Powell Samuel K, Serafini Randal A, Frere Justin J, De Pins Agathe, Saali Alexandra, Sultana Syeda A, Ali Muhammad, Dale Brandon, Datta Debjyoti, Aaronson Cindy, Meah Yasmin, Katz Craig L, Gluhoski Vicki
Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Acad Psychiatry. 2024 Feb;48(1):10-17. doi: 10.1007/s40596-023-01873-8. Epub 2023 Sep 28.
The purpose of the article is to evaluate an innovative education program in which medical students were trained in cognitive behavior therapy (CBT) and provided CBT treatments under supervision to uninsured individuals with depressive, anxiety, adjustment, and trauma-based disorders.
The authors assessed improvements in trainees' CBT knowledge using the Cognitive Therapy Awareness Scale before and after their didactic training. CBT supervisors rated trainees' clinical competencies utilizing standardized checklist evaluations based upon supervision reports. The authors employed mixed effects ANOVA and regression modeling to test the association between the addition of CBT to treatment as usual (TAU) and improvements in patients' depressive and anxious symptom severity. The authors collected feedback and self-assessment of functioning with a Psychotherapy Feedback Questionnaire.
Medical students showed increases in CBT knowledge that were maintained six months later and demonstrated satisfactory competency in CBT techniques. The addition of CBT to TAU was associated with greater improvements in depressive, but not anxious, symptom severity. However, among the TAU + CBT group, there was an association between the number of CBT sessions received and the magnitude of improvement in anxious symptoms from baseline. Patients gave positive feedback to medical student CBT providers and reported improvements in broad domains of psychosocial functioning.
Medical students can provide competent and clinically beneficial CBT treatments for depression and anxiety disorders. These findings have implications for medical training and support the use of medical students to deliver care for individuals with limited access to psychotherapy.
本文旨在评估一项创新教育项目，该项目中，医学生接受了认知行为疗法（CBT）培训，并在监督下为患有抑郁、焦虑、适应障碍和创伤相关障碍的未参保个体提供CBT治疗。
作者在理论培训前后使用认知疗法意识量表评估学员CBT知识的进步情况。CBT督导员根据督导报告，利用标准化清单评估对学员的临床能力进行评分。作者采用混合效应方差分析和回归模型，以检验在常规治疗（TAU）基础上加用CBT与患者抑郁和焦虑症状严重程度改善之间的关联。作者通过一份心理治疗反馈问卷收集了功能方面的反馈和自我评估。
医学生的CBT知识有所增加，且在六个月后仍保持增长，同时在CBT技术方面表现出令人满意的能力。在TAU基础上加用CBT与抑郁症状严重程度的更大改善相关，但与焦虑症状严重程度改善无关。然而，在TAU+CBT组中，接受的CBT疗程数与焦虑症状从基线开始的改善幅度之间存在关联。患者对医学生CBT提供者给予了积极反馈，并报告在心理社会功能的广泛领域有所改善。
医学生可为抑郁和焦虑障碍提供有效且具有临床益处的CBT治疗。这些发现对医学培训具有启示意义，并支持利用医学生为难以获得心理治疗的个体提供护理。
