Becker-Haimes Emily M, Klein Corinna C, Frank Hannah E, Oquendo Maria A, Jager-Hyman Shari, Brown Gregory K, Brady Megan, Barnett Miya L
Department of Psychiatry, University of Pennsylvania Perelman School of Medicine.
Hall Mercer Community Mental Health, University of Pennsylvania Health System.
Front Health Serv. 2022 Jun;2. doi: 10.3389/frhs.2022.833214. Epub 2022 Jun 9.
This paper posits that a clinician's own anxious reaction to delivering specific evidence-based interventions (EBIs) should be better accounted for within implementation science frameworks. A key next step for implementation science is to delineate the causal processes most likely to influence successful implementation of evidence-based interventions (EBIs). This is critical for being able to develop tailored implementation strategies that specifically target mechanisms by which implementation succeeds or fails. First, we review the literature on specific EBIs that may act as negatively valenced stimuli for clinicians, leading to a process of clinician maladaptive anxious avoidance that can negatively impact EBI delivery. In the following sections, we argue that there are certain EBIs that can cause emotional distress or discomfort in a clinician, related to either: (1) a clinicians' fear of the real or predicted short-term distress the EBI can cause patients, or (2) fears that the clinician will inadvertently cause the patient harm and/or face liability. This distress experienced by the clinician can perpetuate a cycle of maladaptive anxious avoidance by the clinician, contributing to lack of or suboptimal EBI implementation. We illustrate how this cycle of maladaptive anxious avoidance can influence implementation by providing several examples from leading EBIs in the psychosocial literature. To conclude, we discuss how leveraging decades of treatment literature aimed at mitigating maladaptive anxious avoidance can inform the design of more tailored and effective implementation strategies for EBIs that are negatively valenced.
本文认为，在实施科学框架内，应更好地考虑临床医生在提供特定循证干预措施（EBI）时自身的焦虑反应。实施科学的关键下一步是确定最有可能影响循证干预措施成功实施的因果过程。这对于能够制定针对性的实施策略至关重要，这些策略专门针对实施成败的机制。首先，我们回顾了关于特定循证干预措施的文献，这些措施可能对临床医生起到负性刺激作用，导致临床医生出现适应不良的焦虑回避过程，进而对循证干预措施的实施产生负面影响。在接下来的部分，我们认为某些循证干预措施会在临床医生中引起情绪困扰或不适，这与以下两种情况有关：（1）临床医生担心循证干预措施会给患者带来实际的或预期的短期痛苦；（2）担心临床医生会无意中对患者造成伤害和/或面临责任。临床医生所经历的这种困扰会使临床医生的适应不良焦虑回避循环持续下去，导致循证干预措施实施不足或效果不佳。我们通过提供心理社会文献中主要循证干预措施的几个例子，来说明这种适应不良焦虑回避循环是如何影响实施的。最后，我们讨论如何利用数十年来旨在减轻适应不良焦虑回避的治疗文献，为设计更具针对性和有效性的针对负性循证干预措施的实施策略提供参考。
