Silverman Wendy K, Pina Armando A, Viswesvaran Chockalingam
Child and Family Psychosocial Research Center, Child Anxiety and Phobia Program, Department of Psychology, University Park, Florida International University, Miami, FL 33199, USA.
J Clin Child Adolesc Psychol. 2008 Jan;37(1):105-30. doi: 10.1080/15374410701817907.
The article reviews psychosocial treatments for phobic and anxiety disorders in youth. Using criteria from Nathan and Gorman (2002), 32 studies are evaluated along a continuum of methodological rigor. In addition, the treatments evaluated in each of the 32 studies are classified according to Chambless et al.'s (1996) and Chambless and Hollon's (1998) criteria. Findings from a series of meta-analyses of the studies that used waitlists also are reported. In accordance with Nathan and Gorman, the majority of the studies were either methodologically robust or fairly rigorous. In accordance with Chambless and colleagues, although no treatment was well-established, Individual Cognitive Behavior Therapy, Group Cognitive Behavior Therapy (GCBT), GCBT with Parents, GCBT for social phobia (SOP), and Social Effectiveness Training for children with SOP each met criteria for probably efficacious. The other treatments were either possibly efficacious or experimental. Meta-analytic results revealed no significant differences between individual and group treatments on diagnostic recovery rates and anxiety symptom reductions, as well as other youth symptoms (i.e., fear, depression, internalizing and externalizing problems). Parental involvement was similarly efficacious as parental noninvolvement in individual and group treatment formats. The article also provides a summary of the studies that have investigated mediators, moderators, and predictors of treatment outcome. The article concludes with a discussion of the clinical representativeness and generalizability of treatments, practice guidelines, and future research directions.
本文综述了针对青少年恐惧症和焦虑症的心理社会治疗方法。根据内森和戈尔曼(2002年)的标准,对32项研究在方法严谨性的连续统一体上进行了评估。此外,根据钱布利斯等人(1996年)以及钱布利斯和霍伦(1998年)的标准,对这32项研究中评估的每种治疗方法进行了分类。还报告了对使用等待名单的研究进行的一系列荟萃分析的结果。按照内森和戈尔曼的标准,大多数研究在方法上要么稳健,要么相当严谨。按照钱布利斯及其同事的标准,虽然没有一种治疗方法被充分确立,但个体认知行为疗法、团体认知行为疗法(GCBT)、有家长参与的GCBT、针对社交恐惧症(SOP)的GCBT以及针对患有SOP的儿童的社会效能训练均符合可能有效的标准。其他治疗方法要么可能有效,要么属于实验性的。荟萃分析结果显示,在诊断康复率、焦虑症状减轻以及其他青少年症状(即恐惧、抑郁、内化和外化问题)方面,个体治疗和团体治疗之间没有显著差异。在个体和团体治疗形式中,家长参与与家长不参与的效果相似。本文还总结了那些调查治疗结果的中介因素、调节因素和预测因素的研究。文章最后讨论了治疗方法的临床代表性和可推广性、实践指南以及未来的研究方向。