Primary-care patients' expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study
Primary-care patients' expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study
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DOI：
10.1111/j.1369-7625.2008.00531.x
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发表时间：
2009-03-01
影响因子：
3.2
通讯作者：
Kessler, David
中科院分区：
文献类型：
--
作者：
Beattie, Angela;Shaw, Alison;Kessler, David
探讨抑郁症初级保健患者对在线认知行为疗法（CBT）的期望和经验，重点关注这种提供模式对治疗体验的影响。质性研究，在治疗前后对患者进行重复的半结构化访谈。该研究与一项随机对照试验同时进行，该试验检验了在线CBT对抑郁症患者的有效性和成本效益。研究人员从英格兰西南部的五家全科医院招募了24名抑郁症患者，他们接受了多达10次的认知行为治疗，由一位心理学家通过互联网提供。大多数参与者从家里的电脑上进行治疗，并发现这是一个主要的优势，就方便和将治疗融入他们的日常生活而言，任何技术问题都很快得到解决。关于在线CBT的期望和体验的两个关键主题是：与治疗师建立虚拟关系，以及通过在线媒体交流思想和情感的过程。在线CBT似乎被某些抑郁症患者亚群所接受，并被他们所体验到的帮助，特别是那些熟悉电脑的人，对写下自己的感受感到舒适，享受回顾和反思书面（或打字）交流的机会，被在线治疗关系的“匿名”所吸引，并对CBT本身的主动要求敞开心扉。然而，由于缺乏视觉线索和面对面互动的即时反应，在线CBT可能会助长抑郁症患者对消极思想的脆弱性。在线CBT有可能加强对抑郁症患者的护理，这些患者愿意将“说话”（或打字）疗法作为治疗的一部分。如果在线CBT是通过NHS提供的，重要的是要建立患者对这种交付模式的偏好，并确保转诊实践是适当的目标。我们主要试验的结果将为通过这种方式接受治疗的有效性和成本效益提供证据。
To explore expectations and experiences of online cognitive behavioural therapy (CBT) among primary-care patients with depression, focusing on how this mode of delivery impacts upon the therapeutic experience.Qualitative study, using repeat semi-structured interviews with patients before and after therapy. The study was conducted in parallel with a randomized controlled trial examining the effectiveness and cost-effectiveness of online CBT for patients with depression.Twenty-four patients with depression recruited from five general practices in southwest England, who were offered up to 10 sessions of CBT, delivered via the internet by a psychologist.Most participants accessed the therapy from their home computer and found this to be a major advantage, in terms of convenience and fitting therapy into their daily routine, with any technical problems quickly resolved. Two key themes regarding expectations and experiences of online CBT were: developing a virtual relationship with a therapist, and the process of communicating thoughts and emotions via an online medium. Online CBT seems to be acceptable to, and experienced as helpful by, certain subgroups of patients with depression, particularly those who are familiar with computers, feel comfortable with writing their feelings down, enjoy the opportunities to review and reflect that written (or typed) communication offers are attracted to the 'anonymity' of an online therapeutic relationship and are open to the proactive requirements of CBT itself. However, on-line CBT may feed into the vulnerability of depressed people to negative thoughts, given the absence of visual cues and the immediate response of face-to-face interaction.Online CBT has the potential to enhance care for patients with depression who are open to engaging in 'talking' (or typing) therapies as part of their treatment. If online CBT is to be provided via the NHS, it is important to establish patient preferences regarding this mode of delivery and ensure that referral practices are appropriately targeted. The results of our main trial will provide evidence regarding the effectiveness and cost-effectiveness of receiving therapy via this modality.