【作者】 刘玎； 侯艳飞； 周社刚； 彭飞； 赵久波； 杨文登； 周颖； 陈晓宇； 高婷婷； 刘欢欢； 杜青芸； 邹来泉； 杨雪岭； 张小远；

【Author】 Liu Ding;Hou Yanfei;Zhou Shegang;Peng Fei;Zhao Jiubo;Yang Wendeng;Zhou Ying;Chen Xiaoyu;Gao Tingting;Liu Huanhuan;Du Qignyun;Zou Laiquan;Yang Xueling;Zhang Xiaoyuan;Department of Psychology,Southern Medical University;School of Psychology,ShenZhen University;Department of Psychology,Faculty of Education,Henan Normal university;Department of Psychology,Guangzhou University;

【机构】 南方医科大学心理学系； 深圳大学心理学院； 河南师范大学教育学部心理学系； 广州大学心理学系；

【摘要】 循证心理治疗曾被认为是心理学实践领域一场最重要的运动。从心理治疗的实践者、研究者到卫生管理部门和相关政策的制定者,都大力呼吁心理学循证实践。然而,自循证心理治疗诞生以来,相关的争论从未停歇。近10年来循证心理治疗的发展速度减缓,其主要原因在于循证实践本身的局限性:(1)循证实践强调将最好的证据应用于临床实践,这容易导致追求最佳证据的过度化和绝对化;(2)循证实践在本质上服务于公共卫生理念,这使其重视证据的普遍性,难以解决针对个体患者的临床决策问题;(3)循证实践的基础是证据,对于证据缺乏甚至难以通过科学手段获取证据的临床领域,这种方法将捉襟见肘。面对循证实践所存在的问题,生物医学开始转向精准实践,即根据患者对特异性疾病的易感性、特异性疗法和预后的反应进行亚群分类,按照各亚群的独特性给予相应的医学处置,实现个性化治疗。生物医学从循证实践向精准实践的转型,为心理治疗突破循证实践的方法困境提供新的思路,研究者开始根据精准医学的理念对心理治疗的精准实践进行探索,基于遗传学、神经科学,寻找特定的生物标记物和来访者心理社会特征,对心理治疗的对象进行亚群划分,结合研究证据,为患者选择最佳的实证支持疗法,从循证实践的寻求最佳证据向精准实践的实现最佳选择发展。此外,当前的精准心理治疗也开始使用机器学习等统计预测和建模方法,对已发现的来访者调节变量加以组合,构建较为完整的疗法选择决策模型,协助治疗师根据特定来访者选择最合适的治疗方法。精准心理治疗以咨访匹配为主要途径,集合计算科学和大数据整合个体精神健康相关的神经科学、遗传学和心理学数据,可突破循证实践的平均化局限,实现个体化干预,有望解决循证实践难以推广、缺乏个体化的实务难题。本研究团队进一步区分三种治疗匹配:治疗形式匹配(药物治疗vs心理治疗)、治疗方法匹配和治疗师匹配,基于此开展研究,并进行临床实践,初步探索精准心理治疗的本土化模式。更多还原

【Abstract】 Evidence-based psychotherapy has been regarded as one of the most important movements in the field of psychological practice.From practitioners and researchers of psychotherapy to health management departments and relevant policy makers, all strongly appeal for evidence-based practice of psychology.However, since the birth of evidence-based psychotherapy, relevant debates have never ceased. The development of evidence-based psychotherapy has slowed down in the past 10 years, mainly due to the limitations of evidence-based practice itself:(1) evidence-based practice emphasizes the application of the best evidence in clinical practice, which tends to lead to excessive and absolute pursuit of the best evidence;(2) evidence-based practice in essence serves the public health, which makes it pay attention to the universality of evidence and difficult to solve the problem of clinical decision-making for individual patients;(3) evidence is the basis of evidence-based practice. For clinical areas where evidence is lacking or even difficult to obtain by scientific means, this method will be insufficient. Faced with the problems existing in evidence-based practice, biomedicine began to turn to precise practice, which is to classify subgroups according to patients’ susceptibility to specific diseases, responses and prognostic to specific therapies, and give corresponding treatment according to the uniqueness of each subgroup to achieve personalized treatment. The transformation of biomedicine from evidence-based practice to precise practice provides a new way for psychotherapy to break through the methodological problems of evidence-based practice and researchers began to explore the precise practice of psychology according to precise medicine. Based on genetics and neuroscience, specific biomarkers and psychosocial characteristics of clients are searched, subgroups of psychological treatment objects are divided, and the best empirical support therapy is selected for patients based on research evidence, developing from the best evidence of evidence-based practice to the best selection of precise practice. In addition, the current precision psychotherapy also begins to use statistical prediction and modeling methods such as machine learning to combine the moderators of clients to build some more complete therapy selection decision-making models to assist therapists in selecting the most appropriate therapy according to specific clients. Precise psychotherapy takes patient-treatment matching as the main approach, and uses computational science and big data to integrate neuroscience, genetics and psychology data related to individual mental health, breaks through the averaging limitation of evidence-based practice, realizes individualized intervention, and is expected to solve the practical problems of difficult popularization and lack of individualization of evidence-based practice. The research team further distinguished three types of treatment matching: treatment form matching(drug therapy vs. psychotherapy), treatment method matching and therapist matching. Based on this, some studies were conducted and combined with the clinical practices to preliminarily explore the localization mode of precise psychotherapy.更多还原