Department of Clinical Psychology and EMGO Institute, Vrije Universiteit, Amsterdam, The Netherlands.
Psychother Psychosom. 2012;81(6):344-55. doi: 10.1159/000339371. Epub 2012 Sep 6.
Guided Internet-based cognitive behavior therapy (ICBT) has been tested in many trials and found to be effective in the treatment of anxiety and mood disorders. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Since there is preliminary support for psychodynamic treatment for GAD, we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet. The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group.
A randomized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT (n = 27) and IPDT (n = 27) against a no treatment waiting list control group (n = 27). The primary outcome measure was the Penn State Worry Questionnaire.
While there were no significant between-group differences immediately after treatment on the main outcome measure, both IPDT and ICBT resulted in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses. The differences against the control group, although smaller, were still significant for both PDT and CBT when conforming to the criteria of clinically significant improvement. The active treatments did not differ significantly. There was a significant group by time interaction regarding GAD symptoms, but not immediately after treatment.
IPDT and ICBT both led to modest symptom reduction in GAD, and more research is needed.
基于互联网的认知行为疗法（ICBT）已在许多试验中进行了测试，并且已被证明对焦虑和情绪障碍的治疗有效。广泛性焦虑症（GAD）也已通过 ICBT 进行治疗，但针对基于互联网的精神动力学治疗（IPDT）的对照试验尚未进行。由于对 GAD 的精神动力学治疗有初步的支持，因此我们决定研究是否可以通过互联网提供基于精神动力学的自助治疗。该研究的目的是调查 IPDT 对 GAD 的疗效，并与 ICBT 和等待名单对照组进行比较。
这是一项针对 GAD 个体的随机对照优势试验，比较了接受指导的 ICBT（n = 27）和 IPDT（n = 27）与无治疗等待名单对照组（n = 27）。主要结局指标为宾夕法尼亚州担忧问卷。
虽然在主要结局指标上，治疗后立即在组间没有显著差异，但在完成分析中，无论是在 3 个月还是 18 个月的随访中，PDT 和 ICBT 都导致了改善，并且具有中等至大的组内效应大小。与对照组相比，即使差异较小，但对于 PDT 和 CBT 来说，符合临床显著改善标准时，差异仍然具有统计学意义。两种积极的治疗方法之间没有明显差异。在 GAD 症状方面，存在组间时间的交互作用，但在治疗后立即不存在。
IPDT 和 ICBT 均导致 GAD 症状的适度减轻，但需要进一步研究。
