ONE-SESSION TREATMENT FOR SPECIFIC PHOBIAS IN CHILDREN

拟议调查的总体目标是检查认知行为治疗（一次性治疗；Ost，1989a）在减少儿童和青少年特定恐惧症的症状和后遗症方面的功效。 研究结果表明，社区样本中约 5% 的儿童存在临床上显着的特定恐惧症，在恐惧症和焦虑症诊所就诊的儿童中约 15% 至 20% 存在这种症状。 此外，研究结果表明，在专科诊所就诊的患有特定恐惧症的儿童可能同时患有其他焦虑症、情感障碍和破坏性行为障碍。 对于许多儿童来说，恐惧症会导致相当大的学业、社交和个人困扰，并干扰日常活动。 恐惧症可能会持续一生。已发现单次治疗对于患有恐惧症的成年人来说是一种快速有效的治疗方法。 令人惊讶的是，这种治疗方法尚未在瑞典以外的国家进行过评估，并且其在治疗儿童恐惧症方面的效用也尚未得到检验。 建议对其在弗吉尼亚州和瑞典的功效进行系统评估。具体目标有三个：1) 在一项对照、随机试验中评估一次性治疗对儿童的疗效； 2）对其在弗吉尼亚州和瑞典的功效进行系统评估； 3）探索治疗结果的预测因素，包括父母的精神病理学、过度参与的养育方式和儿童共病。 弗吉尼亚州 120 名年龄在 8 至 14 岁之间的儿童（60 名男孩，60 名女孩）和瑞典 120 名儿童（60 名男孩，60 名女孩），符合 DSM-IV 特定恐惧症初步诊断标准，将被随机分配到单次治疗、教育/支持或候补控制条件组。 等待名单期结束后，仍符合等待名单控制中特定恐惧症标准和教育/支持条件的儿童将获得单次治疗。 根据缓解率和流失率，这一策略将允许对一次性治疗的疗效、瑞典和弗吉尼亚州的系统评估以及治疗结果的预测因素进行相对有力的检查。因此，本研究将利用现有文献的优势，通过使用认知行为程序来治疗恐惧症儿童，这些程序虽然有限，但仍具有一定的支持（Ollendick 和 King，1998 年，出版中）。 同时，它将通过检查迄今为止未在儿童中研究过的治疗方法（但在成人中使用它得到了相当多的支持），并通过检查父母精神病理学、父母过度保护和儿童共病在调节治疗结果中的作用，来解决现有研究中的缺陷。 “真实世界”临床环境中的有效性研究（Hoagwood、Hibbs、Brent 和 Jensen，1995）正在等待这项更多基于实验室的对照试验的结果。

The overall aim of the proposed investigation is to examine the efficacy of a cognitive-behavioral treatment (One- Session Treatment; Ost, 1989a) in reducing symptoms and sequellae of Specific Phobia in children and adolescents. Findings indicate that clinically significant specific phobias are present in approximately 5 percent of children in community samples and in about 15 percent to 20 percent of children presenting at phobic and anxiety disorders clinics. Furthermore, findings indicate that clinic-referred children who present with specific phobias in specialized clinics are likely to be co-morbid with other anxiety disorders, affective disorders, and disruptive behavior disorders. For many children, the phobia results in considerable academic, social, and personal distress, as well as interference in day-to-day activities. Phobias may persist for a lifetime. One-Session Treatment has been found to be a rapid and effective treatment for adults with phobic disorders. Surprisingly, this treatment has not been evaluated in countries other than Sweden, and its utility in the treatment of childhood phobias has not been examined. A systematic evaluation of its efficacy in Virginia and Sweden is proposed. Specific aims are threefold: 1) to evaluate the efficacy of One- Session Treatment with children in a controlled, randomized trial; 2) to undertake systematic evaluation of its efficacy in Virginia and Sweden; and 3) to explore predictors of treatment outcome, including parental psychopathology, over-involved parenting styles, and child co-morbidity. One-hundred-and twenty children in Virginia (60 boys, 60 girls) and 120 children in Sweden (60 boys, 60 girls) between 8 and 14 years of age and meeting DSM-IV criteria for a primary diagnosis of specific phobia will be randomly assigned to One-Session Treatment, Education/Support, or Waitlist Control conditions. Following the waitlist period, children still meeting criteria for a Specific Phobia in the waitlist control and the Education/Support conditions will be provided One-Session Treatment. Depending upon remission and attrition rates, this strategy will permit a relatively robust examination of the efficacy of One-Session Treatment, its systematic evaluation in Sweden and Virginia, and the predictors of treatment outcome. As such, the present investigation will build on strengths in the current literature by using cognitive-behavioral procedures that have some, albeit limited, support in the treatment of phobic children (Ollendick and King, 1998, in press). At the same time, it will address shortcomings in extant studies by examining a treatment not studied heretofore with children (but with considerable support for its use with adults) and by examining the role of parental psychopathology, parental over- protectiveness, and child co-morbidity in moderating treatment outcome. Effectiveness studies in "real-world" clinical settings (Hoagwood, Hibbs, Brent, and Jensen, 1995) await results of this more laboratory-based controlled trial.