Carroll Kathleen M, Rounsaville Bruce J
Division of Substance Abuse, Yale University School of Medicine, West Haven, CT 06516, USA.
Addiction. 2007 Jun;102(6):850-62; discussion 863-9. doi: 10.1111/j.1360-0443.2007.01798.x.
Whither, or wither, empirically supported therapies? Increasingly rigorous research in behavioral therapies has yielded a large number of effective therapies, but comparatively little work, demonstrating that integrating empirically supported therapies (ESTs) into standard practice results in meaningful improvements in patient outcomes. Methodology and strategies for evaluating ESTs and their effectiveness in clinical practice is a fairly recent innovation, and a host of unanswered questions remain regarding issues such as selection among different ESTs and what type of ESTs should be emphasized in dissemination efforts, what type of clinicians should be trained in what type of ESTs, the most effective training strategies for various types of clinicians, the need for ongoing supervision to maintain minimum levels of treatment fidelity and skill. In this review, we call for broader use of new research strategies and methods relevant to dissemination of ESTs; these may include adaptive designs, identification of mechanisms of action to foster greater emphasis on effective change principles, training and adoption trials, as well as novel implementation strategies including computer-assisted therapy and computer-assisted training.
循证支持疗法何去何从？行为疗法领域日益严谨的研究已产生了大量有效的疗法，但相对而言，证明将循证支持疗法（ESTs）融入标准临床实践能显著改善患者预后的研究却很少。评估循证支持疗法及其在临床实践中的有效性的方法和策略是一项相当新的创新，关于不同循证支持疗法的选择、在推广工作中应强调何种类型的循证支持疗法、何种类型的临床医生应接受何种类型的循证支持疗法培训、针对各类临床医生最有效的培训策略、持续监督以维持最低治疗保真度和技能水平的必要性等问题，仍有许多未得到解答。在本综述中，我们呼吁更广泛地使用与循证支持疗法推广相关的新研究策略和方法；这些策略可能包括适应性设计、确定作用机制以更加强调有效的改变原则、培训和采用试验，以及包括计算机辅助治疗和计算机辅助培训在内的新型实施策略。
