Carey Timothy A, Stiles William B
Centre for Remote Health, A Joint Centre of Flinders University and Charles Darwin University, Alice Springs, Australia.
Department of Psychology, Miami University, Oxford, OH, USA.
Clin Psychol Psychother. 2016 Jan-Feb;23(1):87-95. doi: 10.1002/cpp.1942. Epub 2015 Jan 20.
Randomized controlled trials (RCTs) are currently the dominant methodology for evaluating psychological treatments. They are widely regarded as the gold standard, and in the current climate, it is unlikely that any particular psychotherapy would be considered evidence-based unless it had been subjected to at least one, and usually more, RCTs. Despite the esteem within which they are held, RCTs have serious shortcomings. They are the methodology of choice for answering some questions but are not well suited for answering others. In particular, they seem poorly suited for answering questions related to why therapies work in some situations and not in others and how therapies work in general. Ironically, the questions that RCTs cannot answer are the questions that are of most interest to clinicians and of most benefit to patients. In this paper, we review some of the shortcomings of RCTs and suggest a number of other approaches. With a more nuanced understanding of the strengths and weaknesses of RCTs and a greater awareness of other research strategies, we might begin to develop a more realistic and precise understanding of which treatment options would be most effective for particular clients with different problems and in different circumstances. Copyright © 2015 John Wiley & Sons, Ltd.
Practitioners can think more critically about evidence provided by RCTs and can contribute to progress in psychotherapy by conducting research using different methodologies.
随机对照试验（RCTs）目前是评估心理治疗的主导方法。它们被广泛视为黄金标准，在当前环境下，除非某种特定的心理治疗至少经过一项，通常是多项随机对照试验，否则不太可能被视为循证治疗。尽管随机对照试验备受推崇，但它存在严重缺陷。它是回答某些问题的首选方法，但并不适合回答其他问题。特别是，它似乎不太适合回答与治疗为何在某些情况下有效而在其他情况下无效以及治疗总体上如何起作用相关的问题。具有讽刺意味的是，随机对照试验无法回答的问题正是临床医生最感兴趣且对患者最有益的问题。在本文中，我们回顾了随机对照试验的一些缺陷，并提出了一些其他方法。通过对随机对照试验的优缺点有更细致入微的理解以及对其他研究策略有更深入的认识，我们或许能够开始对哪些治疗方案对有不同问题且处于不同情境的特定患者最为有效形成更现实、更精确的理解。版权所有© 2015约翰威立父子有限公司。
从业者可以更批判性地思考随机对照试验提供的证据，并通过使用不同方法进行研究为心理治疗的发展做出贡献。
