Unit for Social and Community Psychiatry, WHO Collaborating Centre for Mental Health Service Development, Queen Mary University of London, London, UK.
School of Health Sciences, City University of London, London, UK.
Epidemiol Psychiatr Sci. 2019 Aug 15;29:e48. doi: 10.1017/S2045796019000428.
Psychiatric treatments have specific and non-specific components. The latter has been addressed in an extensive literature on the placebo-effect in pharmacology and on common factors in psychotherapy. In the practice of mental health care, pharmacological, psychotherapeutic and social treatments are combined in complex interventions. This paper aims to review non-specific components across diverse psychiatric treatments and consider implications for practice and research.
We conducted a non-systematic review of non-specific components across psychiatric treatments, their impact on treatment processes and outcomes, and interventions to improve them.
The identified research is heterogeneous, both in design and quality. All non-specific components capture aspects of how clinicians communicate with patients. They are grouped into general verbal communication - focusing on initial contacts, empathy, clarity of communication, and detecting cues about unspoken concerns - non-verbal communication, the framing of treatments and decision-making. The evidence is stronger for the impact of these components on process measures - i.e. therapeutic relationship, treatment satisfaction and adherence than on clinical outcomes - i.e. symptoms and relapse. A small number of trials suggest that brief training courses and simple methods for structuring parts of clinical consultations can improve communication and subsequently clinical outcomes.
Methodologically, rigorous research advancing current understandings of non-specific components may increase effectiveness across different treatments, potentially benefitting large numbers of patients. Brief training for clinicians and structuring clinical communication should be used more widely in practice.
精神科治疗有特定和非特定的组成部分。后者在药理学中的安慰剂效应和心理治疗中的共同因素的广泛文献中得到了探讨。在精神卫生保健实践中，药物治疗、心理治疗和社会治疗结合在复杂的干预措施中。本文旨在综述各种精神科治疗中的非特定组成部分，并考虑其对实践和研究的影响。
我们对精神科治疗中的非特定组成部分、它们对治疗过程和结果的影响，以及改善这些组成部分的干预措施进行了非系统性综述。
已确定的研究在设计和质量上都存在异质性。所有非特定组成部分都捕捉到了临床医生与患者沟通的各个方面。它们被分为一般言语沟通 - 侧重于初始接触、同理心、沟通的清晰度，以及检测关于未说出口的关注的线索 - 非言语沟通、治疗和决策制定的框架。这些组成部分对过程测量（即治疗关系、治疗满意度和依从性）的影响证据比对临床结果（即症状和复发）的影响证据更强。少数试验表明，简短的培训课程和简单的方法来构建临床咨询的部分可以改善沟通，随后改善临床结果。
从方法学上讲，对非特定组成部分的严格研究可以提高不同治疗方法的有效性，从而使大量患者受益。对临床医生的简短培训和结构化临床沟通应该更广泛地应用于实践中。
