Who benefits most from therapist-assisted internet-delivered cognitive behaviour therapy in clinical practice? Predictors of symptom change and dropout
Who benefits most from therapist-assisted internet-delivered cognitive behaviour therapy in clinical practice? Predictors of symptom change and dropout
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DOI：
10.1016/j.janxdis.2018.01.003
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发表时间：
2018-03-01
影响因子：
10.3
通讯作者：
Titov, N.
中科院分区：
文献类型：
--
作者：
Edmonds, M.;Hadjistavropoulos, H. D.;Titov, N.
互联网传递的认知行为疗法(ICBT)对治疗焦虑和抑郁有效，但并不是对所有患者都有效。辍学和ICBT结果的预测因素仍然不清楚，文献可能受益于利用先进的统计技术在较大的社区样本中研究对ICBT的反应。在这项研究中，我们试图在接受治疗师辅助的针对焦虑和/或抑郁的跨诊断ICBT治疗的社区大样本(n=1201)中确定辍学和症状变化的预测因素。Logistic回归用于评估辍学情况，结果显示，完全完成ICBT课程的人(n=880)比只完成部分ICBT课程的人(n=321)年龄更大，接受ICBT课程时的心理痛苦更低。在治疗过程中，患者在六个时间点回答了患者健康问卷-9和广泛性焦虑障碍-7。自回归潜在轨迹模型适用于这些数据，以评估人口统计变量、计划参与度、心理和医疗服务使用以及心理苦恼解释初始症状水平和症状随时间变化的个体差异的能力。治疗前症状评分越高，症状改善越明显。那些因残疾而休班的人和那些没有接受过高等教育的人的症状改善更大。对其临床意义进行了讨论。
Intemet-delivered cognitive behavioral therapy (ICBT) is effective for treating anxiety and depression, but not for all patients. Predictors of dropout and outcomes from ICBT remain unclear and the literature could benefit from study of response to ICBT among larger community samples using advanced statistical techniques. In this study, we sought to identify predictors of dropout and symptom change in a large community sample (n = 1201) who received therapist-assisted transdiagnostic ICBT targeting anxiety and/or depression. Logistic regression was used to assess dropout, and showed that those who fully completed ICBT lessons (n = 880) were older and endorsed lower psychological distress at intake than those who only partially completed ICBT lessons (n = 321). During the course of therapy, patients responded to the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 at six time points. Autoregressive latent trajectory models were fitted to this data to assess the ability of demographic variables, program engagement, psychological and medical service usage, and psychological distress to explain individual variance in initial symptom levels and symptom change over time. Higher symptom scores at pre-treatment were predictive of greater symptom improvement. Symptom improvement was greater in those who were off work on disability and those without higher post-secondary education. Clinical implications are discussed.