Integrating AAT into TF-CBT for Maltreated Youth: A Randomized Feasibility Trial

摘要 这项研究的最终目标是确定动物是否以及通过什么机制- 辅助治疗(AAT)有益于受虐待青少年的治疗。目前的项目是可行的。 研究以确定是否有必要进行更大规模的临床试验。目前研究的具体目标是：(1) 检查AAT是否整合到标准的以创伤为中心的认知-行为治疗(TF- CBT)提高治疗效果，(2)评估AAT在整合时的耐受性和可行性 转化为Tf-CBT，以及(3)评估可以解释观察到的阳性的假设的中介过程 对AAT整合的影响。受虐待的青少年可能会表现出无数的情感和行为症状； 其中最突出的是创伤后应激障碍(PTS)。TF-CBT是一种公认的循证治疗方法 对于PTS和儿童虐待后的其他症状，因此是一种合适的干预措施 审判。60(60)名被虐待的青少年(6-17岁)PTS升高，将被分配接受TF-CBT或 Tf-CBT+AAT采用分组随机化程序。TF-CBT方案是标准的12个90分钟 通常用于研究试验的会议。符合TF-CBT+AAT条件的青少年将获得标准 每次会议期间，房间内都有一只经过认证的服务犬，青少年将被允许 在训练过程中与狗狗互动。将采用岗前设计，以确定是否增加学能测验 促进更大程度的PTS减少以及其他结果的更大改善，包括内部化 症状、外化症状和情绪调节。结果指标包括照顾者和年轻人- 报道的客观措施和通过心电图评估的呼吸性窦性心律失常(RSA) (心电图)在静息和应激反应范式中。评估的可行性指标包括治疗 满意度，能够在房间里养狗的情况下实施TF-CBT组件，治疗中断事件 可归因于狗的问题，以及狗是否因其参与而经历了重大压力。 狗所经历的压力将通过RSA、唾液皮质醇和行为反应来确定。 关于AAT作用机制的两个重要假说将被检验。第一，治疗性 融洽的关系将以多个增量进行评估，以确定狗的存在是否改善了 发展融洽的质量或效率。第二，在治疗期间，将为青少年记录RSA 以确定狗的存在是否会在会话期间产生较低的压力强度。两者都有 治疗的融洽程度和会议期间的压力水平将被作为中介变量来确定 任何一种都解释了增强的治疗结果。为了提高研究的方法论严谨性，数据将 由研究助理收集，对年轻人的治疗状况视而不见，同样的临床医生也会 实施这两种治疗条件，从而消除临床医生对结果的特定影响。

Abstract The eventual goal of this line of research is to determine whether, and through what mechanisms, Animal- Assisted Therapy (AAT) is beneficial for the treatment of maltreated youth. The current project is a feasibility study to determine if larger clinical trials are warranted. The specific aims of the current study are (1) to examine whether the integration of AAT into standard Trauma-Focused Cognitive-Behavioral Therapy (TF- CBT) enhances treatment effectiveness, (2) to evaluate the tolerability and feasibility of AAT when integrated into TF-CBT, and (3) to evaluate hypothesized mediational processes that may explain observed positive effects for the integration of AAT. Maltreated youth may display myriad emotional and behavioral symptoms; prominent among these is posttraumatic stress (PTS). TF-CBT is a well-established evidence-based treatment for PTS and other symptoms subsequent to child maltreatment and, therefore, is a suitable intervention for this trial. Sixty (60) maltreated youth (ages 6-17) displaying elevated PTS will be assigned to receive TF-CBT or TF-CBT+AAT using a blocked randomization procedure. The TF-CBT protocol is the standard 12 90-minute sessions typically used in research trials. Youth in the TF-CBT+AAT condition will receive the standard protocol with a certified service dog present in the room for each session and the youth will be allowed to interact with the dog during session. A pre-post design will be used to ascertain whether the addition of AAT prompts greater PTS reduction as well as greater improvements in other outcomes, including internalizing symptoms, externalizing symptoms, and emotion regulation. Outcome metrics include caregiver and youth- reported objective measures, and respiratory sinus arrhythmia (RSA) assessed via an electrocardiogram (ECG) during both a resting and stress reactivity paradigm. Feasibility metrics assessed include treatment satisfaction, ability to implement the TF-CBT components with a dog in the room, treatment disrupting events attributable to the dogs, and whether the dogs experienced significant stress as a result of their participation. Stress experienced by the dog will be determined through RSA, salivary cortisol, and behavioral responses. Two prominent hypotheses regarding the mechanism of effect for AAT will be examined. First, therapeutic rapport will be assessed at multiple increments to determine whether the presence of the dog improved the quality or efficiency of development of rapport. Second, RSA will be recorded for the youth during treatment sessions to determine if the presence of the dog yielded a lower intensity of stress during the sessions. Both therapeutic rapport and level of in-session stress will be examined as mediating variables to determine whether either explained enhanced treatment outcomes. To improve the methodological rigor of the study, data will be collected by research assistants blinded to the youth's treatment condition and the same clinicians will implement both treatment conditions, thereby eliminating clinician-specific effects on outcomes.