ONE-SESSION TREATMENT FOR SPECIFIC PHOBIAS IN CHILDREN

本研究的总体目的是检验认知行为治疗（一次治疗；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疗效。研究结果表明，在社区样本中，大约5%的儿童存在临床上显著的特定恐惧症，而在恐惧症和焦虑症诊所就诊的儿童中，这一比例约为15%至20%。此外，研究结果表明，在专科诊所出现特定恐惧症的临床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，这种恐惧症会导致相当大的学业、社交和个人困扰，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有效的治疗成人恐惧症的方法。令人惊讶的是，这种治疗方法在瑞典以外的国家没有被评估过，它在治疗儿童恐惧症方面的效用也没有被检验过。对其在弗吉尼亚和瑞典的效果进行了系统的评价。具体目的有三个方面：1)在一项对照、随机试验中评估儿童一期治疗的疗效；2)对弗吉尼亚和瑞典的有效性进行系统评估；3)探讨治疗结果的预测因素，包括父母精神病理、过度介入的父母方式和儿童合并症。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对特定恐惧症的初步诊断标准，将被随机分配到一次治疗，教育/支持或候补控制条件。在等候期之后，在等候期控制和教育/支持条件中仍然符合特定恐惧症标准的儿童将被提供一次治疗。根据缓解率和损耗率，该策略将允许对一次治疗的疗效进行相对有力的检查，在瑞典和弗吉尼亚进行系统评估，以及治疗结果的预测因素。因此，目前的研究将建立在现有文献的优势上，通过使用认知行为程序，这些程序在治疗恐惧症儿童方面有一些（尽管有限）支持（Ollendick和King， 1998年出版）。同时，它将通过检验一种迄今未在儿童身上研究过的治疗方法（但在成人身上得到了相当大的支持），以及检验父母精神病理、父母过度保护和儿童合并症在减缓治疗结果中的作用，来解决现有研究中的缺陷。在“真实世界”的临床环境中的有效性研究（Hoagwood, Hibbs, Brent, and Jensen, 1995）等待着这种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.