通过引导父母实施认知行为疗法治疗儿童焦虑障碍：随机对照试验。
Treatment of child anxiety disorders via guided parent-delivered cognitive-behavioural therapy: randomised controlled trial.
机构信息
Kerstin Thirlwall, DClinPsy, Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, UK; Peter J. Cooper, DPhil, Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, UK, and Stellenbosch University, Matieland, South Africa; Jessica Karalus, MSc, Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, UK; Merryn Voysey, MBiostat, Centre for Statistics in Medicine, University of Oxford, UK; Lucy Willetts, MSc, PhD, Cathy Creswell, DClinPsy, PhD, Winnicott Research Unit, School of Psychology and Clinical Language Sciences, University of Reading, UK.
出版信息
Br J Psychiatry. 2013 Dec;203(6):436-44. doi: 10.1192/bjp.bp.113.126698. Epub 2013 Aug 22.
BACKGROUND
Promising evidence has emerged of clinical gains using guided self-help cognitive-behavioural therapy (CBT) for child anxiety and by involving parents in treatment; however, the efficacy of guided parent-delivered CBT has not been systematically evaluated in UK primary and secondary settings.
AIMS
To evaluate the efficacy of low-intensity guided parent-delivered CBT treatments for children with anxiety disorders.
METHOD
A total of 194 children presenting with a current anxiety disorder, whose primary carer did not meet criteria for a current anxiety disorder, were randomly allocated to full guided parent-delivered CBT (four face-to-face and four telephone sessions) or brief guided parent-delivered CBT (two face-to-face and two telephone sessions), or a wait-list control group (trial registration: ISRCTN92977593). Presence and severity of child primary anxiety disorder (Anxiety Disorders Interview Schedule for DSM-IV, child/parent versions), improvement in child presentation of anxiety (Clinical Global Impression - Improvement scale), and change in child anxiety symptoms (Spence Children's Anxiety Scale, child/parent version and Child Anxiety Impact scale, parent version) were assessed at post-treatment and for those in the two active treatment groups, 6 months post-treatment.
RESULTS
Full guided parent-delivered CBT produced superior diagnostic outcomes compared with wait-list at post-treatment, whereas brief guided parent-delivered CBT did not: at post-treatment, 25 (50%) of those in the full guided CBT group had recovered from their primary diagnosis, compared with 16 (25%) of those on the wait-list (relative risk (RR) 1.85, 95% CI 1.14-2.99); and in the brief guided CBT group, 18 participants (39%) had recovered from their primary diagnosis post-treatment (RR = 1.56, 95% CI 0.89-2.74). Level of therapist training and experience was unrelated to child outcome.
CONCLUSIONS
Full guided parent-delivered CBT is an effective and inexpensive first-line treatment for child anxiety.
背景
使用指导自助认知行为疗法（CBT）治疗儿童焦虑症并让家长参与治疗已取得令人鼓舞的临床效果；然而，在英国小学和中学环境中，指导家长实施的 CBT 的疗效尚未得到系统评估。
目的
评估针对焦虑障碍儿童的低强度指导家长实施的 CBT 治疗的疗效。
方法
共有 194 名患有当前焦虑障碍的儿童及其主要照顾者未达到当前焦虑障碍标准的儿童参加了该研究，他们被随机分配到完全指导家长实施的 CBT（4 次面对面和 4 次电话治疗）或简短指导家长实施的 CBT（2 次面对面和 2 次电话治疗），或等待名单对照组（试验注册：ISRCTN92977593）。采用 DSM-IV 儿童/家长版焦虑障碍访谈表评估儿童主要焦虑障碍的存在和严重程度、儿童焦虑表现的改善（临床总体印象-改善量表），以及儿童焦虑症状的变化（儿童焦虑量表，儿童/家长版和儿童焦虑影响量表，家长版），分别在治疗后和两个活跃治疗组的 6 个月时进行评估。
结果
完全指导家长实施的 CBT 在治疗后与等待名单相比产生了更好的诊断结果，而简短指导家长实施的 CBT 则没有：在治疗后，完全指导 CBT 组有 25 名（50%）儿童从主要诊断中康复，而等待名单组只有 16 名（25%）儿童（相对风险（RR）1.85，95%CI 1.14-2.99）；在简短指导 CBT 组中，18 名参与者（39%）在治疗后从主要诊断中康复（RR=1.56，95%CI 0.89-2.74）。治疗师的培训水平和经验与儿童结果无关。
结论
完全指导家长实施的 CBT 是儿童焦虑的一种有效且经济实惠的一线治疗方法。
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