UCL Great Ormond Street Institute of Child Health, London, UK.
Curr Opin Psychiatry. 2023 Jan 1;36(1):28-33. doi: 10.1097/YCO.0000000000000834. Epub 2022 Oct 22.
There are increasing calls for mental health treatments to be adapted for different groups to maximize their acceptability and benefit to patients. However, adaptations can be costly to develop and evaluate, difficult to implement in routine clinical practice and may reduce service capacity at a time when there is unprecedented unmet need. An alternative method is personalization on an individual level. This review provides an overview of the issues related to personalization and adaptation of mental health interventions.
Several terms have been used to describe changes to existing therapies, these reflect different extents to which existing treatments have been changed. Evidence-based practice and modular therapies allow a level of flexibility within intervention delivery without formal changes and not all changes to therapy should be considered as a new/adapted treatment but instead regarded as 'metacompetence'. Implementing existing interventions in new contexts is preferable to developing new interventions in many instances. New guidance outlines how researchers can adapt and transfer interventions to varied contexts.
The review provides proposed definitions of different changes to therapy. Modified and personalized treatments may improve acceptability to patients whilst maximizing implementation of evidence-based practice within clinical services.
越来越多的人呼吁对心理健康治疗方法进行调整,以使其更适合不同群体,从而最大限度地提高其对患者的可接受性和益处。然而,调整可能需要花费大量成本来开发和评估,在常规临床实践中难以实施,并且可能会减少服务能力,而此时的未满足需求却前所未有。另一种方法是在个体层面进行个性化。本综述概述了与心理健康干预措施的个性化和调整相关的问题。
已经使用了几个术语来描述对现有疗法的更改,这些术语反映了对现有治疗方法进行更改的不同程度。循证实践和模块化疗法允许在不进行正式更改的情况下在干预措施的提供中具有一定的灵活性,并且并非所有对疗法的更改都应被视为新的/调整后的治疗方法,而应被视为“元能力”。在许多情况下,在新环境中实施现有干预措施比开发新干预措施更为可取。新的指导方针概述了研究人员如何在不同情况下调整和转移干预措施。
综述提供了对治疗方法的不同更改的拟议定义。改良和个性化的治疗方法可能会提高患者的可接受性,同时最大限度地在临床服务中实施基于证据的实践。