抑郁症的计算机化认知行为治疗

计算机化认知行为治疗(computerized cognitive-behavioral therapy, CCBT), 即指通过电脑交互界面, 以清晰的操作步骤, 高度结构化的多种媒介互动方式(如网页、漫画、动画、视频、声音等)来表现认知行为治疗基本原则和方法的治疗方式。抑郁症的CCBT近年来在西方崭露头角, 目前Beating The Blues、MoodGYM、E-Couch和Good Days Ahead等抑郁症CCBT程序在西方使用较为广泛。从可行性分析上发现, 该疗法较受病人接纳、具有较高的成本效用和易用性; 现有实验研究证明了抑郁症采用CCBT是有效的, 但其有效性仍取决于诸多因素。以往研究存在着较少关注治疗有效性的内在机制、治疗效果差异较大、风险评估简化和被试选择偏向等问题, 建议未来研究应加强：(1)中介效应及机制研究; (2)以人为本的个性化服务研究; (3)风险评估与隐私保护研究; (4)在“弱势群体”中的研究与运用。最后, 对其在中国发展的必要性与可行性进行了展望。     

Psychodynamic psychotherapy for children and adolescents: an updated narrative review of the evidence base

While the evidence base for psychodynamic therapy with adults is now quite substantial, there is still a lack of research evaluating the effectiveness of psychodynamic therapies with children and young people. Those studies that have been carried out are also not widely known in the field. To help address the second point, in 2011, we carried out a review of the evidence base for psychodynamic psychotherapy for children and adolescents, which identified 35 studies which together provided some preliminary evidence for this treatment for a range of childhood disorders. The present study is an updated review, focusing on research published between March 2011 and November 2016. During this period, 23 additional studies were published, of which 5 were reports on randomised controlled trials, 3 were quasi-experimental controlled studies and 15 were observational studies. Although most studies covered children with mixed diagnoses, there were a number of studies examining specific diagnostic groups, including children with depression, anxiety and disruptive disorders. whilst the quality of studies was mixed, some were well-designed and reported, and overall indicated promising findings. Nevertheless, further high-quality research is needed in order to better understand the effectiveness of psychodynamic psychotherapy across a range of different disorders, and to ensure that services can provide a range of evidence-based treatments for children and young people.     

“It’s Worth It in the End”: Veterans’ Experiences in Prolonged Exposure and Cognitive Processing Therapy

Despite the efficacy of evidence-based psychotherapies (EBP) for posttraumatic stress disorder (PTSD) and efforts to disseminate them, only 6–13% of veterans seeking care through the Veterans Affairs health care system receive these treatments. EBPs such as prolonged exposure (PE) and cognitive processing therapy (CPT) are exposure-based treatments. Provider and patient fears regarding the tolerability of exposure-based treatments likely impede their delivery and completion. The present study utilized qualitative interviews with 23 veterans who completed at least eight sessions of either PE or CPT to elicit firsthand accounts of veterans’ experiences in these EBPs. Results suggest that while a minority of veterans reported initial symptom worsening, the majority of veterans reported positive experiences and felt that, despite being stressful, these EBPs were “worth it.” Most veterans discussed thoughts of discontinuing treatment prematurely, but stated that adherence was encouraged by their commitment to finishing, desperation for relief, therapist/group support, and family support. Veterans believed exposure made an important contribution to symptom improvement, as did greater self-understanding and changing negative or unhelpful beliefs. These findings indicate veteran satisfaction with PE and CPT, and may assist providers to develop strategies to increase adherence and treatment completion.     

National Study of School Psychologists’ Use of Evidence-Based Assessment in Autism Spectrum Disorder

This study aimed to better understand predictors of evidence-based assessment practices for autism spectrum disorder (ASD). Nationwide, 402 school psychologists were surveyed for their knowledge of and training and experience with ASD on assessment practices, including reported areas of training needs. The majority of school psychologists reported that they did not engage in comprehensive assessment of ASD, which was defined as assessments that consider all areas of development in addition to the use of ASD-specific instruments. Results from logistic regression revealed that experience and training, working with young children with ASD, and geographic location predicted use of evidence-based assessment practices. Experience and training with ASD was the strongest predictor of evidence-based assessment. No differences in training needs were indicated by school psychologists whose practices were consistent with evidence-based assessment and those whose practices were not. Overall, the results identified gaps between best and current practices by school psychologists and highlight areas of need for additional training and professional development.     

心理治疗中的正式反馈

<正>式反馈是近年来发展出的一项提高临床实践的有效方法,它是指利用标准化的治疗效果测量工具,系统监控当事人评定的治疗进展情况,并将当事人的进展信息提供给治疗师,以供其随后的治疗作参考之用。治疗效果问卷评定系统和合作-改变效果管理系统是目前使用较为广泛的正式反馈测量工具。正式反馈的使用不仅能够改善偏离预期进展当事人(not on track,NOT)的治疗效果,提高当事人治疗进展的速率,同时还能够促进治疗双方更好的合作。正式反馈的作用机制可以使用概念化反馈干预理论和交互作用论进行解释。影响正式反馈作用效果的因素包括反馈本身的特征、当事人初始症状严重程度、治疗师方面因素以及治疗的时长等。未来研究需关注正式反馈的研究方法、作用机制及其跨文化研究的差异。     

GATA4在心肌肥厚中的作用

循证医学的诞生改变了几千年沿袭的医学实践模式。医学工作者通过应用循证医学的思路和方法指导医学研究和临床实践工作,进一步促进了临床决策的科学性,从而提高了医疗质量。随着循证医学的发展,其外延和内涵不断延伸。鉴于其在临床医学等领域的成功,卫生管理学者开始将循证医学的思想和方法应用于公共卫生决策和医院管理,即在卫生管理领域进行循证实践,改善公共卫生决策和医院管理水平,提高卫生资源利用效率和分配的公平性。     

小儿巨大肾积水的循证诊疗策略与思考

通过典型的病例分析,分别从小儿巨大肾积水的概念、影像学诊断、无功能肾脏的判断以及治疗方式的选用等方面入手,结合循证医学实践的三大要素,包括利用最佳的临床研究证据、注重医生的专业技能和经验、尊重患者的期望和权利。简述临床上治疗小儿巨大肾积水时所应当采用的循证诊疗策略,以及从中引申出来的哲学思考。     

急性心肌梗死中医治疗的两点策略——附临床资料回顾性分析

急性心肌梗死(AMI)是临床常见的急重症,现代医学已在循证医学基础上建立了诊疗指南,为临床诊治决策提供依据.相比而言.以辨证论治为特色的中医药缺乏循证依据.对AMI诊治过程中如何发挥中医药治疗的价值,认为不能停留在传统的概念上,应选择正确治疗策略,提高疗效.     

骨质疏松症和细胞因子关系的新思考

在骨质疏松症患者体内,细胞因子的改变和雌激素减少是骨质疏松症发生、发展的启动因素,造成骨的代谢紊乱,致使骨吸收超过骨形成,出现骨重建平衡失调与骨转换加快。细胞因子的提出使骨质疏松症防治观念发生了根本的转变,提出了骨质疏松症防治新策略,对细胞因子与骨质疏松症的关系的认识,体现了循证医学的思想和创新思维的启动。     

Group CBT for Externalizing Disorders in Urban Schools: Effect of Training Strategy on Treatment Fidelity and Child Outcomes

Public schools are an ideal setting for the delivery of mental health services to children. Unfortunately, services provided in schools, and more so in urban schools, have been found to lead to little or no significant clinical improvements. Studies with urban school children seldom report on the effects of clinician training on treatment fidelity and child outcomes. This study examines the differential effects of two levels of school-based counselor training: training workshop with basic consultation (C) vs. training workshop plus enhanced consultation (C +) on treatment fidelity and child outcomes. Fourteen school staff members (counselors) were randomly assigned to C or C +. Counselors implemented a group cognitive behavioral therapy protocol (Coping Power Program, CPP) for children with or at risk for externalizing behavior disorders. Independent coders coded each CPP session for content and process fidelity. Changes in outcomes from pre to post were assessed via a parent psychiatric interview and interviewer-rated severity of illness and global impairment. Counselors in C + delivered CPP with significantly higher levels of content and process fidelity compared to counselors in C. Both C and C + resulted in significant improvement in interviewer-rated impairment; the conditions did not differ from each other with regard to impairment. Groups did not differ with regard to pre- to- posttreatment changes in diagnostic severity level. School-based behavioral health staff in urban schools are able to implement interventions with fidelity and clinical effectiveness when provided with ongoing consultation. Enhanced consultation resulted in higher fidelity. Enhanced consultation did not result in better student outcomes compared to basic consultation. Implications for resource allocation decisions with staff training in EBP are discussed.