Department of Psychology, Harvard University.
Department of Educational Psychology, University of Texas at Austin.
J Consult Clin Psychol. 2020 Mar;88(3):255-268. doi: 10.1037/ccp0000456.
To examine the preliminary effectiveness of a modular, transdiagnostic, behavioral/cognitive-behavioral intervention (MATCH) compared with standard manualized treatments (SMT) and usual care (UC) for treating youth with severe irritability.
We analyzed data from an effectiveness trial in which treatment-referred youths ( = 174; = 10.6 years; 70% boys) were randomized to receive MATCH, SMT, or UC (s = 53-62). Masked assessments of irritability, diagnoses, impairment, and internalizing, externalizing, total, and top problems were collected from caregivers and youths at pre- and posttreatment, weekly during treatment, and quarterly through 2-year follow-up. Baseline measures of irritability and impairment were used to identify a subsample characterized by severe irritability and mood dysregulation (SIMD; = 81; = 10.2 years; 69% boys; s = 24-31 across conditions). Longitudinal multilevel models and ANOVAs were estimated to examine numerous clinical outcomes within and between conditions.
Among youth with SIMD, MATCH produced faster improvements than UC and SMT, with medium or large effect sizes in two thirds of all comparisons tested ( ES = 0.60). Although SIMD youths in all conditions showed reductions in DSM diagnoses, only MATCH predicted significantly fewer posttreatment diagnoses than UC (averaging 1.0 fewer; ES = 0.93). Finally, among the entire sample, MATCH and SMT equivalently outperformed UC in reducing irritability (ES = 0.49) and the effects of each treatment condition on other outcomes were not moderated by baseline irritability.
Extant behavioral/cognitive-behavioral psychotherapies-already well-established and widely used-may be helpful for treating youths with severe irritability. A transdiagnostic, modular format showed the most consistently favorable pattern of results across multiple outcomes, informants, and measurement schedules. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
考察一种模块化、跨诊断、行为/认知行为干预（MATCH）与标准手册化治疗（SMT）和常规护理（UC）相比，对治疗严重易激惹青少年的初步疗效。
我们分析了一项有效性试验的数据，该试验将治疗转介的青少年（n=174；平均年龄为 10.6 岁；70%为男性）随机分配接受 MATCH、SMT 或 UC（n=53-62）。在治疗前和治疗后、治疗期间每周以及治疗后 2 年的季度评估中，由照护者和青少年对易激惹、诊断、功能损害以及内化问题、外化问题、总问题和最突出问题进行评估。使用易激惹和功能损害的基线测量值来确定一个特征为严重易激惹和情绪失调（SIMD）的亚样本（n=81；平均年龄为 10.2 岁；69%为男性；在各条件下，s=24-31）。使用纵向多层模型和方差分析来评估各条件内和各条件间的众多临床结果。
在 SIMD 青少年中，MATCH 的改善速度快于 UC 和 SMT，在所有测试的三分之二比较中具有中等或较大的效应量（ES=0.60）。尽管所有条件下的 SIMD 青少年的 DSM 诊断均有所减少，但只有 MATCH 显著减少了 UC 治疗后的诊断数量（平均减少 1.0 个；ES=0.93）。最后，在整个样本中，MATCH 和 SMT 在降低易激惹方面与 UC 等效（ES=0.49），并且治疗条件对其他结果的影响不受基线易激惹的调节。
现有的行为/认知行为心理疗法——已经得到很好的确立和广泛应用——可能有助于治疗严重易激惹的青少年。跨诊断、模块化格式在多个结果、信息提供者和测量时间表上显示出最一致的有利结果模式。
