this research, we examined the bidirectional relationship between parent ES practices (supportive and non-supportive parenting) and internalizing behavior problems in children of Anglo and Latino parents. Participants...
Background
Stigma has been frequently cited as a barrier to service use for various mental health problems. Studies suggest that stigma may be greater for childhood mental health problems that are perceived as more atypical.
Aims
This study utilized a mixed methods research design (qual + QUAN) to examine parental endorsement of stigma and its imp...
Case:
Bryan is a 10-year-old boy who is brought to his pediatrician by his parents with concerns about oppositional behaviors. Bryan's parents report that he has always been hyperactive and oppositional since a very young age. He has been previously diagnosed with attention-deficit hyperactivity disorder and has been treated with appropriate stimu...
Latinos are among the fastest growing minority group in the U.S. and they continue to experience considerable barriers to accessing medical and behavioral health services in the U.S. As a group, Latinos evidence high prevalence of anxiety disorders and comorbidity, highlighting the need to improve current disparities in quality of and access to men...
The proposed research seeks to introduce a novel model relating Social Anxiety Disorder (SAD) and suicide outcomes (i.e., passive suicidal ideation, active suicidal ideation, and suicide attempts) in diverse adolescents. This model posits that family cohesion is one pathway by which suicide risk is increased for socially anxious youth, and predicts...
Results:
Anxiety comorbidity was common in the current sample (n = 73), with 3-quarters being diagnosed with more than one anxiety disorder. QOL in the current sample did not vary significantly by age, gender, or race/ethnicity. Both greater comorbidity and higher total anxiety symptom severity were inversely associated with QOL across multiple do...
When treating anxious patients with co-occurring depression, research demonstrates that both types of symptoms independently improve. The current analyses examined how reductions in anxiety and depression may be interrelated both during treatment, as well as over time following treatment. Participants were 503 individuals with one or more DSM-IV an...
Qualitative methods were used to understand community perspectives about ways to deliver cognitive behavior therapy (CBT) to rural Latino youth with anxiety. First, four focus groups were conducted with 28 bilingual Latino mental health providers to examine perceptions of CBT using telephone based, therapist supported bibliotherapy, and bibliothera...
Attention deficit hyperactivity disorder (ADHD) is associated with substantial functional impairment in children and in adults. Many individuals with ADHD have clear neurocognitive deficits, including problems with visual attention, processing speed, and set shifting. ADHD is etiologically complex, and although genetic factors play a role in its de...
In this study, we examine the feasibility of cognitive behavior therapy (CBT) for children with anxiety in primary care, using two modes of treatment delivery. A total of 48 parents and youth (8-13) with anxiety disorders were randomly assigned to receive 10-sessions of CBT either delivered by a child anxiety specialist in the primary care clinic o...
Objective:
Obsessive-compulsive disorder (OCD) and Tourette's syndrome are highly heritable neurodevelopmental disorders that are thought to share genetic risk factors. However, the identification of definitive susceptibility genes for these etiologically complex disorders remains elusive. The authors report a combined genome-wide association stud...
Objective:
In the current study, we compared measures of treatment outcome and engagement for Latino and non-Latino White patients receiving a cognitive behavioral therapy (CBT) program delivered in primary care.
Method:
Participants were 18-65 years old and recruited from 17 clinics at 4 different sites to participate in a randomized controlled...
The direct estimation of heritability from genome-wide common variant data as implemented in the program Genome-wide Complex Trait Analysis (GCTA) has provided a means to quantify heritability attributable to all interrogated variants. We have quantified the variance in liability to disease explained by all SNPs for two phenotypically-related neuro...
Research on barriers and utilization of mental health services in older ethnic minorities has been productive. However, little is known about the characterization and beliefs about anxiety and depression symptoms among older Mexican-Americans. Exploration of these conceptualizations will lead to better detection and provision of care to this large,...
Objective
To evaluate the effects of medical comorbidity on anxiety treatment outcomes.Methods
Data were analyzed from 1004 primary care patients enrolled in a trial of a collaborative care intervention for anxiety. Linear-mixed models accounting for baseline characteristics were used to evaluate the effects of overall medical comorbidity (two or m...
Molecular Psychiatry publishes work aimed at elucidating biological mechanisms underlying psychiatric disorders and their treatment
The present study examined rates of trauma exposure, clinical characteristics associated with trauma exposure, and the effect of trauma exposure on treatment outcome in a large sample of primary care patients without posttraumatic stress disorder (PTSD). Individuals without PTSD (N = 1263) treated as part of the CALM program (Roy-Byrne et al., 2010...
Case:
Bryan is a 10-year-old boy who is brought to his pediatrician by his parents with concerns about oppositional behaviors. Bryan's parents report that he has always been hyperactive and oppositional since a very young age. He has been previously diagnosed with attention-deficit hyperactivity disorder and has been treated with appropriate stimu...
The presence of an anxiety disorder is associated with greater frequency of suicidal thoughts and behaviors. Given the high personal and societal costs of suicidal behaviors, suicide prevention is a priority. Understanding factors present within individuals with anxiety disorders that increase suicide risk may inform prevention efforts. The aims of...
Background:
Some data suggest that older adults with anxiety disorders do not respond as well to treatment as do younger adults.
Aims:
We examined age differences in outcomes from the Coordinated Anxiety Learning and Management (CALM) study, an effectiveness trial comparing usual care to a computer-assisted collaborative care intervention for pr...
Large racial disparities in the use of mental health care persist. Differences in treatment preferences could partially explain the differences in care between minority and nonminority populations. We compared beliefs about mental illness and treatment preferences between adult African-Americans, Hispanics, Asian Americans, Native Americans, and Wh...
Objective:
The authors examined the effects of a collaborative care intervention for anxiety disorders in primary care on lower-income participants relative to those with higher incomes. They hypothesized that lower-income individuals would show less improvement or improve at a lower rate, given that they would experience greater economic stress o...
Co-occurring depression is common in patients seeking treatment for anxiety; however, the literature on the effects of depression on anxiety treatment outcomes is inconclusive. The current study evaluated prescriptive and prognostic effects of depression on anxiety treatment outcomes in a large primary care sample.
Data were analyzed from a randomi...
Adolescence is a time of increasing risk for some anxiety disorders. Scant data exist on adolescent anxiety in emergency department (ED) settings. We sought to characterize select clinical characteristics and health care use associated with anxiety disorders in a pediatric ED.
We screened a convenience sample of 100 adolescent-parent dyads presenti...
Obsessive-compulsive disorder (OCD) is a common, debilitating neuropsychiatric illness with complex genetic etiology. The International OCD Foundation Genetics Collaborative (IOCDF-GC) is a multi-national collaboration established to discover the genetic variation predisposing to OCD. A set of individuals affected with DSM-IV OCD, a subset of their...
Obsessive-compulsive disorder (OCD) has a complex etiology involving both genetic and environmental factors. However, the genetic causes of OCD are largely unknown, despite the identification of several promising candidate genes and linkage regions.
Our objective was to conduct genetic linkage studies of the type of OCD thought to have the stronges...
The purpose of this pilot study was to evaluate whether a modified version of the Coping Cat program could be effective in reducing anxiety in children with autism spectrum disorder (ASD). Twenty-two children (ages 8-14; IQ ≥ 70) with ASD and clinically significant anxiety were randomly assigned to 16 sessions of the Coping Cat program (cognitive-b...
This research project sought to estimate the prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) and to determine if the Swanson Nolan and Pelham Rating Scale IV (SNAP-IV) Spanish version is a useful screening tool in a population of Costa Rican school children. The SNAP-IV Spanish version was given to the parents and teachers of 425 chil...
This paper describes the training approach used with primary care staff to deliver an evidence-based computer-assisted cognitive-behavioral therapy (CBT) program for anxiety disorders within a collaborative care treatment delivery model.
We describe the training and proficiency evaluation procedures utilized in the Coordinated Anxiety Learning and...
Obsessive compulsive disorder (OCD) has a complex etiology that encompasses both genetic and environmental factors. However, to date, despite the identification of several promising candidate genes and linkage regions, the genetic causes of OCD are largely unknown. The objective of this study was to conduct linkage studies of childhood-onset OCD, w...
While genetic epidemiological studies demonstrate a substantial degree of genetic predisposition for attention-deficit/hyperactivity disorder (ADHD), they also suggest that the genetics are complex and may differ between populations or ethnic groups.
This study describes the phenomenology of siblings with ADHD from the genetically isolated populati...
Selective mutism (SM), considered an early-onset variant of social anxiety disorder, shares features of impaired social interaction and communication with autism spectrum disorders (ASDs) suggesting a possible shared pathophysiology. We examined association of a susceptibility gene, contactin-associated protein-like 2 (CNTNAP2), for ASDs and specif...
The current review describes the phenomenology of several common anxiety disorders in children and adolescents as they present in medical settings. Anxiety disorders and associated features in children are described, along with epidemiology, functional impairment, common somatic complaints, medical comorbidity, health care utilization, and presenta...
Ethnic minorities from disadvantaged socioeconomic backgrounds report increased utilization of mental health emergency services; however findings have been inconsistent across ethnic/racial groups. In this study we describe patients who present to a rural crisis unit in Southern California, examine rates of psychiatric hospitalizations across ethni...
It has been suggested that attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), both neurodevelopmental disorders with onset in childhood, are highly comorbid, but previous studies examining ADHD and OCD comorbidity have been quite variable, partly because of inconsistency in excluding individuals with tic disord...
[Clin Psychol Sci Prac 17: 162–165, 2010]
Kazantzis, Whittington, and Dattilio (2010) provide convincing evidence for the role of homework in effective psychotherapy. Homework is a common element of many empirically supported treatments for a variety of clinical problems, but we cannot assume that homework is used commonly in routine, community-bas...
Background: Approximately 47 to 84 percent of children with autism spectrum disorder (ASD) experience clinically significant levels of anxiety (Gillott, Furniss, & Walter, 2001; Muris, Steerneman, Merckelbach, Holdrinet, & Meesters, 1998). Children with ASD may be at a greater risk for developing anxiety due to inhibited temperament, physiological...
Improving the quality of mental health care requires moving clinical interventions from controlled research settings into real-world practice settings. Although such advances have been made for depression, little work has been performed for anxiety disorders.
To determine whether a flexible treatment-delivery model for multiple primary care anxiety...
Case:
A 7(1/2)-year-old boy is brought to a new primary care pediatrician because his grandparents, who have legal custody, want a "fresh look" at his behavior. Ian's grandmother begins the history with the comment, "He started out kind of rough." He was exposed to methamphetamine and marijuana throughout gestation and his mother had bipolar disea...
Anxiety disorders are the most prevalent mental health disorders and are associated with substantial disability and reduced well-being. It is unknown whether the relative impact of different anxiety disorders is due to the anxiety disorder itself or to the co-occurrence with other anxiety disorders. This study compared the functional impact of comb...
Background: Rates of suicidal ideation and behaviours as well as associated risk factors are examined among youth recruited from five public sectors of care (i.e. child welfare, juvenile justice, special education services, alcohol and drug services, and county mental health).
Method: 1057 youth (ages 11–18) completed a diagnostic interview and que...
This study's aim was to prospectively examine and identify a model of demographic, clinical, and attitudinal variables that impact improvement among patients with panic disorder. Subjects were 232 primary care patients meeting criteria for DSM-IV panic disorder. Eligible patients were randomly assigned to a collaborative care intervention or to tre...
Since the emergence of social phobia in DSM nomenclature, the mental health community has witnessed an expansion in standardized methods for the screening, diagnosis and measurement of the disorder. This article reviews formal assessment methods for social phobia, including diagnostic interview, clinician-administered instruments, and self report q...