Intensive Treatment of Adolescent Panic and Agoraphobia

描述（由申请人提供）：青少年中伴有或不伴有广场恐怖症（PDA）的惊恐障碍是普遍的、慢性的，并与实质性损害相关，包括逃避学校、同伴参与中断和避免自主活动。也许是因为这个原因，PDA与其他焦虑症相比，在青少年中与更多的抑郁症相关。PDA的有效治疗方法存在于成人中。在我们中心即将完成的一项研究中，我们正在证明，与等待名单对照组相比，经验支持的PDA认知行为治疗的发展适应是有效的。然而，相当高比例的青少年拒绝参加试验，主要是由于疗程的长度和时间（每周疗程，为期三个月）。家庭报告说，他们的青少年正在经历的日常活动受到严重损害和干扰，希望得到更直接的救济。此外，尽管父母渴望参与，但他们并没有明显参与治疗。现在有大量证据表明，将父母纳入青少年PDA的治疗可能会提供额外的临床获益。最后，青少年的治疗中没有包括大量综合的情境和内感受性暴露成分。本申请的目的是评价相对于等待名单对照组，针对青少年PDA的简短、发育定制的8天强化治疗（称为青少年恐慌控制治疗与暴露（APE））的有效性和可接受性，并探索父母直接参与治疗的相对影响。90名12-17岁的患者将被随机分配到三个条件之一：包括家庭成员的强化治疗，没有家庭成员的强化治疗，或候补对照组。该项目的具体目标是：（1）评价强化APE减轻青少年PDA症状的有效性，（2）评价治疗后3、6和12个月的长期疗效持久性，（3）评价父母参与治疗的相对优势，（4）评价治疗对青少年及其家人的损伤和生活质量的影响，（5）分析假设的变化机制。

DESCRIPTION (provided by applicant): Panic Disorder with or without agoraphobia (PDA) in adolescents is prevalent, chronic, and associated with substantial impairment, including avoidance of school, disruption of peer involvement and avoidance of autonomous activities. Perhaps for this reason, PDA is associated with more depression in adolescents compared to other anxiety disorders. Effective treatments for PDA exist in adults. In a study nearing completion at our center, we are demonstrating that a developmental adaptation of an empirically supported cognitive-behavioral treatment for PDA is effective compared to a wait-list control group. However, a rather high percentage of adolescents have refused to enter the trial due mostly to the length and timing of sessions (weekly sessions for three months of treatment). Families reported wanting more immediate relief from the significant impairment and disruption of everyday activities their adolescents were experiencing. Further, parents were not significantly involved in treatment despite their eagerness to be involved. Substantial evidence now exists that the inclusion of parents in the treatment of adolescent PDA might provide additional clinical benefit. Finally, a substantial integrated situational and interoceptive exposure component was not included in adolescents' treatment. The purpose of this application is to evaluate the efficacy and acceptability of a brief, developmentally tailored eight-day intensive treatment for PDA in adolescents referred to as adolescent panic control treatment with exposure (APE) relative to a waitlist control group and to explore the relative impact of involving parents directly in treatment. Ninety patients aged 12-17 will be randomly assigned to one of three conditions: intensive treatment including family members, intensive treatment without family members, or a waitlist control group. The specific goals of this project are: (1) to evaluate the efficacy of intensive APE for reducing symptoms of PDA in adolescents, (2) to assess long term durability of effects at 3, 6, and 12 months following treatment, (3) to assess the relative advantage of involving parents in treatment, (4) to assess the impact of treatment on impairment and quality of life of adolescents and their families, and (5) to analyze hypothesized mechanisms of change.