Huibers Marcus J H, Lorenzo-Luaces Lorenzo, Cuijpers Pim, Kazantzis Nikolaos
Department of Clinical Psychology, Vrije Universiteit Amsterdan (VU), University Amsterdam, Amsterdam, Netherlands.
Department of Psychology, University of Pennsylvania, Philadelphia, PA, United States.
Front Psychiatry. 2021 Jan 8;11:607508. doi: 10.3389/fpsyt.2020.607508. eCollection 2020.
In this conceptual paper, we outline the many challenges on the road to personalized psychotherapy, using the example of cognitive behavior therapy (CBT) for depression. To optimize psychotherapy for the individual patient, we need to find out how therapy works (identification of mechanisms of change) and for whom it works (identification of moderators). To date, psychotherapy research has not resulted in compelling evidence for or against common or specific factors that have been proposed as mechanisms of change. Our central proposition is that we need to combine the "how does it work?"-question with the "for whom does it work?"-question in order to advance the field. We introduce the that emphasizes the links and distinction between individual patient differences, therapeutic procedures and therapy processes as a paradigm to facilitate und understand the concept of personalized psychotherapy. We review the mechanism of change literature for CBT for depression to see what we have learned so far, and describe preliminary observational evidence supporting the personalized causal pathway hypothesis. We then propose a research agenda to push the ball forward: exploratory studies into the links between individual differences, therapeutic procedures, therapy processes and outcome that constitute a potential causal pathway, making use of experience sampling, network theory, observer ratings of therapy sessions, and moderated mediation analysis; testing and isolation of CBT procedures in experiments; and testing identified causal pathways of change as part of a personalized CBT package against regular CBT, in order to advance the application of personalized psychotherapy.
在这篇概念性论文中，我们以抑郁症的认知行为疗法（CBT）为例，概述了通往个性化心理治疗道路上的诸多挑战。为了为个体患者优化心理治疗，我们需要弄清楚治疗是如何起作用的（确定改变机制）以及对谁起作用（确定调节因素）。迄今为止，心理治疗研究尚未得出支持或反对被提议作为改变机制的共同或特定因素的确凿证据。我们的核心主张是，为了推动该领域的发展，我们需要将“它是如何起作用的？”这个问题与“它对谁起作用？”这个问题结合起来。我们引入强调个体患者差异、治疗程序和治疗过程之间的联系与区别的[此处原文缺失相关内容]作为一种范式，以促进并理解个性化心理治疗的概念。我们回顾了抑郁症CBT的改变机制文献，看看我们目前学到了什么，并描述了支持个性化因果路径假设的初步观察证据。然后，我们提出一个研究议程以推动进展：对构成潜在因果路径的个体差异、治疗程序、治疗过程和结果之间的联系进行探索性研究，利用经验抽样、网络理论、治疗会话的观察者评分以及调节中介分析；在实验中测试和分离CBT程序；以及针对常规CBT，测试作为个性化CBT方案一部分的已确定的改变因果路径，以推进个性化心理治疗的应用。
