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IOM REPORT ON PSYCHOSOCIAL INTERVENTIONS: COMMENTARY FROM A DBT PERSPECTIVE
Author(s) -
Comtois Katherine Anne,
Landes Sara J.
Publication year - 2015
Publication title -
depression and anxiety
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.634
H-Index - 129
eISSN - 1520-6394
pISSN - 1091-4269
DOI - 10.1002/da.22435
Subject(s) - psychosocial , psychological intervention , mental health , evidence based practice , standardization , incentive , substance abuse , psychology , medicine , nursing , medical education , psychiatry , alternative medicine , political science , pathology , law , economics , microeconomics
The Institute of Medicine’s (IOM) report, Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence-Based Standards, calls on policy makers and researchers to act on what has been known for a long time—psychosocial interventions are effective and vastly underutilized. The report does an excellent job of identifying and describing barriers to the use of evidence-based psychosocial (EBP) interventions, including the lack of quality standardization; inadequacies of the mental health, substance abuse, and general health care infrastructure; and lack of incentives for payers and providers. Also illustrated is the additional complexity created by having treatment developers and intermediaries (i.e., trainers, consultants, facilitators) lead the charge of both the research and implementation of EBPs. This leads to multiple and often overlapping collections of what the IOM committee terms “elements” of treatment that were crafted by the treatment developer into his or her treatment and evaluated by treatment researchers as that package of elements. Payers and providers are then left to cope with each treatment package independently and are expected to maintain each one’s integrity as articulated in the treatment manual. This can result in a great number of treatment packages being implemented, despite the likely overlap of elements within each package (e.g., a sample of county and state mental health departments report simultaneous implementation from 13 to 50 EBPs).[1–4] This can lead to very expensive training initiatives where an EBP is never subsequently implemented or is not sustained 2 or 5 years later. This commentary will address several key issues in the IOM report from a dialectical behavior therapy (DBT) perspective. DBT is an evidence-based behavioral psychotherapy offered through four modes of treatment: