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Lost in translation? Moving contingency management and cognitive behavioral therapy into clinical practice

机译：迷失了翻译？将应急管理和认知行为疗法应用于临床实践

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摘要

In the treatment of addictions, the gap between the availability of evidence-based therapies and their limited implementation in practice has not yet been bridged. Two empirically validated behavioral therapies, contingency management (CM) and cognitive behavioral therapy (CBT), exemplify this challenge. Both have a relatively strong level of empirical support but each has weak and uneven adoption in clinical practice. This review highlights examples of how barriers to their implementation in practice have been addressed systematically, using the Stage Model of Behavioral Therapies Development as an organizing framework. For CM, barriers such as cost and ideology have been addressed through the development of lower-cost and other adaptations to make it more community-friendly. For CBT, barriers such as relative complexity, lack of trained providers and need for supervision have been addressed via conversion to standardized computer-assisted versions that can serve as clinician extenders. Although these and other modifications have rendered both interventions more disseminable, diffusion of innovation remains a complex, often unpredictable process. The existing specialty addiction treatment system may require significant reforms to fully implement CBT and CM, particularly greater focus on definable treatment goals and performance-based outcomes.
机译：在成瘾的治疗中，尚未消除基于证据的疗法的可获得性与其在实践中有限实施之间的差距。两种经过经验验证的行为疗法，应急管理（CM）和认知行为疗法（CBT）证明了这一挑战。两者都具有相对较强的经验支持水平，但在临床实践中各自采用的情况较弱且参差不齐。本文以行为疗法开发阶段模型为组织框架，重点介绍了如何系统地解决在实践中实施这些障碍的例子。对于CM，已经通过开发低成本和其他改编使其更加社区友好的方式解决了成本和意识形态等障碍。对于CBT，通过转换为可以用作临床医生扩展程序的标准化计算机辅助版本，可以解决诸如相对复杂，缺乏训练有素的提供者以及需要监督等障碍。尽管这些修改和其他修改使两种干预措施都更易于传播，但创新的传播仍然是一个复杂且往往不可预测的过程。现有的专业成瘾治疗系统可能需要进行重大改革，以全面实施CBT和CM，尤其是更加注重可定义的治疗目标和基于绩效的结果。

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