Persons J B, Thase M E, Crits-Christoph P
Department of Psychiatry, University of California at San Francisco, USA.
Arch Gen Psychiatry. 1996 Apr;53(4):283-90. doi: 10.1001/archpsyc.1996.01830040013003.
We review two recent practice guidelines' assessments of the role of psychotherapy in the treatment of major depression in adults. We examine the practice guideline published by the American Psychiatric Association (APA) and that published by the Depression Guideline Panel of the Agency for Health Care Policy and Research. We focus on the guidelines' evaluations of psychotherapies, their statements about the role of psychotherapy in first-line treatment of depression, and the procedures they recommend for choosing among psychotherapies. We argue that the APA guideline understates the value of cognitive, behavioral, brief psychodynamic, and group therapies. Both guidelines understate the value of psychotherapy alone in the treatment of more severely depressed outpatients. The APA guideline overvalues the role of combined psychotherapy-pharmacotherapy regimens, particularly in view of the greater cost of this strategy. The APA guideline also makes recommendations about choosing among psychotherapies that are not well supported by empirical evidence. We conclude with some guidelines for guideline development.
我们回顾了最近两份关于心理治疗在成人重度抑郁症治疗中作用的实践指南评估。我们研究了美国精神病学协会（APA）发布的实践指南以及医疗保健政策与研究机构抑郁症指南小组发布的指南。我们重点关注指南对心理治疗的评估、它们关于心理治疗在抑郁症一线治疗中作用的陈述，以及它们推荐的在多种心理治疗方法中进行选择的程序。我们认为，APA指南低估了认知疗法、行为疗法、短程心理动力学疗法和团体疗法的价值。两份指南都低估了单独使用心理治疗对病情较重的门诊抑郁症患者的治疗价值。APA指南高估了心理治疗与药物治疗联合方案的作用，尤其是考虑到该策略成本更高的情况下。APA指南还对在多种心理治疗方法中进行选择提出了一些建议，但这些建议缺乏充分的实证依据。我们最后给出了一些关于指南制定的指导原则。
