Web-Based Fully Automated Self-Help With Different Levels of Therapist Support for Individuals With Eating Disorder Symptoms: A Randomized Controlled Trial.
Web-Based Fully Automated Self-Help With Different Levels of Therapist Support for Individuals With Eating Disorder Symptoms: A Randomized Controlled Trial.
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DOI：
10.2196/jmir.5709
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发表时间：
2016-06-17
影响因子：
7.4
通讯作者：
van Furth EF
中科院分区：
文献类型：
--
作者：
Aardoom JJ;Dingemans AE;Spinhoven P;van Ginkel JR;de Rooij M;van Furth EF
尽管进食障碍（ED）的致残性，许多有艾德症状的人没有得到适当的精神卫生保健。基于互联网的干预措施有可能通过提供容易获得的保健服务来减少未满足的需求。本研究旨在调查一种基于互联网的干预措施对有艾德症状的个体的有效性，这种干预措施被称为“背部疼痛”。此外，不同强度的治疗师支持的附加值进行了调查。参与者（N=354）年龄在16岁或以上，自我报告有艾德症状，包括神经性厌食症、神经性贪食症和暴食症症状。参与者是通过网站上的repleback和荷兰亲恢复为重点的电子社区的网站与艾德问题的年轻妇女招募。参与者被随机分配至：（1）由心理教育和全自动自我监测和反馈系统组成的反馈，（2）补充低强度（每周）数字治疗师支持的反馈，（3）补充高强度（每周3次）数字治疗师支持的反馈，以及（4）等待列表控制条件。在基线、干预后（即基线后8周）以及3个月和6个月随访时完成互联网管理的自我报告问卷。主要结果测量是艾德精神病理学。次要结局指标为抑郁和焦虑症状、持续性思维和ED相关生活质量。根据意向治疗方法，使用线性混合模型进行统计分析。在减少贪食症精神病理学（d=−0.16，95%置信区间（CI）=−0.31至−0.01）、抑郁和焦虑症状（d=−0.28，95% CI=−0.45至−0.11）和持续性思维（d = − 0.28，95% CI = −0.45至−0.11）方面，3种背部状况上级优于等待名单。没有附加值的治疗师的支持，发现在症状减轻方面，虽然参与者谁收到治疗师的支持显着更满意的干预比那些谁没有收到补充治疗师的支持。没有显着差异的背部条件补充低强度和高强度治疗师的支持，发现有关的有效性和满意度的干预。基于互联网的全自动自我监测和反馈干预能有效减少艾德和共病精神病理学。补充治疗师的支持提高了满意度的干预，但没有增加其有效性。自动化干预措施，如人工呼吸，可以提供广泛传播和容易获得的护理。这种干预措施可以纳入一个阶梯式护理方法在治疗ED，并有助于弥合精神障碍和精神卫生保健服务之间的差距。荷兰试验登记处：NTR 3646; http://www.trialregister.nl/trialreg/admin/ rctview.asp？TC=3646（WebCite存档，网址：http：//www.webcitation.org/6fgHTGKHE）
Despite the disabling nature of eating disorders (EDs), many individuals with ED symptoms do not receive appropriate mental health care. Internet-based interventions have potential to reduce the unmet needs by providing easily accessible health care services. This study aimed to investigate the effectiveness of an Internet-based intervention for individuals with ED symptoms, called “Featback.” In addition, the added value of different intensities of therapist support was investigated. Participants (N=354) were aged 16 years or older with self-reported ED symptoms, including symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder. Participants were recruited via the website of Featback and the website of a Dutch pro-recovery–focused e-community for young women with ED problems. Participants were randomized to: (1) Featback, consisting of psychoeducation and a fully automated self-monitoring and feedback system, (2) Featback supplemented with low-intensity (weekly) digital therapist support, (3) Featback supplemented with high-intensity (3 times a week) digital therapist support, and (4) a waiting list control condition. Internet-administered self-report questionnaires were completed at baseline, post-intervention (ie, 8 weeks after baseline), and at 3- and 6-month follow-up. The primary outcome measure was ED psychopathology. Secondary outcome measures were symptoms of depression and anxiety, perseverative thinking, and ED-related quality of life. Statistical analyses were conducted according to an intent-to-treat approach using linear mixed models. The 3 Featback conditions were superior to a waiting list in reducing bulimic psychopathology (d=−0.16, 95% confidence interval (CI)=−0.31 to −0.01), symptoms of depression and anxiety (d=−0.28, 95% CI=−0.45 to −0.11), and perseverative thinking (d=−0.28, 95% CI=−0.45 to −0.11). No added value of therapist support was found in terms of symptom reduction although participants who received therapist support were significantly more satisfied with the intervention than those who did not receive supplemental therapist support. No significant differences between the Featback conditions supplemented with low- and high-intensity therapist support were found regarding the effectiveness and satisfaction with the intervention. The fully automated Internet-based self-monitoring and feedback intervention Featback was effective in reducing ED and comorbid psychopathology. Supplemental therapist support enhanced satisfaction with the intervention but did not increase its effectiveness. Automated interventions such as Featback can provide widely disseminable and easily accessible care. Such interventions could be incorporated within a stepped-care approach in the treatment of EDs and help to bridge the gap between mental disorders and mental health care services. Netherlands Trial Registry: NTR3646; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3646 (Archived by WebCite at http://www.webcitation.org/6fgHTGKHE)