ABSTRACT

Objective

The relative contribution of individual cognitive behavioral therapy (CBT) components to treatment outcomes for child anxiety disorders (CADs) is unclear. Recent meta-analyses suggest that exposure may be the primary active ingredient in CBT for CADs, and that relaxation may be relatively less effective. This brief report tests the hypothesis that exposure-focused CBT (EF-CBT) would outperform a relaxation-based active therapy control (Relaxation Mentorship Training; RMT) for the treatment of CADs.

Method

Participants were 102 youth with CADs (mean age = 11.91, 26 males; 76.4% White, 14.7% Multiracial, 3.9% Black, 3.9% Asian, 0.9% other/do not wish to identify) as part of an ongoing neuroimaging randomized controlled trial. Participants were randomly assigned (ratio 2:1) to receive 12 sessions of EF-CBT (n = 70) or RMT (n = 32). Clinical improvement was measured at Week 12 (Clinical Global Impression – Improvement scale; CGI-I); treatment response was defined as receiving a rating of “very much” or “much improved” on the CGI-I. Anxiety severity was measured at Weeks 1, 6, 9, 12 (Pediatric Anxiety Rating Scale; PARS). Outcome measures were completed by an independent evaluator unaware of condition.

Results

EF-CBT exhibited 2.98 times higher odds of treatment completion than RMT; 13 treatment non-completers were included in analyses. Estimated treatment response rates were higher for EF-CBT (57.3%) than for RMT (19.2%). Longitudinal analyses indicated that EF-CBT was associated with faster and more pronounced anxiety reductions than RMT on the PARS (Hedges’ g = .77).

Conclusions

Results suggest that EF-CBT without relaxation is effective for CADs, and more effective than a relaxation-based intervention.

中文翻译：

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在儿童和青少年焦虑治疗的随机对照试验中，以暴露为中心的 CBT 优于基于放松的控制

摘要

客观的

个体认知行为治疗 (CBT) 成分对儿童焦虑症 (CAD) 治疗结果的相对贡献尚不清楚。最近的荟萃分析表明，暴露可能是 CBT 治疗 CAD 的主要活性成分，而放松的效果可能相对较差。这份简短的报告测试了以下假设：在治疗 CAD 方面，以暴露为中心的 CBT (EF-CBT) 的效果优于基于放松的主动治疗控制（放松指导培训；RMT）。

方法

参与者为 102 名患有 CAD 的青少年（平均年龄 = 11.91，26 名男性；76.4% 白人，14.7% 多种族，3.9% 黑人，3.9% 亚洲人，0.9% 其他/不想识别身份），作为正在进行的神经影像学随机对照试验的一部分。参与者被随机分配（比例 2:1）接受 12 次 EF-CBT (n = 70) 或 RMT (n = 32)。第 12 周测量临床改善（临床整体印象 – 改善量表；CGI-I）；治疗反应被定义为在 CGI-I 上获得“非常”或“改善很大”的评级。在第 1、6、9、12 周测量焦虑严重程度（儿科焦虑评定量表；PARS）。结果测量由不了解情况的独立评估员完成。

结果

EF-CBT 的治疗完成率比 RMT 高 2.98 倍；分析中包括 13 名未完成治疗者。EF-CBT 的估计治疗反应率 (57.3%) 高于 RMT (19.2%)。纵向分析表明，与 PARS 上的 RMT 相比，EF-CBT 可以更快、更显着地减少焦虑（Hedges' g = .77）。

结论

结果表明，不放松的 EF-CBT 对 CAD 有效，并且比基于放松的干预措施更有效。