Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, ON, Canada.
Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
Front Public Health. 2023 Feb 28;11:1102434. doi: 10.3389/fpubh.2023.1102434. eCollection 2023.
Numerous forms of psychotherapy have demonstrated effectiveness for individuals with specific mental disorders. It is, therefore, the task of the clinician to choose the most appropriate therapeutic approach for any given client to maximize effectiveness. This can prove to be a difficult task due to at least three considerations: (1) there is no treatment approach, method or model that works well on all patients, even within a particular diagnostic class; (2) several treatments are equally efficacious (i.e., more likely to be effective than no treatment at all) when considered only in terms of the patient's diagnosis; and (3) effectiveness in the real-world therapeutic setting is determined by a host of non-diagnostic factors. Typically, consideration of these latter, trans-diagnostic factors is unmethodical or altogether excluded from treatment planning - often resulting in suboptimal patient care, inappropriate clinic resource utilization, patient dissatisfaction with care, patient demoralization/hopelessness, and treatment failure. In this perspective article, we argue that a more systematic research on and clinical consideration of trans-diagnostic factors determining psychotherapeutic treatment outcome (i.e., treatment moderators) would be beneficial and - with the seismic shift toward online service delivery - is more feasible than it used to be. Such a transition toward more client-centered care - systematically considering variables such as sociodemographic characteristics, patient motivation for change, self-efficacy, illness acuity, character pathology, trauma history when making treatment choices - would result in not only decreased symptom burden and improved quality of life but also better resource utilization in mental health care and improved staff morale reducing staff burnout and turnover.
许多形式的心理治疗已被证明对特定精神障碍患者有效。因此，临床医生的任务是为任何特定患者选择最合适的治疗方法，以最大限度地提高疗效。由于至少有三个考虑因素，这可能是一项艰巨的任务：（1）即使在特定的诊断类别内，也没有一种治疗方法、方法或模式对所有患者都有效；（2）仅根据患者的诊断，几种治疗方法同样有效（即比不治疗更有可能有效）；（3）现实治疗环境中的疗效取决于许多非诊断因素。通常，这些后者、跨诊断因素的考虑是无系统的，或者完全排除在治疗计划之外——这通常导致患者护理不佳、不当利用诊所资源、患者对护理不满意、患者沮丧/绝望和治疗失败。在这篇观点文章中，我们认为，对决定心理治疗治疗结果的跨诊断因素（即治疗调节剂）进行更系统的研究和临床考虑将是有益的，而且——随着向在线服务的重大转变——比以往任何时候都更加可行。这种向更以客户为中心的护理的转变——在做出治疗选择时系统地考虑社会人口特征、患者改变的动机、自我效能、疾病严重程度、性格病理学、创伤史等变量——不仅会减轻症状负担和提高生活质量，而且还会改善精神保健的资源利用，并提高员工士气，减少员工倦怠和离职。
