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(单次治疗；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效果。研究结果表明，在社区样本中，大约5%的儿童和在恐惧症和焦虑症诊所就诊的儿童中，约有15%至20%存在临床上显著的特定恐惧症。此外，研究结果表明，在专门诊所出现特定恐惧症的临床转诊儿童可能会与其他焦虑症、情感障碍和破坏性行为障碍并存。对许多孩子来说，恐惧症导致了相当大的学业、社交和个人痛苦，以及对日常活动的干扰。恐惧症可能会持续一生。一次治疗已被发现是一种快速而有效的治疗成人恐惧症的方法。令人惊讶的是，除了瑞典之外，这种疗法还没有在其他国家得到评估，它在治疗儿童恐惧症方面的有效性也没有得到检验。建议对其在弗吉尼亚州和瑞典的疗效进行系统评估。具体目标有三个：1)在对照随机试验中评估儿童单次治疗的疗效；2)在弗吉尼亚州和瑞典对其疗效进行系统评估；3)探索治疗结果的预测因素，包括父母的精神病理学、过度介入的父母教养方式和儿童共同发病率。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到14岁之间，符合DSM-IV的特定恐惧症初步诊断标准，将被随机分配到单次治疗、教育/支持或等待名单控制条件下。在轮候名单期间结束后，仍符合轮候名单控制中特定恐惧症标准的儿童，将接受一次治疗，接受教育/支持条件。根据缓解率和流失率的不同，这一战略将允许对单次治疗的有效性、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可靠的检查。因此，本研究将在现有文献的基础上，通过使用认知-行为程序，在治疗恐惧症儿童方面得到一些支持，尽管支持有限(Ollendick和King，1998，出版社)。同时，它将解决现有研究中的不足之处，通过检查一种迄今为止未在儿童身上研究过的治疗方法(但在成人中使用它得到了相当大的支持)，并通过检查父母精神病理学、父母过度保护和儿童共同发病在调节治疗结果方面的作用。“真实世界”临床环境中的有效性研究(Hoagwood、Hibbs、Brent和Jensen，1995)正在等待这项更多以实验室为基础的对照试验的结果。

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.