Augmented Treatment of Specific Phobias in Children

描述（由申请人提供）：拟议调查的总体目的是比较一次治疗（OST：认知行为治疗的一种变体）和家庭增强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，我们已经表明，在治疗后（分别为60%、26%和0%的免诊率）和6个月的随访（OST为60%，EST为42%，等待名单参与者在等待1个月后随机分配到OST或EST条件），OST在治疗青少年特定恐惧症方面比教育/支持治疗（EST）或等候名单控制条件更有效。虽然OST被证明优于这些条件，但很明显，接受这种治疗的青年中有40%在治疗后或6个月的随访中没有诊断出来，并且他们继续经历痛苦的症状。在此，基于我们的家长利益相关者的反馈，我们建议在标准的OST程序的基础上增加一个家长管理补充，向家长提供关于特定恐惧症的性质、过程和原因的教育，并为他们提供有效的策略，以解决孩子在OST后挥之不去的痛苦和回避。简而言之，我们建议在一项有154名7 - 12岁儿童参与的随机临床对照试验中，比较标准的OST程序和父母强化的OST程序。具体目的有两个：1)在一项随机试验中评估OST和家长增强OST（增强OST）对儿童的疗效；2)探讨治疗结果的调节因素，包括父母精神病理和过度保护的父母行为的影响。154名符合DSM-IV特定恐惧症标准的7至12岁儿童（77名男孩，77名女孩）将被随机分配到个体OST或增强OST治疗中。（年龄范围限制在7至12岁，因为以家庭为基础的增强策略被发现对这个年龄组最有效）。治疗后及1、6、12个月随访评估。因此，这个项目将招募美国有史以来最大的恐惧症青年样本。它将提供有关该疾病、其治疗和治疗结果调节因子的宝贵信息。该疗效试验将为后续疗效试验奠定基础。

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.