Evaluation of Internet-based cognitive behavioral self-help treatments for persecutory ideation and auditory verbal hallucinations

精神分裂症是一种严重的精神障碍，伴随着巨大的个人和社会负担。尽管精神病认知行为疗法（CBTp）的疗效已经确立，但其在常规精神卫生保健中的传播仍然很差。国家法规，如英国的NICE指南，建议向每个有精神病症状的人提供CBTp，但超过50%的人甚至没有接受过一次CBTp。在德国，CBTp“几乎没有出现在心理治疗健康服务中”（克林贝格和维托尔夫，2012年，第916页;自己翻译）。基于互联网的认知行为疗法（CBT）以自助形式已被证明是可行的，有效的焦虑和抑郁症。最近，还通过智能手机应用程序部署了基于互联网的（自助）干预措施。基于互联网的治疗精神分裂症患者的可行性在基于互联网的干预措施中得到了很好的证明（例如，药物管理），并报告了智能手机干预。然而，缺乏实证研究，无法得出结论性的结论。据我们所知，只有一项研究涵盖了90名精神病患者，该研究调查了基于互联网的干预措施，其中包括特定于精神病的认知行为干预措施，该研究来自我们的研究小组。该项目的独特之处在于：1）首次通过互联网对精神病症状患者进行基于CBTP的自助治疗进行评估; 2）调查智能手机辅助下基于互联网的自助治疗的增强。这两项研究被设置为随机对照试验（RCT），每两个积极的治疗与等待名单对照组。研究一评估了基于互联网的指导自助治疗迫害的想法，而研究二评估了模拟自助治疗听觉言语幻觉。两个主动治疗条件是：1）访问自助网站，包括定期与指南进行书面电子联系，以及2）访问有指南的自助网站并访问其他基于智能手机的交互式应用程序（应用程序）。试验联合收割机结合了在线方法的低阈值优势（例如，匿名）与临床试验的优点（例如，症状评估和诊断验证（通过面谈）。主要结果测量是迫害妄想（研究I）和AVH（研究II）。次要结果指标包括完成率、干预退出率、一般神经病学、副作用和客户满意度。该项目将是第一个有助于回答经验性问题的项目，即纯粹以互联网为基础的自助形式的基于能力建设的贸易点的干预措施是否有效。积极的发现将为目前被剥夺心理治疗的精神病症状患者提供一种易于获得的治疗选择铺平道路。

Schizophrenia is a severe mental disorder which is accompanied by an enormous individual and societal burden. Despite established efficacy of cognitive behavioral therapy for psychosis (CBTp), its dissemination into routine mental health care remains poor. National regulations such as the NICE guideline in the United Kingdom recommend that CBTp should be offered to every person with psychotic symptoms, but more than 50% do not receive even a single session of CBTp. In Germany, CBTp is "virtually not represented in the psychotherapy health service" (Klingberg & Wittorf, 2012, p. 916; own translation). Internet-based cognitive behavioral therapy (CBT) in a self-help format has been proven feasible and effective in anxiety and depressive disorders. Recently, Internet-based (self-help) interventions are also deployed via smartphone apps. The feasibility of Internet-based treatments for people with schizophrenia is well documented for Internet-based interventions (e.g., medication management) and also reported for smartphone interventions. However, there is a dearth of empirical studies precluding a conclusive picture. As far as we know, there is only one study encompassing 90 participants with psychosis that investigated an Internet-based intervention with symptom-specific, cognitive behavioral interventions, which is from our research group. The unique features of the proposed project are 1) the first-time evaluation of a symptom-oriented, CBTp-based self-help treatment for people with psychotic symptoms via Internet and 2) the investigation of the enhancement of Internet-based self-help with smartphone assistance. The two studies are set up as randomized controlled trials (RCTs) with each two active treatment versus a wait-list control group. Study I evaluates an Internet-based guided self-help treatment for persecutory ideation, whereas Study II evaluates an analog self-help treatment for auditory verbal hallucinations. The two active treatment conditions are 1) access to a self-help website including regular written electronic contact with a guide, and 2) access to the guided self-help website plus access to additional smartphone-based interactive worksheets (apps). The trials combine the low-threshold advantages of an online approach (e.g., anonymity) with the virtues of a clinical trial (e.g., symptom assessment and diagnostic verification via Interview). Primary outcome measures are persecutory delusions (Study I) and AVH (Study II). Secondary outcome measures include completion rates, drop-out from the intervention, general symptomatology, side-effects, and client satisfaction. The project will be the first that contributes to answering the empirical question whether CBTp-based interventions in a purely Internet-based self-help format are effective. Positive findings would pave the way for an easy-to-access treatment option for patients with psychotic symptoms who currently are deprived of psychotherapeutic treatment.