Angulo Felix, Goger Pauline, Brent David A, Rozenman Michelle, Gonzalez Araceli, Schwartz Karen T G, Porta Giovanna, Lynch Frances L, Dickerson John F, Weersing V Robin
Department of Psychology, San Diego State University, San Diego, CA, USA.
SDSU/UC San Diego Joint Doctoral Program in Clinical Psychology, San Diego, CA, USA.
Npj Ment Health Res. 2024 Feb 27;3(1):8. doi: 10.1038/s44184-023-00049-4.
By adolescence, two-thirds of youth report exposure to at least one traumatic event, yet the impact of trauma history is not routinely considered when evaluating the effect of psychotherapeutic interventions. Trauma may be a particularly important moderator of the effects of transdiagnostic therapies for emotional disorders, as trauma exposure is associated with risk for the development of comorbid depression and anxiety. The current study examined the history of trauma exposure and the presence of clinically significant depression as moderators of treatment outcomes in the Brief Behavioral Therapy (BBT) trial, the largest study of transdiagnostic psychotherapy for youth. Youths (age 8-16 years) were randomized to BBT (n = 89) based in pediatric primary care or assisted referral to outpatient community care (ARC; n = 86). Clinical response, functioning, anxiety symptoms, and depression symptoms were assessed at post-treatment (Week 16) and at follow-up (Week 32). A significant three-way interaction emerged between the treatment group, comorbid depression, and trauma exposure. BBT was broadly effective for 3/4 of the sample, but, for anxious-depressed youth with trauma exposure, BBT never significantly separated from ARC. Differences in outcome were not accounted for by other participant characteristics or by therapist-rated measures of alliance, youth engagement, or homework completion. Implications for models of learning and for intervention theory and development are discussed.
到青春期时，三分之二的青少年报告称至少经历过一次创伤性事件，然而在评估心理治疗干预效果时，创伤史的影响却未被常规考虑。创伤可能是情绪障碍跨诊断疗法效果的一个特别重要的调节因素，因为接触创伤与共病抑郁和焦虑的发生风险相关。在针对青少年的最大规模跨诊断心理治疗研究——简短行为疗法（BBT）试验中，当前研究考察了创伤暴露史以及具有临床意义的抑郁症的存在情况，以此作为治疗结果的调节因素。青少年（8至16岁）被随机分为接受基于儿科初级保健的BBT治疗组（n = 89）或接受转介至门诊社区护理的辅助转诊组（ARC；n = 86）。在治疗后（第16周）和随访时（第32周）评估临床反应、功能、焦虑症状和抑郁症状。治疗组、共病抑郁和创伤暴露之间出现了显著的三因素交互作用。BBT对四分之三的样本总体有效，但对于有创伤暴露的焦虑抑郁青少年，BBT从未与ARC有显著差异。结果的差异不能由其他参与者特征或治疗师评定的联盟、青少年参与度或家庭作业完成情况的指标来解释。文中讨论了对学习模型以及干预理论与发展的启示。
