Pre-treatment child and family characteristics as predictors of outcome in cognitive behavioural therapy for youth anxiety disorders

Abstract

Background: Cognitive behavioural therapy (CBT) has been found to be effective for children and adolescents (6–18 years) with anxiety disorders, but the non-response rate is high—a fact that may argue for the importance of studies on pre-treatment characteristics of children and their families that predict treatment outcome. Aims: To provide a systematic review of clinical and demographic pre-treatment child and family predictors of treatment outcome in CBT for anxiety disorders in youth. Method: A systematic literature search was conducted based on electronic databases (PsycINFO, Embase and PubMed), and retrieved studies were analysed according to the box-score method of counting significant findings. Results: 24 studies with a sample size ≥ 60 were located. Most studies dealt with the following predictors: child age, gender, comorbidity, symptom severity and parental psychopathology. There was some evidence that a higher degree of pre-treatment symptomatic severity and non-anxiety comorbidity predicted higher end-state severity, but not a lesser degree of improvement. There was some but inconsistent support for a negative influence of parental psychopathology. Conclusion: Studies on pre-treatment child and family predictors of outcome in CBT for youth anxiety disorders have until now resulted in few findings of clinical or theoretical significance.     

Impact of youth and caregiver worries about treatment on therapeutic process factors and posttreatment outcomes

ObjectiveTo examine the impact of youth- and caregiver-reported pretreatment worries about treatment (i.e., concerns about the effect of, perceptions of, or aspects involved in treatment) before cognitive behavioral therapy for anxiety on (1) clinician-rated therapeutic process factors (i.e., client engagement, client-therapist alliance, content mastery, and homework completion) and symptom change (i.e., improvement, anxiety severity) assessed throughout treatment and (2) independent evaluator-rated posttreatment outcomes (i.e., response, remission, and functional impairment).MethodsParticipants were 128 youth, aged 7–17 years, who sought treatment for a principal anxiety disorder, and their primary caregiver. Multilevel models were estimated to examine the relationship between worries about treatment and the set of therapeutic factors. Regression models examined the relationship between worries about treatment and posttreatment outcomes.ResultsResults indicated that greater youth-reported worries about treatment flattened/lessened improvement trajectories throughout treatment and had a positive association with higher anxiety severity and lower content mastery. Greater caregiver-reported worries about treatment were associated with greater homework completion, client engagement, and content mastery throughout treatment. Youth- and caregiver-reports of worries about treatment did not impact independent evaluator-rated posttreatment outcomes.ConclusionsFindings support the notion that worries about treatment do not prevent youth from achieving favorable posttreatment outcomes, but do impact various therapeutic factors differentially across youth and caregiver report (e.g., content mastery, client engagement, and homework completion). The value of addressing worries about treatment at the start of therapy is discussed.     

社交焦虑障碍的认知行为集体治疗的初步结果

目的探讨社交焦虑障碍(SAD)的认知行为集体治疗(CBGT)的方法和初步结果。方法上海市精神卫生中心就诊的SAD患者中自愿参加CBGT者,符合DSM-IV关于SAD的诊断标准,性别年龄不限。每个治疗小组6-8人,治疗8周,每周1次,每次2.5小时,内容包括认知重建、放松训练、社交技巧训练、系统暴露、现场暴露和家庭作业。治疗期间患者均未服用治疗SAD药物。疗效评定由两位心理治疗师进行,主要工具为Liebowitz社交焦虑评定量表(LSAS),计总分、恐惧因子分、回避因子分,统计分析用配对T检验。结果符合入组条件58例,年龄16-48岁,起病年龄11-34岁,病程6个月-19年。LSAS总分治疗前后75.89±28.82和47.00±23.71(t=12.60,p<0.01);恐惧因子分治疗前后39.28±13.12和25.39±12.42(t=8.267,p<0.01);回避因子分治疗前后36.39±16.44和22.17±13.29(t=8.067,p<0.01),均有统计学显著性差异。结论CBGT治疗SAD有很好的疗效,尤其对SAD的回避行为效果似更显著,值得推广。     

社交焦虑障碍的认知行为集体治疗效果的影响因素

目的 探讨社交焦虑障碍的认知行为集体治疗疗效的影响因素。方法 上海市精神卫生中心就诊的社交焦虑障碍患者中自愿参加认知行为集体治疗者,每个治疗小组6～8人,治疗8周,每周1次2．5小时,内容包括认知重建、放松训练、社交技巧训练、系统暴露、现场暴露和家庭作业。疗效评定工具为Liebowitz社交焦虑评定量表。结果 58例患者中社交焦虑评定量表总分、恐惧因子分和回避因子分治疗前后差异均有统计学显著性意义。在研究可能影响治疗的20种因素中有19种因素有显著的影响作用。结论 认知行为集体治疗社交焦虑障碍有效,但影响疗效因素较多,应用该治疗方案时应予充分考虑。     

Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: A preliminary randomized controlled trial

Seventy-six individuals with a principal diagnosis of generalized anxiety disorder (GAD) were randomly assigned to receive either an MI pretreatment or no pretreatment (NPT), prior to receiving CBT. Significant group differences favoring the MI-CBT group were observed on the hallmark GAD symptom of worry and on therapist-rated homework compliance, which mediated the impact of treatment group on worry reduction. Adding MI pretreatment to CBT was specifically and substantively beneficial for individuals with high worry severity at baseline. There was evidence of relapse at 6-month follow-up for high severity individuals who received MI-CBT, but significant moderator effects favoring the high severity MI-CBT group were again apparent at 12-months post-treatment. Pending replication in a more controlled test, these findings suggest that MI may be a promising adjunct to CBT for GAD for those of high severity, a group which has been less responsive to CBT in past research.     

Intolerance of uncertainty and transdiagnostic group cognitive behavioral therapy for anxiety

BackgroundRecent evidence suggests intolerance of uncertainty (IU) is a transdiagnostic variable elevated across anxiety disorders. No studies have investigated IU’s response to transdiagnostic group CBT for anxiety (TGCBT). This study evaluated IU outcomes following TGCBT across anxiety disorders.Methods151 treatment-seekers with primary diagnoses of social anxiety disorder, panic disorder, or GAD were evaluated before and after 12 weeks of TGCBT and completed self-report questionnaires at pre-, mid-, and post-treatment.ResultsIU decreased significantly following treatment. Decreases in IU predicted improvements in clinical presentation across diagnoses. IU interacted with time to predict improvement in clinical presentation irrespective of primary diagnosis. IU also interacted with time to predict improvement in clinical presentation although interactions of time with diagnosis-specific measures did not. IUS interacted with time to predict reduction in anxiety and fear symptoms, and inhibitory IU interacted with time to predicted reductions in anxiety symptoms but prospective IU did not.ConclusionIU appears to be an important transdiagnostic variable in CBT implicated in both initial presentation and treatment change. Further implications are discussed     

The link between social anxiety disorder,treatment outcome,and sleep difficulties among patients receiving cognitive behavioral group therapy

ObjectiveThe aim of our study was to examine the association between sleep disturbances and social anxiety disorder (SAD). Another aim was to explore the impact of cognitive behavioral group therapy (CBGT) for SAD on co-occurring sleep difficulties.MethodsData were obtained retrospectively from patient files receiving CBGT for SAD. The sample included 63 patients with SAD (mean age, 30.42 years [standard deviation, 6.92 years]). There were 41 men and 22 women, of whom 41 participants completed the treatment protocol. Before treatment onset participants completed the Liebowitz Social Anxiety Scale (LSAS), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index, and several sociodemographic questions. On completion of the treatment protocol, the same measures were completed, with the addition of the Sheehan Disabilities Scale (SDS).ResultsThe results of our study suggest that: (1) subjective insomnia is associated with SAD severity even after controlling for depression severity and additional variables; (2) participants with SAD with co-occurring clinical levels of subjective insomnia present a more severe clinical picture both at treatment onset and termination; and (3) although CBGT lead to reduction in SAD and depression symptoms severity, it had no significant impact on co-occurring sleep difficulties.ConclusionsSleep difficulties predict SAD severity regardless of depressive symptoms and may be linked to a more severe clinical picture. Clinicians should be aware of these sleep difficulties co-occurring with SAD and consider implementing specific sleep interventions. Future studies should incorporate larger samples sizes from clinical populations outside of Israel.     

A pilot study of intensive 7-day internet-based cognitive behavioral therapy for social anxiety disorder

Accessible, affordable cognitive behavioral therapy (CBT) options for Social Anxiety Disorder (SAD) that allow for rapid symptom improvement are needed. The present study investigated the first intensive, 7-day internet-based CBT for SAD. An open pilot trial was conducted to test the acceptability, feasibility and preliminary outcomes of the program in a sample of 16 participants (9 females, M age = 40.34, SD = 10.55) with a DSM-5 diagnosis of SAD. Participants were enrolled into the 6-lesson online program, and completed the Social Phobia Scale [SPS], Social Interaction Anxiety Scale [SIAS], Patient Health Questionnaire-9 (PHQ-9), and Work and Social Adjustment Scale (WSAS) at baseline, post and one month follow-up. We found support for the feasibility and acceptability of the program; 15 participants (93.8%) completed the program, and all participants reported the program was satisfactory. Large, significant reductions in social anxiety severity on both the SPS and SIAS (Hedges’ g_s = 1.26–1.9) and functional impairment (WSAS; g_s = 0.88–0.98) were found at post-treatment and follow-up. Medium, significant reductions in depressive symptom severity were also found (g_s = 0.88–0.98 at post and follow-up, respectively). A third of participants scored below the clinical cut-off on both the SPS and SIAS at post-treatment and follow-up. A randomized controlled trial with longer follow-up is needed to evaluate the efficacy of this intensive internet-based treatment for SAD. Implications and future research directions are discussed.     

认知行为治疗对产后抑郁症的疗效分析

目的探讨认知行为治疗对产后抑郁症患者的功能失调性认知和抑郁症状的疗效。方法对48例产后抑郁症患者进行8周的认知行为治疗,对照组的45例产后抑郁症给予健康宣教等一般治疗,采用功能失调性态度问卷（DAS）、汉密尔顿抑郁量表（HAMD）等进行评估。结果治疗后干预组的DAS总分及脆弱性、完美化、依赖性及自主性态度等因子分均显著低于对照组（P〈0．05或0．01）,且干预组治疗前后的DAS总分及脆弱性、完美化、依赖性及自主性态度等因子分也有显著性差异（P〈0．05或0．01）;干预组总有效率为89．6％,对照组总有效率为53．3％（t=6．37,P〈0．01）。治疗后两组的HAMD总分有极显著性差异（t=6．37,P〈0．01）。结论认知行为治疗能显著改善产后抑郁症的功能失调性认知,对产后抑郁有较好的疗效。     

认知行为疗法治疗慢性失眠障碍的研究现状

本文目的是分析失眠的认知行为治疗(CBTI)对慢性失眠障碍的效果,以期为推动CBTI的临床运用提供理论依据,为我国慢性失眠障碍患者选用非药物治疗提供参考.慢性失眠障碍是常见的疾病,CBTI已成为慢性失眠障碍的首选治疗方法.本文主要从CBTI对慢性失眠障碍的生理机制及神经影像学方面研究现状、疗效、不良反应、面临的问题及处...     

Temperament and parenting predicting anxiety change in cognitive behavioral therapy: The role of mothers,fathers, and children

ObjectiveA considerable amount of children with anxiety disorders do not benefit sufficiently from cognitive behavioral treatment. The present study examines the predictive role of child temperament, parent temperament and parenting style in the context of treatment outcome.MethodParticipants were 145 children and adolescents (ages 8–18) with DSM-IV-TR anxiety disorders who received a 12-session CBT program and were assessed at pretreatment, posttreatment and three months follow-up. Multiple-regression analyses were used to evaluate the following pretreatment and posttreatment variables as potential predictors of treatment response at follow-up: baseline level of anxiety symptoms, child reported maternal and paternal rearing style (emotional warmth, rejection, and overprotection), parent reported child temperament traits (negative affect, effortful control, and extraversion), and mothers’ and fathers’ self-report temperament traits.ResultsMore maternal negative affect and less emotional warmth as perceived by the child before treatment were related to less favorable treatment outcome (accounting for 29% of the variance in anxiety at follow-up). Furthermore, maternal negative affect and children's extraversion measured after treatment also predicted anxiety at follow-up (together accounting for 19% of the variance). Paternal temperament and parenting style were unrelated to treatment outcome, as were children's pretreatment temperament traits.ConclusionThe results suggest that tailoring intervention to include strategies to reduce maternal negative affect and promote an emotional warm rearing style may improve treatment outcome.     

Computer‐assisted delivery of cognitive behavioral therapy for anxiety disorders in primary‐care settings

Objectives: This article describes a computer‐assisted cognitive behavioral therapy (CBT) program designed to support the delivery of evidenced‐based CBT for the four most commonly occurring anxiety disorders (panic disorder, posttraumatic stress disorder, generalized anxiety disorder, and social anxiety disorder) in primary‐care settings. The purpose of the current report is to (1) present the structure and format of the computer‐assisted CBT program, and (2) to present evidence for acceptance of the program by clinicians and the effectiveness of the program for patients. Methods: Thirteen clinicians using the computer‐assisted CBT program with patients in our ongoing Coordinated Anxiety Learning and Management study provided Likert‐scale ratings and open‐ended responses about the program. Rating scale data from 261 patients who completed at least one CBT session were also collected Results: Overall, the program was highly rated and modally described as very helpful. Results indicate that the patients fully participated (i.e., attendance and homework compliance), understood the program material, and acquired CBT skills. In addition, significant and substantial improvements occurred to the same degree in randomly audited subsets of each of the four primary anxiety disorders (N=74), in terms of self ratings of anxiety, depression, and expectations for improvement. Conclusions: Computer‐assisted CBT programs provide a practice‐based system for disseminating evidence‐based mental health treatment in primary‐care settings while maintaining treatment fidelity, even in the hands of novice clinicians. Depression and Anxiety, 2009. Published 2009 Wiley‐Liss, Inc.     

网络团体认知行为治疗在改善抑郁焦虑症状中的应用

本文目的是对网络团体认知行为治疗（IGCBT）改善抑郁焦虑症状方面的文献进行综述,分别从治疗形式、治疗方案、疗效及作用机制等方面进行阐述,并总结其局限性和未来研究方向。认知行为治疗（CBT）是一套结构化的、短程的、着眼于现在的心理治疗方法,网络和团体的开展形式使得CBT的应用更加广泛,其在缓解不同疾病引起的抑郁焦虑症状方面效果较好,但也存在一些弊端。本文通过回顾IGCBT的临床应用及其对改善患者抑郁焦虑症状的效果和作用机制,为其今后的应用提供参考。     

团体认知行为治疗对广泛性焦虑障碍的临床疗效及其对患者执行功能的影响

背景 广泛性焦虑障碍（GAD）患者常存在执行功能损害。团体认知行为治疗（CBT）有助于改善GAD患者的负性情绪,但对执行功能的改善效果尚不明确。目的 探讨团体CBT对GAD患者焦虑症状和执行功能的影响,以期为GAD患者的康复治疗提供参考。方法 连续选取2021年3月—2022年8月在十堰市太和医院睡眠心身医学中心住院的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）中GAD诊断标准的80例患者为研究对象,采用随机数字表法分为研究组（n=40）和对照组（n=40）。两组均接受药物治疗及疾病健康教育,研究组在此基础上接受为期6周、每周1次、每次60~90 min的团体CBT。分别于治疗前和治疗6周后使用汉密尔顿焦虑量表（HAMA）评定焦虑症状,使用额叶功能评定量表（FAB）评定执行功能。结果 重复测量方差分析结果显示,两组HAMA评分的时间效应有统计学意义（F=1 870.320,P<0.01）,组间效应以及时间与组间的交互效应无统计学意义（F=1.254、0.293,P均>0.05）。两组FAB评分的时间效应、组间效应以及时间与组间的交互效应均有统计学意义（F=311.190、4.399、7.021,P<0.05或0.01）。进一步分析结果显示,治疗后,两组FAB评分均高于治疗前（t=200.569、115.401,P均<0.01）,且研究组FBA评分高于对照组（t=-3.211,P<0.01）。结论 团体CBT联合药物治疗可能有助于降低GAD患者焦虑水平,改善其执行功能。     

认知行为治疗对头颈部肿瘤患者焦虑抑郁情绪的对照研究

目的探讨认知行为疗法对头颈部肿瘤患者伴发情绪问题的治疗作用。方法将43例抑郁症患者用随机数字法分为研究组21例(认知行为治疗,CBT)和对照组22例(支持性咨询),疗程为8周,采用汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)、焦虑自评量表(SAS)和抑郁自评量表(SDS)评定疗效。结果治疗后第8周末,研究组HAMA和HAMD评分显著低于对照组(P<0.05),SAS标分、SDS指数、精神情感症状、躯体性障碍、精神运动性障碍和抑郁心理障碍评分均显著低于治疗前,差异有统计学意义(P<0.05)。结论 CBT可有效减少患者焦虑和抑郁症状,并通过早期干预治疗急性应激,防止癌症患者心理病理状态慢性化。     

Remote cognitive behavioral therapy for panic disorder: A meta-analysis

Cognitive behavioral therapy (CBT) is an established treatment for panic disorder (PD). Remote CBT (RCBT) is becoming increasingly popular and has the potential to enhance access to this treatment. The aim of this study was to examine the efficacy of RCBT for PD using a meta-analytic approach. An electronic database search was used to identify relevant articles and the references of previously completed reviews. Twenty-one studies (n = 1,604; mean age range: 31.9–43.9; mean female representation = 71 %) were included in the meta-analysis. 14/21 (67 %; n = 817 of the included studies were randomised controlled trials and 7/21 (33 %; n = 787) were open trials or non-randomised controlled trials. Pooled within-group effect sizes across all remote treatments for PD symptoms were large from pre-treatment to post-treatment (Hedges’ g = 1.18; 95 % CI: 0.99–1.36) and pre-treatment to follow-up (Hedges’ g = 1.51; 95 % CI: 1.22–1.79). Pooled between-group findings indicate that remote CBT treatments are more effective than passive control (Hedges’ g = 1.17; 95 % CI: 0.85–1.50), but are similar to other active treatments on measures of PD symptoms (e.g., face-to-face CBT) (Hedges’ g = 0.02; 95 % CI: −0.43 to 0.48). Internet-delivered CBT (Hedges’ g = 1.10, 95 % CI: 0.91–1.30), videoconferencing-delivered CBT (Hedges’ g = 1.40, 95 % CI: 0.85–1.95) and bibliotherapy-delivered CBT (Hedges’ g = 1.51, 95 % CI: 0.95–2.06) each produce large effect sizes on measures of PD symptoms. The results have important implications for the dissemination of entirely remote stepped-care treatments for PD.     

慢性失眠症认知行为治疗研究进展

慢性失眠症的治疗方式主要包括药物治疗和认知行为治疗.药物治疗慢性失眠症起效时间短、见效快,但易增加成瘾性,产生不良反应.认知行为疗法（CBT）是应用最广泛的非药物治疗方法,现已用于慢性失眠症的治疗并取得显著的疗效.CBT在治疗慢性失眠症的同时避免了药物治疗的不良反应,并且长期治疗效果优于药物治疗.     

认知疗法合并黛力新治疗脑卒中后焦虑的疗效

目的评价认知疗法合并黛力新(氟哌噻吨/美利曲辛)治疗脑卒中后焦虑的疗效。方法将80例脑卒中后焦虑患者随机分为治疗组(n=40)和对照组(n=40),分别给予认知疗法合并黛力新、单用黛力新治疗8周。用汉密顿焦虑量表、副反应量表分别评定疗效和副反应。结果治疗4、8周时,治疗组汉密顿焦虑量表评分(16.08±7.45,8.80±4.73)明显低于对照组(19.80±8.26,11.35±5.03),P<0.05;临床总疗效无论治疗4、8周,治疗组均优于对照组,P<0.01。结论认知疗法合并黛力新治疗脑卒中后焦虑的疗效较好。