Gros Daniel F, Allan Nicholas P, Szafranski Derek D
Mental Health Service, Ralph H. Johnson Veterans Affairs Medical Center, Charleston, South Carolina, USA; Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.
Evid Based Ment Health. 2016 Aug;19(3):e10-2. doi: 10.1136/eb-2015-102286. Epub 2016 Jun 29.
Evidence-based cognitive behavioural therapy (CBT) practices were first developed in the 1960s. Over the decades, refinements and alternative symptom foci resulted in the development of several CBT protocols/manuals for each of the many disorders, especially in the affective disorders. Although shown to be effective in highly trained providers, the proliferation of CBT protocols also has shown to demonstrate challenges in dissemination and implementation efforts due to the sheer number of CBT protocols and their related training requirements (eg, 6 months per protocol) and their related cost (eg, over US$2000 each; lost days/hours at work). To address these concerns, newer transdiagnostic CBT protocols have been developed to reduce the number of disorder-specific CBT protocols needed to treat patients with affective disorders. Transdiagnostic treatments are based on the notion that various disorder-specific CBT protocols contain important but overlapping treatment components that can be distilled into a single treatment and therefore address the symptoms and comorbidities across all of the disorders at once. 3 examples of transdiagnostic treatments include group CBT of anxiety, unified protocol for transdiagnostic treatment for emotional disorders and transdiagnostic behaviour therapy. Each transdiagnostic protocol is designed for a different set of disorders, contains a varied amount of CBT treatment components and is tested in different types of samples. However, together, these 3 transdiagnostic psychotherapies represent the future of CBT practice.
循证认知行为疗法(CBT)实践最早于20世纪60年代发展起来。几十年来,经过改进以及症状焦点的转变,针对众多疾病,尤其是情感障碍,开发出了多种CBT方案/手册。尽管CBT方案在训练有素的专业人员中已显示出有效性,但由于CBT方案数量众多及其相关培训要求(例如,每个方案需6个月)以及相关成本(例如,每个超过2000美元;工作中的损失天数/小时),CBT方案的激增在传播和实施方面也面临挑战。为解决这些问题,已开发出更新的跨诊断CBT方案,以减少治疗情感障碍患者所需的特定疾病CBT方案数量。跨诊断治疗基于这样一种观念,即各种特定疾病的CBT方案包含重要但重叠的治疗成分,这些成分可以提炼成单一治疗方法,从而一次性解决所有疾病的症状和共病问题。跨诊断治疗的3个例子包括焦虑症团体CBT、情绪障碍跨诊断治疗统一方案和跨诊断行为疗法。每个跨诊断方案针对不同的一组疾病设计,包含不同数量的CBT治疗成分,并在不同类型的样本中进行测试。然而,这3种跨诊断心理疗法共同代表了CBT实践的未来。