Firth Nick, Barkham Michael, Kellett Stephen, Saxon Dave
Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
Clinical Psychology Unit, University of Sheffield, Western Bank, Sheffield S10 2TN, UK; Centre for Psychological Services Research, University of Sheffield, Western Bank, Sheffield S10 2TN, UK.
Behav Res Ther. 2015 Jun;69:54-62. doi: 10.1016/j.brat.2015.04.001. Epub 2015 Apr 3.
The study investigated whether psychological wellbeing practitioners (PWPs) working within the UK government's Improving Access to Psychological Therapies (IAPT) initiative are differentially effective (i.e., therapist effect size) and differentially efficient (i.e., rate of clinical change), and the moderating effect of demographic and process factors on outcomes.
Routine clinical outcome data (depression, anxiety, and functional impairment) were collected from a single IAPT service. A total of 6111 patients were treated by 56 PWPs. Multilevel modelling (MLM) determined the size of the therapist effect and examined significant moderators of clinical outcomes. PWPs were grouped according to below average, average, and above average patient outcomes and compared on clinical efficiency.
Therapist effects accounted for 6-7% of outcome variance that was moderated by greater initial symptom severity, treatment duration, and non-completion of treatment. Clinically effective PWPs achieved almost double the change per treatment session. As treatment durations increased beyond protocol guidance, outcomes atrophied. Treatment non-completion was particularly detrimental to outcome.
PWPs appear to be differentially effective and efficient despite ostensibly delivering protocol driven interventions. Implications for services, training, and supervision are outlined.
本研究调查了在英国政府的“改善心理治疗可及性”（IAPT）计划中工作的心理健康从业者（PWPs）是否具有不同的效果（即治疗师效应量）和不同的效率（即临床变化率），以及人口统计学和过程因素对治疗结果的调节作用。
从一个IAPT服务机构收集常规临床结果数据（抑郁、焦虑和功能损害）。共有6111名患者接受了56名PWPs的治疗。多层次建模（MLM）确定了治疗师效应的大小，并检查了临床结果的显著调节因素。根据患者治疗结果低于平均水平、平均水平和高于平均水平对PWPs进行分组，并比较其临床效率。
治疗师效应占结果变异的6 - 7%，初始症状严重程度更高、治疗持续时间和治疗未完成对其有调节作用。临床有效的PWPs每次治疗疗程的变化几乎是原来的两倍。随着治疗持续时间超过方案指导，治疗结果萎缩。治疗未完成对结果尤其不利。
尽管表面上实施的是方案驱动的干预措施，但PWPs似乎具有不同的效果和效率。概述了对服务、培训和监督的启示。
