Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence
Barriers to the uptake of computerized cognitive behavioural therapy: a systematic review of the quantitative and qualitative evidence
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DOI：
10.1017/s0033291708004224
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发表时间：
2009-05-01
影响因子：
6.9
通讯作者：
Gilbody, S.
中科院分区：
文献类型：
--
作者：
Waller, R.;Gilbody, S.
背景通过计算机提供的认知行为疗法（cCBT）的研究显示了治疗焦虑和抑郁的临床疗效，但没有关注石油摄取障碍。潜在的障碍包括不利后果、可获得性和可接受性。对定量和定性研究以及来自多个电子数据库的调查进行了综合系统评价，其中计算机提供了焦虑或抑郁的cCBT。大量潜在参与者在试验开始前就流失了，而且几乎没有任何解释。在试验参与者中，cCBT组的脱落率可能更高（比值比2.03，95%，置信区间0.81-5.09）。只有56%的中位数完成了完整的cCBT课程，个人情况是辍学的一个更常见的原因，而不是技术或社会背景的困难。在大多数项目中，很少对风险进行评估。需要大量的工作人员时间来支持客户。治疗师对cCBT的态度比客户更消极。虽然cCBT对某些人来说可能是一种有效和可接受的干预措施，但如果不加以解决，其吸收存在障碍，将大大限制其影响。这些包括调查那些没有完成cCBT试验的人的结果和态度，以及为什么很少有人完成cCBT的完整课程。
Background. Studies of cognitive behavioural therapy delivered by computer (cCBT) show clinical efficacy for treating anxiety and depression, but have not focused oil barriers to uptake. Potential barriers include adverse consequences, accessibility and acceptability.Method. An integrated systematic review was conducted of quantitative and qualitative studies, and surveys from Multiple electronic databases where computers delivered cCBT for anxiety or depression.Results. Substantial numbers of potential participants are lost prior to trials commencing with little explanation. Among trial participants, drop-outs may be higher in the cCBT groups (odds ratio 2.03, 95%, confidence interval 0.81-5.09). Only a median of 56%, completed a full course of cCBT and personal circumstance was a more common cause of drop-out than difficulties with the technology or social background. Risk was rarely assessed in the majority of programs. Significant staff time was needed to support clients. Therapists were more negative about cCBT than clients.Conclusions. While cCBT is likely to be an effective and acceptable intervention for some people, there are barriers to its uptake that will substantially limit its impact if not addressed. These included investigating the outcome and attitudes of those who do not make it as far as cCBT trials and why so few finish a full course of cCBT.