Early Intervention in Depression Dyadic Emotion Development Therapy for Preschool

描述（由申请人提供）：本R34申请旨在进一步发展和试点一种早期干预学龄前抑郁症的方法。本研究的具体目的是进一步修改和调整一种已被证明有效的针对学龄前破坏性障碍的手动二元早期干预方法——亲子互动疗法（PCIT, Eyberg, 1988），以应用于学龄前抑郁症。提议的治疗方案名为PCIT-情绪发展（ED），已被修改，以包括专注于“情绪发展”的额外治疗组件。新的ED模块从发展的角度解决了早期情绪反应的偏差，并基于情绪障碍的情绪发展模型。pct - ed是一种发展敏感的儿童抑郁症早期干预策略，侧重于加强亲子关系，并利用父母作为“治疗师的手臂”。父母支持在学龄前抑郁症严重程度中的中介作用先前已被确立，支持二元关系是抑郁症早期干预的理想目标的概念。PCIT以前已经成功地应用于焦虑症。临床学龄前抑郁综合征的有效性现已在两个独立的研究样本中得到证实。已经发现了特定和稳定的症状群、相关疾病的家族史、生物学相关性和低积极性的观察证据。这些验证结果的重复，以及在多种情况下基于独立评分者的发育和适应功能显著损伤的新证据也已确立。这些发现证实了这种早发性抑郁综合征的临床意义以及在学龄前进行干预的必要性。建议进行两阶段的研究，从“公开病例系列”开始，在此期间对每个治疗阶段进行系统评估，并修改手册以最大限度地提高可接受性和保真度。随后将进行一项试点可行性研究，其中N=30名受试者将随机分配到PCIT-ED或积极的父母教育控制条件。与早期干预对几种精神障碍更有效的证据一致，在学龄前时期对抑郁症的干预可能为在快速发育和神经生物学变化时期获得更大的治疗效果提供了机会。由于缺乏针对青春期前儿童的安全且明显有效的治疗方法，公共卫生需要对抑郁症进行新颖和早期的干预。这个项目的公共卫生目标是寻找新的和潜在的更有效的方法来治疗儿童抑郁症。该项目的重点是尽可能早地识别抑郁症，并使用针对亲子关系的新治疗方法。这是必要的，因为抑郁症是一种严重的慢性疾病，目前几乎没有安全有效的治疗方法。

DESCRIPTION (provided by applicant): This R34 application proposes to further develop and pilot an early intervention for depression during the preschool period. The specific aim of the proposed study is to further modify and adapt a proven effective manualized dyadic early intervention for preschool disruptive disorders, Parent Child Interaction Therapy (PCIT, Eyberg, 1988), for application to preschool depression. The proposed treatment entitled PCIT- Emotion Development (ED) has been modified to include additional treatment components that focus on "emotion development". The new ED module addresses deviations in early emotional reactivity from a developmental perspective and is based on an emotion development model of mood disorders. PCIT-ED is proposed as a developmentally sensitive early intervention strategy for childhood depression focused on strengthening the parent-child relationship and utilizing the parent as an "arm of the therapist". The mediating role of parenting support in preschool depression severity has been previously established supporting the notion that the dyadic relationship is an ideal target for early intervention in depression. PCIT has been previously successfully adapted for application to anxiety disorders. The validity of a clinical preschool depressive syndrome has now been established in two independent study samples. Evidence of a specific and stable symptom constellation, family history of related disorders, biological correlates, and observational evidence of low enthusiasm have been found. Replication of these validation findings as well as new evidence for significant impairment in developmental and adaptive functioning based on independent raters in multiple contexts has also been established. These findings confirm the clinical significance of this early onset depressive syndrome and the need for intervention for during the preschool period. A 2-stage study is proposed, beginning with an "open case series" during which each treatment session will be systematically assessed and the manual will be modified to maximize acceptability and fidelity. This will be followed by a pilot feasibility study in which N=30 subjects will be randomized to PCIT-ED or an active parenting education control condition. In keeping with evidence of greater efficacy of earlier intervention in several mental disorders, intervention for depression during the preschool period may provide a window of opportunity for greater therapeutic efficacy during a period of rapid developmental and neurobiological change. The public health need for novel and earlier interventions in depression is underscored by the lack of available safe and clearly effective treatments for prepubertal children. PHS 398 (Rev. 09/04) Page Form Page 2 The public health goal of this project is to find new and potentially more effective methods for treating childhood depression. The project focuses on the earliest possible identification of depression and the use novel therapeutic approaches that target the parent-child relationship. This is needed because depression is a serious and chronic disorder for which there are currently few safe and effective treatments established.