Massachusetts General Hospital, 185 Alewife Brook Parkway, Cambridge, MA 02138, USA.
J Consult Clin Psychol. 2010 Aug;78(4):498-510. doi: 10.1037/a0019055.
To examine the efficacy of a developmentally appropriate parent-child cognitive behavioral therapy (CBT) protocol for anxiety disorders in children ages 4-7 years.
Randomized wait-list controlled trial. Conduct: Sixty-four children (53% female, mean age 5.4 years, 80% European American) with anxiety disorders were randomized to a parent-child CBT intervention (n = 34) or a 6-month wait-list condition (n = 30). Children were assessed by interviewers blind to treatment assignment, using structured diagnostic interviews with parents, laboratory assessments of behavioral inhibition, and parent questionnaires.
Chi-square analyses of outcome rates and linear and ordinal regression of repeated measures, examining time by intervention interactions.
The response rate (much or very much improved on the Clinical Global Impression Scale for Anxiety) among 57 completers was 69% versus 32% (CBT vs. controls), p < .01; intent-to-treat: 59% vs. 30%, p = .016. Treated children showed a significantly greater decrease in anxiety disorders (effect size [ES] = .55) and increase in parent-rated coping (ES = .69) than controls, as well as significantly better CGI improvement on social phobia/avoidant disorder (ES = .95), separation anxiety disorder (ES = .82), and specific phobia (ES = .78), but not on generalized anxiety disorder. Results on the Child Behavior Checklist Internalizing scale were not significant and were limited by low return rates. Treatment response was unrelated to age or parental anxiety but was negatively predicted by behavioral inhibition. Gains were maintained at 1-year follow-up.
Results suggest that developmentally modified parent-child CBT may show promise in 4- to 7-year-old children.
研究适用于 4-7 岁儿童焦虑障碍的发展适当的亲子认知行为疗法 (CBT) 方案的疗效。
随机等待名单对照试验。实施：64 名患有焦虑障碍的儿童（53%为女性，平均年龄为 5.4 岁，80%为欧洲裔美国人）被随机分配至亲子 CBT 干预组（n = 34）或 6 个月的等待名单组（n = 30）。通过访谈员对治疗分配进行盲法评估，使用父母的结构化诊断访谈、行为抑制的实验室评估和父母问卷进行评估。
采用卡方检验分析结局率和重复测量的线性和有序回归，检查时间与干预的交互作用。
57 名完成者的反应率（临床总体印象严重度量表-焦虑分量表上的明显或非常明显改善）为 69%，而对照组为 32%（CBT 与对照组相比，p <.01；意向治疗：59%比 30%，p =.016）。治疗组的焦虑障碍显著减轻（效应量[ES] =.55），父母评定的应对能力显著提高（ES =.69），而对照组则显著改善了临床总体印象严重度量表-社交恐惧症/回避障碍（ES =.95）、分离焦虑障碍（ES =.82）和特定恐惧症（ES =.78），但对广泛性焦虑障碍则无显著改善。儿童行为检查表内部化量表的结果不显著，且受到低回报率的限制。治疗反应与年龄或父母焦虑无关，但与行为抑制呈负相关。在 1 年随访时仍保持疗效。
结果表明，针对儿童发展的亲子 CBT 可能在 4-7 岁儿童中具有潜力。
