School of Applied Psychology and Menzies Health Institute QLD, Griffith University, Southport, Qld, Australia.
School of Applied Psychology and Menzies Health Institute QLD, Griffith University, Mt Gravatt, Qld, Australia.
Brain Behav. 2018 Jun;8(6):e00984. doi: 10.1002/brb3.984. Epub 2018 May 1.
D-Cycloserine has potential to enhance exposure therapy outcomes. The current study presents a preliminary randomized, placebo-controlled double-blind pilot trial of DCS-augmented one-session treatment (OST) for youth (7-14 years) with specific phobia. A secondary aim of this pilot study was to explore the effects of youth age and within-session fear reduction as potential moderators of DCS outcomes in order to generate hypotheses for a larger trial. It was hypothesized that DCS would be associated with greater improvements than placebo, that children (7-10 years) would have greater benefits than adolescents (11-14 years), and that DCS effects would be stronger for participants with the greater within-session fear reduction during the OST.
Thirty-five children and adolescents were randomized to either OST combined with DCS (n = 17), or OST combined with placebo (PBO; n = 18) and assessed at 1 week, 1 month, and 3 month following treatment.
There were no significant pre- to post-treatment or follow-up benefits of DCS relative to placebo. Secondary analyses of age indicated that relative to PBO, DCS was associated with greater improvements for children (but not adolescents) on measures of severity at 1-month follow-up. Children in the DCS condition also showed significantly greater improvement to 1 month on global functioning relative to other groups. Conversely, adolescents had significant post-treatment benefits in the PBO condition on symptom severity measures relative to DCS, and adolescents in the DCS condition had significantly poorer functioning at 3 months relative to all other groups. Finally, there was a trend for within-session fear reduction to be associated with moderating effects of DCS, whereby greater reduction in fear was associated with greater functioning at one-month follow-up for children who received DCS, relative to PBO.
The study sample was small and therefore conclusions are tentative and require replication.
Age and within-session fear reduction may be important moderators of DCS-augmented one-session exposure therapy, which requires testing in a fully powered randomized controlled trial.
D-环丝氨酸具有增强暴露疗法效果的潜力。本研究报告了一项初步的随机、安慰剂对照、双盲试点试验，研究 DCS 增强单次治疗（OST）对患有特定恐惧症的青少年（7-14 岁）的疗效。本试点研究的次要目的是探索青少年年龄和治疗过程中恐惧的降低程度作为 DCS 疗效的潜在调节剂，以便为更大规模的试验产生假设。研究假设 DCS 会比安慰剂产生更大的改善效果，儿童（7-10 岁）的获益大于青少年（11-14 岁），并且在 OST 过程中恐惧降低幅度较大的参与者，DCS 的效果更强。
35 名儿童和青少年被随机分为 OST 联合 DCS（n=17）或 OST 联合安慰剂（PBO；n=18）组，并在治疗后 1 周、1 个月和 3 个月进行评估。
与安慰剂相比，DCS 治疗在治疗前后或随访期间没有显著的获益。对年龄的二次分析表明，与 PBO 相比，DCS 治疗与儿童（但不是青少年）在 1 个月随访时的严重程度评估上有更大的改善。在 DCS 治疗组中，儿童在整体功能上也显示出与其他组相比在 1 个月时显著改善。相反，青少年在 PBO 治疗组的症状严重程度评估上在治疗后有显著的获益，而在 DCS 治疗组中，青少年在 3 个月时的功能明显比其他所有组差。最后，治疗过程中恐惧的降低程度与 DCS 的调节作用呈趋势相关，即接受 DCS 治疗的儿童恐惧降低幅度越大，在 1 个月随访时的功能越好，而 PBO 组则相反。
研究样本较小，因此结论是暂定的，需要进一步验证。
年龄和治疗过程中恐惧的降低程度可能是 DCS 增强单次暴露治疗的重要调节剂，这需要在完全随机对照试验中进行测试。
