Retiring, Rethinking, and Reconstructing the Norm of Once-Weekly Psychotherapy.
Retiring, Rethinking, and Reconstructing the Norm of Once-Weekly Psychotherapy.
复制标题
DOI：
10.1007/s10488-020-01090-7
复制
发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Ollendick T
中科院分区：
文献类型：
--
作者：
Schleider JL;Dobias ML;Mullarkey MC;Ollendick T
循证心理治疗在缓解心理健康问题方面具有明显的潜力（Cuijpers et al. 2020; Weisz et al. 2017），但对于治疗应该持续多长时间（治疗持续时间，包括治疗可能持续的总小时数或周数）或治疗频率（治疗频率）没有科学共识。在实践中，每周一次的治疗是主要的门诊服务提供给青年和成年人一样，主要是由于长期持有的信念和保险公司的限制报销治疗时间为50分钟，每周会议。但是，不能把普遍性误认为是临床或实践上的优越性。事实上，每周一次长达一小时的治疗是众多治疗结构中的一种，可以帮助患者实现临床收益，最近的试验支持对各种问题类型进行简短，密集和集中的治疗（Dobias等人，2020）。此外，现有的心理服务，占主导地位的每周，门诊选项，不能满足人口水平的心理健康需求。大多数患有精神疾病的青少年和成年人由于经济和后勤方面的限制而从未接受过治疗，在接受治疗的人中，过早辍学很常见（Abel et al. 2020; Burns et al. 1999; McKay and Bannon 2004）。在那些确实获得心理支持的人中，接受循证干预的情况仍然很少，通常采取与医生（例如，在初级保健环境中）或心理健康培训有限的医护人员进行非结构化的简短互动的形式（Kazdin 2019）。尽管一再呼吁多样化治疗选择，并确保这些多样化的选择得到科学证据的支持（Kazdin 2019; Schleider et al. 2020），但“每周治疗一小时”-在许多情况下，缺乏任何质量评估，以确保基于证据的方法的可靠性-仍然是实际的默认值。考虑到每周门诊治疗的可及性有限，且有大量患者退出（这表明许多人无法获得常规提供的治疗），以及替代治疗形式的既定疗效（这表明可以重新设计治疗方法，以提高可及性而不牺牲临床效用），我们断言，我们这个领域的道德义务是取消和重建长期以来的每周一次门诊服务的“默认”。[1]需要明确的是，我们并不赞同取消每周一次的心理治疗作为患者的一种选择;许多每周一次的循证治疗，如果按预期进行，可能会使患者受益匪浅。然而，将循证每周治疗重新定位为众多治疗选择之一，并改善额外的、多样化的循证服务类型的可用性，可能会加强心理健康治疗的可及性、灵活性和潜在的整体有效性。
Evidence-based psychotherapies hold clear potential to alleviate mental health problems (Cuijpers et al. 2020; Weisz et al. 2017), yet there is no scientifically-driven consensus for how long treatment should last (treatment duration, including total numbers of hours or weeks a treatment might last) or how often sessions should occur (treatment frequency). In practice, once-weekly therapy is the dominant outpatient service available to youths and adults alike, largely due to long-held beliefs and insurance companies’ limiting reimbursable treatment-time to 50-min, weekly sessions. But ubiquity cannot be mistaken for clinical or practical superiority. Indeed, weekly hour-long therapy sessions are among numerous treatment structures that can help patients achieve clinical gains, with recent trials supporting the utility of brief, intensive, and concentrated treatments for widely-varying problem types (Dobias et al. 2020). Further, existing psychological services—dominated by weekly, outpatient options—fall short of meeting population-level mental health needs. Most youths and adults with psychiatric disorders never access care due to financial and logistical constraints, and among those who do, premature drop-out is common (Abel et al. 2020; Burns et al. 1999; McKay and Bannon 2004). Among those who do access psychological support, receipt of evidence-based intervention remains rare, often taking the form of unstructured, brief interactions with physicians (eg, in primary care settings) or healthcare workers with limited mental health training (Kazdin 2019). Despite repeated calls to diversify treatment options, and to ensure that these diverse options are backed by scientific evidence (Kazdin 2019; Schleider et al. 2020), the “weekly therapy hour”—in many cases, absent of any quality assessment ensuring reliance of evidence-based approaches—remains the practical default. Given limited accessibility of, and significant dropout from, weekly outpatient therapy (suggesting that many are unable to access treatment as it is routinely provided), and the established efficacy of alternative treatment formats (suggesting that treatment may be redesigned to improve accessibility without sacrificing clinical utility), we assert that it is our field’s ethical obligation to retire and rebuild the longstanding “default” to once-weekly outpatient services. 1 To be clear, we do not endorse eliminating weekly psychotherapy as an option for patients; many once-weekly, evidence-based treatments, if delivered as intended, may benefit patients greatly. However, repositioning evidencebased weekly therapy as one of many treatment options, and improving the availability of additional, diverse evidencebased service types, may strengthen the accessibility, flexibility, and potentially the effectiveness of mental health treatment overall.
登录
查看更多内容
影响因子：
4.4
作者：
Kvale G;Hansen B;Björgvinsson T;Børtveit T;Hagen K;Haseth S;Kristensen UB;Launes G;Ressler KJ;Solem S;Strand A;van den Heuvel OA;Öst LG
通讯作者：
Öst LG
影响因子：
3.7
作者：
Endick, Thomas H.;Ryan, Sarah M.;Fraire, Maria
通讯作者：
Fraire, Maria
影响因子：
3.7
作者：
Gallo, Kaitlin P.;Chan, Priscilla T.;Pincus, Donna B.
通讯作者：
Pincus, Donna B.
影响因子：
3.9
作者：
Covi, L;Hess, JM;Preston, KL
通讯作者：
Preston, KL
影响因子：
25.8
作者：
Harris, Meredith G.;Kazdin, Alan E.;Kessler, Ronald C.
通讯作者：
Kessler, Ronald C.