Development of a cognitive bias modification intervention for anxiety disorders in primary care.
Development of a cognitive bias modification intervention for anxiety disorders in primary care.
复制标题
初级保健中针对焦虑症的认知偏差修正干预措施的开发。
DOI：
10.1111/bjc.12281
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Beard,Courtney
中科院分区：
文献类型：
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作者：
Weisberg,RisaB;Gonsalves,MeghanA;Ramadurai,Ramya;Braham,Howard;Fuchs,Cara;Beard,Courtney
在初级保健中，非常需要低强度，可扩展的治疗，大多数焦虑患者首先接受治疗。我们描述了IA阶段治疗的发展和IB阶段的可行性试验的认知偏差修改（CBM）transdiagnosis anxiety in primary care.MethodsThe在线干预，心理习惯，包括8个会议的个性化CBM针对注意力和解释偏见。教练协助患者使用网站，通过仪表板监测进展，并与初级保健提供者共享信息。我们评估了心理习惯在一项开放试验（N = 14）和一项随机对照试验（RCT）（N = 40）在初级保健患者焦虑disorders.ResultsWe比较结果的先验基准的临床意义的结果。在开放试验中，心理习惯符合可行性，可接受性和有效性基准。在试点RCT中，一家最终关闭的研究中心的脱落率更高。在意向治疗分析中，心理习惯符合自我报告的基准，但不符合焦虑的访谈测量。症状跟踪不符合自我报告或焦虑访谈指标的基准。在符合方案分析中，心理习惯超过了自我报告和访谈测量的基准，而症状跟踪符合自我报告的基准。心理习惯组的解释偏差有所改善，但症状追踪组没有改善。没有观察到任何影响的注意力bias.ConclusionThe在线CBM干预表现出良好的可接受性，并在一个稳定的初级保健诊所，初级保健的初步有效性。一个更大的随机对照试验是必要的，以测试有效性。从业者点个性化，跨诊断认知偏差修正（CBM）干预焦虑在初级保健是可以接受的初级保健患者与社交焦虑症，广泛性焦虑症，和/或恐慌症/广场恐怖症。与培训和监督，从持牌精神卫生临床医生，学士水平的教练可以帮助初级保健患者自我管理CBM。在初级保健中提供低强度，自我导向的焦虑干预可以大大扩大焦虑治疗的范围，解释偏差可能是初级保健焦虑患者的一个重要临床目标。
ObjectivesThere is a great need for low‐intensity, scalable treatments in primary care, where most anxious patients first present for treatment. We describe Stage IA treatment development and a Stage IB feasibility trial of cognitive bias modification (CBM) for transdiagnostic anxiety in primary care.MethodsThe online intervention, Mental Habits, comprised eight sessions of a personalized CBM targeting attention and interpretation biases. Coaches assisted patients in using the website, monitored progress via a dashboard, and shared information with primary care providers. We evaluated Mental Habits in an open trial (N = 14) and a randomized controlled trial (RCT) (N = 40) in primary care patients with anxiety disorders.ResultsWe compared results to a priori benchmarks of clinically meaningful outcomes. In the open trial, Mental Habits met feasibility, acceptability, and efficacy benchmarks. In the pilot RCT, there was greater dropout at one study site which ultimately closed. In the intent‐to‐treat analyses, Mental Habits met the benchmark for self‐report, but not the interview measure of anxiety. Symptom Tracking did not meet the benchmark for self‐report or interview measures of anxiety. In per‐protocol analyses, Mental Habits exceeded the benchmark for both self‐report and interview measures, whereas Symptom Tracking met the benchmark for self‐report. Interpretation bias improved in the Mental Habits group, but not in Symptom Tracking. No effects were observed for attention bias.ConclusionThe online CBM intervention demonstrated good acceptability and, when delivered at a stable primary care clinic, preliminary effectiveness in primary care. A larger RCT is warranted to test effectiveness.Practitioner pointsA personalized, transdiagnostic Cognitive Bias Modification (CBM) intervention for anxiety in primary care is acceptable to primary care patients with social anxiety disorder, generalized anxiety disorder, and/or panic disorder /agoraphobia.With training and supervision from licensed mental health clinicians, bachelor’s‐level coaches can assist primary care patients to self‐administer CBM.Offering a low‐intensity, self‐directed anxiety intervention in primary care can greatly expand the reach of anxiety treatment, with minimal need for additional resources.Interpretation bias may be an important clinical target for primary care patients with anxiety.