CAN WE IMPROVE PSYCHOSOCIAL TREATMENTS FOR CHILD ANXIETY?

摘要

Among the most common pediatric psychiatric conditions, anxiety disorders confer impairment across academic, social, and family domains, and, without intervention, continue to be a problem in adulthood,[1] increasing risk for further impairment and psychiatric morbidity.[2] Both antidepressant medications and cognitive-behavioral therapy (CBT) are efficacious although ~30-40% of anxious youth do not clinically respond and many responders remain symptomatic.[3] The modest CBT and pharmacotherapy efficacy highlights the need to examine methods of enhancing treatment outcome. There are multiple strategies that may be undertaken to accomplish this including combining treatments, developing new interventions, or enhancing existing approaches based on accumulated clinical and empirical data. Developing new interventions or combining approaches has promised but often has failed to demonstrate significant incremental benefit over existing approaches, and is challenged by increased cost, clinical complexity (e.g., utilizing dual provider models), patient acceptability, and safety/tolerability. This editorial examines the state of existing psychosocial interventions for childhood anxiety, focusing on two ingredients- ensuring a sufficient exposure therapy dose and maxi- mizing parental involvement-that may further enhance treatment efficacy, with applications for translational approaches.