Peris Tara S, Compton Scott N, Kendall Philip C, Birmaher Boris, Sherrill Joel, March John, Gosch Elizabeth, Ginsburg Golda, Rynn Moira, McCracken James T, Keeton Courtney P, Sakolsky Dara, Suveg Cynthia, Aschenbrand Sasha, Almirall Daniel, Iyengar Satish, Walkup John T, Albano Anne Marie, Piacentini John
Semel Institute for Neuroscience and Human Behavior University of California, Los Angeles.
Department of Psychology and Behavioral Sciences, Duke University Medical Center.
J Consult Clin Psychol. 2015 Apr;83(2):239-52. doi: 10.1037/a0038402. Epub 2014 Dec 8.
To evaluate changes in the trajectory of youth anxiety following the introduction of specific cognitive-behavior therapy (CBT) components: relaxation training, cognitive restructuring, and exposure tasks.
Four hundred eighty-eight youths ages 7-17 years (50% female; 74% ≤ 12 years) were randomly assigned to receive either CBT, sertraline (SRT), their combination (COMB), or pill placebo (PBO) as part of their participation in the Child/Adolescent Anxiety Multimodal Study (CAMS). Youths in the CBT conditions were evaluated weekly by therapists using the Clinical Global Impression Scale-Severity (CGI-S; Guy, 1976) and the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983) and every 4 weeks by blind independent evaluators (IEs) using the Pediatric Anxiety Ratings Scale (PARS; RUPP Anxiety Study Group, 2002). Youths in SRT and PBO were included as controls.
Longitudinal discontinuity analyses indicated that the introduction of both cognitive restructuring (e.g., changing self-talk) and exposure tasks significantly accelerated the rate of progress on measures of symptom severity and global functioning moving forward in treatment; the introduction of relaxation training had limited impact. Counter to expectations, no strategy altered the rate of progress in the specific domain of anxiety that it was intended to target (i.e., somatic symptoms, anxious self-talk, avoidance behavior).
Findings support CBT theory and suggest that cognitive restructuring and exposure tasks each make substantial contributions to improvement in youth anxiety. Implications for future research are discussed. (PsycINFO Database Record
评估引入特定认知行为疗法（CBT）组成部分（放松训练、认知重构和暴露任务）后青少年焦虑轨迹的变化。
488名7至17岁的青少年（50%为女性；74%≤12岁）被随机分配接受CBT、舍曲林（SRT）、二者联合治疗（COMB）或丸剂安慰剂（PBO），作为他们参与儿童/青少年焦虑多模式研究（CAMS）的一部分。接受CBT治疗的青少年由治疗师每周使用临床总体印象量表-严重程度（CGI-S；盖伊，1976年）和儿童总体评估量表（CGAS；沙弗等人，1983年）进行评估，由盲法独立评估者（IEs）每4周使用儿童焦虑评定量表（PARS；RUPP焦虑研究组，2002年）进行评估。SRT组和PBO组的青少年作为对照组。
纵向间断分析表明，认知重构（如改变自我对话）和暴露任务的引入显著加快了治疗中症状严重程度和整体功能测量指标的进展速度；放松训练的引入影响有限。与预期相反，没有任何策略改变其旨在针对的焦虑特定领域（即躯体症状、焦虑的自我对话、回避行为）的进展速度。
研究结果支持CBT理论，并表明认知重构和暴露任务各自对青少年焦虑的改善做出了重大贡献。讨论了对未来研究的启示。（PsycINFO数据库记录）
