Components of Cognitive Behavioral Therapy Related to Outcome in Childhood Anxiety Disorders
Components of Cognitive Behavioral Therapy Related to Outcome in Childhood Anxiety Disorders
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DOI：
10.1007/s10567-015-0184-8
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发表时间：
2015-09-01
影响因子：
6.9
通讯作者：
Whiteside, Stephen P. H.
中科院分区：
文献类型：
--
作者：
Ale, Chelsea M.;McCarthy, Denis M.;Whiteside, Stephen P. H.
本文采用荟萃分析，对35项儿童焦虑障碍（CADs）随机对照试验（RCTs）和8项儿童强迫症（OCD）随机对照试验中与治疗结果相关的治疗成分进行了研究。对儿童焦虑障碍认知行为疗法（CBT）的随机对照试验的研究表明，增加放松训练以及将暴露疗法推迟到引入其他焦虑管理策略之后，并不会提高基于暴露的治疗的疗效。此外，与强迫症的暴露与反应预防（ERP）相关的大效应量（ES）（k = 9，平均ES = 1.93）相比，儿童焦虑障碍认知行为疗法相关的效应量（k = 44，平均ES = 0.89）与注意力安慰剂（k = 11，平均ES = 0.55）没有差异，尽管它比等待列表对照组（k = 24，平均ES = 0.22）更有效。有指导意义的是，强迫症的暴露与反应预防比儿童焦虑障碍的认知行为疗法涉及更多更早开始的暴露以及更少的放松。此外，暴露与反应预防的随机对照试验更有可能使用临床医生评估的测量方法，而非自我报告，并且更有可能在临床样本而非招募样本中进行。这些结果表明，有必要开展拆解研究，使用金标准的临床医生评定的结果测量方法，比较在暴露疗法中增加焦虑管理策略的价值，以将儿童焦虑障碍认知行为疗法的疗效提高到强迫症暴露与反应预防所达到的水平。
The present article uses meta-analysis to examine treatment components related to outcome within 35 randomized controlled trials (RCTs) for childhood anxiety disorders (CADs) and eight RCTs for childhood obsessive compulsive disorder (OCD). Examination of the RCTs of cognitive behavioral therapy (CBT) for CADs suggested that adding relaxation and delaying exposures until after the introduction of other anxiety management strategies does not increase the efficacy of exposure-based treatment. In addition, compared to the large effect size (ES) associated with exposure and response prevention (ERP) for OCD (k = 9, mean ES = 1.93), the effect size associated with CBT for CADs (k = 44, mean ES = 0.89) did not differentiate from attention placebo (k = 11, mean ES = 0.55), although it was more effective than waitlist control (k = 24, mean ES = 0.22). Instructively, ERP for OCD involved more exposure initiated earlier and less relaxation than CBT for CADs. In addition, RCTs of ERP were more likely to use clinician-administered measures as opposed to self-report and to be conducted in clinical versus recruited samples. These results suggest that dismantling studies using a gold-standard clinician-rated outcome measure to compare the value of adding anxiety management strategies to exposure will be necessary to increase the efficacy of CBT for CADs to levels achieved by ERP for OCD.