A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness.
A comparison of two group cognitive behavioral therapy protocols for anxiety in urban schools: appropriateness, child outcomes, and cost-effectiveness.
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DOI：
10.3389/fpsyt.2023.1105630
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发表时间：
2023
影响因子：
4.7
通讯作者：
Eiraldi, Ricardo
中科院分区：
文献类型：
--
作者：
Lawson, Gwendolyn M.;Jawad, Abbas F.;Comly, Rachel;Khanna, Muniya;Glick, Henry A.;Beidas, Rinad S.;Goldstein, Jessica;Brizzolara-Dove, Shelby;Wilson, Tara;Rabenau-McDonnell, Quinn;Eiraldi, Ricardo
认知行为疗法(CBT)治疗儿童焦虑症在缓解焦虑症状和改善功能方面是有效的，但许多儿童无法在社区环境中获得CBT。学校是儿童获得心理健康护理的重要场所，包括治疗焦虑症。在这种情况下，治疗通常由大师级的治疗师提供。生活之友(Friends)是一项为期12个疗程的团体CBT焦虑症治疗计划，在学校实施后证明是有效的。然而，先前的研究也发现，在城市学校背景下交付朋友时，在可行性和文化契合度方面存在挑战。为了应对这些挑战，我们将Friends调整为在学校环境中实施，以便它可能更可行，在文化上更适合美国低收入的城市学校，同时保持治疗的核心组成部分。目前的研究使用混合方法来比较由大师级治疗师和训练师支持的朋友和猫的有效性、成本效益和感知的适当性。首先，我们比较了接受朋友的学生和接受CAT的学生从治疗前到治疗后的学生结果的变化分数(即儿童报告的MASC-2总分、家长报告的MASC-2总分、教师报告的敬业度和不满分量表的分数)，以评估这两种情况是否导致了同等的结果。其次，我们比较了两组之间的成本和成本效益。最后，我们使用应用主题分析来比较治疗师和监督员所感知的干预措施的适当性。儿童报告的MASC-2的平均变化分数在朋友条件下为1.9分(SE = 1.72)，在猫条件下为2.9分(SE = 1.73)；结果表明，两组患者的治疗效果相似，症状减轻幅度较小。与Friends相比，修改后的CATS协议的实施成本显著降低，并显示出更高的成本效益。最后，与猫的情况下的治疗师和监督员相比，朋友情况下的治疗师和监督员更强烈地描述了干预的一些方面，这些方面不适合他们的环境，需要更广泛的适应。相对简短的团体焦虑症CBT，通过调整以提高文化契合度，是一种由学校治疗师在培训教员实施支持下提供的治疗青少年焦虑症状的有前景的方法。
Cognitive behavioral therapy (CBT) for pediatric anxiety is efficacious for reducing anxiety symptoms and improving functioning, but many children are unable to access CBT for anxiety in community settings. Schools are an important setting in which children access mental health care, including therapy for anxiety. In this setting, therapy is usually delivered by Masters-level therapists. Friends for Life (FRIENDS), a 12-session, manualized, group CBT program for anxiety has demonstrated effectiveness when implemented in schools. However, prior research has also found challenges regarding feasibility and cultural fit when delivering FRIENDS in the urban school context. To address these challenges, we adapted FRIENDS for implementation in the school setting so that it might be more feasible and culturally appropriate for low-income, urban schools in the United States, while maintaining the core components of treatment. The current study uses a mixed-method approach to compare the effectiveness, cost-effectiveness, and perceived appropriateness of FRIENDS and CATS when delivered by Masters-level therapists with train-the-trainer support. First, we compared change scores for student outcomes (i.e., child-report MASC-2 total score, parent-report MASC-2 total score, teacher-report Engagement and Disaffection subscale scores) from pre- to post- treatment between students receiving FRIENDS and students receiving CATS to assess whether the two conditions resulted in equivalent outcomes. Second, we compared the cost and cost-effectiveness between the groups. Finally, we used an applied thematic analysis to compare appropriateness of the interventions as perceived by therapists and supervisors. The mean change score for the child-reported MASC-2 was 1.9 (SE = 1.72) points in the FRIENDS condition and 2.9 (SE = 1.73) points in the CATS condition; results indicated that the conditions were similar in their treatment effects, and symptom reductions were small in both groups. The modified protocol, CATS, was shown to cost significantly less to implement compared to FRIENDS and showed greater cost-effectiveness. Finally, compared to therapists and supervisors in the CATS condition, therapists and supervisors in the FRIENDS condition more strongly described aspects of the intervention that were not appropriate for their context and in need of more extensive adaptations. Relatively brief, group CBT for anxiety, with adaptations to improve cultural fit, is a promising approach to treat youth anxiety symptom when delivered by school-based therapists with train-the-trainer implementation support.
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DOI：
10.1080/1754730x.2015.1037848
发表时间：
2015
期刊：
Advances in school mental health promotion
影响因子：
--
作者：
Eiraldi R;Wolk CB;Locke J;Beidas R
通讯作者：
Beidas R
DOI：
10.1016/j.jaac.2013.09.017
发表时间：
2014-01
影响因子：
13.3
作者：
Copeland, William E.;Angold, Adrian;Shanahan, Lilly;Costello, E. Jane
通讯作者：
Costello, E. Jane
影响因子：
16.4
作者：
通讯作者：
--
影响因子：
--
作者：
Kessler, RC;Berglund, P;Walters, EE
通讯作者：
Walters, EE
影响因子：
2.2
作者：
Ali, Mir M.;West, Kristina;Dubenitz, Joel
通讯作者：
Dubenitz, Joel