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Dynamic systems as predictors of response to CBT for child anxiety: An EMA study

动态系统作为儿童焦虑 CBT 反应的预测因子：一项 EMA 研究

基本信息

批准号：
9210552
负责人：
Matthew McKittrick Carper
金额：
$ 3.33万
依托单位：
TEMPLE UNIV OF THE COMMONWEALTH
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-01-01 至 2017-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9210552
关键词：
Adolescent Adult Affect Anxiety Anxiety Disorders Behavioral Biology Cellular Phone Chemistry Child Childhood Clinic Cognitive Cognitive Therapy Comorbidity Complex Coping Skills Data Data Analytics Data Collection Development Diagnostic Discipline Disease Ecological momentary assessment Effectiveness Environment Exhibits Family Healthcare Impairment Individual Intervention Interview Life Literature Measures Mental Depression Mental Health Methods Modeling Outcomes Research Parents Patient Self-Report Patients Pattern Physics Politics Population Prevalence Process Psychopathology Public Health Randomized Clinical Trials Rare Diseases Refractory Research Residual state Risk Sampling Schools Science Severities Statistical Models Substance abuse problem System Temperament Terminology Therapeutic Intervention Time Treatment outcome Underachievement Work Youth adverse outcome aged anxiety symptoms anxious associated symptom avoidance behavior base childhood anxiety cognitive change coping cost depressive symptoms dynamic system emotion regulation flexibility improved novel outcome prediction personalized medicine phase change predicting response predictive of treatment response public health relevance response secondary analysis social situation therapy outcome treatment responders vector

项目摘要

DESCRIPTION (provided by applicant): Anxiety disorders are common among youth, with prevalence estimates around 13%. Though these disorders can occur alone, they are often comorbid and are associated with a variety of adverse outcomes. Anxiety disorders in childhood put individuals at greater risk for educational underachievement, substance abuse, anxiety, and depression later in life. These disorders rarely remit on their own, making understanding their treatment a priority of great public health importance. Cognitive behavioral therapy (CBT) is a "well- established" empirically supported treatment for childhood anxiety, typically achieving response rates of 60% in clinic-based trials. However, there remains a large portion of youth who do not respond to CBT interventions and little is known about the mechanisms of change in CBT for youth anxiety. Thus, there is a need for research examining what factors may differentiate treatment responders from nonresponders, as well as the mechanisms through which CBT for childhood anxiety achieves its effects. Existing research aimed at understanding these factors has tended to take a nomothetic approach to analyses, aggregating information from large samples to understand what predicts outcome for the "average" youth. However, it is unlikely that many youth present to clinics similarly to the "average" youth, which may explain why the results of current studies have been inconclusive. The present study uses a dynamical systems framework to examine mechanisms of change in CBT for childhood anxiety both idiographically (individual level) and nomothetically (group level). We propose to collect ecological momentary assessment (EMA) data via a smartphone application ("app") at pretreatment (Time 1), midtreatment (Time 2), and posttreatment (Time 3) from 80 youth aged 11 - 17 receiving treatment at the Child and Adolescent Anxiety Disorders Clinic. At Time 1 and Time 3, youth and their families will also undergo a diagnostic interview to assess for psychopathology, as well as complete a variety of independent-evaluator administered, parent-, and self-report measures of anxiety severity, coping, emotion regulation, and depressive symptoms. A dynamical systems framework will guide the analytical approach and will allow the simultaneous examination of the relationship between and across variables to model potential mechanisms of change. Results from the present study will inform the mechanisms of change of CBT for childhood anxiety, as well as inform the personalization of treatment, ultimately reducing costs of mental health care.

描述（由申请人提供）：焦虑症在年轻人中很常见，患病率估计在13%左右。虽然这些疾病可以单独发生，但它们通常是共病的，并与各种不良后果有关。儿童期的焦虑症会使个体在以后的生活中面临更大的教育不良、物质滥用、焦虑和抑郁的风险。这些疾病很少自行缓解，因此了解其治疗方法是具有重大公共卫生重要性的优先事项。认知行为疗法（CBT）是一种“成熟的”经验支持的儿童焦虑症治疗方法，通常在临床试验中达到60%的应答率。然而，仍然有很大一部分青年人对CBT干预措施没有反应，并且对CBT对青年焦虑的改变机制知之甚少。因此，有必要研究哪些因素可以区分治疗反应者和无反应者，以及CBT治疗儿童焦虑的机制。现有的旨在了解这些因素的研究往往采取一种规范的分析方法，从大样本中汇总信息，以了解什么可以预测“普通”青年的结果。然而，不太可能有许多年轻人与“普通”年轻人一样去诊所，这可能解释了为什么目前的研究结果没有定论。本研究使用一个动力系统的框架来研究儿童期焦虑的CBT的变化机制，包括个人层面和群体层面。我们建议通过智能手机应用程序（“应用程序”）在治疗前（时间1），治疗中（时间2）和治疗后（时间3）从80名11 - 17岁的青少年接受治疗的儿童和青少年焦虑症诊所收集生态瞬时评估（EMA）数据。在时间1和时间3，青少年和他们的家人也将接受诊断性访谈，以评估精神病理学，以及完成各种独立评估员管理，父母和自我报告的焦虑严重程度，应对，情绪调节和抑郁症状的措施。动态系统框架将指导分析方法，并将允许同时检查变量之间的关系，以模拟潜在的变化机制。本研究的结果将为儿童焦虑的CBT变化机制提供信息，并为治疗的个性化提供信息，最终降低心理健康护理的成本。