Moss Rehabilitation Research Institute, Elkins Park, PA 19027, USA.
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA.
J Int Neuropsychol Soc. 2020 Jan;26(1):119-129. doi: 10.1017/S1355617719000833.
Treatment enactment, a final stage of treatment implementation, refers to patients' application of skills and concepts from treatment sessions into everyday life situations. We examined treatment enactment in a two-arm, multicenter trial comparing two psychoeducational treatments for persons with chronic moderate to severe traumatic brain injury and problematic anger.
Seventy-one of 90 participants from the parent trial underwent a telephone enactment interview at least 2 months (median 97 days, range 64-586 days) after cessation of treatment. Enactment, quantified as average frequency of use across seven core treatment components, was compared across treatment arms: anger self-management training (ASMT) and personal readjustment and education (PRE), a structurally equivalent control. Components were also rated for helpfulness when used. Predictors of, and barriers to, enactment were explored.
More than 80% of participants reported remembering all seven treatment components when queried using a recognition format. Enactment was equivalent across treatments. Most used/most helpful components concerned normalizing anger and general anger management strategies (ASMT), and normalizing traumatic brain injury-related changes while providing hope for improvement (PRE). Higher baseline executive function and IQ were predictive of better enactment, as well as better episodic memory (trend). Poor memory was cited by many participants as a barrier to enactment, as was the reaction of other people to attempted use of strategies.
Treatment enactment is a neglected component of implementation in neuropsychological clinical trials, but is important both to measure and to help participants achieve sustained carryover of core treatment ingredients and learned material to everyday life.
治疗实施是治疗实施的最后阶段，是指患者将治疗过程中学到的技能和概念应用于日常生活情境中。我们在一项双臂、多中心试验中检验了治疗实施，该试验比较了两种针对慢性中重度创伤性脑损伤和问题性愤怒患者的心理教育治疗方法。
在父母试验中，90 名参与者中有 71 名接受了电话实施访谈，至少在治疗结束后 2 个月（中位数 97 天，范围 64-586 天）。实施情况，用七个核心治疗成分的平均使用频率来衡量，在治疗组之间进行比较：愤怒自我管理培训（ASMT）和个人调整与教育（PRE），这是一种结构等效的对照。还评估了使用这些成分的有用性。探讨了实施的预测因素和障碍。
超过 80%的参与者在使用识别格式进行查询时报告记住了所有七个治疗成分。治疗组之间的实施情况相当。使用最多/最有用的成分涉及正常化愤怒和一般愤怒管理策略（ASMT），以及正常化与创伤性脑损伤相关的变化，同时为改善提供希望（PRE）。较高的基线执行功能和智商与更好的实施相关，以及更好的情景记忆（趋势）。许多参与者将较差的记忆力列为实施的障碍，其他人对尝试使用策略的反应也是一个障碍。
治疗实施是神经心理临床试验实施中被忽视的一个组成部分，但它既重要又有助于测量和帮助参与者将核心治疗成分和所学材料持续转移到日常生活中。
