Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA.
Department of Psychology, Harvard University, Cambridge, MA, USA.
J Child Psychol Psychiatry. 2017 Sep;58(9):970-984. doi: 10.1111/jcpp.12747. Epub 2017 May 26.
Psychotherapy for children and adolescents (herein, 'youths') has grown more precise and focused over the decades, shifting toward empirically supported treatments standardized via therapist manuals. The manuals have increasingly emphasized precise targeting of single disorders or problems, or homogenous clusters. These focal treatments represent a valuable advance, with intervention benefit documented in hundreds of studies. However, relatively few of these treatments are widely used in everyday clinical practice, and their level of benefit may not be ideal, particularly in practice contexts and when compared to usual clinical care.
These limitations may be due, in part, to a mismatch between focal treatment design and the young people treated in real-world clinical care, who are diagnostically heterogeneous, and very frequently present with comorbidity. Improved fit may be achieved via transdiagnostic treatment approaches designed to address multiple disorders and problems, if these approaches can retain the benefits of manualization and the substantive clinical strength that has generated empirical support to date.
Here we review the evolution of empirically-based youth psychotherapy from focal treatment manuals toward transdiagnostic approaches, and we describe and illustrate three transdiagnostic treatment strategies: (a) a core dysfunction approach, (b) a common elements and modular design approach, and (c) a principle-guided approach.
We complement research findings with a clinical perspective based on our use of manual-guided transdiagnostic intervention in clinical care settings, and we propose directions for research and practice.
几十年来，儿童和青少年（以下简称“青少年”）的心理治疗已经变得更加精确和集中，逐渐转向通过治疗师手册标准化的循证支持治疗。这些手册越来越强调针对单一障碍或问题，或同质障碍集群的精确靶向。这些聚焦治疗代表了一个有价值的进步，干预效益在数百项研究中得到了证明。然而，这些治疗方法中相对较少的方法在日常临床实践中得到广泛应用，并且它们的效益水平可能不理想，特别是在实践环境中，与常规临床护理相比。
这些局限性部分可能是由于焦点治疗设计与现实世界临床护理中接受治疗的年轻人之间存在不匹配造成的，后者具有诊断异质性，并且非常频繁地出现共病。如果这些方法可以保留手册化的益处和迄今为止产生实证支持的实质性临床优势，那么通过旨在解决多种障碍和问题的跨诊断治疗方法可能会更好地适应。
在这里，我们回顾了从聚焦治疗手册到跨诊断方法的循证青少年心理治疗的演变，并描述和说明了三种跨诊断治疗策略：（a）核心功能障碍方法，（b）共同要素和模块化设计方法，以及（c）基于原则的方法。
我们将研究结果与我们在临床护理环境中使用手册指导的跨诊断干预的临床观点相结合，并提出了研究和实践的方向。
