Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial
Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial
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DOI：
10.1159/000339371
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发表时间：
2012-01-01
影响因子：
22.8
通讯作者：
Silverberg, Farrell
中科院分区：
文献类型：
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作者：
Andersson, Gerhard;Paxling, Bjorn;Silverberg, Farrell
背景：基于互联网引导的认知行为疗法（ICBT）已在许多试验中进行了测试，发现可有效治疗焦虑和情绪障碍。广泛性焦虑症 (GAD) 也已通过 ICBT 进行治疗，但尚无基于互联网指导的心理动力学治疗 (IPDT) 的对照试验。由于广泛性焦虑症的心理动力学治疗已有初步支持，我们决定测试是否可以通过互联网提供心理动力学知情的自助治疗。该研究的目的是调查 IPDT 对广泛性焦虑症的疗效，并与 ICBT 和等候名单对照组进行比较。方法：一项针对被诊断为 GAD 的个体进行的随机对照优效性试验，将引导 ICBT (n = 27) 和 IPDT (n = 27) 与无治疗等待名单对照组 (n = 27) 进行比较。主要结果指标是宾夕法尼亚州立大学忧虑问卷。结果：虽然主要结局指标在治疗后立即没有显着的组间差异，但在完成者分析中，IPDT 和 ICBT 在对主要指标进行 3 个月和 18 个月的随访时均取得了改善，并具有中等到大的组内效应大小。当符合临床显着改善的标准时，PDT 和 CBT 与对照组的差异虽然较小，但仍然显着。积极治疗没有显着差异。关于广泛性焦虑症 (GAD) 症状，按时间分组存在显着的交互作用，但并非在治疗后立即存在交互作用。结论：IPDT 和 ICBT 均能适度减轻 GAD 症状，需要更多研究。版权所有 (C) 2012 S. Karger AG，巴塞尔
Background: Guided Internet-based cognitive behavior therapy (ICBT) has been tested in many trials and found to be effective in the treatment of anxiety and mood disorders. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Since there is preliminary support for psychodynamic treatment for GAD, we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet. The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group. Method: A randomized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT (n = 27) and IPDT (n = 27) against a no treatment waiting list control group (n = 27). The primary outcome measure was the Penn State Worry Questionnaire. Results: While there were no significant between-group differences immediately after treatment on the main outcome measure, both IPDT and ICBT resulted in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses. The differences against the control group, although smaller, were still significant for both PDT and CBT when conforming to the criteria of clinically significant improvement. The active treatments did not differ significantly. There was a significant group by time interaction regarding GAD symptoms, but not immediately after treatment. Conclusions: IPDT and ICBT both led to modest symptom reduction in GAD, and more research is needed. Copyright (C) 2012 S. Karger AG, Basel