Barker Estelle, McCracken Lance M
Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, London, UK.
Health Psychology Section, Psychology Department, Institute of Psychiatry, King's College London, London, UK ; INPUT Pain Management Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
Br J Pain. 2014 Aug;8(3):98-106. doi: 10.1177/2049463713498865.
Health care organizations, both large and small, frequently undergo processes of change. In fact, if health care organizations are to improve over time, they must change; this includes pain services. The purpose of the present study was to examine a process of change in treatment model within a specialty interdisciplinary pain service in the UK. This change entailed a switch from traditional cognitive-behavioural therapy to a form of cognitive-behavioural therapy called acceptance and commitment therapy. An anonymous online survey, including qualitative and quantitative components, was carried out approximately 15 months after the initial introduction of the new treatment model and methods. Fourteen out of 16 current clinical staff responded to the survey. Three themes emerged in qualitative analyses: positive engagement in change; uncertainty and discomfort; and group cohesion versus discord. Quantitative results from closed questions showed a pattern of uncertainty about the superiority of one model over the other, combined with more positive views on progress reflected, and the experience of personal benefits, from adopting the new model. The psychological flexibility model, the model behind acceptance and commitment therapy, may clarify both processes in patient behaviour and processes of staff experience and skilful treatment delivery. This integration of processes on both sides of treatment delivery may be a strength of acceptance and commitment therapy.
无论规模大小，医疗保健机构都经常经历变革过程。事实上，医疗保健机构若要随着时间推移而改进，就必须进行变革；疼痛服务领域也是如此。本研究的目的是考察英国一家专科跨学科疼痛服务机构治疗模式的变革过程。这一变革涉及从传统认知行为疗法转变为一种名为接纳与承诺疗法的认知行为疗法形式。在新治疗模式和方法首次引入约15个月后，开展了一项包含定性和定量成分的匿名在线调查。16名在职临床工作人员中有14人回复了该调查。定性分析中出现了三个主题：对变革的积极参与；不确定性和不适感；以及团队凝聚力与分歧。封闭式问题的定量结果显示，对于一种模式优于另一种模式存在不确定性，同时对采用新模式所反映出的进展以及个人受益体验持更为积极的看法。接纳与承诺疗法背后的心理灵活性模型，可能有助于阐明患者行为过程以及工作人员的体验和熟练治疗实施过程。治疗实施双方过程的这种整合可能是接纳与承诺疗法的一个优势。
