Early Intervention in Depression Dyadic Emotion Development Therapy for Preschool

描述(由申请人提供)：此R34申请建议进一步开发和试点早期干预学龄前阶段的抑郁症。这项研究的具体目的是进一步修改和调整已被证明有效的针对学龄前破坏性障碍的有效的手动早期干预，亲子互动疗法(PCIT，Eyberg，1988)，应用于学龄前抑郁症。拟议的名为PCIT-情绪发展(ED)的治疗已被修改，包括了侧重于“情绪发展”的额外治疗成分。新的ED模块从发展的角度解决早期情绪反应的偏差，并基于情绪障碍的情绪发展模型。PCIT-ED被认为是一种发展敏感的儿童抑郁症早期干预策略，专注于加强亲子关系，并将父母作为“治疗师的手臂”。父母支持在学龄前抑郁严重程度中的中介作用已被证实，支持二元关系是早期干预抑郁症的理想目标的概念。PCIT此前已成功应用于焦虑症。临床学龄前抑郁综合征的有效性现已在两个独立的研究样本中得到证实。已经发现了特定和稳定的症状群、相关疾病的家族史、生物学相关性的证据，以及低热情的观察证据。这些验证结果以及基于独立评分者在多个背景下的发育和适应功能显著受损的新证据也得到了证实。这些发现证实了这种早发性抑郁综合征的临床意义，并需要在学龄前阶段进行干预。建议进行一项分两个阶段的研究，从“开放病例系列”开始，在此期间，将对每个治疗过程进行系统评估，并对手册进行修改，以最大限度地提高可接受性和保真度。随后将进行一项试点可行性研究，将N=30名受试者随机分配到PCIT-ED或积极的育儿教育控制条件下。与早期干预对几种精神障碍更有效的证据一致，学龄前阶段对抑郁症的干预可能提供一个机会之窗，在快速发育和神经生物学变化的时期获得更大的治疗效果。缺乏对青春期前儿童的可用、安全和明显有效的治疗，突显了公共卫生需要对抑郁症采取新的和更早的干预措施。PHS 398(09/04修订版)页面表格第2页这个项目的公共卫生目标是找到治疗儿童抑郁症的新的、可能更有效的方法。该项目的重点是尽早识别抑郁症，并使用针对亲子关系的新的治疗方法。这是必要的，因为抑郁症是一种严重的慢性疾病，目前几乎没有建立安全有效的治疗方法。

DESCRIPTION (provided by applicant): This R34 application proposes to further develop and pilot an early intervention for depression during the preschool period. The specific aim of the proposed study is to further modify and adapt a proven effective manualized dyadic early intervention for preschool disruptive disorders, Parent Child Interaction Therapy (PCIT, Eyberg, 1988), for application to preschool depression. The proposed treatment entitled PCIT- Emotion Development (ED) has been modified to include additional treatment components that focus on "emotion development". The new ED module addresses deviations in early emotional reactivity from a developmental perspective and is based on an emotion development model of mood disorders. PCIT-ED is proposed as a developmentally sensitive early intervention strategy for childhood depression focused on strengthening the parent-child relationship and utilizing the parent as an "arm of the therapist". The mediating role of parenting support in preschool depression severity has been previously established supporting the notion that the dyadic relationship is an ideal target for early intervention in depression. PCIT has been previously successfully adapted for application to anxiety disorders. The validity of a clinical preschool depressive syndrome has now been established in two independent study samples. Evidence of a specific and stable symptom constellation, family history of related disorders, biological correlates, and observational evidence of low enthusiasm have been found. Replication of these validation findings as well as new evidence for significant impairment in developmental and adaptive functioning based on independent raters in multiple contexts has also been established. These findings confirm the clinical significance of this early onset depressive syndrome and the need for intervention for during the preschool period. A 2-stage study is proposed, beginning with an "open case series" during which each treatment session will be systematically assessed and the manual will be modified to maximize acceptability and fidelity. This will be followed by a pilot feasibility study in which N=30 subjects will be randomized to PCIT-ED or an active parenting education control condition. In keeping with evidence of greater efficacy of earlier intervention in several mental disorders, intervention for depression during the preschool period may provide a window of opportunity for greater therapeutic efficacy during a period of rapid developmental and neurobiological change. The public health need for novel and earlier interventions in depression is underscored by the lack of available safe and clearly effective treatments for prepubertal children. PHS 398 (Rev. 09/04) Page Form Page 2 The public health goal of this project is to find new and potentially more effective methods for treating childhood depression. The project focuses on the earliest possible identification of depression and the use novel therapeutic approaches that target the parent-child relationship. This is needed because depression is a serious and chronic disorder for which there are currently few safe and effective treatments established.