Early Intervention in Depression Dyadic Emotion Development Therapy for Preschool

学龄前抑郁症的早期干预二元情绪发展疗法

• 批准号: 7492054
• 负责人: JOAN L. LUBY
• 金额: $ 16.82万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2007
• 资助国家: 美国
• 起止时间: 2007-09-01 至 2010-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7492054
• 关键词: Address; Adherence; Anxiety Disorders; Area; Biological; Caregivers; Case Series; Characteristics; Child; Childhood; Chronic Disease; Clinical; Code; Competence; Condition; Control Locus; DSM-IV; Data; Depressed mood; Depressive Syndromes; Development; Disease; Early Intervention; Education; Emotional; Emotions; Enrollment; Ethnic Origin; Evaluation; Family history of; Feasibility Studies; Future; Gender; Goals; Impairment; Intervention; Investigation; Judgment; Label; Learning; Manuals; Measures; Mediating; Mental Depression; Mental disorders; Methods; Modality; Modification; Mood Disorders; Morbidity - disease rate; Neurobiology; Numbers; Nursery Schools; Outcome; Parent-Child Relations; Parenting Education; Parenting behavior; Parents; Participant; Phase; Placebo Effect; Population; Preschool Child; Process Assessment; Protocols documentation; Public Health; Randomized; Range; Recruitment Activity; Sample Size; Sampling Studies; Self Efficacy; Severities; Staging; Stress; Structure; Supportive care; Symptoms; Time; Training; Treatment Efficacy; Treatment Protocols; Upper arm; Validation; Videotape; aged; base; caregiving; clinically significant; design; dyadic interaction; early onset; emotion regulation; experience; interest; model development; novel; novel therapeutics; parental role; research clinical testing; response; size; skills; therapy development; treatment program

DESCRIPTION (provided by applicant): This R34 application proposes to further develop and pilot an early intervention for depression during the preschool period. The specific aim of the proposed study is to further modify and adapt a proven effective manualized dyadic early intervention for preschool disruptive disorders, Parent Child Interaction Therapy (PCIT, Eyberg, 1988), for application to preschool depression. The proposed treatment entitled PCIT- Emotion Development (ED) has been modified to include additional treatment components that focus on "emotion development". The new ED module addresses deviations in early emotional reactivity from a developmental perspective and is based on an emotion development model of mood disorders. PCIT-ED is proposed as a developmentally sensitive early intervention strategy for childhood depression focused on strengthening the parent-child relationship and utilizing the parent as an "arm of the therapist". The mediating role of parenting support in preschool depression severity has been previously established supporting the notion that the dyadic relationship is an ideal target for early intervention in depression. PCIT has been previously successfully adapted for application to anxiety disorders. The validity of a clinical preschool depressive syndrome has now been established in two independent study samples. Evidence of a specific and stable symptom constellation, family history of related disorders, biological correlates, and observational evidence of low enthusiasm have been found. Replication of these validation findings as well as new evidence for significant impairment in developmental and adaptive functioning based on independent raters in multiple contexts has also been established. These findings confirm the clinical significance of this early onset depressive syndrome and the need for intervention for during the preschool period. A 2-stage study is proposed, beginning with an "open case series" during which each treatment session will be systematically assessed and the manual will be modified to maximize acceptability and fidelity. This will be followed by a pilot feasibility study in which N=30 subjects will be randomized to PCIT-ED or an active parenting education control condition. In keeping with evidence of greater efficacy of earlier intervention in several mental disorders, intervention for depression during the preschool period may provide a window of opportunity for greater therapeutic efficacy during a period of rapid developmental and neurobiological change. The public health need for novel and earlier interventions in depression is underscored by the lack of available safe and clearly effective treatments for prepubertal children. PHS 398 (Rev. 09/04) Page Form Page 2 The public health goal of this project is to find new and potentially more effective methods for treating childhood depression. The project focuses on the earliest possible identification of depression and the use novel therapeutic approaches that target the parent-child relationship. This is needed because depression is a serious and chronic disorder for which there are currently few safe and effective treatments established.

描述（由申请人提供）：此R34申请提议在学龄前期间进一步发展和试行早期干预抑郁症。拟议的研究的具体目的是进一步修改和适应有效的有效手动二聚体早期干预，以解决学前班颠覆性疾病，父母的儿童互动疗法（PCIT，Eyberg，1988），以用于学龄前抑郁症。拟议的标题为PCIT-EMOMIT开发（ED）的治疗已被修改，以包括针对“情绪发展”的其他治疗成分。新的ED模块从发展的角度解决了早期情绪反应性的偏差，并基于情绪障碍的情绪发展模型。 PCIT-ED被认为是针对儿童抑郁症的发育敏感的早期干预策略，重点是加强亲子关系，并利用父母作为“治疗师的手臂”。先前已经确定了育儿支持在学龄前抑郁严重程度中的中介作用，即支持二元关系是早期干预抑郁症的理想目标。 PCIT以前已成功适应焦虑症。现在已经在两个独立的研究样本中建立了临床学龄前抑郁综合症的有效性。已经发现了特定稳定的症状星座，相关疾病的家族史，生物学相关性的家族病史和低热情的观察证据。还建立了这些验证结果以及基于多种情况下独立评估者的发展和适应性功能的重大损害的新证据。这些发现证实了这种早期发作抑郁综合症的临床意义以及在学龄前时期进行干预的需求。提出了一项2阶段的研究，从“开放式案例系列”开始，在此期间将对每个治疗课程进行系统评估，并将修改手册以最大程度地提高可接受性和保真度。随后将进行一项试验可行性研究，其中n = 30受试者将被随机分为PCIT-ED或主动育儿教育控制条件。为了与早期干预在几种精神疾病中更大疗效的证据保持一致，在学龄前期间抑郁症的干预可能为在快速发育和神经生物学变化时期提供了更大治疗功效的机会。由于缺乏对青春期前儿童的可用安全，有效的治疗方法，公共卫生需要新颖和早期干预抑郁症的干预措施。 PHS 398（Rev. 09/04）页面表2页2该项目的公共卫生目标是找到治疗儿童抑郁症的新的且可能更有效的方法。该项目的重点是对抑郁症的最早识别以及针对亲子关系的新型治疗方法。这是需要的，因为抑郁症是一种严重而慢性的疾病，目前几乎没有安全有效的治疗方法。