Intensive Treatment of Adolescent Panic and Agoraphobia

描述（由申请人提供）：惊恐障碍伴或不伴广场恐怖症（PDA）在青少年中是普遍的、慢性的，并与实质性损害相关，包括逃避上学、扰乱同伴交往和避免自主活动。也许正是因为这个原因，与其他焦虑症相比，PDA在青少年中更容易引发抑郁症。成人PDA有有效的治疗方法。在我们中心即将完成的一项研究中，我们正在证明，与等候名单对照组相比，经验支持的认知行为治疗对PDA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，主要原因是疗程的长度和时间（每周疗程，为期三个月）。家庭报告说，他们的青少年正在经历严重的损害和日常活动的中断，他们希望能更迅速地得到缓解。此外，尽管父母渴望参与治疗，但他们并没有明显地参与治疗。现在有大量证据表明，父母参与青少年PDA的治疗可能会带来额外的临床益处。最后，一个实质性的综合情境和内感受暴露成分不包括在青少年的治疗中。本应用程序的目的是评估一个简短的，发展量身定制的8天强化治疗青少年PDA的疗效和可接受性，被称为青少年恐慌控制暴露治疗（APE），相对于等候名单对照组，并探讨让父母直接参与治疗的相对影响。90名年龄在12-17岁的患者将被随机分配到三种情况中的一种：包括家庭成员的强化治疗，没有家庭成员的强化治疗，或等候名单对照组。该项目的具体目标是：(1)评估强化APE减轻青少年PDA症状的疗效，(2)评估治疗后3、6和12个月效果的长期持久性，(3)评估父母参与治疗的相对优势，(4)评估治疗对青少年及其家庭的损害和生活质量的影响，(5)分析假设的改变机制。

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.