Predicting Treatment Failure in Regular Care Internet-Delivered Cognitive Behavior Therapy for Depression and Anxiety Using Only Weekly Symptom Measures
Predicting Treatment Failure in Regular Care Internet-Delivered Cognitive Behavior Therapy for Depression and Anxiety Using Only Weekly Symptom Measures
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DOI：
10.1037/ccp0000462
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发表时间：
2020-04-01
影响因子：
5.9
通讯作者：
Kaldo, Viktor
中科院分区：
文献类型：
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作者：
Forsell, Erik;Isacsson, Nils;Kaldo, Viktor
目的：治疗师引导的互联网认知行为疗法 (ICBT) 是有效的，但与传统 CBT 一样，并非所有患者都有所改善，而且临床医生通常无法及早识别患者。我们预测针对抑郁症、恐慌症和社交焦虑症的 12 周常规护理 ICBT 的治疗失败，仅使用患者的每周症状评级来确定预测的准确性何时超过 2 个基准：(a) 机会，以及 (b) 根据经验得出的临床医生对可行预测的偏好。方法：通过一系列回归模型对瑞典斯德哥尔摩互联网精神病学诊所 4310 名常规护理 ICBT 患者的筛查、预处理和每周症状评级进行分析，每个回归模型增加 1 周的数据。最终分数是在坚持测试样本中预测的，然后分为成功或失败（失败定义为汇款人和应答人状态均不存在）。然后将具有平衡精度和 95% 置信区间的分类分析与预定义的基准进行比较。结果：所有治疗均在 1 周后达到基准 1（优于偶然）。社交焦虑症在第 5 周达到基准 2 (>65%)，而抑郁症和恐慌症在第 6 周达到基准 2。结论：对于抑郁症、社交焦虑症和恐慌症，仅使用患者评定的症状评分进行预测就可以在 ICBT 6 周时检测治疗失败，足够准确，可供临床医生采取行动。早期识别失败的治疗尝试可能是一种可行的方法，可以通过在所谓的适应性治疗策略中为高危患者提供额外的临床资源来提高现有心理治疗的总体成功率。
Objective: Therapist guided Internet-Delivered Cognitive Behavior Therapy (ICBT) is effective, but as in traditional CBT, not all patients improve, and clinicians generally fail to identify them early enough. We predict treatment failure in 12-week regular care ICBT for Depression, Panic disorder and Social anxiety disorder, using only patients' weekly symptom ratings to identify when the accuracy of predictions exceed 2 benchmarks: (a) chance, and (b) empirically derived clinician preferences for actionable predictions. Method: Screening, pretreatment and weekly symptom ratings from 4310 regular care ICBT-patients from the Internet Psychiatry Clinic in Stockholm, Sweden was analyzed in a series of regression models each adding 1 more week of data. Final score was predicted in a holdout test sample, which was then categorized into Success or Failure (failure defined as the absence of both remitter and responder status). Classification analyses with Balanced Accuracy and 95% Confidence intervals was then compared to predefined benchmarks. Results: Benchmark 1 (better than chance) was reached 1 week into all treatments. Social anxiety disorder reached Benchmark 2 (>65%) at week 5, whereas Depression and Panic Disorder reached it at week 6. Conclusions: For depression, social anxiety and panic disorder, prediction with only patient-rated symptom scores can detect treatment failure 6 weeks into ICBT, with enough accuracy for a clinician to take action. Early identification of failing treatment attempts may be a viable way to increase the overall success rate of existing psychological treatments by providing extra clinical resources to at-risk patients, within a so-called Adaptive Treatment Strategy.