Collaborative assessment as an intervention in the treatment of mental Illness: a systematic review

Three meta-analyses suggested that the psychological assessment as a therapeutic intervention approach might have therapeutic effects but had unspecific inclusion criteria. We searched four databases for RCTs that reported on the use of psychological assessment as an intervention. Two reviewers independently selected papers, extracted data, and assessed study quality. We conducted and reported the systematic review following the PRISMA statement. We assessed the Risk of bias in included studies using the Risk of Bias tool and graded the strength of the evidence with GRADE. We included two RCTs: The first study investigated Therapeutic Assessment (TA) combined with Manual-Assisted Cognitive Behavior Therapy (MACT) compared with MACT only in 16 outpatients with personality disorders. The trial found among completers (<i>n</i> = 7) no difference in borderline symptomatology but a possible difference regarding suicidality favoring MACT + TA. The trial did not provide any outcomes relating to readiness for treatment. The other trial investigated TA compared with a Goal-focused Pretreatment Intervention in a sample of 74 outpatients with personality disorders. The results found no intervention effects on symptomatology but suggested that TA might improve patient expectancy for future treatment among completers of the intervention. Both trials were judged at a high risk of bias and with very low certainty of evidence. We found no support for the clinical effect of psychological assessment as a therapeutic intervention due to the high risk of bias and low certainty of the evidence.

三项元分析结果显示，作为治疗性干预手段的心理评估（psychological assessment）或许具备治疗效应，但其纳入标准缺乏特异性。本研究检索了4个数据库中以心理评估作为干预手段的随机对照试验（Randomized Controlled Trials, RCTs）。由2名评价者独立完成文献筛选、数据提取及研究质量评估。本研究遵循PRISMA声明（PRISMA statement）开展系统评价并报告研究结果。采用偏倚风险评估工具（Risk of Bias tool）评价纳入研究的偏倚风险，使用GRADE分级系统（GRADE）对证据强度进行分级。最终纳入2项随机对照试验：第一项研究针对16名人格障碍（personality disorders）门诊患者，对比了治疗性评估（Therapeutic Assessment, TA）联合手动辅助认知行为疗法（Manual-Assisted Cognitive Behavior Therapy, MACT）与单纯MACT的干预效果。该研究在完成干预者（completers，n=7）中未观察到边缘型症状（borderline symptomatology）存在组间差异，但在自杀倾向（suicidality）方面可能存在有利于MACT+TA的组间差异。该研究未报告与治疗准备度相关的结局指标。第二项研究针对74名人格障碍门诊患者，对比了治疗性评估与目标导向的治疗前干预（Goal-focused Pretreatment Intervention）的干预效果。结果显示，两组在症状方面无显著干预差异，但提示治疗性评估或许能够提升完成干预者对未来治疗的期待（patient expectancy）。两项试验均被判定为存在高偏倚风险，且证据确定性极低。鉴于偏倚风险较高且证据确定性较低，本研究未发现支持心理评估作为治疗性干预手段具备临床效应的证据。