On the Dissemination of Clinical Experiences in Using Empirically Supported Treatments

This article addresses the long-standing gap that has existed between psychotherapy research and practice and the efforts that have been made to bridge it. It also introduces one such effort, which has consisted of 3 clinical surveys on the experiences of practitioners in using empirically supported treatments for panic disorder, social anxiety, and OCD. In contrast to attempts to close the gap by disseminating research findings to the clinician, the clinical surveys are intended to allow for practitioners to disseminate their clinical experiences to the researcher—and also to other clinicians. What we view as a “two-way bridge” initiative is a collaboration between the Society of Clinical Psychology, Division 12 of the APA, and the Psychotherapy Division of the APA—Division 29. The mechanism that has been established provides a way for clinicians to be a part of the research process, which we hope will provide evidence that can help to enhance our clinical effectiveness.     

Bridging the Gap between Explicative and Treatment Research: A Model and Practical Implications

The recent move toward the recognition of empirically supported treatments (ESTs) within numerous facets of the field of clinical psychology has been met with general enthusiasm. The EST movement would not have been possible without the efforts of earlier treatment researchers. Paradoxically, this is also a time when some of the leaders in clinical psychology are recognizing that there is a paucity of experimental treatment research being conducted today relative to the high volume of correlationally based, explicative research, which examines the associations among variables. In this paper we present numerous reasons for the relative excess of explicative research and the paucity of treatment outcome research. Clinical practice is used to exemplify how assessment-oriented, explicative activities and the design of treatment can be integrated. A research-based example in which explicative research is used directly to inform the design of the intervention in treatment outcome research is presented as one model for emulation. Specific recommendations are made to help guide professionals and students entering the field who wish to conduct treatment research. An expansion on some of the themes highlighted in this paper can be found in the chapter from which it was in part derived (Blount, Bunke, & Zaff, 1999).     

Rules Versus Principles in Psychotherapy: Implications of the Quest for Universal Guidelines in the Movement for Empirically Supported Treatments

In this article we briefly review the mission and criteria of the EST movement and several of its criticisms. We question an often-unacknowledged feature of the EST initiative—its foundation in a rule-governed approach to the regulation of psychotherapy—and argue that this approach encounters significant problems that are better resolved through an alternative, principle-based approach. The contrast between these perspectives is illustrated by presenting results of a qualitative research project identifying the implicit principles actually used by expert therapists across psychotherapy orientations to regulate values and interventions within their practice.     

以患者为中心的现代医学模式与喉癌治疗

随着现代医学模式兴起,人们的健康观念有了新的内容,不再是单纯的躯体健康,还涉及好的心理状态和良好的社会适应。医疗服务也由单纯的技术服务转变为技术与心理和精神相结合。喉癌是头颈部常见的恶性肿瘤,喉癌治疗方式直接影响患者的生活质量,因此喉癌的治疗应与以患者为中心的现代医学模式相结合,以达到良好的治疗效果。     

A Randomized Community-Based Trial of Behavior Therapy vs. Usual Care for Adolescent ADHD: Secondary Outcomes and Effects on Comorbidity

Though behavior therapy (BT) for ADHD in adolescence is evidence-based, almost no work examines its implementation and effectiveness in community settings. A recent randomized community-based trial of an evidence-based BT for adolescent ADHD (Supporting Teens’ Autonomy Daily; STAND; N = 278) reported high clinician, parent, and youth acceptability but variable implementation fidelity. Primary outcome analyses suggested no significant differences between STAND and usual care (UC) unless the clinician delivering STAND was licensed. The present study reports secondary outcomes for this trial on indices of comorbidity (anxiety, depression, oppositional defiant disorder, conduct disorder) and ADHD outcomes not targeted by the active treatment (social skills, sluggish cognitive tempo). We also examine whether therapist licensure moderated treatment effects (as in primary outcome analyses). Using intent-to-treat and per protocol linear mixed models, patients randomized to STAND were compared to those randomized to UC over approximately 10 months of follow-up. Group × Time effects revealed that, overall, STAND did not outperform usual care when implemented by community clinicians. However, a Group × Time × Licensure interaction revealed a significant effect on conduct problems when STAND was delivered by licensed clinicians (d = .19–.47). When delivered in community settings, behavior therapy for adolescent ADHD can outperform UC with respect to conduct problems reduction. Community mental health clinics should consider: (1) assigning adolescent ADHD cases to licensed professionals to maximize impact and (2) choosing psychosocial approaches when ADHD presents with comorbid conduct problems. There is also a need to reduce implementation barriers for unlicensed clinicians in community settings.     

胃部恶性肿瘤临床实践中的医疗艺术

医学是一门讲求艺术性的科学.随着社会的发展,医疗艺术在整个医学临床实践中的重要性越来越突出.医疗艺术体现了医生对生命的尊重和伦理的理解.讲求医疗艺术对于建立和谐的医患关系具有重要意义.因此,如何在过硬的现代医学技术基础上提高临床医疗的艺术性,是医学教育和临床实践领域都应该思考的问题.本文以胃部恶性肿瘤的临床实践为例,从态度、语言、表情以及医患互动等细节方面入手,探讨在初诊、术前、康复以及面对晚期临终患者的不同情况中应该如何提高医疗艺术.     

在新医学模式指导下预防碘缺乏病

碘缺乏病严重危害人类健康,是最大的、可预防的智力损伤因素。通过“社会动员”,推动防治碘缺乏病（ＩＤＤ）“轮子”运转,使我国消除ＩＤＤ事业有了巨大进步。目前存在的问题可能会影响到该事业的可持续发展。对此,提出一些建议。     

临床路径在医疗质量管理中的应用与思考

就临床路径的发展和概念进行了描述,阐明了临床路径的实施步骤,讨论了临床路径在医院医疗质量管理中的作用,同时对其未得到普及的原因和在我国的发展前景进行了分析。     

医学生疼痛共情的认知过程特征：来自ERP的证据

以往研究发现临床医生的疼痛共情显著低于常人,表现为前者感知他人疼痛时会出现早期情绪分享和晚期情绪调节的相对抑制。而处于职前培养期的医学生是否存在相似问题,其疼痛共情又是否会受到重复暴露的影响,目前并不清楚。为此,本研究采用ERP技术比较了医学与非医学专业大学生疼痛共情的认知过程,并通过前后测设计检验了重复暴露对二者疼痛共情的影响。行为结果发现两组被试的主观疼痛判断都出现了疼痛共情效应,但未出现组别差异,也未发现重复暴露的影响。但ERP结果显示,医学生的疼痛共情过程显著区别于非医学生。他们虽表现出早期情绪分享成分N1的抑制效应,但LPP反映的晚期认知加工却显著增强,且上述两阶段加工均未受到重复暴露的显著影响。研究表明：（1）医学学习能够抑制疼痛共情的早期情绪分享,但医学生仍可通过更多晚期认知资源投入来维持其疼痛共情水平。（2）医学生的疼痛共情较少受到重复暴露的影响,呈现情绪适应特点。     

Description of Exemplar Cases in the Intensive Mental Health Program: Illustrations of Application of the Therapeutic Model

We describe cases from the clinical records in the Intensive Mental Health Program to illustrate the diverse presenting problems, intervention strategies, therapeutic process, and outcomes for children receiving services in this school-based, community-oriented treatment model. Cases reflect varying degrees of treatment response and potential factors that influence the fluctuating levels of emotional disturbance and impaired functioning in the home, school, and community.     

Challenges in Disseminating Model Programs: A Qualitative Analysis of the Strengthening Washington DC Families Program

This article discusses the challenges faced when a popular model program, the Strengthening Families Program, which in the past has been implemented on a smaller scale in single organizations, moves to a larger, multiorganization endeavor. On the basis of 42 interviews conducted with program staff, the results highlight two main themes that address program and organizational characteristics. The themes relate to the cultural relevance of the program, the accessibility of program partners, the organization of program services, and the coordination of program activities. The article also offers a discussion of how to better prepare sites for program delivery. This discussion focuses explicitly on the need for good communication among program partners, extensive community outreach, and the ability to secure additional resources.     

临床思维的逻辑性

临床思维是临床能力的核心和基础,是成为一名合格医生的前提条件。临床思维是按照逻辑规律反映疾病的思维方式。在临床思维活动过程中最重要的就是医学假说的提出、验证、推理和遵守逻辑思维的过程。逻辑思维能力对于医学工作者是至关重要的,作为医学工作者应该不断加强逻辑修养,不断提升我们临床思维水准。     

The Treatment Planning of Experienced Counselors: A Qualitative Examination

Using consensual qualitative research, the authors examined the treatment planning process of experienced counselors (N = 9). The data analysis resulted in 4 domains: assessment steps, clinical impressions, treatment factors, and treatment strategies. These domains describe the process used by experienced counselors in making clinical decisions and offer insight into the nature of clinical expertise and the need for further research on treatment planning.     

Standardized Web-Based Cognitive Behavioural Therapy of Mild to Moderate Depression: A Randomized Controlled Trial with a Long-Term Follow-Up

Depression is common but undertreated. Web-based self-help provides a widely accessible treatment alternative for mild to moderate depression. However, the lack of therapist guidance may limit its efficacy. The authors assess the efficacy of therapist-guided web-based cognitive behavioural treatment (web-CBT) of mild to moderate depression. Fifty-four individuals with chronic, moderate depression participated in a randomized wait-list controlled trial, with an 18-month follow-up (immediate treatment: n = 36, wait-list control: n = 18). Primary outcome measures were the Beck Depression Inventory (BDI-IA) and the Depression scale of the Symptom Checklist-90-Revised (SCL-90-R. DEP). Secondary outcome measures were the Depression Anxiety Stress Scales and the Well-Being Questionnaire. Five participants (9%) dropped out. Intention-to-treat analyses of covariance revealed that participants in the treatment condition improved significantly more than those in the wait-list control condition (.011 < p < .015). With regard to the primary measures, between-group effects (d) were 0.7 for the BDI-IA and 1.1 for the SCL-90-R DEP. Posttest SCL-90- R DEP scores indicated recovery of 49% of the participants in the treatment group compared with 6% in the control group (odds ratio = 14.5; p < .004). On average, the effects were stable up to 18 months (n = 39), although medication was a strong predictor of relapse. The results demonstrate the efficacy of web-CBT for mild to moderate depression and the importance of therapist guidance in psychological interventions.     

The Trait Emotional Intelligence Questionnaire in Lebanon and the UK: A comparison of the psychometric properties in each country

The aim of this study was to validate the Trait Emotional Intelligence Questionnaire (TEIQue v. 1.5) in a Lebanese sample and compare its factorial structure to that of a UK sample. There were similar gender and age distributions in both samples as well as satisfactory structural reliabilities at the global, factor, and facet levels. Results from exploratory factor analysis showed a four-factor structure similar to that originally obtained by the author of the questionnaire. There were strong correlations between the factor scores derived from the two datasets (≥.90). Tucker congruence supported the similarity between the Lebanese and UK factors. Independent-samples t tests showed that Lebanese participants scored higher on the Sociability factor and the facets of self-esteem, social awareness and emotion perception, whereas UK participants scored higher on the facets of stress management, optimism and relationships. Gender differences are also reported, and recommendations for future research discussed.     

差异中的医学人类学与社会学意义——对《中国人群死亡及其危险因素流行水平、趋势和分布》数据的透视

从医学人类学的视角对《中国人群死亡及其危险因素流行、趋势和分布》一书进行了评述,认为本书以大量的数据重新论证了医学人类学和社会医学的基本命题,也给读者带来了一些关于"人类发展与疾病流行"关系的思考。     

医疗界与法律界的关系问题——中国医疗秩序重构中的重要课题

医疗秩序是指各医疗要素的合理配置、医疗关系中各主体的有规则的有序互动所形成的整齐规则状态。当今中国医疗失序的本质是医疗正义的缺失。医疗秩序重构和恢复的实质在于医疗正义的彰显。在彰显医疗正义的过程中,需要研究解决的重要课题之一是如何处理作为医疗实践者的医疗界与作为正义实践者的法律界之间的关系。