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基于互联网的认知行为指导治疗创伤后应激障碍不逊于面对面治疗
作者:小柯机器人 发布时间:2022/6/19 19:28:03

英国卡迪夫大学医学院Jonathan I Bisson团队研究了创伤后应激障碍进行指导性、基于互联网的认知行为疗法的效果。2022年6月16日出版的《英国医学杂志》发表了这项成果。

为了确定基于互联网的认知行为指导治疗(CBT-TF)针对创伤事件的轻度至中度创伤后应激障碍(PTSD)的疗效是否不低于个体面对面CBT-TF,研究组在英国NHS的初级和二级心理健康环境进行了一项实用、多中心、随机对照非劣效性试验(RAPID)。

共招募了196名初步诊断为轻度至中度创伤后应激障碍的成年人,将其以1:1的比例随机分为两组,16周时保留82%,52周时保留71%。对19名参与者和10名治疗师进行了有目的的抽样和访谈,以评估这一过程。

参与者分别接受最多12次面对面、手动、单独的CBT-TF会议,每次持续60-90分钟;或基于互联网指导的CBT-TF,采用八步在线计划,与治疗师进行长达三个小时的联系,并在两次疗程之间进行四次简短的电话或电子邮件联系。

主要结局是随机分组后16周的DSM-5临床医师PTSD量表(CAPS-5)(根据《精神障碍诊断和统计手册》[第五版,DSM-5]的标准诊断PTSD)。次要结局包括52周时PTSD症状的严重程度,以及随机化后16周和52周时的功能、抑郁和焦虑症状、饮酒和感知的社会支持。

两组在16周时的CAPS-5主要终点发现非劣效性。两组CAPS-5评分的改善在52周时保持在60%以上,但非劣效性结果在该时间点对面对面CBT-TF没有决定性的支持。基于互联网的指导性CBT-TF比面对面CBT-TF便宜得多,而且参与者可接受,且耐受性良好。定性分析的主要主题是基于互联网的指导性CBT-TF参与的促进因素和障碍、治疗结果以及对其未来实施的考虑。

研究结果表明,基于互联网的CBT-TF治疗创伤事件轻中度创伤后应激障碍的疗效并不逊于个体面对面CBT-TF,应被视为此类患者的一线治疗。

附:英文原文

Title: Guided, internet based, cognitive behavioural therapy for post-traumatic stress disorder: pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID)

Author: Jonathan I Bisson, Cono Ariti, Katherine Cullen, Neil Kitchiner, Catrin Lewis, Neil P Roberts, Natalie Simon, Kim Smallman, Katy Addison, Vicky Bell, Lucy Brookes-Howell, Sarah Cosgrove, Anke Ehlers, Deborah Fitzsimmons, Paula Foscarini-Craggs, Shaun R S Harris, Mark Kelson, Karina Lovell, Maureen McKenna, Rachel McNamara, Claire Nollett, Tim Pickles, Rhys Williams-Thomas

Issue&Volume: 2022/06/16

Abstract:

Objective To determine if guided internet based cognitive behavioural therapy with a trauma focus (CBT-TF) is non-inferior to individual face-to-face CBT-TF for mild to moderate post-traumatic stress disorder (PTSD) to one traumatic event.

Design Pragmatic, multicentre, randomised controlled non-inferiority trial (RAPID).

Setting Primary and secondary mental health settings across the UK’s NHS.

Participants 196 adults with a primary diagnosis of mild to moderate PTSD were randomised in a 1:1 ratio to one of two interventions, with 82% retention at 16 weeks and 71% retention at 52 weeks. 19 participants and 10 therapists were purposively sampled and interviewed for evaluation of the process.

Interventions Up to 12 face-to-face, manual based, individual CBT-TF sessions, each lasting 60-90 minutes; or guided internet based CBT-TF with an eight step online programme, with up to three hours of contact with a therapist and four brief telephone calls or email contacts between sessions.

Main outcome measures Primary outcome was the Clinician Administered PTSD Scale for DSM-5 (CAPS-5) at 16 weeks after randomisation (diagnosis of PTSD based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, DSM-5). Secondary outcomes included severity of PTSD symptoms at 52 weeks, and functioning, symptoms of depression and anxiety, use of alcohol, and perceived social support at 16 and 52 weeks after randomisation.

Results Non-inferiority was found at the primary endpoint of 16 weeks on the CAPS-5 (mean difference 1.01, one sided 95% confidence interval ∞ to 3.90, non-inferiority P=0.012). Improvements in CAPS-5 score of more than 60% in the two groups were maintained at 52 weeks, but the non-inferiority results were inconclusive in favour of face-to-face CBT-TF at this time point (3.20, ∞ to 6.00, P=0.15). Guided internet based CBT-TF was significantly (P<0.001) cheaper than face-to-face CBT-TF and seemed to be acceptable and well tolerated by participants. The main themes of the qualitative analysis were facilitators and barriers to engagement with guided internet based CBT-TF, treatment outcomes, and considerations for its future implementation.

Conclusions Guided internet based CBT-TF for mild to moderate PTSD to one traumatic event was non-inferior to individual face-to-face CBT-TF and should be considered a first line treatment for people with this condition.

DOI: 10.1136/bmj-2021-069405

Source: https://www.bmj.com/content/377/bmj-2021-069405

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
官方网址:http://www.bmj.com/
投稿链接:https://mc.manuscriptcentral.com/bmj