Augmented Treatment of Specific Phobias in Children

描述(由申请人提供)：拟议调查的总体目标是比较单次治疗(OST：认知行为疗法的变体)和家庭增强型OST(增强OST)在治疗儿童特定恐惧症方面的疗效。在我们目前资助的NIMH项目中，我们发现OST在治疗青少年特定恐惧症方面比教育/支持治疗(EST)或轮候名单控制条件更有效，在治疗后(分别为60%、26%和0%)和6个月的随访(OST为60%和EST为42%，轮候名单参与者在等待1个月后随机分配到OST或EST条件下)。虽然OST被证明优于这些条件，但很明显，接受这种治疗的40%的年轻人在治疗后或6个月的随访中并不是没有被诊断出来，他们继续经历令人痛苦的症状。在此，根据家长利益相关者的反馈，我们建议在标准的OST程序中增加一个家长管理补充程序，为家长提供有关特定恐惧症的性质、过程和原因的教育，并为他们配备有效的策略，以解决OST后子女挥之不去的痛苦和回避。简而言之，我们建议在一项随机临床对照试验中，对7至12岁的154名儿童进行标准OST手术和父母强化OST手术的比较。具体目标有两个：1)在随机试验中评估OST和父母增强的OST(增强的OST)对儿童的疗效；2)探索治疗结果的调节因素，包括父母精神病理学和过度保护的父母养育做法的影响。154名7至12岁的儿童(77名男孩，77名女孩)符合特定恐惧症的DSM-IV标准，他们将被随机分配到单独的OST或加强OST治疗。(年龄范围被限制在7至12岁，因为已发现以家庭为基础的加强战略对这一年龄段最有效)。将进行治疗后以及1、6和12个月的随访评估。因此，该项目将招募有史以来在美国进行的最大规模的恐惧症青年样本。它将提供关于这种疾病、其治疗和治疗结果的调节因素的有价值的信息。这项疗效试验将为有效性试验奠定基础。

DESCRIPTION (provided by applicant): The overall aim of the proposed investigation is to compare the efficacy of One-Session Treatment (OST: a variant of Cognitive-Behavior Therapy) to family-enhanced OST (Augmented OST) in the treatment of Specific Phobia in children. In our presently funded NIMH project, we have shown that OST is more effective in treating specific phobias in youth than Education/Support Treatment (EST) or Wait List Control conditions at post-treatment (60%, 26%, and 0% diagnosis free, respectively) and at 6-month follow-up (60% for OST and 42% for EST, with Waitlist participants randomly assigned to either OST or EST conditions following a 1 month wait). Although OST was shown to be superior to these conditions, it is evident that 40% of the youth who received this treatment were not diagnosis free at post-treatment or 6 month follow-up and that they continued to experience distressing symptoms. Herein, based on feedback from our parent stakeholders, we propose to augment standard OST procedures with a parent-management supplement that provides education to the parents about the nature, course, and causes of specific phobias and equips them with effective strategies to address lingering distress and avoidance in their children following OST. In brief, we propose to compare the standard OST procedure to a parent-enhanced one in a randomized clinical control trial with 154 children between 7 and 12 years of age. Specific aims are twofold: 1) to evaluate the efficacy of OST and a parent-augmented OST (Augmented OST) with children in a randomized trial; and 2) to explore moderators of treatment outcome, including the effects of parental psychopathology and overprotective parenting practices. One hundred and fifty-four children (77 boys, 77 girls) between 7 and 12 years of age who meet DSM-IV criteria for a specific phobia will be randomly assigned to individual OST or to Augmented OST treatments. (The age range is restricted to 7 to 12 years of age because family-based enhancement strategies have been found to be most effective with this age group). Post-Treatment and 1,6, and 12 month follow-up evaluations will be conducted. As such, this project will recruit the largest sample of phobic youth ever undertaken in the Unified States. It will provide valuable information about the disorder, its treatment, and the moderators of treatment outcome. This efficacy trial will lay the foundation for an effectiveness trial.