模块化CBT治疗癫痫儿童和青少年精神健康障碍的突然获益

IF 6.5 1区医学 Q1 PSYCHIATRY

Journal of Child Psychology and Psychiatry Pub Date : 2025-03-20 DOI:10.1111/jcpp.14164

Alvin Richards-Belle, Daniela Linton, J Helen Cross, Isobel Heyman, Emma Dalrymple, Bruce Chorpita, Sophia Varadkar, Mariam Shah, Roz Shafran, Sophie Bennett

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引用次数: 0

摘要

背景：突然获益（症状快速、大幅度、稳定的改善）在心理治疗中很常见，并与良好的结果相关，但没有研究调查慢性身体疾病的儿童和年轻人（CYP）的突然获益。方法：组内研究嵌套在癫痫儿童心理健康干预（MICE）模块化认知行为治疗癫痫CYP的随机试验中，利用基于目标的结果（GBOs）和标准化的逐次测量（包括简短的父母自我效能量表和优势和困难问卷[SDQ]逐次测量）。使用多变量逻辑回归和线性回归研究突然增益的发生和潜在预测因素，以及突然增益与最后一次治疗和随访结果的关系。结果：在147名参与者中（平均年龄10.4岁，49%为女性），在9项测量中，39%的人经历了2到4次突然增加，最常见的是平均GBO（发生率，44.9%）。在某些测量中，智力残疾、预处理得分和接受治疗的次数等特征与突然获益的几率显著增加有关，而非白人种族和主要照顾者没有工作则与几率降低有关。突然增加与平均GBO （GBO，调整后的平均差值[aMD]: 0.9, 95% CI: 0.3至1.6,p = 0.004, D = 0.63）、父母自我效能（aMD: 1.2, 95% CI， 0.1至2.4,p = 0.63）的有利期末评分相关。027, D = 0.37)和SDQ逐会话测量(aMD: -1.7, 95% CI, -3.0至-0.3,p =。014, D = -0.44)，但与6个月调整后的SDQ总难度评分无关。结论：突然获益在该人群中很常见，最常发生在个性化测量中，并且与有利的期末评分相关。在每次会议上采取个性化的措施，关注突然的收益可能是治疗的有用辅助。今后的研究和临床实践应探讨如何增加长期接受心理治疗的CYP骤升的发生率。

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Sudden gains in modular CBT for mental health disorders in children and young people with epilepsy.

Background: Sudden gains (rapid, large, stable improvements in symptoms) are common in psychological therapy and are associated with favourable outcomes, but no studies have investigated sudden gains in children and young people (CYP) with a chronic physical condition.

Methods: Within-group study nested in the Mental Health Intervention for Children with Epilepsy (MICE) randomised trial of modular cognitive-behavioural therapy for CYP with epilepsy, utilising goal-based outcomes (GBOs) and standardised session-by-session measures (including the brief parental self-efficacy scale and Strengths and Difficulties Questionnaire [SDQ] session-by-session measure). The occurrence and potential predictors of sudden gains, and the association of sudden gains with outcomes at final session and follow-up were investigated using multivariable logistic and linear regression.

Results: Among 147 participants (mean age: 10.4 years, 49% female) and across nine measures, 39% experienced between two and four sudden gains, most frequently on the mean GBO (occurrence, 44.9%). Characteristics such as intellectual disability, pretreatment scores and the number of sessions received were associated with significantly greater odds of sudden gains in some measures, whereas nonwhite ethnicity and nonemployment of the primary caregiver were associated with reduced odds. Sudden gains were associated with favourable final-session scores for mean GBO (GBO, adjusted mean difference [aMD]: 0.9, 95% CI: 0.3 to 1.6, p = .004, D = 0.63), parental self-efficacy (aMD: 1.2, 95% CI, 0.1 to 2.4, p = .027, D = 0.37) and the SDQ session-by-session measure (aMD: -1.7, 95% CI, -3.0 to -0.3, p = .014, D = -0.44), but not with 6-month adjusted SDQ total difficulties scores.

Conclusions: Sudden gains were common in this population, occurring most frequently on personalised measures, and were associated with favourable final-session scores. Personalised measures taken at each session with a focus on sudden gains may be a useful adjunct to treatment. Future research and clinical practice should investigate how to increase the occurrence of sudden gains in CYP with long-term conditions receiving psychological therapy.

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来源期刊

Journal of Child Psychology and Psychiatry 医学-精神病学

CiteScore

13.80

自引率

5.30%

发文量

169

审稿时长

1 months

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.