Type of Document Dissertation Author Porter, Daniel B. III Author's Email Address csokol@vt.edu URN etd-32998-125918 Title A Post-Treatment Evaluation of the Combined Effects of Imipramine Pharmacotherapy and Brief Psychotherapy in the Treatment of Childhood Anxiety Disorders Degree PhD Department Family and Child Development Advisory Committee
Advisor Name Title Benson, Mark J. Houska, Charles R. Hutchins, David E. Stremmel, Andrew J. Taylor, Larry T. Protinsky, Howard O. Jr. Committee Chair Keywords
- Psychotherapy
- Pharmacotherapy
- Childhood Anxiety Disorders
Date of Defense 1998-02-01 Availability unrestricted Abstract A POST-TREATMENT EVALUATION OF THE COMBINED EFFECTS OF
IMIPRAMINE PHARMACOTHERAPY AND BRIEF PSYCHOTHERAPY
IN THE TREATMENT OF CHILDHOOD ANXIETY DISORDERS
by
Daniel B. Porter
Committee Chair: Howard O. Protinsky, Ph.D.
Family and Child Development
(ABSTRACT)
This study evaluated a treatment program for anxiety disordered children, ages five
to twelve years, utilizing both qualitative and quantitative methodologies. The treatment
program integrated Imipramine pharmacotherapy and brief psychotherapy. The
participants' nuclear and extended family histories were examined in terms of the
occurrence of psychopathology and endemic transactional patterns. The examination of
family patterns utilized Murray Bowen's Generational Model, as well as the T-F-A model
of Hutchins and Cole, as a means of explaining the transmission of anxiety in the family.
Ten children suspected of experiencing anxiety disorders were referred by pediatric
physicians for treatment. Following an initial diagnostic assessment, children were placed
on 25 milligrams of Imipramine per day for four to six weeks, while participating in
weekly conjoint psychotherapy with their mothers for a six to eight-week period.
A post-treatment evaluation was conducted by selecting ten prototypic
participants. Selection was based upon age, diagnosis of overanxious disorder or
separation anxiety disorder in childhood, and a time interval of no more than one year or less than one week following treatment. Semi-structured interviews were conducted with
mother-child pairs separately to evaluate participants' perceptions of pre- and post-treatment
symptom levels and family dynamics. DSM-III diagnostic criteria, Bowenian
and T-F-A models served as the frameworks for organizing and evaluating qualitative
data. All child participants experienced a dramatic and lasting resolution of both OAD
and SAD symptomology. A quantitative analysis was performed utilizing the Wilcoxon
sign rank to compare pre- and post-treatment symptom levels, with a significant effect by
treatment occurring at the .005 level of significance. Cross-validation of treatment
outcome was achieved through review of medical records, original psychotherapy notes,
and videotapes of the interviews. Qualitative data regarding transgenerational medical and
psychological disorders and family dynamics was generated. The data supported the
Unitary model of generational family pathology. Six of seven Bowenian constructs were
confirmed in this sample. The T-F-A model was used to demonstrate a cyclical pattern of
reassurance, anxiety reduction, and child dependency between anxious children and their
mothers. These results were discussed to provide a better understanding of the etiology
and treatment of childhood anxiety disorders (OAD and SAD). The term "anxogenic
family" was suggested to convey the interaction of genetics and generational learning in
the families of anxiety disordered children. Implications for future research and
modification of the DSM-IV regarding childhood anxiety disorders were discussed.
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