Griffith University, Mt Gravatt, QLD, Australia.
The University of Southern Queensland, Springfield, QLD, Australia.
J Child Psychol Psychiatry. 2020 Aug;61(8):914-927. doi: 10.1111/jcpp.13257. Epub 2020 May 19.
In general, Internet-delivered cognitive behavior therapy (iCBT) produces significant reductions in child and adolescent anxiety, but a proportion of participants continue to show clinical levels of anxiety after treatment. It is important to identify demographic, clinical, and family factors that predict who is most likely to benefit from iCBT in order to better tailor treatment to individual needs.
Participants were 175 young people (7-18 years) with an anxiety disorder, and at least one of their parents, who completed an iCBT intervention with minimal therapist support. Multilevel modeling (MLM) examined predictors of response to iCBT as measured by the slope for changes in the primary outcome measures of child- and parent-reported anxiety scores, from pretreatment, to 12-weeks, 6-month, and 12-month follow-ups, controlling for pretreatment total clinician severity ratings of all anxiety diagnoses.
Child age, gender, father age, parental education, parental mental health, parenting style, and family adaptability and cohesion did not significantly predict changes in anxiety in the multivariate analyses. For child-reported anxiety, greater reductions were predicted by a separation anxiety disorder diagnosis (SEP) and elevated depression, with lower reductions predicted by poor couple relationship quality. For parent-reported child anxiety, greater reductions were predicted by higher pretreatment total CSRs, SEP, and lower family income, with lower reductions for children of older mothers. Irrespective of these predictors of change, children in general showed reductions in anxiety to within the normal range.
Overall, children responded well to iCBT irrespective of the demographic, clinical, and family factors examined here. Poor couple relationship quality and older mother age were risk factors for less positive response to iCBT in terms of reductions in anxiety symptoms although still to within the normal range.
一般来说，互联网提供的认知行为疗法（iCBT）可显著降低儿童和青少年的焦虑水平，但一部分参与者在治疗后仍表现出临床水平的焦虑。重要的是要确定人口统计学、临床和家庭因素，这些因素可以预测谁最有可能从 iCBT 中受益，以便更好地根据个人需求调整治疗。
参与者是 175 名患有焦虑症的年轻人（7-18 岁），以及他们的至少一位父母，他们在最少的治疗师支持下完成了 iCBT 干预。多层次模型（MLM）检查了 iCBT 反应的预测因素，这些因素通过儿童和父母报告的焦虑评分的主要结果指标的变化斜率来衡量，从治疗前、12 周、6 个月和 12 个月随访进行测量，同时控制所有焦虑诊断的治疗师总体严重程度评分。
儿童年龄、性别、父亲年龄、父母教育、父母心理健康、育儿风格、家庭适应性和凝聚力在多变量分析中并未显著预测焦虑的变化。对于儿童报告的焦虑，分离焦虑障碍诊断（SEP）和抑郁程度升高预示着更大的缓解，而夫妻关系质量差则预示着缓解程度较低。对于父母报告的儿童焦虑，较高的治疗前总 CSR、SEP 和较低的家庭收入预示着更大的缓解，而母亲年龄较大的孩子则缓解程度较低。无论这些变化的预测因素如何，儿童的焦虑一般都有所缓解，降至正常范围内。
总体而言，儿童对 iCBT 的反应良好，无论这里检查的人口统计学、临床和家庭因素如何。夫妻关系质量差和母亲年龄较大是 iCBT 反应较差的风险因素，尽管焦虑症状的缓解仍在正常范围内。
