Unpacking the heterogeneity in treatment effects as a path to personalized psychotherapies: Are we there yet?
Unpacking the heterogeneity in treatment effects as a path to personalized psychotherapies: Are we there yet?
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DOI：
10.1037/cps0000101
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发表时间：
2022-09
影响因子：
5.8
通讯作者：
Barber, Jacques P
中科院分区：
文献类型：
--
作者：
Solomonov, Nili;Barber, Jacques P
在过去的二十年里，医学研究的重点已经转移到个性化；也就是说，确定哪种治疗方法对特定的个体是最佳的。这一努力包括发现解释接受相同治疗的患者临床结果异质性的变量。在心理治疗研究中，匹配治疗和患者需要确定调节因子（患者先前存在的特征）和调节因子或改变机制（驱动结果的积极治疗成分）。Kaiser等人（2022）的荟萃分析通过量化不同心理疗法与积极对照相比疗效的异质性，推进了个性化。他们利用应用于大量现有研究数据集的新方法，总结了几种广泛治疗方法中结果可变性的证据。此外，他们比较了心理治疗与主动控制条件下的整体可变性。目前的研究扩展了之前由Cuijpers及其同事进行的荟萃分析，证明了与主动控制相比，心理治疗的益处更大。Kaiser等人发现，不同心理疗法之间的异质性大于不同对照条件之间的异质性，提供相同治疗的研究之间也存在有意义的异质性。下一个重要的问题是：是什么导致了这种异质性？我们提供了几个潜在的解释和建议，为未来的研究来解决这个问题。
In the past two decades medicine research has shifted its focus to personalization; ie, identifying which treatments are optimal for specific individuals. This endeavor involves the detection of variables that explain heterogeneity in clinical outcomes across patients who receive the same treatment. In psychotherapy research, matching treatments and patients requires identifying moderators (patients’ pre-existing characteristics) and mediators or mechanisms of change (active therapeutic components that drive outcome).Kaiser et al.’s (2022) meta-analysis advances personalization by quantifying the heterogeneity in the efficacy of distinct psychotherapies, compared to active controls. Using novel methods applied on a large dataset of available studies, they summarize the evidence on variability in outcomes within several broad treatment approaches. Further, they compare the overall variability among psychotherapies to those in active control conditions. The current study expands previous meta-analyses conducted by Cuijpers and colleagues, demonstrating superior benefits for psychotherapy compared to active controls. Kaiser el al. found greater heterogeneity across psychotherapies than across different control conditions, as well as meaningful heterogeneity across studies delivering the same treatment. An important next question is: what contributes to this heterogeneity? We offer several potential explanations and suggestions for future studies to address this question.