Tumur Indra, Kaltenthaler Eva, Ferriter Michael, Beverley Catherine, Parry Glenys
School of Health and Related Research, University of Sheffield, Sheffield, UK.
Psychother Psychosom. 2007;76(4):196-202. doi: 10.1159/000101497.
Computer-guided therapy is an innovative treatment strategy that could have an important role in the future of psychological treatment. This paper summarises the available published evidence that assesses the effectiveness of a computerised cognitive behaviour therapy (CCBT) for obsessive-compulsive disorder (OCD).
Fifteen electronic bibliographic databases including Medline, Embase, the Cochrane Library, Cinahl, PsycINFO, Biological Abstracts, HMIC and NHS CRD databases were comprehensively searched in March 2004: ['obsessive compulsive disorder' (text and indexed terms)] AND ['cognitive therapy' (text and indexed terms)] AND ['computer' (text and indexed terms)]. Reference lists of included studies, guidelines, generic research, trials registers and specialist mental health sites were hand-searched.
The search produced 149 citations from which we identified two RCTs and two single-arm studies with relevant data. All four studies used one software programme - BTSteps. In the large RCT, YBOCS effect sizes for BTSteps, therapist-led cognitive behaviour therapy (TCBT) and relaxation (RLX) were 0.84, 1.22, and 0.35, respectively. The smaller RCT found significantly better outcomes with brief scheduled support compared to brief on-demand phone support.
BTSteps was as good as TCBT for reducing time spent in rituals and obsessions and for improving the Work and Social Adjustment Scale (WSA), and was superior to RLX treatment. The available evidence also showed that improvement of OCD persisted beyond the end of CCBT. TCBT was more effective than CCBT for all patients overall though not in those who went on to start self-exposure. Such a system has the potential to widen the access to CBT in general and considerably shorten clinician-guided care.
计算机引导治疗是一种创新的治疗策略，可能在未来心理治疗中发挥重要作用。本文总结了已发表的评估计算机化认知行为疗法（CCBT）治疗强迫症（OCD）有效性的现有证据。
2004年3月全面检索了15个电子文献数据库，包括Medline、Embase、Cochrane图书馆、Cinahl、PsycINFO、生物学文摘、卫生管理信息库和英国国家医疗服务体系研究与发展数据库：['强迫症'（文本和索引词）] AND ['认知疗法'（文本和索引词）] AND ['计算机'（文本和索引词）]。对纳入研究的参考文献列表、指南、一般研究、试验注册库和专业心理健康网站进行了手工检索。
检索产生了149条引文，从中我们确定了两项随机对照试验（RCT）和两项有相关数据的单臂研究。所有四项研究都使用了一个软件程序——BTSteps。在大型随机对照试验中，表示BTSteps、治疗师主导的认知行为疗法（TCBT）和放松疗法（RLX）的耶鲁布朗强迫症量表（YBOCS）效应量分别为0.84、1.22和0.35。规模较小 的随机对照试验发现，与按需提供的简短电话支持相比，定期安排的简短支持能显著带来更好的结果。
BTSteps在减少仪式行为和强迫观念所花费的时间以及改善工作和社会适应量表（WSA）方面与TCBT一样有效，且优于RLX治疗。现有证据还表明，强迫症的改善在CCBT结束后仍持续存在。总体而言，TCBT对所有患者比CCBT更有效，但对那些开始自我暴露的患者则不然。这样的系统有可能普遍扩大认知行为疗法的可及性，并大幅缩短临床医生指导的治疗时间。
