Taylor C Barr, Chang Vickie Y
Stanford University School of Medicine, Dept of Psychiatry & Behavioral Sciences, Stanford, CA 94305-5722, USA.
Nord J Psychiatry. 2008;62 Suppl 47:37-44. doi: 10.1080/08039480802315673.
In the past 40 years, cognitive-behavior therapy (CBT) has emerged as the initial treatment of choice for patients with mild to moderate depression, anxiety disorders and other problems. In this paper, we discuss issues related to the dissemination and implementation of CBT in various practice settings as well as the use of manuals, computers, the telephone, and the Internet to aid dissemination and implementation. We review key aspects of CBT dissemination, such as the reach of CBT, models of dissemination, and obstacles and barriers to dissemination including patient interest, therapist training and research priorities. The effectiveness of manualized programs is considered, as well as the increasing sophistication of computer-assisted therapy. Stepped-care approaches are discussed as a viable solution to some of these barriers. We provide two examples of successful CBT dissemination, the Staying Free program, a smoking cessation program for inpatients, and the Improving Access to Psychological Therapies program in Britain, which aims to improve access to psychological therapy. We argue that two critical factors will determine the success of implementation of CBT in this century: 1) mandated outcomes and 2) leadership.
在过去40年里，认知行为疗法（CBT）已成为轻至中度抑郁症、焦虑症及其他问题患者的首选初始治疗方法。在本文中，我们讨论了与CBT在各种实践环境中的传播与实施相关的问题，以及使用手册、计算机、电话和互联网来辅助传播与实施的情况。我们回顾了CBT传播的关键方面，如CBT的覆盖范围、传播模式以及传播的障碍，包括患者兴趣、治疗师培训和研究重点。我们考虑了手册化项目的有效性以及计算机辅助治疗日益复杂的情况。讨论了逐步护理方法，认为这是解决其中一些障碍的可行方案。我们提供了两个CBT成功传播的例子，即“保持自由”项目（一项针对住院患者的戒烟项目）和英国的“改善心理治疗可及性”项目，该项目旨在改善心理治疗的可及性。我们认为，两个关键因素将决定CBT在本世纪实施的成功：1）规定的结果；以及2）领导力。
