Process as a predictor of Outcomes in CBT for Youth

描述(申请人提供)：焦虑症很常见，如果不治疗，会影响孩子的生活。在随机临床试验(RCT)中，研究表明认知行为疗法(CBT)对焦虑障碍的年轻人有利。我们目前正在比较个体CBT、家庭CBT和教育/支持/关注状况。虽然对结果的研究有所增加，但对治疗过程的研究很少。通过对154例在以前的随机对照试验中接受过单个CBT的病例和50例来自本试验的病例的录音和录像，我们将检验CBT中的过程变量和治疗结果之间的关系。过程变量是(1)治疗联盟，(2)儿童参与和(3)治疗师对手动治疗的灵活性。这三个变量将从整个数据集的会话1-4(较早的流程)和会话5-8(较晚的流程)进行测量。此外，将从第9至16届会议为当前区域工作队的50个案例衡量这三个过程变量。评分员将使用儿童心理治疗过程量表、儿童参与评定量表和修改后的礼仪遵守情况检查表，从总共1600个CBT会话中，每次对整个会话进行三分之一的评分。据推测，强大的治疗联盟和高水平的儿童参与将预测积极的治疗结果。确定中介影响(例如，后来的参与、治疗师的灵活性)将进一步使结果研究人员和执业临床医生能够更好地理解治疗和受益结果的累积之间的因果机制。为了评估导致患者自然流失的潜在过程变量，我们将比较完成治疗的儿童和停止治疗的儿童的早期过程变量。假设非完成者在联盟、灵活性和参与度方面的经验较低。

DESCRIPTION (provided by applicant): Anxiety disorders are common and, if untreated, influence children's lives. In randomized clinical trials (RCT), research has shown that cognitive behavioral therapy (CBT) benefits anxiety-disordered youth. We are currently comparing individual CBT, family CBT, and an education/support/attention condition. Though there has been an increase in outcome research, there has been very little study of the treatment process. With audio and video taped sessions from 154 cases that have received individual CBT in previous RCTs and 50 cases from the current trial, we will examine the relations between process variables and treatment outcome within CBT. The process variables are (1) therapeutic alliance, (2) child involvement and (3) therapist flexibility with the manual-based treatment. These three variables will be measured from sessions 1-4 (earlier process) and sessions 5-8 (later process) for the entire data set. In addition, the three process variables will be measured from sessions 9-16 for the 50 cases in the current RCT. Raters will rate the entire sessions a third at a time from a total of 1600 sessions of individual CBT using the Child Psychotherapy Process Scale, Child Involvement rating scales and the Modified Protocol Adherence Checklist. It is hypothesized that a strong therapeutic alliance and high levels of child involvement will predict positive treatment outcome. The identification of mediating influences (e.g., later involvement, therapist flexibility) will further enable the outcome researcher and the practicing clinician to develop a better understanding of the causal mechanisms between therapy and the accrual of beneficial outcomes. To evaluate potential process variables that contribute to patient attrition, we will compare the early process variables for children completing treatment and those who discontinue. It is hypothesized that non-completers will have the experienced lower levels of alliance, flexibility, and involvement.