Mechanisms of action in youth psychotherapy.
Mechanisms of action in youth psychotherapy.
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青少年心理治疗的作用机制。
DOI：
10.1111/1469-7610.00002
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发表时间：
2002
期刊：
影响因子：
--
通讯作者：
Weisz,JohnR
中科院分区：
文献类型：
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作者：
Weersing,VRobin;Weisz,JohnR
背景在这篇综述中，我们讨论了一个关于青少年心理社会干预的基本问题，但尚未得到回答：心理治疗是如何起作用的？方法我们提出了一个使用中介分析来回答这个问题的框架，并回顾了青年治疗结果文献，以寻找中介机制的证据。我们将重点放在经验性支持的治疗青少年焦虑、抑郁和破坏性行为的临床试验上(N=67)。结果与以前的报告显示很少评估潜在的中介因素相反，63%的研究在设计中包含了潜在中介机制的测量。在治疗领域，百分比从22%的基于学习的焦虑症干预研究(即系统的脱敏、建模和强化练习)到91%的家长培训调查。尽管对潜在的调解人进行了相当广泛的评估，但只有六项研究包括在正式调解测试中使用这些措施的任何尝试。因此，尽管治疗的效果是积极的，而且对中介的评估也出人意料地充分，但我们仍然对青少年心理治疗是如何发挥作用的知之甚少。结论我们注意到阻碍调解测试的常见问题(例如，许多试验的设计使得很难确定机制和结果变化的时间顺序)，我们提出了改进研究设计的建议，以更好地评估治疗行动的机制。我们还注意到，需要对在有代表性的实践环境中接受治疗的被转介青年进行调解测试，以补充迄今为止普遍存在的关于治疗机制的实验室证据。
BackgroundIn this review, we address a basic, but unanswered, question about psychosocial interventions for youth: How does psychotherapy work?MethodsWe propose a framework for using mediation analysis to answer this question, and we review the youth therapy outcome literature for evidence on mediating mechanisms. We focus our review on clinical trials of empirically supported treatments for youth anxiety, depression, and disruptive behavior (N= 67).ResultsContrary to previous reports indicating that potential mediators are rarely assessed, 63% of the studies included measures of potential mediating mechanisms in their designs. Across treatment domains, percentages ranged from 22% of the studies of learning‐based interventions for anxiety (i.e., systematic desensitization, modeling, and reinforced practice) to 91% of parent training investigations. Despite the rather extensive assessment of potential mediators, only six studies included any attempt to use the measures in a formal mediation test. Thus, despite the positive effects of treatments and surprisingly ample assessment of mediators, we still know remarkably little about how youth psychotherapies work.ConclusionsWe note common problems that hampered mediation testing (e.g., the design of many trials made it difficult to determine the temporal order of change in the mechanism and outcome), and we offer recommendations for improving study design to better assess mechanisms of therapeutic action. We also note the need to test mediation among referred youth treated in representative practice settings to complement the laboratory‐based evidence on therapy mechanisms that prevails to date.