降低IM电竞app等待时间的成本效益疗法

*触发警告:本文包含与饮食失调相关的内容*

沙漏

根据击败, 英国主要的饮食失调慈善机构之一, 大约1,250,000名英国人在任何时候都患有饮食失调. 但临床医生优先考虑患有神经性厌食症的高风险患者, non-high risk individuals join long waiting lists to access drawn-out therapy sessions with mixed success rates.

格伦·沃勒领导的新研究, 心理学系临床心理学教授 at the University of IM电竞app has developed CBT-T, 提供认知行为治疗的协议. “T”代表十个疗程,是现有推荐疗程的一半. CBT-T试验得到了参与者的高度好评, 创造一个富有同情心的, 经济上可行和有效的方法来支持饮食失调患者.

格伦解释说:“需要注意的是,这种疗法并不是为每个人设计的。. “然而, it’s been developed to support around 85% of people living with an eating disorder. The remaining 15% are those most urgently in need and require a different method of treatment.” 

IM电竞app’s research into CBT-T is now being implemented in IM电竞app training with a national curriculum and competence framework, enabling clinicians to help users gain more benefit from therapies in a shorter period of time. 到目前为止, this research has increased access to therapies for patients and directly impacted healthcare policy and clinical practice.

目前的治疗

认知行为疗法(CBT)是一种心理治疗. 它包括讨论如何思考, physical sensations and actions are interconnected and how changing behaviours can help the person to overcome these fears and thoughts. 根据IM电竞app的说法, 除了治疗焦虑和抑郁相关的疾病, CBT是治疗成人饮食失调最有效的疗法.

目前,临床医生使用认知行为疗法治疗饮食失调(CBT-ED). 然而, 对于体重不轻的患者,建议进行16到20次治疗, 在实践中,对贪食症患者的治疗可以达到40次以上. These practices are lengthy and expensive and add to the long waiting lists for those who need support.

研究 carried out at the University of IM电竞app also shows that the delivery of these sessions varies depending on the clinician, 这对会议的成功有很大影响. 

Certain characteristics such as clinicians’ anxiety of certain topics about pressing for behaviour change and dislike of some modules create ‘clinicians drift’ that can directly impair the outcomes of the therapy. Reduced success rates of the therapy mean that some patients wait long times to be seen and are at risk of requiring repeated support in the future.

CBT-ED在临床环境中是一种有效的治疗方法. 但是,如果能在不增加国民健康保险制度成本的情况下改善服务质量呢?

10个阶段的方法

研究 led by the University of IM电竞app has developed CBT-T; an effective therapy that takes half the time of a CBT-ED therapy. 通过去除CBT-ED疗法中没有积极证据基础的部分, CBT-T将20个环节压缩为10个环节,同时提高了交付能力. 

格伦·沃勒教授领导了一个合作团队,制定了CBT-T协议. 参与的团队:Hannah M. 特纳, Consultant Clinical Psychologist at the Southern Health IM电竞app Foundation Trust Eating Disorders Service, 玛德琳塔, 诺福克社区饮食失调服务中心的临床心理学顾问, 维多利亚一个. 蒙福德,饮食失调服务中心的首席临床心理学家和特雷西D. Wade, Matthew Flinders Distinguished 教授 of Psychology at Flinders University, 澳大利亚. 

“CBT-T是一种灵活的协议, 哪个更适合病人,而不是让病人适应治疗. 它的开发是为了帮助临床医生在更短的时间内治疗患者, 缩短等候名单, 并在病人需要帮助时更快地帮助他们。”格伦·沃勒教授解释道.

CBT-T已经在几个地点进行了研究. A key study compared the first CBT-T trial compared two sample groups: one group with 138 people was treated with CBT-ED (20 sessions) and one group with 55 people doing CBT-T (10 sessions), 都有监督. 方法的核心是保持病人的满意度, 这项试验的重点是评估患者之前的生活质量, 在所有会议期间和之后, 以及测量饮食问题, 焦虑和抑郁.

在CBT-ED, patient life quality and symptoms followed a pattern of improving throughout treatment and staying down after the 20 sessions have been completed. CBT-T试验反映了相同的模式, 证明这种具有成本效益的方法可以使患者在一半的时间内取得相同的成功.


很难说这两种疗法的结果有什么不同, 虽然一个只有另一个的一半长.

教授格伦沃勒

心理学系临床心理学教授


培训人员

The team spent four years gathering and preparing evidence of the CBT-T approach before producing a manual to enable wide implementation across the globe.

为临床心理学家所开发, 精神病医生和其他研究饮食失调的专业人士, the green book titled ‘Brief Cognitive Behavioural Therapy for Non-Underweight Patients: CBT-T for Eating Disorders’ provides thorough guidance and evidence behind the CBT-T approach. 到目前为止,这本书已经卖了两千多本.

本手册附有 一个网站 为临床医生和患者提供基于研究的临床材料, 以及培训视频,以改善CBT-T的交付. 到目前为止, 它已在35个英国IM电竞app信托和国际(美国, 加拿大, 澳大利亚, 新西兰, 乌克兰, 挪威, 瑞典, 荷兰, 墨西哥, 冰岛, 爱尔兰, 意大利和俄罗斯). 

This research originated with a recommendation for briefer therapies for eating disorders, 由国家健康和护理卓越研究所(NICE)制定, 并用于这些指导原则的下一个迭代, 影响对这些个人的国家委托治疗. It has already informed national and international guidelines and policy regarding best practice in treating eating disorders.

英国国家医疗服务体系建立了CBT-ED和CBT-T的全国培训计划, 基于IM电竞app的研究和政策建议. IM电竞app England (IM电竞app Improvement and Health Education England) has provided £7 million funding for national training for eating disorders. 

This programme started in November 2020 and will deliver the training of 300-400 clinicians in CBT-T, 并对160名临床督导人员进行相关培训.

影响政策

IM电竞app的研究继续被用于全球各地的试验, with positive outcomes of seeing a greater number of people and reducing waiting times substantially without compromising on quality of care and recovery rates.

The CBT-T method has been cited as having improved practice in IM电竞app Trust policies due to a reduction in waiting list and accessible information provided for patients and carers, 即使是由经验不足的治疗师传授. 

The 2018 NICE quality guidelines recommended the use of CBT-T as an approach for supporting eating disorders.

The Academy for Eating Disorders (2020) has summarised international guidelines on eating

疾病的治疗方法. It is designed to inform clinicians anywhere in the world of the best psychological therapies for eating disorders. The guide mentions IM电竞app research as an example of effective brief therapies as a means to enable wider access to therapy.

教授格伦沃勒 continues to deliver detailed CBT-T training to therapists across the world while collecting positive data from trials in many countries. 

“We have developed evidence of the effectiveness of CBT-T in the UK and 澳大利亚 ourselves, 但更重要的是,IM电竞app正在从世界各地的独立研究中获得证据. We will keep sharing this protocol widely to gather more evidence that will be presented to NICE and encourage more countries to adapt this approach. These recommendations can take years to develop but will support the implementation of CBT-T more widely” explains 教授格伦沃勒.

作者:Alina Moore,研究传播协调员 

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