Kazdin Alan E, Fitzsimmons-Craft Ellen E, Wilfley Denise E
Department of Psychology, Yale University, New Haven, Connecticut.
Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri.
Int J Eat Disord. 2017 Mar;50(3):170-189. doi: 10.1002/eat.22670. Epub 2017 Jan 19.
Remarkable progress has been made in developing psychosocial interventions for eating disorders and other mental disorders. Two priorities in providing treatment consist of addressing the research-practice gap and the treatment gap. The research-practice gap pertains to the dissemination of evidence-based treatments from controlled settings to routine clinical care. Closing the gap between what is known about effective treatment and what is actually provided to patients who receive care is crucial in improving mental health care, particularly for conditions such as eating disorders. The treatment gap pertains to extending treatments in ways that will reach the large number of people in need of clinical care who currently receive nothing. Currently, in the United States (and worldwide), the vast majority of individuals in need of mental health services for eating disorders and other mental health problems do not receive treatment. This article discusses the approaches required to better ensure: (1) that more people who are receiving treatment obtain high-quality, evidence-based care, using such strategies as train-the-trainer, web-centered training, best-buy interventions, electronic support tools, higher-level support and policy; and (2) that a higher proportion of those who are currently underserved receive treatment, using such strategies as task shifting and disruptive innovations, including treatment delivery via telemedicine, the Internet, and mobile apps.
在为饮食失调及其他精神障碍开发心理社会干预措施方面已取得显著进展。提供治疗的两个优先事项包括解决研究与实践之间的差距以及治疗差距。研究与实践之间的差距涉及将循证治疗从受控环境推广到常规临床护理。弥合关于有效治疗的已知信息与实际提供给接受护理的患者的信息之间的差距,对于改善精神卫生保健至关重要,尤其是对于饮食失调等病症。治疗差距涉及以能够惠及大量目前未接受任何治疗的需要临床护理的人群的方式扩展治疗。目前,在美国(以及全球范围内),绝大多数需要针对饮食失调和其他心理健康问题提供心理健康服务的人未接受治疗。本文讨论了为更好地确保以下两点所需采取的方法:(1)让更多接受治疗的人获得高质量的循证护理,可采用培训培训师、以网络为中心的培训、最佳购买干预措施、电子支持工具、更高层次的支持和政策等策略;(2)让目前未得到充分服务的人群中更高比例的人接受治疗,可采用任务转移和颠覆性创新等策略,包括通过远程医疗、互联网和移动应用程序提供治疗。