Improvement in Symptoms Versus Functioning: How Do Our Best Treatments Measure Up?
Improvement in Symptoms Versus Functioning: How Do Our Best Treatments Measure Up?
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DOI：
10.1007/s10488-010-0332-x
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发表时间：
2011-11-01
影响因子：
2.6
通讯作者：
Daleiden, Eric L.
中科院分区：
文献类型：
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作者：
Becker, Kimberly D.;Chorpita, Bruce F.;Daleiden, Eric L.
我们通过将结果从减轻症状扩展到包括功能，研究了重新定义针对儿童心理健康问题的治疗证据标准的效果。根据经验证据对来自 435 项随机对照试验的 750 多个治疗方案进行了评级。近三分之二（63.9%）的人至少表现出最低水平的减轻症状的证据；然而，只有 18.8% 的治疗显示出减少功能障碍的证据。在那些具有减轻症状的经验支持的治疗中，大多数没有表现出对功能改善的经验支持，因为测试这些治疗的研究中没有包括功能测量。然而，即使纳入了功能测量，治疗也很难取得改善。在实现功能改善的治疗中，最引人注目的是针对破坏性行为的协作问题解决和针对创伤应激的认知行为疗法加药物治疗，因为它们没有表现出对减轻症状的支持，但对改善功能有良好的支持。结果是在评估治疗证据标准和转向多维框架的机会的背景下讨论的，该多维框架的效用有可能超过其各个部分的总和。
We examined the effects of redefining standards of evidence for treatments targeting childhood mental health problems by expanding outcomes beyond symptom reduction to include functioning. Over 750 treatment protocols from 435 randomized controlled trials were rated based on empirical evidence. Nearly two-thirds (63.9%) demonstrated at least a minimum level of evidence for reducing symptoms; however, only 18.8% of treatments demonstrated evidence for reducing functional impairment. Of those treatments with empirical support for symptom reduction, the majority did not demonstrate empirical support for improvement in functioning because measures of functioning were not included in the studies in which these treatments were tested. However, even when measures of functioning were included, it was much more difficult for treatments to achieve improvement. Among treatments that achieved improvement in functioning, the most notable were Collaborative Problem Solving for disruptive behavior and Cognitive Behavioral Therapy plus Medication for traumatic stress because they demonstrated no support for symptom reduction but good support for improvement in functioning. Results are discussed within the context of evaluating the standards of evidence for treatments and the opportunity to move towards a multidimensional framework whose utility has the potential to exceed the sum of its parts.