Davison G C
Department of Psychology, University of Southern California, Los Angeles 90089-1061, USA.
J Consult Clin Psychol. 2000 Aug;68(4):580-5.
Several issues concerning stepped care are discussed: the constraints of using Diagnostic and Statistical Manual of Mental Disorders diagnoses in randomized clinical trials (RCTs), the importance of basic and process research, the unintended negative effects of exaggerated claims of effectiveness and efficiency, the limits of RCTs in evaluating improvement and deterioration, the self-correcting nature of stepped care, the link between stepped care and empirically supported treatments, clinical judgment in clinical work, the concept of the least restrictive alternative, the costs of using low-intensity but ineffective psychosocial treatments, and the costs of both ineffective and effective psychotropic drug therapy. An analysis of stepped care can lead to an appreciation that the dialectic operating between science and practice affords an opportunity to synthesize the seemingly irreconcilable standards and needs of researchers and clinicians.
在随机临床试验（RCT）中使用《精神疾病诊断与统计手册》诊断的局限性、基础研究和过程研究的重要性、对有效性和效率的夸大宣称所带来的意外负面影响、RCT在评估改善和恶化方面的局限性、阶梯式治疗的自我纠正性质、阶梯式治疗与循证治疗之间的联系、临床工作中的临床判断、限制最少的替代方案的概念、使用低强度但无效的心理社会治疗的成本，以及无效和有效的精神药物治疗的成本。对阶梯式治疗的分析可以让人认识到，科学与实践之间的辩证关系为整合研究人员和临床医生看似不可调和的标准和需求提供了机会。
