背景:近年来,越来越多的兴趣集中在心理治疗工作联盟上,以此作为理解数字心理健康干预措施临床变化的一种手段。然而,对于数字心理健康计划如何以及在多大程度上可以对抑郁症的混合(治疗师加数字计划)认知行为疗法(bCBT)干预中的工作联盟和临床结果产生影响,人们知之甚少。
目的:本研究旨在测试bCBT和照常治疗(TAU)之间工作联盟得分的差异,检查双方工作联盟和抑郁严重程度评分之间的关联,并在3个月的评估中,就工作联盟与bCBT抑郁评分之间的关联,测试系统可用性与工作联盟之间的相互作用。
方法:我们对E-COMPARED(欧洲混合抑郁症治疗与常规治疗的比较有效性研究)试验进行了二次数据分析,比较了9个欧洲国家的bCBT和TAU。数据收集了2015年4月至2017年12月之间的初级保健和专门服务。年龄在18岁或以上并被诊断为重度抑郁症的合格参与者被随机分配到bCBT(n=476)或TAU(n=467)。bCBT包括6-20次bCBT课程(包括与治疗师的面对面课程和基于互联网的计划)。TAU包括抑郁症的常规治疗。主要结果是随机分组后3个月的工作联盟(工作联盟清单-短修订客户[WAI-SR-C])和抑郁症状(患者健康问卷-9[PHQ-9])得分。其他变量包括3个月时的系统可用性得分(系统可用性量表-客户端[SUS-C])和基线人口统计信息。使用线性回归模型分析来自基线和3个月评估的数据,该模型针对一组基线变量进行了调整。
结果:在945名参与者中,644(68.2%)为女性,平均年龄为38.96岁(IQR38)。与TAU相比,bCBT与较高的WAI-SR-C综合评分相关(B=5.67,95%CI4.48-6.86)。在bCBT(B=-0.12,95%CI-0.17至-0.06)和TAU(B=-0.06,95%CI-0.11至-0.02)中,WAI-SR-C和PHQ-9之间呈负相关,随着WAI-SR-C分数的增加,PHQ-9评分下降。最后,在bCBT中较高的WAI-SR-C评分和较低的PHQ-9评分之间的负相关方面,SUS-C和WAI-SR-C之间存在显著的交互作用(b=-0.030,95%CI-0.05至-0.01;P=.005).
结论:据我们所知,这是第一项研究表明,与服务报告提供的循证常规抑郁症护理相比,bCBT可能会增强客户工作联盟。bCBT中的工作联盟也与临床改进相关,这些改进似乎通过良好的程序可用性得到了增强。我们的发现进一步增加了这样一种观点,即在面对面的CBT中添加互联网提供的CBT可能会积极增强工作联盟的经验。
背景:ClinicalTrials.govNCT02542891,https://clinicaltrials.gov/study/NCT02542891;德国临床试验注册DRKS00006866,https://drks.de/search/en/trial/DRKS00006866;荷兰试验注册NTR4962,https://www.onderzoekmetmensen.nl/en/trial/25452;临床试验。GovNCT02389660,https://clinicaltrials.gov/study/NCT02389660;ClinicalTrials.govNCT02361684,https://clinicaltrials.gov/study/NCT02361684;ClinicalTrials.NCT0go447;ClinicalNCT2449isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10;ClinicalTrials.govNCT02796573,https://classic。clinicaltrials.gov/ct2/show/NCT02796573.
■RR2-10.1186/s13063-016-1511-1。
BACKGROUND: Increasing interest has centered on the psychotherapeutic working alliance as a means of understanding clinical change in digital mental health interventions in recent years. However, little is understood about how and to what extent a digital mental health program can have an impact on the working alliance and clinical outcomes in a blended (therapist plus digital program) cognitive behavioral therapy (bCBT) intervention for depression.
OBJECTIVE: This study aimed to test the difference in working alliance scores between bCBT and treatment as usual (TAU), examine the association between working alliance and depression severity scores in both arms, and test for an interaction between system usability and working alliance with regard to the association between working alliance and depression scores in bCBT at 3-month assessments.
METHODS: We conducted a secondary data analysis of the E-COMPARED (European Comparative Effectiveness Research on Blended Depression Treatment versus Treatment-as-usual) trial, which compared bCBT with TAU across 9 European countries. Data were collected in primary care and specialized services between April 2015 and December 2017. Eligible participants aged 18 years or older and diagnosed with major depressive disorder were randomized to either bCBT (n=476) or TAU (n=467). bCBT consisted of 6-20 sessions of bCBT (involving face-to-face sessions with a therapist and an internet-based program). TAU consisted of usual care for depression. The main outcomes were scores of the working alliance (Working Alliance Inventory-Short Revised-Client [WAI-SR-C]) and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]) at 3 months after randomization. Other variables included system usability scores (System Usability Scale-Client [SUS-C]) at 3 months and baseline demographic information. Data from baseline and 3-month assessments were analyzed using linear regression models that adjusted for a set of baseline variables.
RESULTS: Of the 945 included participants, 644 (68.2%) were female, and the mean age was 38.96 years (IQR 38). bCBT was associated with higher composite WAI-SR-C scores compared to TAU (B=5.67, 95% CI 4.48-6.86). There was an inverse association between WAI-SR-C and PHQ-9 in bCBT (B=-0.12, 95% CI -0.17 to -0.06) and TAU (B=-0.06, 95% CI -0.11 to -0.02), in which as WAI-SR-C scores increased, PHQ-9 scores decreased. Finally, there was a significant interaction between SUS-C and WAI-SR-C with regard to an inverse association between higher WAI-SR-C scores and lower PHQ-9 scores in bCBT (b=-0.030, 95% CI -0.05 to -0.01; P=.005).
CONCLUSIONS: To our knowledge, this is the first study to show that bCBT may enhance the client working alliance when compared to evidence-based routine care for depression that services reported offering. The working alliance in bCBT was also associated with clinical improvements that appear to be enhanced by good program usability. Our findings add further weight to the view that the addition of internet-delivered CBT to face-to-face CBT may positively augment experiences of the working alliance.
BACKGROUND: ClinicalTrials.gov NCT02542891, https://clinicaltrials.gov/study/NCT02542891; German Clinical Trials Register DRKS00006866, https://drks.de/search/en/trial/DRKS00006866; Netherlands Trials Register NTR4962, https://www.onderzoekmetmensen.nl/en/trial/25452; ClinicalTrials.Gov NCT02389660, https://clinicaltrials.gov/study/NCT02389660; ClinicalTrials.gov NCT02361684, https://clinicaltrials.gov/study/NCT02361684; ClinicalTrials.gov NCT02449447, https://clinicaltrials.gov/study/NCT02449447; ClinicalTrials.gov NCT02410616, https://clinicaltrials.gov/study/NCT02410616; ISRCTN Registry ISRCTN12388725, https://www.isrctn.com/ISRCTN12388725?q=ISRCTN12388725&filters=&sort=&offset=1&totalResults=1&page=1&pageSize=10; ClinicalTrials.gov NCT02796573, https://classic.clinicaltrials.gov/ct2/show/NCT02796573.
UNASSIGNED: RR2-10.1186/s13063-016-1511-1.