Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: a randomized controlled trial.
Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: a randomized controlled trial.
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DOI：
10.1371/journal.pone.0036905
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发表时间：
2012
期刊：
影响因子：
3.7
通讯作者：
Andersson G
中科院分区：
文献类型：
--
作者：
Johansson R;Sjöberg E;Sjögren M;Johnsson E;Carlbring P;Andersson T;Rousseau A;Andersson G
重度抑郁症可以通过认知行为疗法治疗，通过互联网提供指导自助。个体定制的指导自助治疗在焦虑症的治疗中显示出有希望的结果。这项随机对照试验测试了基于互联网的个性化指导自助治疗的疗效，该治疗专门针对伴有共病症状的抑郁症。将该治疗与标准化（非定制）基于互联网的治疗和以在线讨论组形式的活动对照组进行比较。这两种指导性自助治疗都是基于认知行为疗法，持续10周。讨论组每周讨论与抑郁症和抑郁症治疗相关的主题。共有121名被诊断为重度抑郁症并伴有一系列共病症状的参与者被随机分为三组。量身定制的治疗包括一套针对抑郁症以及共病问题的规定模块。标准化治疗是一个先前测试过的抑郁症自助指导计划。从治疗前到治疗后，两个治疗组的抑郁、焦虑和生活质量指标都有所改善。结果在6个月随访时保持不变。亚组分析显示，在基线时抑郁水平较高和合并症较多的参与者中，定制治疗比标准化治疗更有效，无论是在抑郁症状的减少还是在恢复率方面。在基线抑郁评分较低的亚组中，治疗组和讨论组之间几乎没有差异。这项研究表明，定制的基于互联网的抑郁症治疗是有效的，通过定制来解决合并症可能是一种方法，使指导自助治疗比标准化方法更有效地治疗更严重的抑郁症。Clinicaltrials.gov www.example.com
Major depression can be treated by means of cognitive behavior therapy, delivered via the Internet as guided self-help. Individually tailored guided self-help treatments have shown promising results in the treatment of anxiety disorders. This randomized controlled trial tested the efficacy of an Internet-based individually tailored guided self-help treatment which specifically targeted depression with comorbid symptoms. The treatment was compared both to standardized (non-tailored) Internet-based treatment and to an active control group in the form of a monitored online discussion group. Both guided self-help treatments were based on cognitive behavior therapy and lasted for 10 weeks. The discussion group consisted of weekly discussion themes related to depression and the treatment of depression. A total of 121 participants with diagnosed major depressive disorder and with a range of comorbid symptoms were randomized to three groups. The tailored treatment consisted of a prescribed set of modules targeting depression as well as comorbid problems. The standardized treatment was a previously tested guided self-help program for depression. From pre-treatment to post-treatment, both treatment groups improved on measures of depression, anxiety and quality of life. The results were maintained at a 6-month follow-up. Subgroup analyses showed that the tailored treatment was more effective than the standardized treatment among participants with higher levels of depression at baseline and more comorbidity, both in terms of reduction of depressive symptoms and on recovery rates. In the subgroup with lower baseline scores of depression, few differences were seen between treatments and the discussion group. This study shows that tailored Internet-based treatment for depression is effective and that addressing comorbidity by tailoring may be one way of making guided self-help treatments more effective than standardized approaches in the treatment of more severe depression. Clinicaltrials.gov NCT01181583
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