Chavira Denise A, Drahota Amy, Garland Ann F, Roesch Scott, Garcia Maritza, Stein Murray B
University of California Los Angeles, Department of Psychology, Los Angeles, CA, USA; University of California San Diego, Department of Psychiatry, La Jolla, CA, USA.
San Diego State University, Department of Psychology, San Diego, CA, USA.
Behav Res Ther. 2014 Sep;60:60-6. doi: 10.1016/j.brat.2014.06.010. Epub 2014 Jul 11.
In this study, we examine the feasibility of cognitive behavior therapy (CBT) for children with anxiety in primary care, using two modes of treatment delivery. A total of 48 parents and youth (8-13) with anxiety disorders were randomly assigned to receive 10-sessions of CBT either delivered by a child anxiety specialist in the primary care clinic or implemented by the parent with therapist support by telephone (i.e., face-to-face or therapist-supported bibliotherapy). Feasibility outcomes including satisfaction, barriers to treatment participation, safety, and dropout were assessed. Independent evaluators, blind to treatment condition, administered the Anxiety Disorders Interview Schedule for Children (ADIS) and the Clinical Global Impression of Improvement (CGI-I) at baseline, post-treatment and 3-month follow-up; clinical self-report questionnaires were also administered. Findings revealed high satisfaction, low endorsement of barriers, low drop out rates, and no adverse events across the two modalities. According to the CGI-I, 58.3%-75% of participants were considered responders (i.e., much or very much improved) at the various time points. Similar patterns were found for remission from "primary anxiety disorder" and "all anxiety disorders" as defined by the ADIS. Clinically significant improvement was seen on the various parent and child self-report measures of anxiety. Findings suggest that both therapy modalities are feasible and associated with significant treatment gains in the primary care setting. (clinicaltrials.gov unique identifier: NCT00769925).
在本研究中，我们采用两种治疗方式，检验了在初级保健中对患有焦虑症的儿童进行认知行为疗法（CBT）的可行性。共有48名患有焦虑症的父母及青少年（8 - 13岁）被随机分配，接受由初级保健诊所的儿童焦虑症专家提供的10节CBT课程，或由家长在治疗师通过电话提供支持的情况下实施（即面对面治疗或治疗师支持的自助疗法）。评估了包括满意度、治疗参与障碍、安全性和退出率在内的可行性结果。对治疗情况不知情的独立评估人员在基线、治疗后和3个月随访时，使用儿童焦虑症访谈量表（ADIS）和临床总体改善印象量表（CGI - I）进行评估；还发放了临床自我报告问卷。结果显示，两种治疗方式的满意度都很高，对障碍的认可程度低，退出率低，且无不良事件。根据CGI - I，在各个时间点，58.3% - 75%的参与者被视为有反应者（即有很大改善或非常大的改善）。在ADIS所定义的“原发性焦虑症”和“所有焦虑症”的缓解方面，也发现了类似模式。在各种父母和儿童焦虑症自我报告测量中都观察到了具有临床意义的改善。研究结果表明，两种治疗方式在初级保健环境中都是可行的，并且与显著的治疗效果相关。（clinicaltrials.gov唯一标识符：NCT00769925）
