Cognitive and Behavioral Skills Exercises Completed by Patients with Major Depression During Smartphone Cognitive Behavioral Therapy: Secondary Analysis of a Randomized Controlled Trial.
Cognitive and Behavioral Skills Exercises Completed by Patients with Major Depression During Smartphone Cognitive Behavioral Therapy: Secondary Analysis of a Randomized Controlled Trial.
复制标题
智能手机认知行为疗法期间患有严重抑郁症患者完成的认知和行为技巧练习：随机对照试验的次要分析。
DOI：
10.2196/mental.9092
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发表时间：
2018-01-11
影响因子：
5.2
通讯作者：
Hasegawa A
中科院分区：
文献类型：
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作者：
Furukawa TA;Horikoshi M;Fujita H;Tsujino N;Jinnin R;Kako Y;Ogawa S;Sato H;Kitagawa N;Shinagawa Y;Ikeda Y;Imai H;Tajika A;Ogawa Y;Akechi T;Yamada M;Shimodera S;Watanabe N;Inagaki M;Hasegawa A
越来越多的强有力的证据表明，认知行为疗法(CBT)对抑郁症有效，无论是面对面的，面对面的，还是通过互联网的自助。然而，CBT是一个由几个假定有效的成分组成的复杂干预措施，每个成分如何可能或可能不有助于CBT的整体有效性尚不清楚。这项研究的目的是调查智能手机CBT的用户如何使用该计划的各个组成部分并从中受益。这是一项为期9周的单盲随机对照试验的二次分析，该试验证明，在耐药的严重抑郁障碍患者中，辅助性使用智能手机CBT(Kokoro-App)比单用抗抑郁药物治疗有效(总计164例，第9周抑郁严重程度的标准化平均差异=0.40，J Med Internet Res)。Kokoro-App由自我监控、行为激活和认知重构三种认知行为技能组成，并有相应的工作表需要填写。参与者学习每个课程并完成每个工作表的所有活动都被上传到Kokoro-Web上，每个患者都可以使用该网站进行自我检查。我们研究了CBT应用程序的使用特征将成功的用户与不成功的用户区分开来，按抑郁严重程度变化的中位数分为两组。共有81名重度抑郁症患者被分配到智能手机CBT。平均而言，他们在该程序的8个会话中完成了7.0(标准差[SD]1.4)；他们花了10.8(SD 4.2)天完成一个会话，在此期间他们在应用程序上花费了62分钟(SD 96)。在受益者和非受益者之间，在完成的疗程数量、用于该计划的时间或完成的自我监测工作表的数量方面没有统计学上的显著差异。然而，前者完成了更多的行为激活任务，从事了不同类型的活动，也比后者填写了更多的认知重构工作表。“试驾一辆新车”、“午餐后去咖啡厅”或“给老朋友打电话”等活动被发现特别有意义。研究发现，所有的认知重组策略都能显著降低痛苦程度，比如“你对有类似问题的朋友有什么建议？”发现比其他一些策略更有帮助。通过智能手机提供并连接到远程服务器的CBT计划不仅在缓解抑郁方面有效，而且还开辟了一条新的途径，收集每个参与者可能使用该计划的内容和方式的信息。在此分析中发现的有用的活动和策略将为项目本身和移动健康(MHealth)总体上的改进提供有价值的信息。日本临床试验注册中心Umin CTR 000013693；https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi？recptno=R000015984(由网站http://www.webcitation.org/6u6pxVwik)存档
A strong and growing body of evidence has demonstrated the effectiveness of cognitive behavioral therapy (CBT), either face-to-face, in person, or as self-help via the Internet, for depression. However, CBT is a complex intervention consisting of several putatively effective components, and how each component may or may not contribute to the overall effectiveness of CBT is poorly understood. The aim of this study was to investigate how the users of smartphone CBT use and benefit from various components of the program. This is a secondary analysis from a 9-week, single-blind, randomized controlled trial that has demonstrated the effectiveness of adjunctive use of smartphone CBT (Kokoro-App) over antidepressant pharmacotherapy alone among patients with drug-resistant major depressive disorder (total n=164, standardized mean difference in depression severity at week 9=0.40, J Med Internet Res). Kokoro-App consists of three cognitive behavioral skills of self-monitoring, behavioral activation, and cognitive restructuring, with corresponding worksheets to fill in. All activities of the participants learning each session of the program and completing each worksheet were uploaded onto Kokoro-Web, which each patient could use for self-check. We examined what use characteristics differentiated the more successful users of the CBT app from the less successful ones, split at the median of change in depression severity. A total of 81 patients with major depression were allocated to the smartphone CBT. On average, they completed 7.0 (standard deviation [SD] 1.4) out of 8 sessions of the program; it took them 10.8 (SD 4.2) days to complete one session, during which they spent 62 min (SD 96) on the app. There were no statistically significant differences in the number of sessions completed, time spent for the program, or the number of completed self-monitoring worksheets between the beneficiaries and the nonbeneficiaries. However, the former completed more behavioral activation tasks, engaged in different types of activities, and also filled in more cognitive restructuring worksheets than the latter. Activities such as “test-drive a new car,” “go to a coffee shop after lunch,” or “call up an old friend” were found to be particularly rewarding. All cognitive restructuring strategies were found to significantly decrease the distress level, with “What would be your advice to a friend who has a similar problem?” found more helpful than some other strategies. The CBT program offered via smartphone and connected to the remote server is not only effective in alleviating depression but also opens a new avenue in gathering information of what and how each participant may utilize the program. The activities and strategies found useful in this analysis will provide valuable information in brush-ups of the program itself and of mobile health (mHealth) in general. Japanese Clinical Trials Registry UMIN CTR 000013693; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ ctr_view.cgi?recptno=R000015984 (Archived by WebCite at http://www.webcitation.org/6u6pxVwik)