Holmes, EA;
Ghaderi, A;
Harmer, CJ;
Ramchandani, PG;
Cuijpers, P;
Morrison, AP;
Roiser, JP;
... Craske, MG; + view all
(2018)
The Lancet Psychiatry Commission on psychological treatments research in tomorrow's science.
Lancet Psychiatry
, 5
(3)
pp. 237-286.
10.1016/S2215-0366(17)30513-8.
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Abstract
Background: Psychological treatments occupy an important place in evidence-based mental health treatments. Now is an exciting time to fuel treatment research: a pressing demand for improvements is poised alongside new opportunities from closer links with sister scientific and clinical disciplines. The need to improve mental health treatment is great; even the best treatments do not work for everyone, treatments have not been developed for many mental disorders, and the implementation of treatments needs to address worldwide scalability. Psychological treatments have yet to benefit from numerous innovations that have occurred in science, particularly those that have emerged in the past 20 years, and arguably vice versa. This Commission comprises ten parts that each outline an area in which we see substantial opportunity and scope for advancements that will move psychological treatments research forward. / Part 1: How do existing treatments work? Making the case for the mechanisms of psychological treatments Beyond knowing that an intervention is efficacious, research initiatives are needed that clarify the key mechanisms through which interventions work. An experimental psychopathological approach enables the identification of mechanisms. Research on these mechanisms has considerable scope to facilitate treatment innovation. / Part 2: Where can psychological treatments be deployed? Research to improve mental health worldwide We outline a number of factors to facilitate worldwide access to psychological treatments. Future research initiatives need to continue to develop and assess the efficacy of brief and flexible interventions that can be adapted to meet the needs of individuals across cultural contexts, and delivered and disseminated in a sustainable way. / Part 3: With what? The potential for synergistic treatment effects—using and developing cross-modal treatment approaches The combination of psychological and pharmacological treatments needs to be better understood, both in terms of the clinical effect and the underlying shared and different mechanisms. Efforts to develop and investigate the efficacy of novel cross-modal treatments could contribute to treatment innovation. / Part 4: When in life? Psychological science, prevention, and early intervention—getting the approach right from the start The social and economic tolls of mental health problems early in life make the development of effective prevention and early intervention approaches a priority. A preventive focus and a developmental approach are needed to identify risk factors for psychopathology, and identification of the optimal time at which to offer prevention approaches is needed to increase the likelihood of vulnerable young people growing up with positive mental health. / Part 5: Technology—can we transform the availability and efficacy of psychological treatment through new technologies? New technologies provide exciting and timely means by which to disseminate and extend the efficacy and global reach of evidence-based interventions. eHealth and mHealth approaches that use information technology (eg, the internet, virtual reality, serious gaming) and mobile and wireless applications (eg, text messaging, apps) are examples of how technology has been harnessed to innovate psychological treatments and their availability and evaluation. / Part 6: Trials to assess psychological treatments The findings of randomised controlled trials that assess psychological therapies inform policy and practice. Accordingly, the design and conduct of these trials warrants scrutiny and ongoing efforts for quality improvement (eg, reporting standards, specification of protocols, inclusion and exclusion criteria, choice of outcome measures, measurement of adverse effects, and prevention of bias in design and analysis). We outline several opportunities for further improvement that should enhance the credibility and quality of future trials. / Part 7: Training—can we cultivate a vision for interdisciplinary training across mental health sciences to improve psychological treatments? Early examples of collaboration between basic scientists and clinicians translated into historical steps in the innovation of psychological treatment. Such synergy has become less apparent in the past few years. The improvement in links between clinical psychology, psychiatry, and basic research has the potential to deliver more advances in psychological treatments. We propose opportunities to improve training in interdisciplinary mental health sciences. This training approach would be the first step toward forging links between scientists and clinicians in the next generation and bridging the gap between clinical practice and the basic research programmes that underpin psychological treatments. / Part 8: Whom should we treat, for what, and with what? Embracing the complexity of mental disorders from personalised models to universal approaches Mental disorders are inherently complex (eg, hetero-geneity in symptoms across disorders, high rates of comorbidity) and evidence-based treatments must address this complexity. Potential solutions include considering both highly individualised (ie, personalised) approaches and so-called universal or transdiagnostic approaches that target common mechanisms. A goal of future research will be to examine whether these approaches improve treatment effectiveness. / Part 9: Target: suicidal behaviour—protecting lives Suicidal behaviour is one of many areas in which advances are needed. Despite developments in the understanding of risk factors that predict the likelihood of suicide attempts, and the treatment and prevention of suicidal behaviour, many questions remain. We specify areas for future research—eg, use of new technologies, the role of culture, input from individuals with lived experience of suicidal behaviour, and using a team-based approach in the development, assessment, and dissem-ination of prevention efforts. / Part 10: Active innovation and scrutiny of future psychological treatments research The task of improving psychological treatments is an exciting prospect for scientists and clinicians with an interest in the so-called science of mental life. Clinicians, researchers, service users, carers, funders, commissioners, managers, policy planners, and change experts all have a part to play in improving psychological treatment. Some long-held ideas need examination, from the branding of psychological treatment types, to considering what people actually want treatment for. Scrutiny of new ideas should be rigorous and yet encourage innovation.
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