ONE-SESSION TREATMENT FOR SPECIFIC PHOBIAS IN CHILDREN

本研究的总体目的是检查认知行为治疗（一次性治疗; Ost，1989 a）在减少儿童和青少年特定恐惧症症状和后遗症方面的疗效。 研究结果表明，在社区样本中，约5%的儿童存在临床显著的特定恐惧症，在恐怖症和焦虑症诊所中，约15%至20%的儿童存在临床显著的特定恐惧症。 此外，研究结果表明，在专门诊所出现特定恐惧症的诊所转诊儿童可能与其他焦虑症，情感障碍和破坏性行为障碍共病。 对许多孩子来说，恐惧症会导致相当大的学业，社交和个人困扰，以及日常活动的干扰。 恐惧症可能会持续一辈子。一次性治疗已被发现是一种快速有效的治疗成人恐惧症。 令人惊讶的是，这种治疗方法在瑞典以外的国家尚未进行过评估，其在儿童恐惧症治疗中的效用也未得到研究。 在弗吉尼亚州和瑞典的功效进行了系统的评价。具体目标有三个方面：1）在一项对照随机试验中评价儿童一次性治疗的疗效; 2）在弗吉尼亚州和瑞典对其疗效进行系统评价; 3）探索治疗结果的预测因素，包括父母的精神病理学、过度参与的父母教养方式和儿童共病。 弗吉尼亚州的120名儿童（60名男孩，60名女孩）和瑞典的120名儿童（60名男孩，60名女孩），年龄在8至14岁之间，符合DSM-IV标准，初步诊断为特定恐惧症，将被随机分配到一次性治疗，教育/支持或等待控制条件。 在等待名单期结束后，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一次性治疗。 根据缓解率和脱落率，该策略将允许对一次性治疗的疗效进行相对可靠的检查，其在瑞典和弗吉尼亚州的系统评价以及治疗结果的预测因素。因此，目前的调查将建立在现有文献的优势，通过使用认知行为程序，有一些，虽然有限的，支持恐怖症儿童的治疗（Ollendick和国王，1998年，在印刷）。 与此同时，它将通过检查迄今为止未在儿童中研究的治疗（但相当多的人支持其在成人中的使用）以及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点。 在“真实世界”临床环境中进行的有效性研究（Hoagwood、Hibbs、布伦特和詹森，1995）正在等待这一更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.