Department of Human Development and Family Studies, The Pennsylvania State University, University Park, PA, USA.
Department of Pediatrics, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
Res Child Adolesc Psychopathol. 2022 Nov;50(11):1487-1499. doi: 10.1007/s10802-022-00946-w. Epub 2022 Jun 11.
Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is a well-established treatment for pediatric posttraumatic stress disorder (PTSD). Animal-assisted therapy (AAT) has been proposed as an adjunct to TF-CBT that may improve treatment effects through enhanced targeting of affect regulation, as indexed by specific changes in the respiratory sinus arrhythmia (RSA). The current study reports results from a randomized controlled feasibility trial (N = 33; M = 11.79 [SD = 3.08]; 64% White; 67% female) that measured RSA during Sessions 1, 4, 8, and 12 of a twelve-session TF-CBT protocol and tested whether: 1) TF-CBT + AAT achieved higher average RSA amplitudes relative to TF-CBT alone, and 2) RSA regulation, defined as less variability around person-specific RSA slopes during treatment, explained variation in post-treatment PTSD symptoms. Multilevel modeling failed to support an effect for TF-CBT + AAT on RSA amplitudes (δ = 0.08, p = 0.844). However, regardless of treatment condition, greater RSA withdrawal was observed within Sessions 4 (γ = -.01, p < .001) and 12 (γ = -.01, p = .015) relative to the Session 1 baseline. The average level of RSA amplitude in Session 8 was also significantly lower compared to Session 1 (γ = -0.70, p = .046). Intraindividual regression models demonstrated that greater RSA regulation predicted improved PTSD symptoms at post-treatment after adjusting for pre-treatment levels (b = 20.00, p = .012). These preliminary results offer support for future confirmatory trials testing whether affect regulation, as indexed by changes in RSA, is a mechanism of action for TF-CBT in the treatment of pediatric PTSD.
创伤焦点认知行为疗法（TF-CBT）是一种成熟的儿童创伤后应激障碍（PTSD）治疗方法。动物辅助疗法（AAT）已被提议作为 TF-CBT 的辅助治疗方法，通过增强对情绪调节的靶向作用，可能会改善治疗效果，这可以通过呼吸窦性心律失常（RSA）的特定变化来衡量。本研究报告了一项随机对照可行性试验（N = 33；M = 11.79 [SD = 3.08]；64%为白人；67%为女性）的结果，该试验在 12 节 TF-CBT 方案的第 1、4、8 和 12 节期间测量了 RSA，并测试了以下两个问题：1）TF-CBT + AAT 是否相对于单独的 TF-CBT 实现了更高的平均 RSA 幅度，2）RSA 调节，定义为治疗过程中个人 RSA 斜率周围的变异性较小，是否解释了治疗后 PTSD 症状的变化。多层次模型未能支持 TF-CBT + AAT 对 RSA 幅度的影响（δ = 0.08，p = 0.844）。然而，无论治疗条件如何，与第 1 节基线相比，第 4 节（γ = -.01，p < .001）和第 12 节（γ = -.01，p = .015）中的 RSA 退缩更为明显。与第 1 节相比，第 8 节的 RSA 幅度的平均水平也显著降低（γ = -0.70，p = .046）。个体内回归模型表明，在调整治疗前水平后，更大的 RSA 调节预测了治疗后 PTSD 症状的改善（b = 20.00，p = .012）。这些初步结果为未来的验证性试验提供了支持，这些试验旨在测试 RSA 变化所衡量的情绪调节是否是 TF-CBT 治疗儿童 PTSD 的作用机制。
