Department of Child and Adolescent Psychiatry and Psychotherapy, School of Child and Adolescent Cognitive Behavior Therapy, University Hospital Cologne, Pohligstraße 9, 50969, Cologne, Germany.
Institute of Child and Adolescent Psychotherapy of the Christoph-Dornier-Foundation for Clinical Psychology, University of Cologne, Cologne, Germany.
Eur Child Adolesc Psychiatry. 2018 Sep;27(9):1181-1192. doi: 10.1007/s00787-018-1181-5. Epub 2018 Jun 13.
Previous research has shown that child-oppositional defiant disorder (ODD) and conduct disorders (CD) are associated with parental symptoms of depression, anxiety and/or stress, probably in a bidirectional relationship with mutual influences. It is, therefore, reasonable to assume that in child-centered treatment, a decrease in child-oppositional behavior problems constitutes (at least in part) a mechanism of change for a subsequent reduction in parental psychopathology. The aim of the present study (Clinical trials.gov Identifier: NCT01406067) was to examine whether the reduction in ODD symptoms due to child-based cognitive behavioral treatment (CBT) led to a reduction in parental depression, anxiety and stress. Eighty-one boys (age 6-12 years) with a diagnosis of ODD/CD were randomized either to a cognitive behavioral intervention group or an educational play group (acting as control group). Mediation analyses were conducted using path analysis. The stronger reduction in child ODD symptoms in the CBT group compared to the control group led to a decrease in parental depression and stress, as indicated by significant indirect effects (ab = 0.07 and ab = 0.08, p < 0.05). The proposed model for mechanisms of change was, therefore, confirmed for two of the three outcome parameters. Parental psychopathology and stress can be modified by child-centered CBT. The preceding reduction in ODD symptoms acts as a mediator for at least some of the changes in parental depression and stress. However, due to some limitations of the study, other possible explanations for the results found cannot be completely ruled out and are, therefore, discussed.
先前的研究表明，儿童对立违抗性障碍（ODD）和品行障碍（CD）与父母的抑郁、焦虑和/或压力症状有关，可能存在相互影响的双向关系。因此，可以合理地假设，在以儿童为中心的治疗中，减少儿童对立行为问题构成（至少部分）随后父母精神病理学减轻的变化机制。本研究（临床试验.gov 标识符：NCT01406067）的目的是检验由于基于儿童的认知行为治疗（CBT）导致 ODD 症状减少是否会导致父母抑郁、焦虑和压力减轻。81 名患有 ODD/CD 诊断的男孩（年龄 6-12 岁）被随机分配到认知行为干预组或教育性游戏组（作为对照组）。使用路径分析进行中介分析。与对照组相比，CBT 组儿童 ODD 症状的明显减少导致父母抑郁和压力的降低，这表明存在显著的间接效应（ab=0.07 和 ab=0.08，p<0.05）。因此，对于三个结果参数中的两个，确认了变化机制的拟议模型。以儿童为中心的 CBT 可以改变父母的精神病理学和压力。ODD 症状的先前减少充当父母抑郁和压力变化的至少部分中介。然而，由于研究的一些局限性，不能完全排除对所发现结果的其他可能解释，并因此进行了讨论。
