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

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.