෱ౡݝཱҩՊେֶҩֶ෦ ݈߁ϦεΫίϛϡχέʔγϣϯֶߨ࠲ ॿڭ஛ྛ༝෢ 19/10/11 42

•  հೖݚڀͷϙΠϯτ – ৺ཧྍ๏ʹ͓͚ΔϓϥηϘޮՌ •  ౷੍܈ઃఆͷϙΠϯτ – ࣮ફͷΤϏσϯεΛ஝ੵ͢Δ࿮૊Έ •  ୯Ұࣄྫ࣮ݧσβΠϯ •  3PVUJOF0VUDPNF.POJUPSJOH 30.

(RCT)

Murad HM et al: The New Evidence Pyramid (http://www.isehc.net/wp-content/uploads/2011/12/October-2015.pdf) 5 :

Murad HM et al: The New Evidence Pyramid (http://www.isehc.net/wp-content/uploads/2011/12/October-2015.pdf) 5 :

R C T ... ... R C T ... ... . 97 7 2 32GRADE . 65 , 2015. Guyatt G et al: J Clin Epidemiol. 2011 Apr;64(4):383-94.

( ) 7 ! ! ! ! ! ! Chapter 8: Assessing risk of bias in included studies (http://www.cochrane.org/handbook)

CBT RCT •  $VJKQFSTFUBM )JHIRVBMJUZͳ$#5ͷ3$5͸গͳ͍ ೥Ҏ߱ ೥Ҏલɿ –  ੒ਓͷ͏ͭප΍ෆ҆ʹର͢Δ$#5ͷ3$5݅ •  ରর܈͸5"6 8- QJMMQMBDFCPʹݶఆ –  ཚ਺ੜ੒ ׂΓ෇͚ͷӅณԽ ධՁऀͷ໡ݕԽ Ξ΢τΧϜଌ ఆͷ׬શੑ *55Λ࣮ࢪ͍ͯ͠Δ͔ʣΛͭΛ९क͍ͯ͠Ε ͹IJHIRVBMJUZͱ൑அ Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. (2016). How effecMve are cogniMve behavior therapies for major depression and anxiety disorders? A meta-analyMc update of the evidence. World Psychiatry, 15(3), 245-258.

CBT •  $#5͕ΰʔϧυελϯμʔυͱ͸ೝΊΒΕͳ͍ •  $#5͸ݱঢ়Ͱ͸ؒҧ͍ͳ͘ΰʔϧυελϯμʔυ Leichsenring, F., & Steinert, C. (2017). Is cogniMve behavioral therapy the gold standard for psychotherapy?: the need for plurality in treatment and research. Jama, 318(14), 1323-1324. David, D., Cristea, I., & Hofmann, S. G. (2018). Why cogniMve behavioral therapy is the current gold standard of psychotherapy. FronMers in psychiatry, 9, 4.

1.  2.  3.  ( TAU , 4.  5.  6.  Allegiance ( Leichsenring, F., & Steinert, C. (2017). Is cogniMve behavioral therapy the gold standard for psychotherapy?: the need for plurality in treatment and research. Jama, 318(14), 1323-1324.

CBT -  CBT (RCT ) -  CBT CBT -  ( -  -  TAU TAU David, D., Cristea, I., & Hofmann, S. G. (2018). Why cogniMve behavioral therapy is the current gold standard of psychotherapy. FronMers in psychiatry, 9, 4.

-  CBT RCT -  CBT -  de Abreu Costa, M., de Oliveira, G. S. D. A., Tacon-Ramos, T., Manfro, G. G., & Salum, G. A. (2019). Anxiety and stress-related disorders and mindfulness-based intervenMons: a systemaMc review and mulMlevel meta-analysis and meta-regression of mulMple outcomes. Mindfulness, 10(6), 996-1005.

CBT •  ݚڀͷ࣭͕௿͍ͱޮՌΛա৒ਪఆ 1"%΍4"%Ͱݦஶʣ 0 0.2 0.4 0.6 0.8 1 PAD SAD GAD MDD HQ All Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. (2016). How effecMve are cogniMve behavior therapies for major depression and anxiety disorders? A meta-analyMc update of the evidence. World Psychiatry, 15(3), 245-258.

CBT •  ෆ҆঱࣏ྍͷ ͏ͭප࣏ྍͰ͸͕౷ ੍܈ʹ଴ػϦετ܈ •  ଴ػϦετ౷੍܈͸$#5ͷޮՌΛաେධՁ Cuijpers, P., Cristea, I. A., Karyotaki, E., Reijnders, M., & Huibers, M. J. (2016). How effecMve are cogniMve behavior therapies for major depression and anxiety disorders? A meta-analyMc update of the evidence. World Psychiatry, 15(3), 245-258. 0 0.5 1 1.5 PAD SAD GAD MDD WL TAU Pill Placebo

Guidi, J., Rafanelli, C., & Fava, G. A. (2018). The clinical role of well-being therapy. Nordic journal of psychiatry, 72(6), 447-453. •  ޮՌͷա৒ਪఆ •  ϊγʔϘ OPDFCP ޮՌ •  ྙཧత໰୊ʢ࣏ྍͷ஗Ԇʣ ৺ཧྍ๏ͷ3$5ʹ͓͚Δద੾ͳ౷੍܈ͱ͸ʁ

: vs 16 : Enck, P., & Zipfel, S. (2019). Placebo Effects in Psychotherapy: A Framework. FronMers in Psychiatry, 10, 456.

: , , , , , , , , : , , , , : , , , , , , , , , , , , , , , Enck, P., & Zipfel, S. (2019). Placebo Effects in Psychotherapy: A Framework. FronMers in Psychiatry, 10, 456.

•  ະ࣏ྍ܈ •  ଴ػϦετ܈ •  QJMMϓϥηϘ܈ •  ௨ৗ࣏ྍ܈ •  ৺ཧֶతϓϥηϘ܈ •  ΞΫςΟϒରর܈ $#5WTༀ෺ྍ๏ͳͲ •  σΟεϚϯτϦϯά

Gold, S. M., Enck, P., Hasselmann, H., Friede, T., Hegerl, U., Mohr, D. C., & Oce, C. (2017). Control condiMons for randomised trials of behavioural intervenMons in psychiatry: a decision framework. The Lancet Psychiatry, 4(9), 725-732. 125 CBT RCT: WL TAU, , pill-pracebo

: vs 20 WLC TAU

࣬ױ΍࣬ױͷಛੑݚڀϑΣʔζݚڀͷ໨తೖ खՄೳͳࢿݯͷτϨʔυΦϑͰ͖·Δɻ Gold, S. M., Enck, P., Hasselmann, H., Friede, T., Hegerl, U., Mohr, D. C., & Oce, C. (2017). Control condiMons for randomised trials of behavioural intervenMons in psychiatry: a decision framework. The Lancet Psychiatry, 4(9), 725-732.

Gold, S. M., Enck, P., Hasselmann, H., Friede, T., Hegerl, U., Mohr, D. C., & Oce, C. (2017). Control condiMons for randomised trials of behavioural intervenMons in psychiatry: a decision framework. The Lancet Psychiatry, 4(9), 725-732. ױऀͷϦεΫ ࣬ױͷಛੑʣ ਍அͷҧ͍ ྟচతಛ௃ͷҧ͍ ౷੍܈΁ͷ༧ظ΍ظ଴ ϊηϘͷੜ͡΍͢͞ ෳ਺༗ޮͳ࣏ྍ͕͋Δ৔߹ʹ ະ࣏ྍ΍8-Λબ୒͢Δ৔߹ͷྙཧత໰୊

Gold, S. M., Enck, P., Hasselmann, H., Friede, T., Hegerl, U., Mohr, D. C., & Oce, C. (2017). Control condiMons for randomised trials of behavioural intervenMons in psychiatry: a decision framework. The Lancet Psychiatry, 4(9), 725-732. ྟচݚڀͷϑΣʔζ   1IBTF୳ࡧతͳ༰ྔ୳ࡧͳͲGFBTJCJMJUZ   1IBTF༧උతͳޮՌݚڀ લޙൺֱ খن໛3$5   1IBTFݕূతͳޮՌݚڀ େن໛3$5   1IBTF༗ޮੑݚڀ ࣮஍ࢼݧʣ

Gold, S. M., Enck, P., Hasselmann, H., Friede, T., Hegerl, U., Mohr, D. C., & Oce, C. (2017). Control condiMons for randomised trials of behavioural intervenMons in psychiatry: a decision framework. The Lancet Psychiatry, 4(9), 725-732. ྟচݚڀͷϑΣʔζ   ॳظͷ୳ࡧతͳϑΣʔζ QIBTF Ͱ͸ɺݕূΛݫີʹ͢͠ ͗ͣɺ༗๬ͳ࣏ྍΛૣ͍ͩΜ͔ΜͰݟམͱͯ͠͠·Θͳ͍Α ͏ʹ͢Δ 5ZQFΤϥʔͷճආʣɻ͜ͷஈ֊Ͱ͸8-΋͋Γɻ   ݕূతͳϑΣʔζͰ͸ɺΞΫςΟϒͳରর܈ ৺ཧతϓϥη Ϙ܈ σΟεϚϯτϦϯά౷੍܈ͳͲɺൺֱ͕ݫ֨ʢ৽ن࣏ ྍͷಛఆཁҼͷޮՌ͕໌֬ʹͳΔΑ͏౷੍܈Λઃఆʣ   ࣮஍ࢼݧ F⒎FDUJWFOFTTTUVEZ Ͱ͸ɺױऀબ୒΍࠷খ࣏ྍ ͳͲ

Gold, S. M., Enck, P., Hasselmann, H., Friede, T., Hegerl, U., Mohr, D. C., & Oce, C. (2017). Control condiMons for randomised trials of behavioural intervenMons in psychiatry: a decision framework. The Lancet Psychiatry, 4(9), 725-732. ݚڀࢿݯ ΞΫςΟϒͳ౷੍܈͸ίετ͕͔͔Δ հೖऀͷޏ༻ͳͲ খ͞ͳޮՌΛݕग़͢ΔͨΊʹ͸ɺେ͖ͳαϯ ϓϧαΠζ͕ඞཁ ˠαϯϓϧαΠζ࠶ਪఆ΍దԠܕσβΠϯ΋༗ޮ

Gold, S. M., Enck, P., Hasselmann, H., Friede, T., Hegerl, U., Mohr, D. C., & Oce, C. (2017). Control condiMons for randomised trials of behavioural intervenMons in psychiatry: a decision framework. The Lancet Psychiatry, 4(9), 725-732.   3$5ͷ࣮ࢪऀ͸ɺࢼݧͷϓϩτίϧ΍࿦จʹ ࣄલʹ౷੍܈બ୒ͷਖ਼౰ੑʹ͍ͭͯৄࡉʹه ࡌ͢΂͖   ౷੍܈ΛબͿͱ͖ɺױऀूஂͱؔ࿈ϦεΫɺ ݚڀͷϑΣʔζΛߟྀ   ϝλ෼ੳ΍࣏ྍΨΠυϥΠϯͰ౷੍܈ͷ৘ใ Λ໌ࣔ͢΂͖   ࣏ྍΨΠυϥΠϯʹɺ଴ػϦετ܈Ͱͷ3$5 Ͱ͔͠༗ޮੑ͕ࣔ͞Ε͍ͯͳ͍΋ͷ͸ܝࡌ͠ ͳ͍

Take home message •  ਫ਼ਆྍ๏ͷ3$5͸·ͩ·ͩݕ౼ͷ༨஍͋Γ •  ·ͩ·࣭ͩͷߴ͍3$5ͷ࣮ࢪ͕ඞཁ •  ւ֎Ͱͦ͏͍ͬͨݱঢ়ͳͷͰ͍ΘΜ΍ࠃ಺Ͱ ͸ʜ •  ਫ਼ਆྍ๏ͷ3$5Ͱ͸౷੍܈ͷઃఆ͕ॏཁ •  ױऀͷಛੑͱݚڀஈ֊ʹԠͯ͡ɺద੾ͳ౷੍ ܈ઃఆΛ •  ਫ਼ਆྍ๏ͷ3$5ͷΤϑΥʔτ͸ਙେͳͷͰɺ ֶձओಋ·ͨ͸νʔϜͰ

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(Research supported psychological intervenMon) •  े෼ʹཱ֬͞Ε࣏ͨྍ •  ͓ͦΒ͘ޮՌͷ͋Δ࣏ྍ •  ࣮ݧతͳ࣏ྍ Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of consulMng and clinical psychology, 66(1), 7.

(research supported psychological intervenMon) 1 2 ( / ) 2 ( / ) 3 4 5 Chambless, D. L., & Hollon, S. D. (1998). Defining empirically supported therapies. Journal of consulMng and clinical psychology, 66(1), 7.

Gold, S. M., Enck, P., Hasselmann, H., Friede, T., Hegerl, U., Mohr, D. C., & Oce, C. (2017). Control condiMons for randomised trials of behavioural intervenMons in psychiatry: a decision framework. The Lancet Psychiatry, 4(9), 725-732.   1IBTF୳ࡧతͳ༰ྔ୳ࡧͳͲGFBTJCJMJUZ   1IBTF༧උతͳޮՌݚڀ લޙൺֱ খن໛3$5 4$&%   1IBTFݕূతͳޮՌݚڀ ( RCT)   1IBTF༗ޮੑݚڀ ࣮஍ࢼݧ 4$&% ʣ

1 1.  ݸਓΛର৅ʹ 2.  ݸਓ಺Ͱಠཱ ม਺Λૢ࡞ 3.  Ξ΢τΞϜม ਺Λ൓෮ଌఆ Kratochwill, T. R., Hitchcock, J., Horner, R. H., Levin, J. R., Odom, S. L., Rindskopf, D. M & Shadish, W. R. (2010). Single-case designs technical documentaMon. Retrieved from What Works Clearinghouse website: hcp://ies.ed.gov/ncee/wwc/pdf/wwc_scd.pdf. ϕʔεϥΠϯ ظ A հೖظ

1 1.  ྟচ”࣮ફ”ͷޮՌΛՊֶతʹݕূՄೳ •  ΫϥΠΤϯτʹݱࡏ࣮ࢪ͍ͯ͠Δհೖ͕༗ޮ ͔ΛɺΫϥΠΤϯτͷ؍࡯σʔλʹج͍ͮͯ ٬؍తʹ൑அͰ͖Δ 2.  RCTͷ࣮ࢪ͕ࠔ೉ͳঢ়گͰհೖ๏ͷ༗ޮੑ ΛՊֶతʹධՁ͢Δ୅ସ๏ͱͯ͠ͷظ଴ •  ঱ྫूੵͷݱ࣮తͳࠔ೉ •  ౷੍܈΁ͷׂΓ౰ͯͷྙཧత໰୊ •  RCTࣗମͷݶքͷࢦఠ RCTͱ࣮ྟচͷױऀͱͷဃ཭΍ݸਓࠩ౳ Barlow, D. H., Nock, M., & Hersen, M. (2009). Single case experimental designs: Strategies for studying behavior for change (No. Sirsi) i9780205474554).

1 ࠃ·ͨ͸ֶձϨϕϧͰɺओཁͳλεΫϑΥʔε͕ɺ RCTͱڞʹɺΤϏσϯεϕʔευͳհೖɾ࣏ྍͷޮՌ ධՁʹ1ࣄྫ࣮ݧσβΠϯͷ׆༻Λਪ঑ •  ถࠃ৺ཧֶձͷྟচɺࣇಐྟচ෦ձɺֶߍ৺ཧֶ෦ձ ͷΤϏσϯεʹج͍ͮͨհೖͷλεΫϑΥʔε •  ถࠃࠃཱڭҭݚڀॴಡղҕһձ (National reading panel) •  ࠃཱڭҭධՁɾ஍ҬࢧԉηϯλʔͷWhat Works ClearinghouseʹΑΔਪ঑ Kratochwill, T. R., & Levin, J. R. (2014). Single-case intervention research: Methodological and statistical advances. American Psychological Association.

1 ҩֶྖҬͰͷN of 1 trial (ABABσβΠϯ)΁ͷ஫໨ •  Guyatte et al. (2000)͕JAMAץߦ࿦จͰ ΤϏσϯε֊૚ͷτοϓ •  ΞϝϦΧҩֶձ(2000)Ͱ΋ΤϏσϯε֊૚ ͷτοϓ •  Oxford center for Evidence based medicineͷΤϏσϯεϨϕϧ(2011) Ͱ”ڧݻͳΤϏσϯε”ʹ֘౰ Mirza, R. D., Punja, S., Vohra, S., & Guyac, G. (2017). The history and development of N-of-1 trials. Journal of the Royal Society of Medicine, 110(8), 330-340. Guyac, G. H., Haynes, R. B., Jaeschke, R. Z., Cook, D. J., Green, L., Naylor, C. D., ... & Evidence- Based Medicine Working Group. (2000). Users' guides to the medical literature: XXV. Evidence- based medicine: principles for applying the users' guides to paMent care. Jama, 284(10), 1290-1296.

Behavior Research and TherapyͰࠓ೥ͷ6݄߸ʹɺ ୯Ұࣄྫ࣮ݧσβΠϯͷಛू߸͕اը

1 1.  ܥ౷తͳಠཱม਺ͷૢ࡞ 2.  Ξ΢τΧϜม਺ͷଌఆ 1ਓҎ্ͷධఆऀ ධఆऀؒͷҰக཰͕Ұఆਫ४Ҏ্ (֤ϑΣʔζ20%Ҏ্ͷσʔλ࢖༻) 3.  গͳ͘ͱ΋֤ϑΣʔζ3࣌఺ͷଌఆɺ3ͭͷҟͳΔϑΣʔζ Λ൓෮ 4.  ֤ϑΣʔζ಺ͰͷϨϕϧɺ܏޲ੑɺมಈੑͷ໌ࣔ 5.  ޮՌͷ໌ࣔ ޮՌͷimmediacy / ॏෳ౓ / ϑΣʔζؒͰͷσʔλͷҰ؏ੑ ؍࡯σʔλͱ༧ଌσʔλͷύλʔϯΛൺֱ 6.  ֎తཁҼͱಛҟੑͷݕ౼ Institute of Education Sciences. (2014). What Works Clearinghouse procedures and standards handbook.

1ࣄྫ࣮ݧݚڀͷใࠂͷ࣭޲্ͷͨΊͷΨΠυϥΠϯͷ੔උ (SCRIBE੠໌) ݚڀͷ಺తଥ౰ੑͱ֎తଥ౰ੑΛۛຯ͢Δई౓ (RoBiNT scale) Tate, R. L., Perdices, M., Rosenkoecer, U., Wakim, D., Godbee, K., Togher, L., & McDonald, S. (2013). Revision of a method quality raMng scale for single-case experimental designs and n-of-1 trials: The 15-item Risk of Bias in N-of-1 Trials (RoBiNT) Scale. Neuropsychological rehabilitaMon, 23(5), 619-638. Tate, R. L., Perdices, M., Rosenkoecer, U., McDonald, S., Togher, L., Shadish, W., ... & Sampson, M. (2016). The Single-Case ReporMng Guideline In BEhavioural IntervenMons (SCRIBE) 2016: ExplanaMon and elaboraMon. Archives of ScienMfic Psychology, 4(1), 10.

1 ւ֎Ͱ͸ೖ໳ςΩετॏ൛ɺ৽نൃߦ͕࣋ଓ ೝ஌ߦಈྍ๏ͷݚڀऀ͕ࣥච

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1 •  ॏෳ཰ հೖظͷಘ఺͕ ϕʔεϥΠϯͷ࠷௿ ࠷ߴ ಘ఺Ҏ্ ҎԼ Ͱ͋Δׂ߹ •  ฏۉ஋ࠩ ֤ϑΣʔζͷಘ఺ͷฏۉ Λࢉग़ࠩ͠ΛٻΊΔ Aͷ࠷௿఺=17 17఺Ҏ্ͷBͷσʔλ਺=3 ॏෳ཰=3/18 A=20 B=12 =8

•  ॏෳ཰ܥɿ5BV6 – ϕʔεϥΠϯͷτϨϯυͷӨڹΛߟྀ – ࣗݾ૬ؔ͸ߟྀ͞Εͳ͍ – ϊϯύϥϝτϦοΫͳࢦඪɺ෼෍ͷԾఆͳ͠ –  •  ฏۉ஋ࠩ1)4ͷඪ४ԽޮՌྔ   ෳ਺໊ͷ࣌ܥྻσʔλΛ౷߹͠ޮՌྔΛࢉग़   ࣗݾ૬ؔτϨϯυΛߟྀ   ύϥϝτϦοΫͳࢦඪ   ਖ਼ن෼෍Ҏ֎ͷ෼෍ʹ΋֦ுՄೳ Parker, R. I., Vannest, K. J., Davis, J. L., & Sauber, S. B. (2011). Combining nonoverlap and trend for single-case research: Tau- U. Behavior Therapy, 42(2), 284-299. Pustejovsky, J. E., Hedges, L. V., & Shadish, W. R. (2014). Design-comparable effect sizes in mulMple baseline designs: A general modeling framework. Journal of EducaMonal and Behavioral StaMsMcs, 39(5), 368-393.

PHS   ୯Ұࣄྫ࣮ݧͷ݁ՌΛɺଞͷ܈ؒൺֱσβΠ ϯͷ݁ՌͷղऍͰ׳Ε਌͠ΜͰ͍ΔޮՌྔɺ ৴པ۠ؒʹج͍ͮͯղऍͰ͖Δɻ   ಉ͡ϦαʔνΫΤενϣϯΛ࣋ͭݸʑͷ୯Ұ ࣄྫ࣮ݧͷ݁ՌΛ౷߹Ͱ͖Δɻ   ແ࡞ҝԽൺֱࢼݧͷΑ͏ͳ܈ؒൺֱࢼݧͷ݁ Ռͱ୯Ұࣄྫ࣮ݧͷ݁ՌΛൺֱͰ͖Δɻ   ୯Ұࣄྫ࣮ݧͷ݁Ռͱଞͷ܈ؒൺֱσβΠϯ ͷ஌ݟΛ౷߹Ͱ͖Δɻ Shadish, W. R., Hedges, L. V., Horner, R. H., & Odom, S. L. (2015). The Role of Between-Case Effect Size in ConducMng, InterpreMng, and Summarizing Single-Case Research. NCER 2015-002. NaMonal Center for EducaMon Research.

δBC = √ + 1 3 (RCT DO) ( δBC ) = Shadish, W. R., Hedges, L. V., Horner, R. H., & Odom, S. L. (2015). The Role of Between-Case Effect Size in ConducMng, InterpreMng, and Summarizing Single-Case Research. NCER 2015-002. NaMonal Center for EducaMon Research.

CBT : ACT : Au, T. M., Sauer-Zavala, S., King, M. W., Petrocchi, N., Barlow, D. H., & Litz, B. T. (2017). Compassion-based therapy for trauma-related shame and poscraumaMc stress: IniMal evaluaMon using a mulMple baseline design. Behavior therapy, 48(2), 207-221. Ruiz, F. J., Flórez, C. L., García-Martín, M. B., Monroy-Cifuentes, A., Barreto-Montero, K., García-Beltrán, D. M., ... & Gil-Luciano, B. (2018). A multiple-baseline evaluation of a brief acceptance and commitment therapy protocol focused on repetitive negative thinking for moderate emotional disorders. Journal of Contextual Behavioral Science.

CBT Au, T. M., Sauer-Zavala, S., King, M. W., Petrocchi, N., Barlow, D. H., & Litz, B. T. (2017). Compassion-based therapy for trauma- related shame and poscraumaMc stress: IniMal evaluaMon using a mulMple baseline design. Behavior therapy, 48(2), 207-221. : An overall, standardized mean difference effect size for each outcome variable was also calculated, using a d-sta:s:c specifically developed for singlecase designs (Shadish, Hedges, & Pustejovsky, 2014). The resulMng d- staMsMc takes into account autocorrelaMon, between- and within-case variance, and corrects for small sample bias using Hedges’ g. It is in the same metric as the d-staMsMc used for between-subjects designs and can be pooled with those staMsMcs in meta-analyses.

CBT Au, T. M., Sauer-Zavala, S., King, M. W., Petrocchi, N., Barlow, D. H., & Litz, B. T. (2017). Compassion-based therapy for trauma- related shame and poscraumaMc stress: IniMal evaluaMon using a mulMple baseline design. Behavior therapy, 48(2), 207-221. ACT : To obtain an overall esMmate of the effect size of the intervenMon, the design-comparable effect size for mulMple-baseline designs developed by Pustejovsky, Hedges, and Shadish (2014) was computed. This standardized mean difference effect size for SCED shares the same metric as the Cohen's d typically used in group designs, which facilitates the direct comparison and integraMon through meta-analysis of the results obtained in both types of designs. This d-staMsMc has a formal mathemaMcal development, requires at least three cases for computaMon, and corrects for small sample bias using Hedges’ g. It is an extension of the standardized mean difference advocated by Hedges, Pustejovsky, and Shadish (2012, 2013) that uses restricted maximum likelihood esMmaMon and offers the possibility of obtaining the d-staMsMc by controlling for baseline trend and taking into account change in slope. The R package scdhlm was used to compute this d-staMsMc (Pustejovsky, 2016) following the guidelines provided by ValenMne, Tanner- Smith, and Pustejovsky (2016). According to the global visual inspecMon of the dataset, we modelled baselines without trends including both fixed and random effects for level. The treatment phase was modelled with linear trends with both fixed and random effects at level and slope. We computed the d-staMsMc to esMmate the overall effect sizes at the 4-week follow-up (i.e., just before implemenMng the second session of the protocol) and at the 12-week follow-up.

1 •  ෳ਺ճͷϕʔεϥΠϯଌఆ – ʙճͷϕʔεϥΠϯ͕ඞཁͩͱ͢Δͱɺຖि਍ ࡯ʹ͘Δױऀ͞ΜʹհೖΛ։࢝͢Δ·Ͱϲ݄લ ޙ଴ػͯ͠΋ΒΘͳ͚Ε͹͍͚ͳ͍ɻۤ͠Ήױऀ ͞ΜΛલʹͯ͠଴ػΛڧ͍Δͷ͸ྙཧతʹ໰୊ɻ ˠࢪઃʹ͓͚ΔΞ΢τΧϜଌఆΛϧʔςΟϯԽ 3PVUJOFPVUDPNFNPOJUPSJOH 30. ˠΞ΢τΧϜଌఆΛߴස౓Խ ܦݧαϯϓϦϯά๏

RouMne outcome monitoring (ROM) •  ೔ৗྟচͰɺ঱ঢ়΍20-ͳͲɺਫ਼ਆత݈߁ʹؔΘΔࢦඪΛຖ ೔·ͨ͸ຖिͷස౓ͰධՁ͠ɺױऀ΍࣏ྍνʔϜͰڞ༗͢Δ •  30.ͷ࣮ࢪࣗମʹਫ਼ਆత݈߁ͷվળʹର͢ΔޮՌ͕͋Δ #SBUUMBOEFUBM •  ϝϯλϧΫϦχοΫͷױऀ໊Λର৅ʹ3$5 •  30.࣮ࢪ܈ͱ௨ৗ࣏ྍ܈ʹແ࡞ҝׂΓ౰ͯ •  ͍ͣΕͷ܈ͷױऀ΋ਫ਼ਆྍ๏Λఏڙ͞Εͨɻ •  30.࣮ࢪ܈͸௨ৗ࣏ྍ܈ͱൺ΂ͯɺഒΞ΢τΧϜ͕վળ Brattland, H., Koksvik, J. M., Burkeland, O., Gråwe, R. W., Klöckner, C., Linaker, O. M., ... & Iversen, V. C. (2018). The effects of routine outcome monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial. Journal of counseling psychology, 65(5), 641. Shimokawa, K., Lambert, M. J., & Smart, D. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of consulting and clinical psychology, 78(3), 298.

RouMne outcome monitoring (ROM) Van Der Lem, R., Van Der Wee, N. J., Van Veen, T., & Zitman, F. G. (2012). Efficacy versus effecMveness: a direct comparison of the outcome of treatment for mild to moderate depression in randomized controlled trials and daily pracMce. Psychotherapy and psychosomaMcs, 81(4), 226-234. 30.σʔλΛ࢖ͬͯɺ͏ͭප࣏ྍͷQIBTFݚڀ F⒎FDUJWFOFTTTUVEZ 1IBTFͷྟচࢼݧσʔλͷϝλ෼ੳσʔλͱɺ30.Ͱଌఆ͠ ͨݱ৔ͰͷΞ΢τΧϜͷ܈಺ޮՌྔ ׮ղ཰ Λൺֱ Clinical pracMce < RCT (32 vs.40–74%). Clinical pracMve < RCT (21 vs. 34–47%) : Clinical pracice < RCT (27 vs. 34–58% : Clinical pracMce < RCT (21 vs. 45–63%)

ROM •  ΠΪϦε*"15 – 1)2 ("% 84"4ͷϧʔςΟϯଌఆΛਪ঑ – ిࢠγεςϜͰͷσʔλͷొ࿥Λਪ঑ •  ঱ྫσʔλͷσʔλϕʔεԽ

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Take ome message •  ୯Ұࣄྫ࣮ݧݚڀ๏ͷՁ஋͕ݟ௚͞ΕɺࣄྫใࠂΛ ՊֶతͳΤϏσϯεͱͯ͠൑அ͢ΔͨΊͷίϯηϯ αε͕੔උ͞Εͭͭ͋Δ •  ౷ܭղੳख๏ͷൃలʹΑΓɺ୯Ұࣄྫ࣮ݧͷϝλ෼ ੳ΋Մೳʹͳ͖͍ͬͯͯΔ •  ϧʔνϯͰΞ΢τΧϜଌఆ͢Δ͜ͱࣗମ͕ྟচతͳ ޮՌΛ࣋ͪɺͳ͓͔ͭF⒎FDUJWFOFTTTUVEZ͕࣮ࢪ ՄೳͱͳΔ͜ͱͰ࣮ફͷޮՌΛ஝ੵɺݕূՄೳ •  ܦݧαϯϓϦϯά๏౳ͷ*5ػثΛ׆༻͢Δ͜ͱͰ೔ ৗྟচ͔Β΋ղੳʹ଱͑͏Δߴີ౓ͳσʔλ͕औಘ Մೳ

•  ૯ྗΛ͔͚ͯ3$5Λຊ૸ΒͤΔ •  ୯Ұࣄྫ࣮ݧݚڀʹجͮ͘঱ྫใࠂ ͷਪ঑ •  ϧʔνϯଌఆʹ࢖༻Մೳͳई౓ͷਪ ঑࡞੒΍ई౓ͷඪ४Խ •  ిࢠγεςϜʹΑΔ঱ྫͷొ࿥σʔ λϕʔεԽ RCT CBT