Beattie Angela, Shaw Alison, Kaur Surinder, Kessler David
Department of Social Medicine, Academic Unit of Primary Health Care, Natinoal Institute for Health Research (NIHR), School for Primary Care Research, University of Bristol, Bristol, UK.
Health Expect. 2009 Mar;12(1):45-59. doi: 10.1111/j.1369-7625.2008.00531.x.
To explore expectations and experiences of online cognitive behavioural therapy (CBT) among primary-care patients with depression, focusing on how this mode of delivery impacts upon the therapeutic experience.
Qualitative study, using repeat semi-structured interviews with patients before and after therapy. The study was conducted in parallel with a randomized controlled trial examining the effectiveness and cost-effectiveness of online CBT for patients with depression.
Twenty-four patients with depression recruited from five general practices in southwest England, who were offered up to 10 sessions of CBT, delivered via the internet by a psychologist.
Most participants accessed the therapy from their home computer and found this to be a major advantage, in terms of convenience and fitting therapy into their daily routine, with any technical problems quickly resolved. Two key themes regarding expectations and experiences of online CBT were: developing a virtual relationship with a therapist, and the process of communicating thoughts and emotions via an online medium. Online CBT seems to be acceptable to, and experienced as helpful by, certain subgroups of patients with depression, particularly those who are familiar with computers, feel comfortable with writing their feelings down, enjoy the opportunities to review and reflect that written (or typed) communication offers are attracted to the 'anonymity' of an online therapeutic relationship and are open to the proactive requirements of CBT itself. However, on-line CBT may feed into the vulnerability of depressed people to negative thoughts, given the absence of visual cues and the immediate response of face-to-face interaction.
Online CBT has the potential to enhance care for patients with depression who are open to engaging in 'talking' (or typing) therapies as part of their treatment. If online CBT is to be provided via the NHS, it is important to establish patient preferences regarding this mode of delivery and ensure that referral practices are appropriately targeted. The results of our main trial will provide evidence regarding the effectiveness and cost-effectiveness of receiving therapy via this modality.
探讨抑郁症初级保健患者对在线认知行为疗法（CBT）的期望和体验，重点关注这种治疗方式如何影响治疗体验。
定性研究，在治疗前后对患者进行重复的半结构化访谈。该研究与一项随机对照试验同时进行，该试验考察在线CBT对抑郁症患者的有效性和成本效益。
从英格兰西南部的五个全科诊所招募了24名抑郁症患者，他们接受了由一名心理学家通过互联网提供的多达10次的CBT治疗。
大多数参与者通过家用电脑接受治疗，他们认为这在便利性以及将治疗融入日常生活方面具有很大优势，任何技术问题都能迅速得到解决。关于在线CBT的期望和体验有两个关键主题：与治疗师建立虚拟关系，以及通过在线媒介交流思想和情感的过程。在线CBT似乎为某些抑郁症患者亚组所接受，并被他们认为是有帮助的，特别是那些熟悉电脑、愿意写下自己感受、喜欢书面（或打字）交流所提供的回顾和反思机会、被在线治疗关系的“匿名性”所吸引并且愿意接受CBT自身积极要求的患者。然而，鉴于缺乏视觉线索以及面对面互动的即时回应，在线CBT可能会加剧抑郁症患者产生消极想法的倾向。
在线CBT有潜力加强对愿意将“谈话”（或打字）疗法作为治疗一部分的抑郁症患者的护理。如果要通过英国国家医疗服务体系（NHS）提供在线CBT，重要的是确定患者对这种治疗方式的偏好，并确保转诊做法目标明确。我们主要试验的结果将提供关于通过这种方式接受治疗的有效性和成本效益的证据。
