Leigh Eleanor, Creswell Cathy, Stallard Paul, Waite Polly, Violato Mara, Pearcey Samantha, Brooks Emma, Taylor Lucy, Warnock-Parkes Emma, Clark David M
Department of Experimental Psychology, University of Oxford, Oxford Centre for Anxiety Disorders and Trauma, The Old Rectory, Paradise Square, OxfordOX1 1TW, UK.
Department of Experimental Psychology and Department of Psychiatry, University of Oxford, Anna Watts Building, Radcliffe Observatory Quarter, Woodstock Road, OxfordOX2 6GG, UK.
Behav Cogn Psychother. 2021 Mar 1:1-13. doi: 10.1017/S1352465821000035.
Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed.
Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment?
CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training.
Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was £4047 (SD = £1003) per adolescent treated, of which £1861 (SD = £358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment.
This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults.
基于克拉克和韦尔斯（1995年）模型的认知疗法是成人社交焦虑障碍（SAD）的一线治疗方法，研究机构的研究结果表明，该疗法有望用于青少年（青少年社交焦虑障碍认知疗法；CT-SAD-A）。然而，要使该疗法适用于常规临床护理，需要解决两个问题。
治疗师能否在常规儿童和青少年心理健康服务（CAMHS）中接受培训并取得良好效果，培训和治疗的成本是多少？
在两个国民保健服务信托机构工作的CAMHS治疗师接受了CT-SAD-A培训。他们在一段监督实践期间为患有SAD的青少年提供治疗。我们检查了在此期间接受治疗的12名患者的临床结果，并估计了与治疗和培训相关的成本。
治疗使社交焦虑症状、一般焦虑和抑郁症状有显著改善，并降低了假定的过程指标。75%（12名中的9名）的患者社交焦虑症状有可靠且具有临床意义的改善，64%（11名中的7名）不再被初步诊断为SAD。国民保健服务系统为每名接受CT-SAD-A治疗的青少年的总费用为4047英镑（标准差=1003英镑），其中1861英镑（标准差=358英镑）是面对面治疗的具体估计费用；其余费用用于培训和监督以前不熟悉该治疗方法的治疗师。
本研究提供了初步证据，表明临床医生在参加为期两天的培训工作坊后，在一段监督实践期间，可以在常规CAMHS中为患有SAD的青少年取得良好的患者治疗效果。此外，为青少年提供CT-SAD-A的成本似乎不高于为成人提供CT-SAD的成本。
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