OBJECTIVE Thus far, most applications in precision mental health have not been evaluated prospectively. This article presents the results of a prospective randomized-controlled trial investigating the effects of a digital decision support and feedback system, which includes two components of patient-specific recommendations: (a) a clinical strategy recommendation and (b) adaptive recommendations for patients at risk for treatment failure. METHOD Therapist-patient dyads (N = 538) in a cognitive behavioral therapy outpatient clinic were randomized to either having access to a decision support system (intervention group; n = 335) or not (treatment as usual; n = 203). First, treatment strategy recommendations (problem-solving, motivation-oriented, or a mix of both strategies) for the first 10 sessions were evaluated. Second, the effect of psychometric feedback enhanced with clinical problem-solving tools on treatment outcome was investigated. RESULTS The prospective evaluation showed a differential effect size of about 0.3 when therapists followed the recommended treatment strategy in the first 10 sessions. Moreover, the linear mixed models revealed therapist symptom awareness and therapist attitude and confidence as significant predictors of an outcome as well as therapist-rated usefulness of feedback as a significant moderator of the feedback-outcome and the not on track-outcome associations. However, no main effects were found for feedback. CONCLUSIONS The results demonstrate the importance of prospective studies and the high-quality implementation of digital decision support tools in clinical practice. Therapists seem to be able to learn from such systems and incorporate them into their clinical practice to enhance patient outcomes, but only when implementation is successful. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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心理治疗中临床决策支持系统的前瞻性评估。

目标 迄今为止，大多数精准心理健康应用尚未进行前瞻性评估。本文介绍了一项前瞻性随机对照试验的结果，该试验调查了数字决策支持和反馈系统的效果，其中包括针对患者的建议的两个组成部分：（a）临床策略建议和（b）针对患者的适应性建议治疗失败的风险。方法 认知行为治疗门诊的治疗师-患者二人组（N = 538）被随机分配到可以使用决策支持系统（干预组；n = 335）或不使用（照常治疗；n = 203）。首先，评估了前 10 个疗程的治疗策略建议（解决问题、以动机为导向或两种策略的混合）。第二，研究了使用临床问题解决工具增强的心理测量反馈对治疗结果的影响。结果 前瞻性评估显示，当治疗师在前 10 个疗程中遵循推荐的治疗策略时，差异效应大小约为 0.3。此外，线性混合模型揭示了治疗师症状意识和治疗师态度和信心作为结果的重要预测因素，以及治疗师评定的反馈有用性作为反馈结果的重要调节者和不跟踪结果关联。但是，没有发现反馈的主要影响。结论结果表明前瞻性研究和数字决策支持工具在临床实践中的高质量实施的重要性。治疗师似乎能够从这些系统中学习并将其纳入临床实践以提高患者的治疗效果，但前提是实施成功。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。