Brown Alexandra, Creswell Cathy, Barker Chris, Butler Stephen, Cooper Peter, Hobbs Catherine, Thirlwall Kerstin
University College London, UK.
University of Reading, UK.
Br J Clin Psychol. 2017 Jun;56(2):149-159. doi: 10.1111/bjc.12127. Epub 2017 Jan 9.
Brief guided parent-delivered cognitive behaviour therapy (CBT) has been developed to meet the demand for non-intensive interventions for children with anxiety disorders, and initial trials have shown it to be effective for children with a range of anxiety disorders. This study examined outcomes 3-5 years post-treatment.
A long-term follow-up (LTFU) cohort study.
Families who (1) completed at least 50% of allocated treatment sessions of guided parent-delivered CBT for childhood anxiety as part of a randomized control trial (RCT), (2) provided consent to be recontacted, (3) had not received further mental health interventions, and (4) were contactable were invited to take part. Fifty-seven families (29% of the original sample) completed structured diagnostic interviews on average 50 months after treatment (39-61 months).
At LTFU, 79% of the assessed children who had received the treatment no longer met criteria for their primary diagnosis, 63% did not meet criteria for any anxiety disorder, and 61% did not meet criteria for any DSM-IV disorder. Treatment gains were mostly maintained (60%), and some children went on to recover during the follow-up period without additional input from mental health services (19%). Few young people had relapsed since their last assessment (12%). Mean scores on standardized symptom questionnaires were within the normal range.
Children who recovered from anxiety disorders following brief guided parent-delivered CBT typically maintained good outcomes and few relapsed. These findings suggest that this is a viable first-line, low-intensity treatment approach. This study only included a small subsample of those in the original RCT (29%), and more information is required about those who dropped out of treatment and those who required further intervention immediately after treatment.
Treatment gains from brief guided parent-delivered cognitive behaviour therapy for children with anxiety are maintained for most children 3-5 years later. The majority of children who completed at least 50% of the intervention required no further mental health intervention in that time. Some children make continued improvement after completing the intervention. Data are based on a sample of families from southern England where the primary caregiving parent was free of mental health difficulties. Further research is needed to explore the mental health needs of those who do not benefit from this intervention.
简短的由家长指导实施的认知行为疗法（CBT）已被开发出来，以满足对焦虑症儿童进行非强化干预的需求，初步试验表明该疗法对一系列焦虑症儿童有效。本研究考察了治疗后3至5年的结果。
一项长期随访（LTFU）队列研究。
邀请了符合以下条件的家庭参与：（1）作为随机对照试验（RCT）的一部分，完成了至少50%分配的针对儿童焦虑症的家长指导实施的CBT治疗疗程；（2）同意被再次联系；（3）未接受过进一步的心理健康干预；（4）能够联系上。57个家庭（占原始样本的29%）在治疗后平均50个月（39至61个月）完成了结构化诊断访谈。
在长期随访时，接受治疗的被评估儿童中，79%不再符合其主要诊断标准，63%不符合任何焦虑症标准，61%不符合任何《精神疾病诊断与统计手册》第四版（DSM-IV）疾病标准。治疗效果大多得以维持（60%），一些儿童在随访期间无需心理健康服务的额外干预就康复了（19%）。自上次评估以来，很少有年轻人复发（12%）。标准化症状问卷的平均得分在正常范围内。
通过简短的家长指导实施的CBT从焦虑症中康复的儿童通常能维持良好的结果，很少复发。这些发现表明这是一种可行的一线低强度治疗方法。本研究仅纳入了原始RCT中一小部分样本（29%），对于那些退出治疗的儿童以及治疗后立即需要进一步干预的儿童，还需要更多信息。
对于焦虑症儿童，由家长指导实施的简短认知行为疗法所取得的治疗效果在3至5年后对大多数儿童得以维持。在那段时间里，完成至少50%干预的大多数儿童无需进一步的心理健康干预。一些儿童在完成干预后持续改善。数据基于英格兰南部的一个家庭样本，其中主要照顾家长没有心理健康问题。需要进一步研究以探索那些未从该干预中受益的人的心理健康需求。
