Initial outcomes of a real-world multi-site primary care psychotherapy program
Initial outcomes of a real-world multi-site primary care psychotherapy program
复制标题
DOI：
10.1016/j.genhosppsych.2018.06.005
复制
发表时间：
2018-09-01
影响因子：
7
通讯作者：
Katzelnick, David J.
中科院分区：
文献类型：
--
作者：
Sawchuk, Craig N.;Craner, Julia R.;Katzelnick, David J.
目的：虽然焦虑、情绪和适应障碍通常在初级保健中得到治疗，但很少有证据表明这种情况下的心理治疗效果。这项研究的主要目的是描述大规模初级保健心理治疗计划的结果。方法：作为多地点初级保健计划的一部分，患者(N=2772)参加了认知行为疗法(CBT)。使用跟踪系统收集人口统计学、诊断、护理过程、焦虑和抑郁症状以及在初级保健CBT过程中使用心理治疗原则的频率。结果：焦虑症是最常见的，常与抑郁并存。超过三分之二的样本参加了至少一次CBT课程。案例形成、认知干预、暴露和行为激活是常用的方法。所有组的GAD-7和PHQ-9都有显著改善，产生中等效应大小(d=0.50-0.68)。严重程度在中等范围内的患者的可靠改善率(48-80%)、有效率(35-53%)和缓解率(21-36%)。结论：焦虑、抑郁和适应障碍患者可以在初级保健中使用CBT进行有效治疗。未来需要努力将患者特征与治疗干预的类型和时机相匹配，以改善临床和功能结果。
Objective: Although anxiety, mood, and adjustment disorders are commonly treated in primary care, little evidence exists regarding psychotherapy outcomes within this setting. The primary objective of this study was to describe outcomes of a large-scale primary care psychotherapy program.Methods: Patients (N=2772) participated in cognitive behavioral therapy (CBT) as part of a multi-site primary care program. A tracking system was utilized to collect data on demographics, diagnoses, course of care, anxiety and depressive symptoms, and frequencies of psychotherapy principles used over the course of primary care CBT.Results: Anxiety disorders were most frequent, often comorbid with depression. Over two-thirds of the sample participated in at least one CBT session. Case formulation, cognitive interventions, exposure, and behavioral activation were frequently utilized approaches. Significant improvements on the GAD-7 and PHQ-9 occurred for all groups, yielding medium effect sizes (d=0.50-0.68). Rates of reliable change (48-80%), response (35-53%), and remission (21-36%) were noted for those scoring in the moderate range of severity.Conclusion: Patients suffering from anxiety, depression, and adjustment disorders can be effectively treated in primary care with CBT. Future efforts are needed to match patient characteristics with the types and timing of therapy interventions to improve clinical and functional outcomes.