Internet-Based Treatment of Depression: A Randomized Controlled Trial Comparing Guided with Unguided Self-Help
Internet-Based Treatment of Depression: A Randomized Controlled Trial Comparing Guided with Unguided Self-Help
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DOI：
10.1080/16506073.2011.616531
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发表时间：
2011-01-01
影响因子：
4.7
通讯作者：
Caspar, Franz
中科院分区：
文献类型：
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作者：
Berger, Thomas;Haemmerli, Katja;Caspar, Franz
在治疗师的指导下，互联网提供的抑郁症自助在几次试验中显示出了效果。荟萃分析的结果表明，指导很重要，没有支持的自助计划效果较差。然而，在有指导和无指导的基于互联网的抑郁症治疗之间没有直接的实验比较。目前的研究比较了为期10周的基于网络的无指导自助治疗与每周通过电子邮件进行治疗师支持的相同干预的益处。还包括一个等候名单对照组。76名符合重度抑郁症或心境恶劣诊断标准的个体被随机分配到三种情况中的一种。贝克抑郁量表（BDI-II）作为主要结局指标。次要结局包括一般精神病理、人际问题和生活质量。69名参与者（91%）在治疗后完成评估，59名参与者（78%）在6个月的随访中完成评估。结果显示，与等候名单对照组相比，两个治疗组的症状明显减轻。治疗后，无指导自助组与等候名单组的BDI-II组间效应量为d = 0.66，有指导自助组与等候名单组的效应量为d = 1.14。在两种积极治疗的比较中，在所有测量维度上都发现了有利于引导条件的小到中度但没有统计学意义的影响。两组在随访6个月时均保持治疗效果。这一发现提供了证据，证明无论是否增加支持，互联网提供的抑郁症治疗都是有效的。然而，在纳入之前，所有参与者都接受了结构化的诊断电话访谈，这禁止对没有任何人类接触的非指导治疗得出结论。关键词：认知行为治疗；基于互联网的治疗;抑郁症;自助
Internet-delivered self-help for depression with therapist guidance has shown efficacy in several trials. Results from meta-analyses suggest that guidance is important and that self-help programs without support are less effective. However, there are no direct experimental comparisons between guided and unguided internet-based treatments for depression. The present study compared the benefits of a 10-week web-based unguided self-help treatment with the same intervention complemented with weekly therapist support via e-mail. A waiting-list control group was also included. Seventy-six individuals meeting the diagnostic criteria of major depression or dysthymia were randomly assigned to one of the three conditions. The Beck Depression Inventory (BDI-II) was used as the primary outcome measure. Secondary outcomes included general psychopathology, interpersonal problems, and quality of life. Sixty-nine participants (91%) completed the assessment at posttreatment and 59 (78%) at 6-month follow-up. Results showed significant symptom reductions in both treatment groups compared to the waiting-list control group. At posttreatment, between-group effect sizes on the BDI-II were d = .66 for unguided self-help versus waiting-list and d = 1.14 for guided self-help versus waiting-list controls. In the comparison of the two active treatments, small-to-moderate, but not statistically significant effects in favor of the guided condition were found on all measured dimensions. In both groups, treatment gains were maintained at 6-month follow-up. The findings provide evidence that internet-delivered treatments for depression can be effective whether support is added or not. However, all participants were interviewed in a structured diagnostic telephone interview before inclusion, which prohibits conclusions regarding unguided treatments that are without any human contact. Key words: cognitive behavioral therapy; internet-based treatment; depression; self-help