Ronald M. Rapee's research while affiliated with Macquarie University and other places
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Publications (506)
Adolescence is a time of heightened vulnerability for both peer victimization (PV) and internalizing symptoms. While the positive association between them is well established, there is little understanding of the mechanisms underpinning this relationship. To address this gap, the current study aimed to investigate sleep hygiene and school night sle...
Background:
Loneliness and social isolation are known to be associated with depression, general anxiety, and social anxiety. However, knowledge on the overlapping and unique features of these relationships, while differentiating between social loneliness (perceived absence of an acceptable social network) and emotional loneliness (perceived absenc...
There is tremendous need for brief and supported, non-commercial youth- and caregiver-report questionnaires of youth anxiety. The pediatric and parent proxy short forms of the Patient-Reported Outcome Measurement System (PROMIS) Anxiety scale (8a v2.0) are free, brief, publicly accessible measures of youth- and caregiver-reported anxiety in childre...
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...
The aim of this randomized controlled trial was to evaluate an adapted cognitive behavioural therapy (CBT) programme for treating anxiety in adolescents with acquired brain injury (ABI). Participants with ABI (12-19 years, N = 36) recruited from two sites were randomly allocated into either the intervention receiving 11 sessions of CBT (n = 19) or...
Research has consistently shown that more physically attractive individuals are perceived by others to be happier and better psychologically adjusted than those perceived as less attractive. However, due to the lack of longitudinal research in adolescents, it is still unclear whether poor mental health predicts or is predicted by either objective o...
Study objectives:
Parental warmth in adolescence protects sleep in early adulthood, yet the nature, directions, and mechanisms of this association across adolescence are unknown. This study examined parental warmth, adolescent sleep hygiene and sleep outcomes (morning/eveningness, school night sleep duration and daytime sleepiness) across five ann...
The goal of this study was to evaluate the measurement invariance of an adapted assessment of motivations for social withdrawal ( Social Preference Scale–Revised; SPS-R) across cultural contexts and explore associations with loneliness. Participants were a large sample of university students ( N = 4,397; M age = 20.08 years, SD = 2.96; 66% females)...
Background
Peer victimization and anxiety frequently co-occur and result in adverse outcomes in youth. Cognitive behavioural treatment is effective for anxiety and may also decrease children’s vulnerability to victimization.
Aims
This study aims to examine peer victimization in youth who have presented to clinical services seeking treatment for an...
Cognitive models of social anxiety propose that overestimation of the probability and cost of negative evaluation plays a central role in maintaining the disorder. However, there are currently no self-report state-based measures of probability and cost appraisals. The current paper examines the psychometric properties of the Probability and Consequ...
Objective
Pediatric social anxiety disorder consistently shows the poorest treatment response of all anxiety disorders. The current study compared a generic CBT treatment for pediatric anxiety against a modified (social anxiety) treatment that incorporated specific components to target theoretically important maintaining processes.
Method
200 chil...
A substantial empirical base supports the use of psychotherapy to alleviate anxiety symptoms and diagnoses in children and adolescents. However, focusing only on symptom or diagnostic reduction provides an incomplete picture of clinically meaningful efficacy given that anxiety disorders in this age group are integrally associated with problems in f...
Background
Increasing both the frequency and quality of social interactions within treatments for anxiety and depressive disorders in older adults may improve their mental health outcomes and quality of life. This study aims to evaluate the clinical efficacy and cost utility of an enhanced cognitive behavioural therapy (CBT) plus social participati...
Social anxiety disorder (SAD) is associated with marked physiological reactivity in social-evaluative situations. However, objective measurement of biomarkers is rarely evaluated in treatment trials, despite potential utility in clarifying disorder-specific physiological correlates. This randomized controlled trial sought to examine the differentia...
Objective
To examine the efficacy of weight‐adjusted D‐cycloserine (DCS) (35 or 70 mg) relative to placebo augmentation of intensive exposure therapy for youth with obsessive‐compulsive disorder (OCD) in a double‐blind, randomised controlled trial, and examine whether antidepressant medication or patient age moderated outcomes.
Methods
Youth (n =...
Objective:
The current study examined whether children with a social anxiety disorder (SAD) demonstrate divergent facial emotion processing and a disorder-specific negative interpretation bias in the processing of facial emotional expressions. This study aimed to overcome previous study limitations by including both a nonsocially anxious control g...
Objectives
The aims of this study were to determine the impact of adolescent-relevant risk factors on changes in social anxiety symptoms from pre-to early-adolescence.
Methods
From 2016 to 2018, 528 youth (51% boys) were tested in three annual waves across grades 6, 7, and 8 (M ages 11.2, 12.7, 13.7 years). Through online surveys youth reported on...
Objective
Adolescents experiencing both anxiety and mood disorders show greater life impairment than those with either disorder alone. The aim of this study was to evaluate the efficacy of an online cognitive behavior therapy (CBT) program for these comorbid youth.
Methods
Ninety-one adolescents aged 12 to 17 years (M = 14.29, S.D. = 1.62; 66% fem...
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. This scoping review, informed by three stakeholder groups and a scientific advisory group, aim...
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...
A considerable body of research in adults has demonstrated that anxiety disorders are characterised by attentional biases to threat. Findings in children have been inconsistent. The present study examined anxiety-related attention biases using eye tracking methodology in 463 preadolescents between 10 and 12 years of age, of whom 92 met criteria for...
To examine treatment fidelity in a randomized controlled trial of indicated school-based cognitive-behavioral therapy (CBT) delivered in groups to youth with anxiety. We investigated whether adherence and competence (a) differed across brief and standard-length CBT, and (b) if adherence and competence predicted change in anxiety symptoms and impair...
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...
This three-wave panel study examined the prospective and bidirectional relationships between parental control of social media use, and parents’ and adolescents’ perceived time spent on social media over a 2-year period. Adolescents (52% males, T1: M age = 12.19, SD = 0.52) and one of their parents (96% mothers, T1: M age = 45.26, SD = 4.28) complet...
Background
Evidence about empathy in people high in social anxiety has produced mixed outcomes. The current study aimed to compare cognitive and emotional forms of empathy among university women who were high or low in social anxiety.
Methods
Empathy was assessed using both self-report and a directly observable social interaction task. Sixty adult...
Negative correlations between religiosity or spirituality and depression symptoms have been frequently reported, but relatively few empirical studies have investigated the processes that mediate the relationships. This study investigated four theorized mediators in a single model to assess the unique contributions of self-esteem, social support, me...
Background
Social anxiety and depressive symptoms increase markedly during adolescence. Most research examining the emergence of these symptoms has used a variable-centered approach providing little information about how these symptoms group together in individuals over time.
Method
A person-centered approach utilizing latent profile and latent tr...
Although treatments for child and adolescent (hereafter, children) anxiety show good efficacy, a significant proportion of children do not remit, even 12 months after receiving treatment. Barriers to treatment responsiveness among chronically anxious children is not well studied. The current study evaluated barriers and predictors of poor treatment...
This feasibility study explored suitability of a preventive intervention for internalising problems in young children for culturally and linguistically diverse families in Australia. A subsample of 62 families whose main language at home was other than English was selected from a population-based randomised trial of the Cool Little Kids parenting p...
The efficacy of the Cool Kids program has been consistently demonstrated both within Australia and internationally, but limited data are available on the use of Cool Kids as a universal program. The purpose of the study is to evaluate Cool Kids as a universal program for preventing childhood anxiety in the school context. There were 73 Italian chil...
Initial research suggests stepped-care approaches to therapy for youth anxiety is associated with reduced therapy time with similar therapeutic outcomes to treatment-as-usual in real-world settings. Research on the acceptability and feasibility of stepped-care approaches in routine practice is very limited. In a secondary analysis of a pilot random...
Background
Parenting is a modifiable factor proposed to underpin the transmission of anxiety and depression from parents to children. This study examined the role of parenting in the intergenerational transmission of anxiety and depression across pre- and early adolescence.
Method
Participants were 531 youth (Mage = 11.18, SD = 0.56; 50.85% boys)...
PurposeThe importance of both frequent and high-quality social connections is widely recognised. Previous reviews of interventions for promoting social connections found mixed results due to the inclusion of uncontrolled studies and merging of objective and subjective dimensions of social connections. This study aimed to compare the effectiveness o...
Reliable, valid, and brief measures are important for identifying young people in community contexts who experience mental health problems. This paper reports the development and preliminary validation of the Brief Emotional Distress Scale for Youth (BEDSY), a measure based on anxiety and depression symptoms that load strongly upon the general cons...
Introduction
Emerging adulthood is a phase in life that is associated with an increased risk to develop a variety of mental health disorders including anxiety and depression. However, less than 25% of university students receive professional help for their mental health reports. Internet-based cognitive behavioural therapy (iCBT) may entail useful...
This study examined whether distorted cognition changes during cognitive behavioural therapy (CBT) in children (N = 61; aged 7–12) with social anxiety disorder (SAD) and whether changes in distorted cognition from pre- to post-treatment predict SAD at 6-month follow-up. Baseline distorted cognition was also examined as a predictor of post-treatment...
This study described the psychometric properties of a self-report measure of functional impairment related to anxiety and depression in adolescents, the Adolescent Life Interference Scale for Internalizing symptoms (ALIS-I). A clinical sample of 266 adolescents and a community sample of 63 adolescents, aged 11 to 18 years (Mean = 14.7, SD = 1.71) c...
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...
In light of concerning evidence that many young people with mental disorders are not receiving appropriate mental health intervention, school-based mental health screening has been advocated as one way to improve identification of at-risk youth. Despite having much promise, universal screening in schools remains a relatively uncommon practice inter...
Background
Anxiety disorders are the most prevalent mental disorder in children and young people. Developing effective therapy for these children is critical to reduce mental disorders across the lifespan. The study aimed to evaluate the efficacy of combining cognitive behavioural therapy (CBT) and sertraline (SERT) in the treatment of anxiety in y...
Shy/inhibited young children are at risk for internalising difficulties; however, for many, this temperamental style does not result in mental health problems. This study followed a population-based sample of temperamentally inhibited preschool children into mid childhood to explore the aetiology of clinical-level anxious and depressive problems. A...
Methods to deliver empirically validated treatments for anxious youth that require fewer therapist resources (low intensity) are beginning to emerge. However, the relative efficacy of low-intensity treatment for youth anxiety against standard face-to-face delivery has not been comprehensively evaluated. Young people aged 6–16 years with a primary a...
Cognitive models have consistently recognised pre-event and post-event rumination as maintaining factors in Social Anxiety Disorder (SAD). This study aimed to investigate the psychometric properties of a state-based measure of pre-event and post-event rumination in SAD: The Socially Anxious Rumination Questionnaire (SARQ), which was formerly known...
Many young people with mental disorders are not identified until some years after the first onset of symptoms and then frequently do not receive professional intervention. One promising strategy to better identify these young people is mental health screening in schools. Despite a growing literature on the benefits of school-based screening, it rem...
High anxiety and anxiety disorders are among the most prevalent mental health problems in children and lead to significant interference with children’s daily functioning. Most empirical evaluations of treatment come from English-language countries. The aim of the present study was to evaluate and replicate the effectiveness of a cognitive-behaviora...
Much of the literature investigating the association between coping and psychopathology is cross-sectional, or associations have been investigated in a unidirectional manner; hence, bidirectionality between coping and psychopathology remains largely untested. To address this gap, this study investigated bidirectional relations between coping and ps...
Objective
A bi-directional relationship between technology use and adolescent sleep is likely, yet findings are mixed, and it is not known whether parental control of technology use can protect sleep. The current study examined bi-directionality between technology use on school nights and morning/eveningness, sleep duration and daytime sleepiness i...
The objectives of this study are to assess the association between childhood bullying and preference-based health-related quality of life (QoL) in Australian school children and their parents and estimate quality-adjusted life years (QALYs) associated with bullying chronicity. Children aged 8–10 years completed the child health utilities (CHU-9D),...
Background
Public health advocates have highlighted internalising problems as a
leading cause of global burden of disease. Internalising problems (anxiety/depression)
affect up to 20 percent of school age children and can impact peer relations, school
engagement and later employment and mortality. This translational trial aimed to
determine whethe...
This pilot study aimed to explore the suitability of a preventative intervention for internalising problems in young children with chronic physical health conditions. The pilot study focused on a subsample of 27 children with chronic physical health conditions within a population-level randomised controlled trial of the Cool Little Kids parenting p...
This study developed an online diagnostic tool for anxiety disorders in youth, and evaluated its reliability and validity amongst 297 children aged 6–16 years (Mage = 9.34, 46% male). Parents completed the online tool, the Youth Online Diagnostic Assessment (YODA), which is scored either using a fully-automated algorithm, or combined with clinician...
Comorbid social anxiety and alcohol use disorders (SAD-AUD) in the community and the complex interactions that occur between these disorders have emerged as a significant clinical, public health, and research issue. The authors examined (a) the rates of comorbid SAD-AUD, (b) the impact of comorbid SAD-AUD on outcomes targeting social anxiety disord...
There is limited knowledge about sleep in adolescents with elevated levels of anxiety treated within primary health care settings, potentially resulting in sleep problems not being sufficiently addressed by primary health care workers. In the current study self-reported anxiety, insomnia, sleep onset latency, sleep duration, and depressive symptoms...
Background
With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system.
Design
A multisite pragmatic randomised controlled trial evaluating the clinical a...
Much of the knowledge about the relationships among domains of psychopathology is built on the diagnostic categories described in the Diagnostic and Statistical Manual of Mental Disorders ( DSM), and relatively little research has examined the symptom-level structure of psychopathology. The aim of this study was to delineate a detailed hierarchical...
This research examined the bidirectional effects between internalizing problems and peer victimization within a meta-analytic framework. The study also investigated several potential moderators of these effects, which have not been examined previously in related meta-analytic studies
Social anxiety is one of the most common mental health problems worldwide; however , the prevalence of social anxiety symptoms differs between collectivistic and individualistic cultures. These differences may have important implications for guiding cognitive-behavioral treatment. The purpose of this study was to determine whether differences in th...
The current research examined the bidirectional effects between internalizing problems and peer victimization within a meta-analytic framework. The study also investigated several potential moderators of these effects, which have not been examined previously in related meta-analytic studies. Only longitudinal studies examining the association betwe...
The restrictions put in place to contain the COVID-19 virus have led to widespread social isolation, impacting mental health worldwide. These restrictions may be particularly difficult for adolescents, who rely heavily on their peer connections for emotional support. However, there has been no longitudinal research examining the psychological impac...
Background:
Despite considerable evidence on parenting risk and protective factors for child anxiety and depressive disorders, the development of interventions based on this evidence is still lagging behind. To address this gap, the web-based Parenting Resilient Kids (PaRK) program was developed to target these risk and protective factors. This st...
Background
Poor mental health literacy and greater alignment with norms of hegemonic masculinity are established barriers to mental health help-seeking in men. However, little is known about how these variables influence adolescent male help-seeking and in particular, help-seeking for anxiety disorders. This study investigated the relationship betw...
Intolerance of uncertainty is a psychological vulnerability implicated in the development and maintenance of generalized anxiety disorder (GAD). The Intolerance of Uncertainty Scale-12 (IUS-12) is a widely used measure, however no studies have thoroughly tested the psychometric properties in a clinically diagnosed GAD sample. This study aimed to ev...
Background
Evidence suggests that adolescents with comorbid anxiety and depression are a high-risk group in terms of symptom severity, life quality and prognosis, with unique treatment needs compared to their peers who meet criteria for a single diagnosis. The current study evaluated the efficacy of a transdiagnostic treatment designed specifically...
Background:
Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior...
Objective:
Alcohol use disorder and social anxiety disorder are interconnected disorders that commonly co-occur. We report the first trial to assess whether integrated treatment for social anxiety and alcohol use disorder comorbidity improves outcomes relative to standard alcohol-focussed treatment.
Method:
Participants were recruited to a rando...
Background:
The aim was to determine outcomes in the first year of school of a population-delivered parenting program to prevent internalising problems in temperamentally inhibited preschool children and predictors of engagement in parenting groups.
Method:
Design: Randomised controlled trial.
Setting:
307 preschool services across eight socio...
Consistent associations have been shown between self-reported peer victimisation and internalising symptoms. In distinct literature, anxious and depressed youth have been shown to interpret ambiguous social stimuli in a manner consistent with social threat and rejection. The aim of the current study was to determine whether this sensitivity to soci...
Background:
Anxiety disorders in children and young people are common and bring significant personal and societal costs. Over the last two decades, there has been a substantial increase in research evaluating psychological and pharmacological treatments for anxiety disorders in children and young people and exciting and novel research has continue...
The integrated aetiological and maintenance (IAM) model of social anxiety disorder (SAD) conceptualises four social-evaluative cognitive processes (anticipatory processing, attention to the self, attention to threat in the environment, and post-event processing) as facets of a social-evaluative threat detection construct. The current study tested t...
A growing body of evidence points to a strong overlap between selective mutism (SM) and social anxiety disorder in children, specifically with regard to characteristics such as social reticence and anxiety. Yet few studies have directly compared these populations, especially with young children. This study compared 25 children (aged 3–7 years) with...
The purpose of this paper is to determine how youth with anxiety recruited for a school-based randomized controlled trial (RCT) compare demographically and clinically to clinically referred youth with anxiety who participated in an RCT conducted in community mental health clinics. Youth (N = 99) with anxiety aged 12–15 years were: (a) 37 youth (M a...
Background:
This study explored whether temperamentally inhibited children who experience early trauma are vulnerable to developing internalizing problems in the face of later life-stressors.
Methods:
A validated screen for temperamental inhibition was distributed to parents of young children attending preschools in six government regions of Mel...
Cognitive Behavioural Therapy (CBT) programs adapted to children with Autism Spectrum Disorder (ASD) effectively reduce anxiety when run in university clinics. Forty-nine children aged 8–14 years participated in a waitlist controlled study in a general child psychiatric hospital setting. Post-treatment 30% of the children were free of their primary...
Social anxiety is a common mental disorder with an average age of onset in early adolescence. Current theories focus largely on risk factors that are present from early in life, but reasons for onset of the disorder as youth move into adolescence are rarely discussed. We recently proposed a model of the onset of certain mental disorders during the...
Objective:
A translational trial evaluated the effectiveness of screening for inhibited childhood temperament, followed by a preventive parenting program -Cool Little Kids. This study determined the cost-effectiveness from societal and health sector perspectives using trial data.
Method:
Resources to deliver the screening and parenting sessions...
Experiences of peer victimization are common in adolescence and have been associated with a broad variety of psychopathology in adolescence. The present study aimed to test whether some types of victimization are more harmful than others; whether the harms associated with different types of peer victimization are specific to particular domains of p...