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初始检验:基于原则的儿童和青少年共病心理治疗方法。

Initial Test of a Principle-Guided Approach to Transdiagnostic Psychotherapy With Children and Adolescents.

机构信息

a Department of Psychology , Harvard University.

b Department of Educational Psychology , University of Texas at Austin.

出版信息

J Clin Child Adolesc Psychol. 2017 Jan-Feb;46(1):44-58. doi: 10.1080/15374416.2016.1163708. Epub 2016 Jul 21.

Abstract

To address implementation challenges faced by some evidence-based youth psychotherapies, we developed an efficient transdiagnostic approach-a potential "first course" in evidence-based treatment (EBP)-guided by five empirically supported principles of therapeutic change. An open trial of the resulting FIRST protocol was conducted in community clinics. Following a 2-day training, staff practitioners treated 24 clinically referred youths ages 7-15, 50% male, 87% White and 13% Latino, all with the Schedule for Affective Disorders and Schizophrenia for School-Age Children Diagnostic and Statistical Manual of Mental Disorders (4th ed.) anxiety, depressive, or conduct-related disorders, and averaging 2.21 disorders. We evaluated the protocol's (a) feasibility for use in everyday clinical practice (examining therapy process, client engagement, and therapist adherence and competence in using the protocol), (b) acceptability (examining therapeutic alliance and treatment satisfaction by youths, caregivers, and therapists), and (c) potential for clinical benefit (examining treatment outcomes across multiple measures and time points). FIRST scored well on measures of feasibility, acceptability to clients and clinicians, and clinical outcomes, matching or exceeding the corresponding scores in most benchmarking comparisons. Observational coding of sessions showed high levels of protocol adherence (86.6%) and good therapist competence in the evidence-based skills. Weekly assessments throughout treatment showed effect sizes for clinical improvement ranging from .41 to 2.66 on weekly total problems and problems deemed "most important" by caregivers and youths. The FIRST protocol showed evidence of feasibility, acceptability, and clinical benefit when used by practitioners with referred youths treated in community clinics. The findings suggest sufficient potential to justify a full randomized controlled trial of FIRST.

摘要

为了解决一些基于证据的青少年心理治疗方法实施过程中面临的挑战,我们开发了一种高效的跨诊断方法——一种基于五项经证实的治疗变化原则的潜在“基础课程”,为基于证据的治疗(EBP)提供指导。在社区诊所进行了一项针对该结果的 FIRST 方案的开放性试验。在为期两天的培训后,工作人员从业者治疗了 24 名临床转诊的 7-15 岁青少年,其中 50%为男性,87%为白人,13%为拉丁裔,所有患者均符合《儿童青少年情感障碍和精神分裂症诊断与统计手册》(第四版)的焦虑、抑郁或品行障碍诊断标准,平均患有 2.21 种障碍。我们评估了该方案在日常临床实践中的(a)可行性(评估治疗过程、客户参与度、治疗师使用该方案的依从性和能力),(b)可接受性(评估青少年、护理人员和治疗师的治疗联盟和治疗满意度),以及(c)临床获益的潜力(通过多个测量和时间点评估治疗结果)。FIRST 在可行性、客户和临床医生的可接受性以及临床结果方面得分较高,与大多数基准比较的相应得分相匹配或超过。会议的观察性编码显示,协议遵守率较高(86.6%),治疗师在循证技能方面的能力较好。整个治疗过程中的每周评估显示,临床改善的效果大小在每周总问题和护理人员和青少年认为“最重要”的问题上从 0.41 到 2.66 不等。当从业者在社区诊所治疗转介的青少年时,FIRST 方案表现出了可行性、可接受性和临床获益的证据。研究结果表明,该方案有足够的潜力证明其值得进行全面的随机对照试验。

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