Leiden University Institute of Psychology, the Netherlands.
Behav Cogn Psychother. 2013 Oct;41(5):549-64. doi: 10.1017/S1352465812000756. Epub 2012 Sep 28.
Cognitive-behavioural therapy (CBT) has proven to be effective for anxiety-based school refusal, but it is still unknown how CBT for school refusal works, or through which mechanisms.
Innovative statistical approaches for analyzing small uncontrolled samples were used to investigate the role of self-efficacy in mediating CBT outcomes for anxiety-based school refusal.
Participants were 19 adolescents (12 to 17 years) who completed a manual-based cognitive-behavioural treatment. Primary outcomes (school attendance; school-related fear; anxiety) and secondary outcomes (depression; internalizing problems) were assessed at post-treatment and 2-month follow-up.
Post-treatment increases in school attendance and decreases in fear about attending school the next day were found to be mediated by self-efficacy. Mediating effects were not observed at 2-month follow-up.
These findings provide partial support for the role of self-efficacy in mediating the outcome of CBT for school refusal. They contribute to a small body of literature suggesting that cognitive change enhances CBT outcomes for young people with internalizing problems. Regarding methodology, the product of coefficient test appears to be a valuable way to study mediation in outcome studies involving small samples.
认知行为疗法（CBT）已被证明对基于焦虑的学校拒绝有效，但尚不清楚 CBT 如何治疗学校拒绝，或者通过哪些机制。
创新性的统计方法用于分析小样本的无对照研究，以调查自我效能感在介导基于焦虑的学校拒绝的 CBT 结果中的作用。
参与者为 19 名青少年（12 至 17 岁），他们完成了基于手册的认知行为治疗。主要结果（上学出勤率；与学校相关的恐惧；焦虑）和次要结果（抑郁；内化问题）在治疗后和 2 个月随访时进行评估。
发现治疗后上学出勤率的增加和对第二天上学的恐惧的减少是通过自我效能感介导的。在 2 个月随访时没有观察到中介效应。
这些发现部分支持自我效能感在介导学校拒绝的 CBT 结果中的作用。它们为一小部分文献提供了支持，这些文献表明认知改变增强了对有内化问题的年轻人的 CBT 结果。关于方法，系数检验的乘积似乎是研究涉及小样本的结果研究中中介作用的一种有价值的方法。
