A social contextual analysis of CBT

青年人的GAD和相关焦虑症是慢性的，具有高度的损害性。认知行为疗法 (CBT)和其他积极形式的心理治疗（如教育，支持），与减少 焦虑（Barrett等1996; Kendall等1997; Last等1998; Silverman等1999）;然而， 大约44%的接受CBT治疗的焦虑儿童没有改善（James等人，2005年）。理解 儿童焦虑症治疗反应的预测因素和相关因素将使我们能够：（1）靶向治疗， 最有可能受益的儿童，（2）通过关注显示与 治疗反应，（3）开发针对CBT无反应者的新治疗方法。我们建议让这个孩子 焦虑症，如广泛性焦虑症（Rapee，2002），与“警惕-回避”模式有关 其特征在于在监测和评估情绪信息以及调节情绪方面存在问题， 反应.这种模式可以通过控制和批评性的父母行为，父母 精神病理学和与同伴的负面互动。CBT治疗儿童焦虑症的目标中断 通过教孩子识别和管理消极情绪的技能来调节情绪， 在暴露过程中练习这些技能的机会。这些技能然后被假定为推广到社会 在诊所外的日常生活环境中的互动，包括与父母和同龄人的互动。虽然 在社会环境中情感功能的改善被认为在焦虑儿童的 虽然对CBT的反应积极，但研究尚未明确表明儿童或父母的行为之间的联系。 情感行为及其对治疗的反应。我们将研究儿童的情绪调节在 社会背景及其与父母和同伴的关系（1）预测CBT的初始和长期反应 治疗（单独治疗，并与以儿童为中心的积极比较治疗进行比较）和（2）改变 在整个治疗过程中。我们将依靠两种生态有效的方法来评估情感 自然主义情境下的行为：（a）行为观察和（B）生态瞬时评估。

GAD and related anxiety disorders in youth are chronic and highly impairing. Cognitive-behavioral therapy (CBT), and other active forms of psychotherapy (e.g. education, support), are associated with reductions in anxiety (Barrett et al 1996; Kendall et al 1997; Last et al 1998; Silverman et al 1999); however, approximately 44% of anxious children treated with CBT do not improve (James et al 2005). Understanding predictors and correlates of treatment response in child anxiety will allow us to: (1) target treatments to children most likely to benefit, (2) refine treatments by focusing on components shown to be associated with treatment response, and (3) develop new treatments tailored to CBT non-responders. We propose that child anxiety disorders, as exemplified by GAD (Rapee, 2002), are associated with a "vigilance-avoidance" pattern characterized by problems in monitoring and evaluating emotional information and modifying emotional reactions. This pattern can be reinforced by controlling and critical parenting behaviors, parental psychopathology, and negative interactions with peers. CBT treatments for child anxiety target disruptions in emotion regulation by teaching children skills for identifying and managing negative emotion and providing opportunities to practice these skills during exposures. These skills are then presumed to generalize to social interactions in daily life settings outside the clinic, including interactions with parents and peers. Although improvements in affective functioning in the social context are believed to play a role in anxious children's positive response to CBT, research has not yet clearly demonstrated links between children's or parents' affective behaviors and their response to treatment. We will examine how children's emotion regulation in the social context and their relationships with parents and peers (1) predict initial and long-term response to CBT treatment (individually and compared to an active comparison Child Centered treatment) and (2) change across the course of treatment. We will rely on two ecologically valid methods for assessing affective behaviors in naturalistic contexts: (a) Behavioral Observation and (b) Ecological Momentary Assessment.