Creswell Cathy, Hentges Francoise, Parkinson Monika, Sheffield Paul, Willetts Lucy, Cooper Peter
Clinical Research Fellow.
Ment Health Fam Med. 2010 Mar;7(1):49-57.
Anxiety disorders in childhood are common, disabling and run a chronic course. Cognitive behaviour therapy (CBT) is effective but expensive and trained therapists are scarce. Guided self-help treatments may be a means of widening access to treatment. This study aimed to examine the feasibility of guided CBT self-help in primary care for childhood anxiety disorders, specifically in terms of therapist adherence, patient and therapist satisfaction and clinical gain.Participants were children aged between five and 12 years referred to two primary child and adolescent mental health services (PCAMHSs) in Oxfordshire, UK, who met diagnostic criteria for a primary anxiety disorder. Of the 52 eligible children, 41 anxious children were assessed for anxiety severity and interference before and after receiving CBT self-help delivered via a parent (total therapy time = five hours) by primary mental health workers (PMHWs). Therapy sessions were rated for treatment adherence and parents and PMHWs completed satisfaction questionnaires after treatment completion. Over 80% of therapy sessions were rated at a high level of treatment adherence. Parents and PMHWs reported high satisfaction with the treatment. Sixty-one percent of the children assessed no longer met the criteria for their primary anxiety disorder diagnosis following treatment, and 76% were rated as 'much'/'very much' improved on the Clinical Global Impression-Improvement (CGI-I) scale. There were significant reductions on parent and child report measures of anxiety symptoms, interference and depression. Preliminary exploration indicated that parental anxiety was associated with child treatment outcome. The findings suggest that guided CBT self-help represents a promising treatment for childhood anxiety in primary care.
儿童焦虑症很常见，会导致功能障碍且病程呈慢性。认知行为疗法（CBT）有效但费用高昂，且训练有素的治疗师稀缺。引导式自助治疗可能是扩大治疗可及性的一种方式。本研究旨在检验在初级保健中针对儿童焦虑症进行引导式CBT自助治疗的可行性，具体涉及治疗师的依从性、患者及治疗师的满意度以及临床获益情况。研究参与者为年龄在5至12岁之间、被转介至英国牛津郡两家初级儿童及青少年心理健康服务机构（PCAMHSs）的儿童，他们符合原发性焦虑症的诊断标准。在52名符合条件的儿童中，41名焦虑儿童在接受由初级心理健康工作者（PMHWs）通过家长实施的CBT自助治疗（总治疗时长 = 5小时）前后，接受了焦虑严重程度和干扰情况的评估。对治疗课程进行治疗依从性评级，家长和PMHWs在治疗结束后完成满意度调查问卷。超过80%的治疗课程被评为具有高度的治疗依从性。家长和PMHWs对治疗表示高度满意。在接受评估的儿童中，61%在治疗后不再符合其原发性焦虑症诊断标准，76%在临床总体印象改善（CGI - I）量表上被评为“明显”/“非常明显”改善。家长和儿童报告的焦虑症状、干扰及抑郁指标均有显著下降。初步探索表明，家长的焦虑与儿童治疗结果相关。研究结果表明，引导式CBT自助治疗是初级保健中治疗儿童焦虑症的一种有前景的治疗方法。
