Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial
Internet-versus group-administered cognitive behaviour therapy for panic disorder in a psychiatric setting: a randomised trial
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DOI：
10.1186/1471-244x-10-54
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发表时间：
2010-07-02
期刊：
影响因子：
4.4
通讯作者：
Lindefors, Nils
中科院分区：
文献类型：
--
作者：
Bergstrom, Jan;Andersson, Gerhard;Lindefors, Nils
背景资料：互联网管理的认知行为疗法（CBT）是一种很有前途的心理治疗新方法，但其在常规护理环境中的有效性以及与更传统的CBT团体治疗的关系尚未确定。本研究的主要目的是在一项随机试验中，在常规精神病护理环境中比较互联网和团体管理的CBT对惊恐障碍（伴或不伴广场恐怖症）的有效性。本研究的第二个目的是建立这些interventions.Methods的成本效益：患者转诊治疗，由他们的医生，或自我介绍，电话筛选精神科护士。符合筛选标准的患者接受了由精神科医生进行的面对面结构化临床访谈。然后，共有113名连续患者被随机分配到10周的指导互联网交付CBT（n = 53）或CBT组（n = 60）。治疗后，并在6个月的后续行动，患者再次评估的精神科医生，盲目的治疗condition.Results：随机后立即9例患者退出，留下104例患者开始治疗。两种治疗条件下的患者在治疗后的主要结局指标惊恐障碍严重程度量表（PDSS）上均显示出显著改善。对于互联网治疗，PDSS的组内效应量（治疗前-治疗后）为Cohen d = 1.73，对于组治疗，为d = 1.63。组间效应量较低，治疗效应在6个月随访时得以维持。使用混合模型方法解释缺失数据，我们发现两种治疗条件之间无统计学显著差异。小组CBT利用更多的治疗时间比互联网CBT。将效果定义为PDSS应答者的比例，关于治疗时间的成本效益分析表明，在治疗后和随访时，互联网治疗与团体治疗相比具有上级成本效益比。这项研究为互联网CBT在精神科环境中对惊恐障碍患者的有效性提供了支持，并表明，它是同样有效的，作为更广泛使用的组管理CBT在减少恐慌和广场恐惧症的症状，以及更符合成本效益的治疗时间。
Background: Internet administered cognitive behaviour therapy (CBT) is a promising new way to deliver psychological treatment, but its effectiveness in regular care settings and in relation to more traditional CBT group treatment has not yet been determined. The primary aim of this study was to compare the effectiveness of Internet- and group administered CBT for panic disorder (with or without agoraphobia) in a randomised trial within a regular psychiatric care setting. The second aim of the study was to establish the cost-effectiveness of these interventions.Methods: Patients referred for treatment by their physician, or self-referred, were telephone-screened by a psychiatric nurse. Patients fulfilling screening criteria underwent an in-person structured clinical interview carried out by a psychiatrist. A total of 113 consecutive patients were then randomly assigned to 10 weeks of either guided Internet delivered CBT (n = 53) or group CBT (n = 60). After treatment, and at a 6-month follow-up, patients were again assessed by the psychiatrist, blind to treatment condition.Results: Immediately after randomization 9 patients dropped out, leaving 104 patients who started treatment. Patients in both treatment conditions showed significant improvement on the main outcome measure, the Panic Disorder Severity Scale (PDSS) after treatment. For the Internet treatment the within-group effect size (pre-post) on the PDSS was Cohen's d = 1.73, and for the group treatment it was d = 1.63. Between group effect sizes were low and treatment effects were maintained at 6-months follow-up. We found no statistically significant differences between the two treatment conditions using a mixed models approach to account for missing data. Group CBT utilised considerably more therapist time than did Internet CBT. Defining effect as proportion of PDSS responders, the cost-effectiveness analysis concerning therapist time showed that Internet treatment had superior cost-effectiveness ratios in relation to group treatment both at post-treatment and follow-up.Conclusions: This study provides support for the effectiveness of Internet CBT in a psychiatric setting for patients with panic disorder, and suggests that it is equally effective as the more widely used group administered CBT in reducing panic-and agoraphobic symptoms, as well as being more cost effective with respect to therapist time.