Empirically supported treatments for all: Realizing equitable coverage of care for trauma survivors globally

IF 4.2 2区心理学 Q1 PSYCHOLOGY, CLINICAL

Behaviour Research and Therapy Pub Date : 2025-04-29 DOI:10.1016/j.brat.2025.104757

Anushka R. Patel , Nuwan Jayawickreme , Vanessa Visquerra , Kelly Dixon , Vikram Patel

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引用次数: 0

Abstract

Global mental health is focused on reducing inequities in treatment access for mental health disorders. A core social determinant of mental health is trauma (e.g., violence, disasters, wars), contributing to myriad psychosocial outcomes such as posttraumatic stress disorder (PTSD), depression, anxiety, and functional impairment. Despite the development of numerous efficacious empirically supported treatments (ESTs), trauma survivors remain a particularly vulnerable group and rarely receive quality trauma-informed treatment. In this paper, we argue that in order to reduce global inequities in mental health treatment access, we need to fully embrace Chambless and Hollon's (1998) criteria for ESTs – that they be efficacious, effective in routine clinical contexts, feasible to deploy and scale up, and cost-effective. While the field of clinical science has made impressive strides in developing efficacious treatments, we argue that we ought to place greater emphasis on an EST being effective across contexts, feasible for delivery by a wide cadre of providers, and cost-effective to scale to improve equity. We discuss efforts in the field of global mental health that use innovative paradigms to fully realize the latter criteria, which have been under-appreciated in clinical science. We conclude with recommendations to improve EST access by applying an equity lens within and between contexts.

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经验支持的全民治疗：实现全球创伤幸存者护理的公平覆盖

全球精神卫生的重点是减少精神卫生疾患获得治疗方面的不公平现象。心理健康的一个核心社会决定因素是创伤（如暴力、灾难、战争），它会导致无数的心理社会后果，如创伤后应激障碍（PTSD）、抑郁、焦虑和功能障碍。尽管发展了许多有效的经验支持治疗（est），创伤幸存者仍然是一个特别脆弱的群体，很少得到高质量的创伤知情治疗。在本文中，我们认为，为了减少全球在心理健康治疗方面的不平等，我们需要完全接受Chambless和Hollon（1998）的est标准——它们是有效的，在常规临床环境中是有效的，可以部署和扩大规模，并且具有成本效益。虽然临床科学领域在开发有效的治疗方法方面取得了令人印象深刻的进步，但我们认为，我们应该更加强调EST在各种情况下都是有效的，可以由广泛的提供者提供，并且具有成本效益，以扩大规模以提高公平性。我们讨论了在全球精神卫生领域的努力，使用创新的范式来充分实现后一种标准，这在临床科学中被低估了。最后，我们提出了通过在上下文中应用公平视角来改善EST访问的建议。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Behaviour Research and Therapy PSYCHOLOGY, CLINICAL-

CiteScore

7.50

自引率

7.30%

发文量

148

期刊介绍： The major focus of Behaviour Research and Therapy is an experimental psychopathology approach to understanding emotional and behavioral disorders and their prevention and treatment, using cognitive, behavioral, and psychophysiological (including neural) methods and models. This includes laboratory-based experimental studies with healthy, at risk and subclinical individuals that inform clinical application as well as studies with clinically severe samples. The following types of submissions are encouraged: theoretical reviews of mechanisms that contribute to psychopathology and that offer new treatment targets; tests of novel, mechanistically focused psychological interventions, especially ones that include theory-driven or experimentally-derived predictors, moderators and mediators; and innovations in dissemination and implementation of evidence-based practices into clinical practice in psychology and associated fields, especially those that target underlying mechanisms or focus on novel approaches to treatment delivery. In addition to traditional psychological disorders, the scope of the journal includes behavioural medicine (e.g., chronic pain). The journal will not consider manuscripts dealing primarily with measurement, psychometric analyses, and personality assessment.