Acceptability of a Clinician-Assisted Computerized Psychological Intervention for Comorbid Mental Health and Substance Use Problems: Treatment Adherence Data from a Randomized Controlled Trial
Acceptability of a Clinician-Assisted Computerized Psychological Intervention for Comorbid Mental Health and Substance Use Problems: Treatment Adherence Data from a Randomized Controlled Trial
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DOI：
10.2196/jmir.1522
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发表时间：
2011-01-01
影响因子：
7.4
通讯作者：
Carr, Vaughan
中科院分区：
文献类型：
--
作者：
Kay-Lambkin, Frances;Baker, Amanda;Carr, Vaughan
背景：计算机提供的心理治疗有很大的潜力，特别是对于那些无法使用传统方法的人。对于计算机提供的治疗的可接受性知之甚少，特别是在那些患有精神健康和物质使用问题的患者中。目的：本研究的目的是评估临床医师辅助计算机为基础的心理治疗（CAC）的可接受性（在诊所环境中以DVD形式提供）与治疗师相关的共病抑郁症和酒精或大麻使用问题-方法：我们比较了治疗的可接受性，治疗辍学/参与和治疗联盟，治疗师提供与CAC心理治疗。我们将97名患有抑郁症和有问题的酒精/大麻使用的参与者随机分配到三种情况：短暂干预（BI，一个面对面的单独会议），治疗师提供（一个初始的面对面会议加上9个由治疗师提供的单独会议）和CAC干预（一个初始的面对面会议加上9个单独的CAC会议）。随机化发生后的基线和提供的初始会话，并获得治疗联盟评级从参与者完成后的初始会话，并在会议5和10之间的治疗师交付和CAC conditions.Results：治疗保留率和出勤率是相等的治疗师交付和CAC条件，51%（34/67）完成所有10个疗程。在治疗中的任何时候，治疗师提供的和CAC条件下的参与者之间在大多数治疗联盟分量表上都没有显著差异。然而，相对于治疗师提供的治疗，分配到BI（F-2，F-54 = 4.86，P = 0.01）和CAC参与者的参与者在第5次会议后（F-1，F-29=9.24，P= 0.005）中的客户主动性子量表评分显著较高，并且该领域与更好的酒精结局相关。线性回归模型治疗联盟在所有会议，治疗分配，保留，其他人口因素和基线症状表现出没有predictive value.Conclusions：在一项试验中的CAC与治疗师提供的治疗参与者同样能够参与，债券，并致力于治疗，尽管合并症通常与增加治疗辍学，有问题的参与，和治疗计划的复杂性。在何种程度上，客户认为他们是指导治疗（客户倡议）可能是一个重要组成部分的变化，在BI和CAC干预，特别是危险的酒精使用。
Background: Computer-delivered psychological treatments have great potential, particularly for individuals who cannot access traditional approaches. Little is known about the acceptability of computer-delivered treatment, especially among those with comorbid mental health and substance use problems.Objective: The objective of our study was to assess the acceptability of a clinician-assisted computer-based (CAC) psychological treatment (delivered on DVD in a clinic-setting) for comorbid depression and alcohol or cannabis use problems relative to a therapist-delivered equivalent and a brief intervention control.Methods: We compared treatment acceptability, in terms of treatment dropout/participation and therapeutic alliance, of therapist-delivered versus CAC psychological treatment. We randomly assigned 97 participants with current depression and problematic alcohol/cannabis use to three conditions: brief intervention (BI, one individual session delivered face to face), therapist-delivered (one initial face-to-face session plus 9 individual sessions delivered by a therapist), and CAC interventions (one initial face-to-face session plus 9 individual CAC sessions). Randomization occurred following baseline and provision of the initial session, and therapeutic alliance ratings were obtained from participants following completion of the initial session, and at sessions 5 and 10 among the therapist-delivered and CAC conditions.Results: Treatment retention and attendance rates were equal between therapist-delivered and CAC conditions, with 51% (34/67) completing all 10 treatment sessions. No significant differences existed between participants in therapist-delivered and CAC conditions at any point in therapy on the majority of therapeutic alliance subscales. However, relative to therapist-delivered treatment, the subscale of Client Initiative was rated significantly higher among participants allocated to the BI (F-2,F-54 = 4.86, P = .01) and CAC participants after session 5 (F-1,F-29=9.24, P=.005), and this domain was related to better alcohol outcomes. Linear regression modeled therapeutic alliance over all sessions, with treatment allocation, retention, other demographic factors, and baseline symptoms exhibiting no predictive value.Conclusions: Participants in a trial of CAC versus therapist-delivered treatment were equally able to engage, bond, and commit to treatment, despite comorbidity typically being associated with increased treatment dropout, problematic engagement, and complexities in treatment planning. The extent to which a client feels that they are directing therapy ( Client initiative) may be an important component of change in BI and CAC intervention, especially for hazardous alcohol use.