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

 描述(由申请者提供)：焦虑症在年轻人中很常见，估计患病率约为13%。虽然这些疾病可以单独发生，但它们往往是并存的，并与各种不良后果有关。儿童期的焦虑症使个人在以后的生活中面临更大的学习成绩低下、药物滥用、焦虑和抑郁的风险。这些疾病很少自行缓解，这使得了解它们的治疗成为公共卫生的重要优先事项。认知行为疗法(CBT)是一种经过经验支持的儿童焦虑治疗方法，在临床试验中的有效率通常为60%。然而，仍然有很大一部分青年对CBT干预没有反应，而且对CBT改变青少年焦虑的机制知之甚少。因此，有必要研究哪些因素可以区分治疗应答者和无应答者，以及CBT治疗儿童焦虑症的机制。现有的旨在理解这些因素的研究倾向于采取一种非命题的方法进行分析，从大样本中收集信息，以了解是什么预测了“普通”年轻人的结果。然而，不太可能有许多年轻人去诊所就诊，这可能解释了为什么目前的研究结果没有定论。本研究使用一个动态系统框架，从个体层面和理论层面两个层面考察儿童焦虑症CBT的变化机制。我们建议通过智能手机应用程序(APP)收集在儿童和青少年焦虑症诊所接受治疗的80名11-17岁青少年在治疗前(时间1)、治疗中(时间2)和治疗后(时间3)的生态瞬间评估(EMA)数据。在时间1和时间3，青少年及其家人还将接受诊断性面谈，以评估精神病理学，并完成各种由独立评估者管理、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测量。动力系统框架将指导分析方法，并将允许同时检查变量之间和变量之间的关系，以模拟潜在的变化机制。本研究的结果将为儿童焦虑的CBT改变机制提供信息，并为个性化治疗提供信息，最终降低心理健康护理的成本。

 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.