Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy
Computer-based psychological treatment for comorbid depression and problematic alcohol and/or cannabis use: a randomized controlled trial of clinical efficacy
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DOI：
10.1111/j.1360-0443.2008.02444.x
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发表时间：
2009-03-01
期刊：
影响因子：
6
通讯作者：
Carr, Vaughan J.
中科院分区：
文献类型：
--
作者：
Kay-Lambkin, Frances J.;Baker, Amanda L.;Carr, Vaughan J.
为了评估计算机与治疗师提供的心理治疗的人共病抑郁症和酒精/大麻使用问题。随机对照试验。以社区为基础的参与者在新南威尔士州的猎人地区，澳大利亚。97人共病的严重抑郁症和酒精/大麻滥用。所有参与者接受了简短的干预（BI）抑郁症状和物质滥用，然后随机分配到：没有进一步的治疗（单独BI）;或9次动机访谈和认知行为治疗（强化MI/CBT）。被分配到密集MI/CBT条件的参与者被随机选择接受他们的治疗“生活”（即由心理学家提供）或通过基于计算机的程序（与简短的每周输入从心理学家）。抑郁，酒精/大麻的使用和有害物质的使用指数得分测量基线，3，6和12个月后基线评估。(i)与单独BI相比，抑郁症对强化MI/CBT的反应更好，“现场”治疗显示出强烈的短期有益效果，在12个月随访时与基于计算机的治疗相匹配;（ii）有问题的酒精使用对单独BI反应良好，甚至对强化MI/CBT干预更好;（iii）强化MI/CBT在减少大麻使用和危险物质使用方面明显优于单独BI，基于计算机的治疗显示出最大的治疗效果。同时针对抑郁症和物质使用，导致至少相当于12个月的结果相对于“活”的干预。对于治疗抑郁症和酒精问题共病患者的临床医生来说，解决这两个问题的BI似乎是一种适当且有效的治疗选择。患有抑郁症和大麻使用问题的人的初级保健可能涉及基于计算机的抑郁症和大麻使用的综合干预措施，并与临床医生进行简短的定期联系以检查进展情况。
To evaluate computer- versus therapist-delivered psychological treatment for people with comorbid depression and alcohol/cannabis use problems.Randomized controlled trial.Community-based participants in the Hunter Region of New South Wales, Australia.Ninety-seven people with comorbid major depression and alcohol/cannabis misuse.All participants received a brief intervention (BI) for depressive symptoms and substance misuse, followed by random assignment to: no further treatment (BI alone); or nine sessions of motivational interviewing and cognitive behaviour therapy (intensive MI/CBT). Participants allocated to the intensive MI/CBT condition were selected at random to receive their treatment 'live' (i.e. delivered by a psychologist) or via a computer-based program (with brief weekly input from a psychologist).Depression, alcohol/cannabis use and hazardous substance use index scores measured at baseline, and 3, 6 and 12 months post-baseline assessment.(i) Depression responded better to intensive MI/CBT compared to BI alone, with 'live' treatment demonstrating a strong short-term beneficial effect which was matched by computer-based treatment at 12-month follow-up; (ii) problematic alcohol use responded well to BI alone and even better to the intensive MI/CBT intervention; (iii) intensive MI/CBT was significantly better than BI alone in reducing cannabis use and hazardous substance use, with computer-based therapy showing the largest treatment effect.Computer-based treatment, targeting both depression and substance use simultaneously, results in at least equivalent 12-month outcomes relative to a 'live' intervention. For clinicians treating people with comorbid depression and alcohol problems, BIs addressing both issues appear to be an appropriate and efficacious treatment option. Primary care of those with comorbid depression and cannabis use problems could involve computer-based integrated interventions for depression and cannabis use, with brief regular contact with the clinician to check on progress.