Barriers to remission from child and adolescent anxiety disorders following extensive treatment: An exploratory study

Sarah Farraway , Viviana M. Wuthrich , Heidi Lyneham , Jennifer Hudson , Maria Kangas , Mary-Lou Chatterton , Catherine Mihalopoulos , Ronald M. Rapee
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Abstract

Although treatments for child and adolescent (hereafter, children) anxiety show good efficacy, a significant proportion of children do not remit, even 12 months after receiving treatment. Barriers to treatment responsiveness among chronically anxious children is not well studied. The current study evaluated barriers and predictors of poor treatment response among a small sample of children who reached the third step in a three-stage stepped-care intervention. Stepped-care involved low-intensity CBT, followed by standard CBT if required, and subsequently high intensity CBT if still warranted. Children moved to the next step of stepped-care if requested by their caregiver following feedback of clinical status and symptom change by their therapist. From the initial sample of 139 children entering step 1, 26 (18.7%) children provided data in the third step and were assessed approximately 12 months following their baseline assessment. Several baseline constructs and treatment engagement measures were completed both quantitatively and qualitatively. At the end of Step 3, 14 of 26 (54%) participants had not remitted from their primary disorder and 19 (77%) were not remitted from all anxiety disorders. Non-remission was associated with baseline measures of higher primary disorder severity, fewer anxiety disorders, higher child self-reported social anxiety and total difficulties, and poorer mood. Therapy factors associated with non-remission included greater avoidance, less engagement with exposure tasks, and poorer homework completion. Identifying factors that predict poor response to treatment can help to tailor intervention and improve outcomes for this very complex group of young people.

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广泛治疗后儿童和青少年焦虑症缓解的障碍:一项探索性研究
虽然对儿童和青少年(以下简称儿童)焦虑症的治疗效果良好,但相当比例的儿童在接受治疗12个月后仍未缓解。慢性焦虑儿童的治疗反应障碍尚未得到很好的研究。目前的研究在一个小样本的儿童中评估了障碍和不良治疗反应的预测因素,这些儿童在三个阶段的阶梯护理干预中达到了第三步。阶梯式护理包括低强度的CBT,如果需要,接着是标准的CBT,如果仍然需要,随后是高强度的CBT。如果他们的照顾者要求,孩子们在他们的治疗师反馈临床状态和症状变化后,转移到下一步的阶梯护理。从进入第1步的139名儿童的初始样本中,26名(18.7%)儿童在第三步提供了数据,并在基线评估后约12个月进行了评估。定量和定性地完成了几个基线构建和治疗参与措施。在第3步结束时,26名参与者中有14名(54%)没有从他们的原发障碍中缓解,19名(77%)没有从所有焦虑症中缓解。未缓解与较高的原发性疾病严重程度、较少的焦虑症、较高的儿童自我报告的社交焦虑和总困难以及较差的情绪相关。与非缓解相关的治疗因素包括更大的回避,更少的接触任务,更差的家庭作业完成情况。确定预测治疗不良反应的因素可以帮助定制干预措施并改善这一非常复杂的年轻人群体的结果。
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来源期刊
Journal of Behavioral and Cognitive Therapy
Journal of Behavioral and Cognitive Therapy Psychology-Clinical Psychology
CiteScore
3.30
自引率
0.00%
发文量
38
审稿时长
60 days
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