Department of Child and Adolescent Psychiatry, NYU Child Study Center, New York, New York 10016, USA.
Depress Anxiety. 2011 Jul;28(7):551-9. doi: 10.1002/da.20821. Epub 2011 Jun 16.
Children and adolescents who seek medical treatment for persistent physical distress often suffer from co-occurring anxiety disorders. Treatment options for this impaired population are limited. This study tests the feasibility and potential efficacy of a cognitive-behavioral intervention targeting pain and anxiety for youth with impairing functional physical symptoms and anxiety disorders presenting to pediatricians for medical care.
Children and adolescents (aged 8-16) experiencing somatic complaints, without an explanatory medical disorder (i.e., functional), were recruited from primary care and specialty (gastroenterologists and cardiologists) pediatricians. Forty children, primarily with gastrointestinal symptoms, who met criteria for a co-occurring anxiety disorder, were randomly assigned to a cognitive-behavioral treatment addressing pain and anxiety, Treatment of Anxiety and Physical Symptoms (TAPS), or to a waiting list control.
TAPS was found to be an acceptable treatment for this population and was superior to the waiting list condition. Eighty percent of children in TAPS were rated as treatment responders by independent evaluators compared with none of the controls. Overall, self- and parent ratings indicated reductions in children's somatic discomfort and anxiety following intervention. TAPS participants maintained clinical gains 3 months following treatment.
The study supports the feasibility and preliminary efficacy of a cognitive-behavioral intervention targeting co-occurring physical distress and anxiety in youth presenting for medical treatment. Such an approach has the potential to exert broad impact on children's dysfunction and to minimize exposure to invasive, ineffective, and costly medical procedures and treatments.
因持续性躯体不适而寻求医疗救治的儿童和青少年常共患焦虑障碍。针对该受损人群的治疗选择有限。本研究检验了一种针对疼痛和焦虑的认知行为干预措施，对因功能障碍性躯体症状和焦虑障碍而就诊于儿科医生接受医疗护理的青少年的可行性和潜在疗效。
从初级保健和专科（胃肠病学家和心脏病学家）儿科医生处招募了经历躯体抱怨但无解释性医学疾病（即功能性）的儿童和青少年。40 名主要有胃肠道症状且符合共患焦虑障碍标准的儿童被随机分配到针对疼痛和焦虑的认知行为治疗（TAPS）或等候名单对照中。
TAPS 被发现是该人群可接受的治疗方法，优于等候名单条件。80%的 TAPS 儿童被独立评估者评为治疗反应者，而对照组无一例。总体而言，自我和家长评估表明，干预后儿童的躯体不适和焦虑有所减轻。TAPS 参与者在治疗后 3 个月仍保持临床获益。
该研究支持针对因躯体不适和焦虑共患而就诊于医疗护理的青少年的认知行为干预措施的可行性和初步疗效。这种方法有可能对儿童的功能障碍产生广泛影响，并最大限度地减少对侵入性、无效和昂贵的医疗程序和治疗的暴露。
