Branson Amanda, Myles Pamela, Mahdi Mishka, Shafran Roz
School of Psychology and CLS,University of Reading,Earley Gate,Reading.
University College London Great Ormond Street Institute of Child Health,Gower Street,London.
Behav Cogn Psychother. 2018 Jan;46(1):101-114. doi: 10.1017/S1352465817000522. Epub 2017 Sep 14.
Little is understood about the relationship between therapist competence and the outcomes of patients treated for common mental health disorders. Furthermore, the evidence is yet to extend to competence in the delivery of low-intensity cognitive behavioural interventions. Understanding this relationship is essential to the dissemination and implementation of low-intensity cognitive behavioural interventions.
The aim of this study was to explore the relationship between Psychological Well-being Practitioner (PWP) competence and patient outcome within the framework of the British government's Improving Access to Psychological Therapies (IAPT) initiative.
Forty-seven PWPs treating 3688 patients participated. Relationships between PWP scores on three observed standardized clinical examinations and reliable change in patients' symptoms of anxiety and depression were explored at two time points: during the year-long training phase, and over a 12-month follow-up.
Results indicated that patients treated by qualified PWPs achieved superior outcomes than those treated by trainees. Little support was found for a general association between practitioner competence in delivering low-intensity cognitive behavioural interventions and patient outcome, either during or post-training; however, significantly more patients of the most competent PWPs demonstrated reliable improvement in their symptoms of anxiety and depression than would be expected by chance alone and fewer deteriorated compared with those treated by the least competent PWPs.
Results were indicative of a complex, non-linear relationship, with patient outcome affected by PWP status (trainee or qualified) and by competence at its extremes. The implications of these results for the dissemination and implementation of low-intensity cognitive behavioural interventions are discussed.
对于治疗常见心理健康障碍的治疗师能力与患者治疗结果之间的关系，人们了解甚少。此外，证据尚未扩展到低强度认知行为干预的实施能力方面。了解这种关系对于低强度认知行为干预的传播和实施至关重要。
本研究的目的是在英国政府的改善心理治疗可及性（IAPT）倡议框架内，探讨心理健康从业者（PWP）能力与患者治疗结果之间的关系。
47名治疗3688名患者的PWP参与了研究。在两个时间点探讨了PWP在三项标准化临床观察考试中的得分与患者焦虑和抑郁症状可靠变化之间的关系：在为期一年的培训阶段以及12个月的随访期间。
结果表明，由合格PWP治疗的患者比由实习生治疗的患者取得了更好的治疗效果。在培训期间或培训后，几乎没有发现低强度认知行为干预实施能力与患者治疗结果之间存在普遍关联；然而，与能力最差的PWP治疗的患者相比，能力最强的PWP治疗的患者中，焦虑和抑郁症状有可靠改善的人数明显多于仅靠随机概率预期的人数且病情恶化的人数更少。
结果表明存在复杂的非线性关系，患者治疗结果受PWP身份（实习生或合格）以及极端能力的影响。讨论了这些结果对低强度认知行为干预传播和实施的影响。
