A social contextual analysis of CBT

青少年的GAD和相关的焦虑症是慢性的，危害很大。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等人1996年；Kendall等人1997年；Last等人1998年；Silverman等人1999年)；然而， 接受CBT治疗的焦虑儿童中，大约44%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)有针对性地治疗 儿童最有可能受益，(2)通过关注与疾病相关的成分来完善治疗 治疗反应，以及(3)开发针对CBT无反应者的新治疗方法。我们向那个孩子求婚 焦虑症，如广泛性焦虑症(Rapee，2002)所示，与“警觉-回避”模式有关 以监控和评估情绪信息以及修改情绪为特征的 反应。这种模式可以通过控制和批判性的父母养育行为、父母 精神病，以及与同龄人的负面互动。儿童焦虑症的CBT治疗目标干扰 通过教授儿童识别和管理负面情绪的技能并提供 在曝光期间练习这些技能的机会。这些技能然后被推定为推广到社会 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 社会环境中情感功能的改善被认为在焦虑的儿童中起到了作用 对CBT的积极回应，研究尚未清楚地证明孩子或父母之间的联系 情感行为及其对治疗的反应。我们将研究儿童的情绪调节是如何在 社会背景及其与父母和同龄人的关系(1)预测对CBT的初始和长期反应 治疗(单独和与积极的以儿童为中心的治疗相比较)和(2)改变 在整个疗程中。我们将依靠两种生态上有效的方法来评估情感 自然主义背景下的行为：(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.