{"title":"推进过渡年龄青少年焦虑症的治疗：无意识暴露治疗效果回顾。","authors":"Paul Siegel, Bradley S. Peterson","doi":"10.1111/jcpp.14037","DOIUrl":null,"url":null,"abstract":"<div>\n \n <section>\n \n <h3> Background</h3>\n \n <p>The real-world effectiveness of exposure-based therapies for youth depends on the willingness and ability of young people to tolerate confronting their fears, which can be experienced as highly aversive and create problems with treatment engagement and acceptance. Recently, neuroscientific research on the nonconscious basis of fear has been translated into novel exposure interventions that bypass conscious processing of feared stimuli and that thus do not cause phobic youth to experience distress. We present a review of these unconscious exposure interventions.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A PRISMA-based search yielded 20 controlled experiments based on three paradigms that tested if fear-related responses could be reduced without conscious awareness in highly phobic, transition-age youth: 14 randomized controlled trials (RCTs), 5 fMRI studies (1 was also an RCT), 4 psychophysiological studies (3 were also RCTs), and 1 ERP study. We conducted meta-analyses of outcomes where feasible.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Unconscious exposure interventions significantly (1) reduced avoidance behavior (range of Cohen's <i>d</i> = 0.51–0.95) and self-reported fear (<i>d</i> = 0.45–1.25) during in vivo exposure to the feared situation; (2) reduced neurobiological indicators of fear (<i>d</i> = 0.54–0.62) and concomitant physiological arousal (<i>d</i> = 0.55–0.64); (3) activated neural systems supporting fear regulation more strongly than visible exposure to the same stimuli (<i>d</i> = 1.2–1.5); (4) activated regions supporting fear regulation that mediated the reduction of avoidance behavior (<i>d</i> = 0.70); (5) evoked ERPs suggesting encoding of extinction memories (<i>d</i> = 2.13); and (6) had these effects without inducing autonomic arousal or subjective fear.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>Unconscious exposure interventions significantly reduce a variety of symptomatic behaviors with mostly moderate effect sizes in transition-age youth with specific phobias. fMRI and physiological findings establish a neurophysiological basis for this efficacy, and suggest it occurs through extinction learning. Unconscious exposure was well tolerated, entirely unassociated with drop out, and is highly scalable for clinical practice. However, a number of limitations must be addressed to assess potential clinical impacts, including combining unconscious exposure with exposure therapy to boost treatment acceptance and efficacy.</p>\n </section>\n </div>","PeriodicalId":187,"journal":{"name":"Journal of Child Psychology and Psychiatry","volume":"66 1","pages":"98-121"},"PeriodicalIF":6.5000,"publicationDate":"2024-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Advancing the treatment of anxiety disorders in transition-age youth: a review of the therapeutic effects of unconscious exposure\",\"authors\":\"Paul Siegel, Bradley S. Peterson\",\"doi\":\"10.1111/jcpp.14037\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n <section>\\n \\n <h3> Background</h3>\\n \\n <p>The real-world effectiveness of exposure-based therapies for youth depends on the willingness and ability of young people to tolerate confronting their fears, which can be experienced as highly aversive and create problems with treatment engagement and acceptance. Recently, neuroscientific research on the nonconscious basis of fear has been translated into novel exposure interventions that bypass conscious processing of feared stimuli and that thus do not cause phobic youth to experience distress. We present a review of these unconscious exposure interventions.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A PRISMA-based search yielded 20 controlled experiments based on three paradigms that tested if fear-related responses could be reduced without conscious awareness in highly phobic, transition-age youth: 14 randomized controlled trials (RCTs), 5 fMRI studies (1 was also an RCT), 4 psychophysiological studies (3 were also RCTs), and 1 ERP study. We conducted meta-analyses of outcomes where feasible.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Unconscious exposure interventions significantly (1) reduced avoidance behavior (range of Cohen's <i>d</i> = 0.51–0.95) and self-reported fear (<i>d</i> = 0.45–1.25) during in vivo exposure to the feared situation; (2) reduced neurobiological indicators of fear (<i>d</i> = 0.54–0.62) and concomitant physiological arousal (<i>d</i> = 0.55–0.64); (3) activated neural systems supporting fear regulation more strongly than visible exposure to the same stimuli (<i>d</i> = 1.2–1.5); (4) activated regions supporting fear regulation that mediated the reduction of avoidance behavior (<i>d</i> = 0.70); (5) evoked ERPs suggesting encoding of extinction memories (<i>d</i> = 2.13); and (6) had these effects without inducing autonomic arousal or subjective fear.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusions</h3>\\n \\n <p>Unconscious exposure interventions significantly reduce a variety of symptomatic behaviors with mostly moderate effect sizes in transition-age youth with specific phobias. fMRI and physiological findings establish a neurophysiological basis for this efficacy, and suggest it occurs through extinction learning. Unconscious exposure was well tolerated, entirely unassociated with drop out, and is highly scalable for clinical practice. 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Advancing the treatment of anxiety disorders in transition-age youth: a review of the therapeutic effects of unconscious exposure
Background
The real-world effectiveness of exposure-based therapies for youth depends on the willingness and ability of young people to tolerate confronting their fears, which can be experienced as highly aversive and create problems with treatment engagement and acceptance. Recently, neuroscientific research on the nonconscious basis of fear has been translated into novel exposure interventions that bypass conscious processing of feared stimuli and that thus do not cause phobic youth to experience distress. We present a review of these unconscious exposure interventions.
Methods
A PRISMA-based search yielded 20 controlled experiments based on three paradigms that tested if fear-related responses could be reduced without conscious awareness in highly phobic, transition-age youth: 14 randomized controlled trials (RCTs), 5 fMRI studies (1 was also an RCT), 4 psychophysiological studies (3 were also RCTs), and 1 ERP study. We conducted meta-analyses of outcomes where feasible.
Results
Unconscious exposure interventions significantly (1) reduced avoidance behavior (range of Cohen's d = 0.51–0.95) and self-reported fear (d = 0.45–1.25) during in vivo exposure to the feared situation; (2) reduced neurobiological indicators of fear (d = 0.54–0.62) and concomitant physiological arousal (d = 0.55–0.64); (3) activated neural systems supporting fear regulation more strongly than visible exposure to the same stimuli (d = 1.2–1.5); (4) activated regions supporting fear regulation that mediated the reduction of avoidance behavior (d = 0.70); (5) evoked ERPs suggesting encoding of extinction memories (d = 2.13); and (6) had these effects without inducing autonomic arousal or subjective fear.
Conclusions
Unconscious exposure interventions significantly reduce a variety of symptomatic behaviors with mostly moderate effect sizes in transition-age youth with specific phobias. fMRI and physiological findings establish a neurophysiological basis for this efficacy, and suggest it occurs through extinction learning. Unconscious exposure was well tolerated, entirely unassociated with drop out, and is highly scalable for clinical practice. However, a number of limitations must be addressed to assess potential clinical impacts, including combining unconscious exposure with exposure therapy to boost treatment acceptance and efficacy.
期刊介绍：
The Journal of Child Psychology and Psychiatry (JCPP) is a highly regarded international publication that focuses on the fields of child and adolescent psychology and psychiatry. It is recognized for publishing top-tier, clinically relevant research across various disciplines related to these areas. JCPP has a broad global readership and covers a diverse range of topics, including:
Epidemiology: Studies on the prevalence and distribution of mental health issues in children and adolescents.
Diagnosis: Research on the identification and classification of childhood disorders.
Treatments: Psychotherapeutic and psychopharmacological interventions for child and adolescent mental health.
Behavior and Cognition: Studies on the behavioral and cognitive aspects of childhood disorders.
Neuroscience and Neurobiology: Research on the neural and biological underpinnings of child mental health.
Genetics: Genetic factors contributing to the development of childhood disorders.
JCPP serves as a platform for integrating empirical research, clinical studies, and high-quality reviews from diverse perspectives, theoretical viewpoints, and disciplines. This interdisciplinary approach is a key feature of the journal, as it fosters a comprehensive understanding of child and adolescent mental health.
The Journal of Child Psychology and Psychiatry is published 12 times a year and is affiliated with the Association for Child and Adolescent Mental Health (ACAMH), which supports the journal's mission to advance knowledge and practice in the field of child and adolescent mental health.
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