基于父母的治疗对儿童焦虑症的疗效与认知行为疗法相当：一项针对焦虑儿童情绪的支持性育儿随机非劣效性研究。
Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions.
作者信息
Lebowitz Eli R, Marin Carla, Martino Alyssa, Shimshoni Yaara, Silverman Wendy K
机构信息
Yale University Child Study Center, New Haven, CT.
Yale University Child Study Center, New Haven, CT.
出版信息
J Am Acad Child Adolesc Psychiatry. 2020 Mar;59(3):362-372. doi: 10.1016/j.jaac.2019.02.014. Epub 2019 Mar 7.
OBJECTIVE
Treatment for childhood anxiety disorders is insufficient in many cases. Parent involvement has been examined to augment child-based cognitive-behavioral therapy (CBT), but no studies have compared the efficacy of stand-alone parent-based treatment to CBT. Research implicates family accommodation in the maintenance and course of childhood anxiety. Supportive Parenting for Anxious Childhood Emotions (SPACE) is a parent-based treatment that reduces accommodation of childhood anxiety. This study compared SPACE to CBT in a noninferiority trial.
METHOD
Participants were children with primary anxiety disorders (N = 124; 7-14 years of age; 53% female participants; 83% white), randomly assigned to either SPACE (n = 64) with no direct child-therapist contact, or CBT (n = 60) with no parent treatment. A total of 97 participants (78%) completed all treatment sessions and assessments. Attrition did not differ significantly between groups. Primary anxiety outcomes included diagnostic interview and clinician-rated scales. Secondary outcomes included parent and child ratings of anxiety severity, family accommodation, and parenting stress. Noninferiority margins were determined based on statistical and clinical considerations. Change in family accommodation and parenting stress were examined using mixed models analyses.
RESULTS
SPACE was noninferior, relative to CBT, on primary and secondary anxiety outcomes, and based on ratings provided by independent evaluators, parents, and children. Family accommodation and parenting stress were significantly reduced in both treatments, with significantly greater reduction in family accommodation following SPACE compared to CBT. Treatment credibility and satisfaction were high.
CONCLUSION
SPACE is an acceptable and efficacious treatment for childhood anxiety disorders, is noninferior to CBT, and provides an alternative strategy for treating anxiety in children.
CLINICAL TRIAL REGISTRATION INFORMATION
Explanatory Clinical Trial of a Novel Parent Intervention for Childhood Anxiety (SPACE); https://clinicaltrials.gov; NCT02310152.
目的
在许多情况下，儿童焦虑症的治疗并不充分。人们已经对家长参与进行了研究，以增强基于儿童的认知行为疗法（CBT），但尚无研究比较独立的基于家长的治疗与CBT的疗效。研究表明家庭迁就行为在儿童焦虑症的维持和病程中起作用。支持性养育焦虑儿童情绪疗法（SPACE）是一种基于家长的治疗方法，可减少对儿童焦虑的迁就。本研究在一项非劣效性试验中将SPACE与CBT进行了比较。
方法
参与者为患有原发性焦虑症的儿童（N = 124；7 - 14岁；53%为女性参与者；83%为白人），随机分配至无儿童与治疗师直接接触的SPACE组（n = 64）或无家长治疗的CBT组（n = 60）。共有97名参与者（78%）完成了所有治疗疗程和评估。两组的失访情况无显著差异。主要焦虑结局包括诊断性访谈和临床医生评定量表。次要结局包括家长和儿童对焦虑严重程度、家庭迁就行为和养育压力的评分。非劣效性界值是基于统计学和临床考虑确定的。使用混合模型分析检验家庭迁就行为和养育压力的变化。
结果
在主要和次要焦虑结局方面，以及根据独立评估者、家长和儿童提供的评分，SPACE相对于CBT是非劣效的。两种治疗方法均使家庭迁就行为和养育压力显著降低，与CBT相比，SPACE治疗后家庭迁就行为的降低幅度显著更大。治疗的可信度和满意度较高。
结论
SPACE是一种可接受且有效的儿童焦虑症治疗方法，不劣于CBT，并为治疗儿童焦虑症提供了一种替代策略。
临床试验注册信息
儿童焦虑症新型家长干预的解释性临床试验（SPACE）；https://clinicaltrials.gov；NCT02310152。
Zotero 插件