Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD
Challenges and Successes in Dissemination of Evidence-Based Treatments for Posttraumatic Stress: Lessons Learned From Prolonged Exposure Therapy for PTSD
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DOI：
10.1177/1529100612468841
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发表时间：
2013-05-01
影响因子：
25.4
通讯作者：
Bryant, Richard A.
中科院分区：
文献类型：
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作者：
Foa, Edna B.;Gillihan, Seth J.;Bryant, Richard A.
创伤后应激障碍(PTSD)对公共卫生构成巨大挑战，因为它对心理健康、身体健康以及人际和社会问题都有贡献。最近在伊拉克和阿富汗的军事行动以及由此导致的大量创伤后应激障碍病例突显了这些疾病对公共卫生的重要性。现在有可以有效治疗大多数创伤后应激障碍患者的心理治疗方法，包括现役军人、退伍军人和平民。我们首先回顾这些治疗的有效性，重点是长期暴露(PE)，这是一种治疗创伤后应激障碍的认知行为疗法(CBT)。在独立研究实验室进行的许多研究表明，PE在治疗各种创伤类型、幸存者特征和文化条件下的创伤后应激障碍方面非常有效。此外，没有CBT经验的治疗师可以很容易地学习并成功实施治疗。尽管存在像PE这样高效的治疗方法，但大多数PTSD患者接受的治疗效果尚不清楚。因此，至关重要的是确定必须解决的障碍和挑战，以促进有效治疗创伤后应激障碍的广泛传播。在这篇综述中，我们首先讨论了一些主要的挑战，例如经常与循证治疗(EBTS)对立的专业文化，缺乏EBTS的临床医生培训，常用传播技术的有效性有限，以及与有效的传播模式相关的巨大成本。接下来，我们回顾了地方、国家和国际传播PE和类似治疗的努力，并说明了在精神卫生系统中促进采用EBTS所涉及的挑战和成功。然后，我们考虑克服前面讨论的障碍的方法，以及在精神卫生系统中实现持续的组织变革所涉及的困难。我们还介绍了在发展中国家传播精神障碍的努力以及在精神卫生系统严重不发达时随之而来的挑战。最后，我们提出了为创伤后应激障碍传播EBTS的未来方向，包括使用更新的技术，如基于网络的治疗和远程医疗。最后，我们讨论了需要在多个相互作用的系统之间采取协调一致的行动，以克服现有的传播障碍，并促进广泛获得创伤后应激障碍的有效治疗。这些系统包括研究生培训计划、政府机构、健康保险公司、专业组织、医疗保健提供系统、临床研究人员和媒体等公共教育系统。这些实体中的每一个都可以在减少与创伤后应激有关的个人痛苦和公共卫生负担方面发挥重要作用。
Posttraumatic stress disorder (PTSD) poses monumental public health challenges because of its contribution to mental health, physical health, and both interpersonal and social problems. Recent military engagements in Iraq and Afghanistan and the multitude of resulting cases of PTSD have highlighted the public health significance of these conditions.There are now psychological treatments that can effectively treat most individuals with PTSD, including active duty military personnel, veterans, and civilians. We begin by reviewing the effectiveness of these treatments, with a focus on prolonged exposure (PE), a cognitive-behavioral therapy (CBT) for PTSD. Many studies conducted in independent research labs have demonstrated that PE is highly efficacious in treating PTSD across a wide range of trauma types, survivor characteristics, and cultures. Furthermore, therapists without prior CBT experience can readily learn and implement the treatment successfully.Despite the existence of highly effective treatments like PE, the majority of individuals with PTSD receive treatments of unknown efficacy. Thus, it is crucial to identify the barriers and challenges that must be addressed in order to promote the widespread dissemination of effective treatments for PTSD. In this review, we first discuss some of the major challenges, such as a professional culture that often is antagonistic to evidence-based treatments (EBTs), a lack of clinician training in EBTs, limited effectiveness of commonly used dissemination techniques, and the significant cost associated with effective dissemination models.Next, we review local, national, and international efforts to disseminate PE and similar treatments and illustrate the challenges and successes involved in promoting the adoption of EBTs in mental health systems. We then consider ways in which the barriers discussed earlier can be overcome, as well as the difficulties involved in effecting sustained organizational change in mental health systems. We also present examples of efforts to disseminate PE in developing countries and the attendant challenges when mental health systems are severely underdeveloped.Finally, we present future directions for the dissemination of EBTs for PTSD, including the use of newer technologies such as web-based therapy and telemedicine. We conclude by discussing the need for concerted action among multiple interacting systems in order to overcome existing barriers to dissemination and promote widespread access to effective treatment for PTSD. These systems include graduate training programs, government agencies, health insurers, professional organizations, healthcare delivery systems, clinical researchers, and public education systems like the media. Each of these entities can play a major role in reducing the personal suffering and public health burden associated with posttraumatic stress.