A Post-Treatment Evaluation of the Combined Effects of Imipramine Pharmacotherapy and Brief Psychotherapy in the Treatment of Childhood Anxiety Disorders

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.