Reivich, et al., 1995). Clarke’s program included both the risk factor of depressogenic cognitive style and the presence of parental depression.
A high level of depressive symptoms is an important risk factor for the onset of the disorder. In addition, depression is a recurrent disorder, with more than half of those who experience an initial episode experiencing a recurrence. Indicated prevention programs for those with symptoms or a history of depression have focused on changing processes thought to be related to the development of depression, such as depressogenic cognitive styles, explanatory style, interpersonal problem solving, and optimistic thinking (see Garber, 2006, for a review).
Anxiety tends to begin at an early age and to be chronic (McClure and Pine, 2006; Silverman and Pina, 2008). In the Great Smoky Mountains Study, for example, the mean age of onset was about 7 years old for specific phobias, separation anxiety, and social phobia and about 10 years old for agoraphobia, panic, and obsessive-compulsive disorder (Costello, Egger, and Angold, 2004). Research to identify specific protective, risk, or maintaining factors has been limited (e.g., Craske and Zucker, 2001; Donovan and Spence, 2000; Hudson, Flannery-Schroeder, and Kendall, 2004; Shanahan, Copeland, et al., 2008). The factors identified are generally related to the individual, the family, or school and peers.
Although most of the factors associated with anxiety are implicated in other MEB disorders as well, some are more specific. A child’s temperament, specifically behavioral inhibition (characterized by irritability in infancy, fearfulness in toddlerhood, and shyness in childhood), has been found to be associated with an increased vulnerability to anxiety disorders (e.g., Biederman, Rosenbaum, et al., 1993). Similarly, anxiety sensitivity (a predisposition to fear anxiety-related sensations arising from the belief that these sensations are signs of physical, psychological, or social harm; Reiss, 1991; Reiss and McNally, 1985) also appears to be a specific risk factor for anxious symptoms (e.g., Reiss, Silverman, and Weems, 2001).
In the family, parents with anxiety disorders are more likely to have children who are at increased risk for anxiety disorders than their non-anxious counterparts (e.g., Rosenbaum, Biederman, et al., 1993). It also appears that anxious children are more likely than their nonanxious counterparts to have anxious parents (e.g., Last, Hersen, et al., 1987; Turner, Beidel, and Costello, 1987). Some of this association is likely to be due to shared genes or inheritable temperamental styles (e.g., behavioral inhibition). Children also learn anxious reactions via parental modeling and reinforcement of anxious behaviors (e.g., Barrett, Dadds, and Rapee, 1996; Rapee, 2002). Parents of anxious children are typically more controlling