Change during cognitive and exposure phases of cognitive-behavioral therapy for autistic youth with anxiety disorders.
Change during cognitive and exposure phases of cognitive-behavioral therapy for autistic youth with anxiety disorders.
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DOI：
10.1037/ccp0000755
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发表时间：
2022-09
影响因子：
5.9
通讯作者：
Storch, Eric A
中科院分区：
文献类型：
--
作者：
Guzick, Andrew G;Schneider, Sophie C;Kendall, Philip C;Wood, Jeffrey J;Kerns, Connor M;Small, Brent J;Park, Ye Eun;Cepeda, Sandra L;Storch, Eric A
评估在认知行为治疗（CBT）的（a）认知和（B）暴露治疗阶段对患有焦虑症的自闭症青少年的改善。参与者是148名患有临床显著焦虑的自闭症青少年（7-13岁; 77%男性; 64%白色），他们被随机分配到标准或适应性CBT。在每次预约时记录临床医生评定的焦虑严重程度。使用分段多水平模型分析治疗的（a）认知阶段和（B）暴露阶段期间的变化轨迹。与心理教育和认知治疗阶段相比，暴露阶段对应的症状减轻明显更快，B =-0.11，95% CI：-0.13至-0.071。这一发现适用于标准CBT，其中包括暴露开始前的9次会议（平均），以及针对自闭症青少年的个性化CBT，其中在第五次会议后引入了暴露（平均）。相比之下，与初始心理教育阶段的改善相比，认知技能的引入与症状减轻的速度明显较慢，B = 0.066，95% CI：0.020至0.11。这一发现也适用于适应性和标准CBT。结果强调了暴露在自闭症青少年焦虑治疗中的核心作用，并质疑在暴露过程中没有后续实践这些技能的认知策略的效用。假设有一个工作关系，治疗师应该考虑快速通过CBT的暴露前应对阶段。未来的研究应评估暴露在何种程度上可以保持其效力，同时尽量减少应对技能的准备。
To evaluate improvement during the (a) cognitive and (b) exposure therapy phases of cognitive-behavioral therapy (CBT) for autistic youth with anxiety disorders. Participants were 148 autistic youth (ages 7–13; 77% male; 64% White) with clinically significant anxiety who were randomized to standard or adapted CBT. Clinician-rated anxiety severity was recorded at each appointment. Trajectories of change during (a) the cognitive phase and (b) the exposure phase of treatment were analyzed using piecewise multilevel modeling. Compared to the psychoeducation and cognitive therapy phases, the exposure phase corresponded with significantly more rapid symptom reduction, b = −.11, 95% CI: −.13 to −.071. This finding was true for standard CBT, which included nine sessions prior to exposure initiation (on average), as well as for CBT personalized for autistic youth, which introduced exposure following the fifth session (on average). In contrast, compared with improvements during initial psychoeducation sessions, the introduction of cognitive skills corresponded with significantly slower symptom reduction, b = .066, 95% CI: .020 to .11. This finding was also true for both adapted and standard CBT. Results underscore the central role of exposure in the treatment of anxiety among autistic youth and question the utility of cognitive strategies without subsequent practice of these skills during exposure. Assuming a working relationship, therapists should consider moving through the pre-exposure coping phase of CBT quickly. Future research should evaluate the extent to which exposure can maintain its potency while minimizing coping skill preparation.