Department of Psychology, University of Sheffield, Sheffield, United Kingdom.
J Consult Clin Psychol. 2012 Oct;80(5):928-39. doi: 10.1037/a0029630. Epub 2012 Aug 13.
Rates of nonattendance for psychotherapy hinder the effective delivery of evidence-based treatments. Although many strategies have been developed to increase attendance, the effectiveness of these strategies has not been quantified. Our aim in the present study was to undertake a meta-analysis of rigorously controlled studies to quantify the effects of interventions to promote psychotherapy attendance.
The inclusion criteria were that studies (a) concerned attendance at individual or group psychotherapy by adults, (b) used a randomized controlled trial design to test an attendance strategy, and (c) used an objective measure of attendance. Computerized literature searches and hand searching resulted in a total of 31 randomized controlled trials that involved 33 independent tests of strategies for reducing treatment refusal and premature termination (N = 4,422). Effect sizes from individual studies were meta-analyzed, and moderator analyses were conducted.
Interventions had a small-to-medium effect on attendance across studies (d+= .38). Interventions to reduce treatment refusal and premature termination were similarly effective (d+= .37 and .39, respectively). Choice of appointment time or therapist, motivational interventions, preparation for psychotherapy, informational interventions, attendance reminders, and case management were the most effective strategies. Diagnosis also moderated effect sizes; samples with a single diagnosis benefited more from attendance interventions compared to samples with a variety of diagnoses.
Interventions to increase attendance at adult psychotherapy are moderately effective. However, relatively few studies met the strict study inclusion criteria. Further methodologically sound and theoretically informed interventions geared at increasing attendance are required.
心理咨询的失约率阻碍了循证治疗的有效实施。尽管已经开发出许多提高就诊率的策略，但这些策略的有效性尚未量化。本研究旨在对严格控制的研究进行荟萃分析，以量化促进心理治疗就诊率的干预措施的效果。
纳入标准为：（a）关注成人个体或团体心理咨询的就诊率，（b）使用随机对照试验设计来测试就诊策略，（c）使用客观的就诊率衡量标准。计算机文献检索和手工检索共产生了 31 项随机对照试验，涉及 33 项独立测试策略，以减少治疗拒绝和过早终止（N=4422）。对个别研究的效应大小进行了荟萃分析，并进行了调节分析。
跨研究的干预措施对就诊率有小到中等的影响（d+=.38）。减少治疗拒绝和过早终止的干预措施同样有效（d+=.37 和.39）。选择预约时间或治疗师、动机干预、心理治疗准备、信息干预、就诊提醒和个案管理是最有效的策略。诊断也调节了效应大小；单一诊断的样本比多种诊断的样本从就诊干预中获益更多。
提高成人心理治疗就诊率的干预措施是中等有效的。然而，只有相对较少的研究符合严格的研究纳入标准。需要进一步开展方法上合理、理论上有依据的、旨在提高就诊率的干预措施。
