在因特网提供的认知行为治疗抑郁症中的活性成分的调查:随机优化试验
Edward Watkins1, Alexandra Newbold1, Michelle Tester-Jones1
1Sir Henry Wellcome Building for Mood Disorders Research, College of Life and Environmental Sciences, University of Exeter, Exeter, United Kingdom.
JAMA psychiatry
|June 28, 2023
概括
通过互联网提供的抑郁症认知行为疗法 (CBT) 的大部分成分并没有显著减少症状. 只有吸收训练显示有好处,这表明其他因素有助于治疗成功.
科学领域:
- 精神病学和心理健康 精神病学和心理健康
- 数字治疗学数字治疗学
- 临床心理学 临床心理学
背景情况:
- 了解复杂心理干预的活性成分,如抑郁症的认知行为疗法 (CBT),对于提高治疗疗效至关重要.
- 通过互联网提供的CBT (iCBT) 提供了一个可扩展的方法,但其特定的有效组件需要进一步研究.
研究的目的:
- 为了识别通过互联网提供的CBT治疗抑郁症中的活性治疗成分.
- 测试ICBT中七个不同的治疗组件的各个主要作用和相互作用.
主要方法:
- 一个随机优化试验 (IMPROVE-2) 涉及767名患有抑郁症的成年人 (PHQ-9分数≥10).
- 参与者被随机分配到32个条件中,测试iCBT七个组件的存在或缺失:活动安排,功能分析,思想挑战,放松,具体性训练,吸收和自我同情训练.
- 主要结局是抑郁症状 (PHQ-9);次要结局包括焦虑和功能,随访6个月.
主要成果:
- 总的来说,ICBT从治疗前到治疗后以及6个月的随访期间显著减少了抑郁症症状.
- 然而,分析显示,活动安排,功能分析,思想挑战,放松,具体性训练或自我同情训练对抑郁症状没有显著的主要影响.
- 只有吸收训练在6个月的随访中对减少抑郁症状产生了显著的主要影响.
结论:
- 对于抑郁症的ICBT大多数测试组件都没有显示出显著的个人对减轻症状的影响.
- 国际CBT的整体治疗益处可能来自于诸如自发缓解,治疗联盟或预期等非特异性因素,吸收训练是潜在的特定活性成分.
- 研究结果表明,需要完善iCBT协议,以隔离和增强核心有效机制,以提高功效和可扩展性.
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