Chu Brian C, Colognori Daniela B, Yang Guang, Xie Min-ge, Lindsey Bergman R, Piacentini John
Rutgers, The State University of New Jersey.
Kean University.
Behav Ther. 2015 May;46(3):395-408. doi: 10.1016/j.beth.2015.01.003. Epub 2015 Feb 8.
Behavioral engagement and cognitive coping have been hypothesized to mediate effectiveness of exposure-based therapies. Identifying which specific child factors mediate successful therapy and which therapist factors facilitate change can help make our evidence-based treatments more efficient and robust. The current study examines the specificity and temporal sequence of relations among hypothesized client and therapist mediators in exposure therapy for pediatric Obsessive Compulsive Disorder (OCD).
Youth coping (cognitive, behavioral), youth safety behaviors (avoidance, escape, compulsive behaviors), therapist interventions (cognitive, exposure extensiveness), and youth anxiety were rated via observational ratings of therapy sessions of OCD youth (N=43; ages=8 - 17; 62.8% male) who had received Exposure and Response Prevention (ERP). Regression analysis using Generalized Estimation Equations and cross-lagged panel analysis (CLPA) were conducted to model anxiety change within and across sessions, to determine formal mediators of anxiety change, and to establish sequence of effects.
Anxiety ratings decreased linearly across exposures within sessions. Youth coping and therapist interventions significantly mediated anxiety change across exposures, and youth-interfering behavior mediated anxiety change at the trend level. In CLPA, youth-interfering behaviors predicted, and were predicted by, changes in anxiety. Youth coping was predicted by prior anxiety change.
The study provides a preliminary examination of specificity and temporal sequence among child and therapist behaviors in predicting youth anxiety. Results suggest that therapists should educate clients in the natural rebound effects of anxiety between sessions and should be aware of the negatively reinforcing properties of avoidance during exposure.
行为参与和认知应对被假定为基于暴露疗法有效性的中介因素。确定哪些特定的儿童因素介导成功的治疗，以及哪些治疗师因素促进改变，有助于使我们基于证据的治疗更有效且更稳健。本研究考察了儿童强迫症（OCD）暴露疗法中假定的来访者和治疗师中介因素之间关系的特异性和时间顺序。
通过对接受暴露与反应阻止法（ERP）治疗的OCD青少年（N = 43；年龄 = 8 - 17岁；62.8%为男性）治疗 session 的观察评分，对青少年应对方式（认知、行为）、青少年安全行为（回避、逃避、强迫行为）、治疗师干预措施（认知、暴露广度）和青少年焦虑进行评分。使用广义估计方程进行回归分析和交叉滞后面板分析（CLPA），以模拟 session 内和 session 间的焦虑变化，确定焦虑变化的正式中介因素，并建立效应顺序。
session 内焦虑评分在暴露过程中呈线性下降。青少年应对方式和治疗师干预措施显著介导了暴露过程中的焦虑变化，青少年干扰行为在趋势水平上介导了焦虑变化。在 CLPA 中，青少年干扰行为预测了焦虑变化，同时也被焦虑变化所预测。青少年应对方式由先前的焦虑变化所预测。
本研究对预测青少年焦虑的儿童和治疗师行为之间的特异性和时间顺序进行了初步考察。结果表明，治疗师应向来访者说明 session 间焦虑的自然反弹效应，并应意识到暴露期间回避行为的负强化特性。
