a Department of Psychology , University of California , Los Angeles.
J Clin Child Adolesc Psychol. 2019;48(sup1):S269-S283. doi: 10.1080/15374416.2018.1443459. Epub 2018 Apr 20.
Our aim was to investigate whether four treatment features (i.e., the inclusion of parental involvement, goal-setting strategies, maintenance/relapse prevention sessions, the addition of booster sessions) were associated with posttreatment and follow-up effect size of youth cognitive behavioral therapies (yCBTs) for anxiety, depression, posttraumatic stress disorder, and obsessive-compulsive disorder in age groups spanning young children to adolescents. We conducted a random-effects meta-analysis of 106 yCBTs tested in 76 randomized clinical trials from the PracticeWise Database to examine average effects of yCBTs posttreatment and at a later follow-up assessment. We coded the use of parental involvement, goal setting, booster sessions, and maintenance/relapse prevention in each yCBT and conducted random-effects meta-regression analyses to investigate whether these treatment features were associated with yCBT effects at posttreatment as well as at follow-up. Overall, yCBTs produced large pre- to posttreatment effects (d = 1.05), 95% confidence interval [0.94, 1.15], and larger pre- to follow-up effects (d = 1.29), 95% confidence interval [1.18, 1.40]. Metaregression results indicated that parental involvement was significantly associated with larger pre- to posttreatment effect sizes as well as pre- to follow-up effect sizes. Booster sessions, goal setting, and maintenance/relapse prevention were not significantly related to effect sizes at posttreatment or follow-up. Parental involvement may be helpful for maximizing long-term effectiveness of yCBT. Future studies should investigate for whom and under what conditions inclusion of yCBT treatment features is related to the durability of treatment gains.
我们旨在探讨四项治疗特征（即纳入父母参与、设定目标策略、维持/复发预防课程、增加强化课程）是否与儿童认知行为疗法（yCBT）治疗焦虑、抑郁、创伤后应激障碍和强迫症的青少年群体在治疗后的和随访时的效果大小有关。我们对 PracticeWise 数据库中的 76 项随机临床试验中的 106 项 yCBT 进行了随机效应荟萃分析，以检查 yCBT 在治疗后和之后的随访评估中的平均效果。我们对每项 yCBT 中使用的父母参与、目标设定、强化课程和维持/复发预防进行了编码，并进行了随机效应荟萃回归分析，以调查这些治疗特征是否与 yCBT 在治疗后和随访时的效果有关。总体而言，yCBT 产生了从治疗前到治疗后的大效应（d=1.05），95%置信区间[0.94,1.15]，以及从治疗前到随访的更大效应（d=1.29），95%置信区间[1.18,1.40]。元回归结果表明，父母参与与从治疗前到治疗后的效果大小以及从治疗前到随访的效果大小显著相关。强化课程、目标设定和维持/复发预防与治疗后的效果大小或随访时的效果大小无显著相关性。父母参与可能有助于最大限度地提高 yCBT 的长期效果。未来的研究应该调查哪些情况下纳入 yCBT 治疗特征与治疗效果的持久性有关。
