Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial.
Automated Text Messaging as an Adjunct to Cognitive Behavioral Therapy for Depression: A Clinical Trial.
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DOI：
10.2196/jmir.6914
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发表时间：
2017-05-08
影响因子：
7.4
通讯作者：
Avila P
中科院分区：
文献类型：
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作者：
Aguilera A;Bruehlman-Senecal E;Demasi O;Avila P
认知行为疗法(CBT)治疗抑郁症是有效的，但在低收入环境中实施时效果有限，因为参与困难包括不遵守技能培养作业和过早停止治疗。可以在临床环境中使用自动消息传递来增加抑郁症治疗的剂量，并鼓励持续参与心理治疗。这项研究的目的是测试短信辅助工具(情绪监测短信、与治疗相关的短信和显示患者数据的临床医生仪表板)是否增加了参与并改善了抑郁症CBT集体治疗的临床结果。具体地说，我们的目标是评估与标准CBT组对照条件相比，短信辅助工具是否导致低收入西班牙语拉丁裔患者参加小组治疗的次数增加、治疗持续时间增加，以及患者健康问卷9项(PHQ-9)症状的减少。门诊行为健康诊所的患者被分配到标准组CBT治疗抑郁症(对照条件；n=40)或相同的治疗加短信附件(n=45)。附件包括每日情绪监测信息、重申该周内容主题的每日信息以及用药和预约提醒。情绪数据和定性回答被发送到一个基于网络的平台(HealthSMS)，供治疗师审查，并在会话中显示，作为教授CBT技能的工具。意向治疗分析发现，在每周16个疗程的治疗中，被分配了短信辅助工具的患者在治疗中停留的时间(退出前的中位数为13.5周)明显长于被分配到对照组的患者(退出前的中位数为3周；Wilcoxon-Mann-Whitney z=−2.21，P=.03)。在此期间，被分配到短信辅助设备的患者通常也比被分配到对照条件的患者参加更多的治疗(中位数=6次)，但效果并不显著(Wilcoxon-Mann-Whitney z=−1.65，P=.10)。在整个治疗过程中，被分配到短信附件(B=−.29，95%CI−0.38到−0.19，z=−5.80，P<；.001)的患者和被分配到对照组(B=−.20，95%CI−0.32到−0.07，z=−3.12，P=0.002)的患者都经历了抑郁症状严重程度的显著降低；然而，这两种情况在症状减轻程度上没有显著差异。这项研究支持将自动短信作为一种工具，以维持随着时间的推移对抑郁症患者进行CBT的参与度。不同情况下的抑郁结果没有差异，但这可能受到退出治疗的患者随访率较低的影响。
Cognitive Behavioral Therapy (CBT) for depression is efficacious, but effectiveness is limited when implemented in low-income settings due to engagement difficulties including nonadherence with skill-building homework and early discontinuation of treatment. Automated messaging can be used in clinical settings to increase dosage of depression treatment and encourage sustained engagement with psychotherapy. The aim of this study was to test whether a text messaging adjunct (mood monitoring text messages, treatment-related text messages, and a clinician dashboard to display patient data) increases engagement and improves clinical outcomes in a group CBT treatment for depression. Specifically, we aim to assess whether the text messaging adjunct led to an increase in group therapy sessions attended, an increase in duration of therapy attended, and reductions in Patient Health Questionnaire-9 item (PHQ-9) symptoms compared with the control condition of standard group CBT in a sample of low-income Spanish speaking Latino patients. Patients in an outpatient behavioral health clinic were assigned to standard group CBT for depression (control condition; n=40) or the same treatment with the addition of a text messaging adjunct (n=45). The adjunct consisted of a daily mood monitoring message, a daily message reiterating the theme of that week’s content, and medication and appointment reminders. Mood data and qualitative responses were sent to a Web-based platform (HealthySMS) for review by the therapist and displayed in session as a tool for teaching CBT skills. Intent-to-treat analyses on therapy attendance during 16 sessions of weekly therapy found that patients assigned to the text messaging adjunct stayed in therapy significantly longer (median of 13.5 weeks before dropping out) than patients assigned to the control condition (median of 3 weeks before dropping out; Wilcoxon-Mann-Whitney z=−2.21, P=.03). Patients assigned to the text messaging adjunct also generally attended more sessions (median=6 sessions) during this period than patients assigned to the control condition (median =2.5 sessions), but the effect was not significant (Wilcoxon-Mann-Whitney z=−1.65, P=.10). Both patients assigned to the text messaging adjunct (B=−.29, 95% CI −0.38 to −0.19, z=−5.80, P<.001) and patients assigned to the control conditions (B=−.20, 95% CI −0.32 to −0.07, z=−3.12, P=.002) experienced significant decreases in depressive symptom severity over the course of treatment; however, the conditions did not significantly differ in their degree of symptom reduction. This study provides support for automated text messaging as a tool to sustain engagement in CBT for depression over time. There were no differences in depression outcomes between conditions, but this may be influenced by low follow-up rates of patients who dropped out of treatment.