Types of Parental Involvement in CBT With Anxious Youth: A Preliminary Meta-Analysis
Types of Parental Involvement in CBT With Anxious Youth: A Preliminary Meta-Analysis
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DOI：
10.1037/a0036969
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发表时间：
2014-12-01
影响因子：
5.9
通讯作者：
Wood, Jeffrey J.
中科院分区：
文献类型：
--
作者：
Manassis, Katharina;Lee, Trevor Changgun;Wood, Jeffrey J.
目的：荟萃分析研究尚未证实，让父母参与认知行为疗法（CBT）对焦虑儿童有治疗益处。父母参与的类型也有很大的异质性。我们使用个体患者数据的荟萃分析，调查了父母参与的情况，重点是应急管理（CM）和控制转移（TC）作为潜在的结果调节剂。方法：研究人员的随机对照试验（RCT）的CBT焦虑儿童，系统地确定，被邀请提交他们的数据。根据父母参与CBT的类型（即，低参与、不强调CM或TC的积极参与、强调CM或TC的积极参与）。使用一期荟萃分析比较治疗结局。结果：所有参与积极治疗的病例（1，618例中的894例）均纳入亚组分析。在所有CBT组中，临床严重程度、焦虑和内化症状的平均值在治疗后显著降低，并且各组之间具有可比性。未强调CM或TC的组显示出治疗后焦虑诊断的比例高于低参与组。在治疗后和1年随访期间，父母积极参与的CBT组焦虑诊断的比例显著降低，重点是CM或TC，而其他2组的治疗收益仅维持不变。结论：无论父母是否积极参与，CBT对焦虑儿童都是一种有效的治疗方法。然而，父母积极参与的CBT强调CM或TC可能支持长期维持治疗收益。应在发表其他RCT时复制结果。
Objective: Meta-analytic studies have not confirmed that involving parents in cognitive behavior therapy (CBT) for anxious children is therapeutically beneficial. There is also great heterogeneity in the type of parental involvement included. We investigated parental involvement focused on contingency management (CM) and transfer of control (TC) as a potential outcome moderator using a meta-analysis with individual patient data. Method: Investigators of randomized controlled trials (RCTs) of CBT for anxious children, identified systematically, were invited to submit their data. Conditions in each RCT were coded based on type of parental involvement in CBT (i.e., low involvement, active involvement without emphasis on CM or TC, active involvement with emphasis on CM or TC). Treatment outcomes were compared using a 1-stage meta-analysis. Results: All cases involved in active treatment (894 of 1,618) were included for subgroup analyses. Across all CBT groups, means of clinical severity, anxiety, and internalizing symptoms significantly decreased posttreatment and were comparable across groups. The group without emphasis on CM or TC showed a higher proportion with posttreatment anxiety diagnoses than the low-involvement group. Between posttreatment and 1-year follow-up, the proportion with anxiety diagnoses significantly decreased in CBT with active parental involvement with emphasis on CM or TC, whereas treatment gains were merely maintained in the other 2 groups. Conclusions: CBT for anxious children is an effective treatment with or without active parental involvement. However, CBT with active parental involvement emphasizing CM or TC may support long-term maintenance of treatment gains. Results should be replicated as additional RCTs are published.