Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?
Does the Delivery of CBT for Youth Anxiety Differ Across Research and Practice Settings?
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DOI：
10.1016/j.beth.2016.07.004
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发表时间：
2017-07
期刊：
影响因子：
3.7
通讯作者：
Weisz JR
中科院分区：
文献类型：
--
作者：
Smith MM;McLeod BD;Southam-Gerow MA;Jensen-Doss A;Kendall PC;Weisz JR
在不同的研究和实践环境中，针对青少年焦虑症的相同的基于手动的个体认知行为治疗（ICBT）计划的实施是否存在差异？我们在89名被诊断为原发性焦虑症的青年（M年龄= 10.56，SD = 1.99; 63.70%为白人; 52.80%为男性）样本中检查了这个问题。这些青少年接受（a）在研究环境中的ICBT，（B）在实践环境中的ICBT，或（c）在实践环境中的非人工常规护理。使用儿童心理治疗修订策略量表（TPOCS-RS）的治疗过程观察编码系统中的四个基于理论的子量表（认知行为，心理动力学，以客户为中心，家庭）评估治疗交付。可靠的独立编码器，使用TPOCS-RS，对来自两项随机对照试验（1项疗效和1项有效性试验）的954次治疗进行了评级。在这两种情况下，接受过ICBT培训和监督的治疗师在治疗开始时提供了相当水平的认知行为干预。然而，在研究环境中接受过ICBT培训的治疗师随着治疗的进展而增加了他们对认知行为干预的使用，而他们的实践环境则随着时间的推移而减弱。相对于两个ICBT组，UC治疗师提供了显着更高剂量的心理动力学和家庭干预和显着更低剂量的认知行为干预。总体而言，结果表明，在整个研究和实践环境中，基于手动的ICBT交付的相似性大于差异。未来的研究应该探讨为什么在ICBT计划中提供认知行为干预随着时间的推移和跨设置而变化，以及这些问题的答案是否可以为ICBT计划的实施提供信息。
Does delivery of the same manual-based individual cognitive-behavioral treatment (ICBT) program for youth anxiety differ across research and practice settings? We examined this question in a sample of eighty-nine youths (M age = 10.56, SD = 1.99; 63.70% Caucasian; 52.80% male) diagnosed with a primary anxiety disorder. The youths received (a) ICBT in a research setting, (b) ICBT in practice settings, or (c) non-manual-based usual care (UC) in practice settings. Treatment delivery was assessed using four theory-based subscales (Cognitive-behavioral, Psychodynamic, Client-Centered, Family) from the Therapy Process Observational Coding System for Child Psychotherapy–Revised Strategies scale (TPOCS-RS). Reliable independent coders, using the TPOCS-RS, rated 954 treatment sessions from two randomized controlled trials (1 efficacy and 1 effectiveness trial). In both settings, therapists trained and supervised in ICBT delivered comparable levels of cognitive-behavioral interventions at the beginning of treatment. However, therapists trained in ICBT in the research setting increased their use of cognitive-behavioral interventions as treatment progressed whereas their practice setting counterparts waned over time. Relative to the two ICBT groups, the UC therapists delivered a significantly higher dose of psychodynamic and family interventions and a significantly lower dose of cognitive-behavioral interventions. Overall, results indicate that there were more similarities than differences in manual-based ICBT delivery across research and practice settings. Future research should explore why the delivery of cognitive-behavioral interventions in the ICBT program changed over time and across settings, and whether the answers to these questions could inform implementation of ICBT programs.