Clinical Research Unit for Anxiety and Depression, School of Psychiatry, University of New South Wales at St Vincent's Hospital, Darlinghurst, NSW, Australia.
Psychol Med. 2013 Dec;43(12):2635-48. doi: 10.1017/S0033291713000111. Epub 2013 Feb 18.
Major depressive disorder (MDD) and generalized anxiety disorder (GAD) have the highest co-morbidity rates within the internalizing disorders cluster, yet no Internet-based cognitive behavioural therapy (iCBT) programme exists for their combined treatment.
We designed a six-lesson therapist-assisted iCBT programme for mixed anxiety and depression. Study 1 was a randomized controlled trial (RCT) comparing the iCBT programme (n = 46) versus wait-list control (WLC; n = 53) for patients diagnosed by structured clinical interview with MDD, GAD or co-morbid GAD/MDD. Primary outcome measures were the Patient Health Questionnaire nine-item scale (depression), Generalized Anxiety Disorder seven-item scale (generalized anxiety), Kessler 10-item Psychological Distress scale (distress) and 12-item World Health Organization Disability Assessment Schedule II (disability). The iCBT group was followed up at 3 months post-treatment. In study 2, we investigated the adherence to, and efficacy of the same programme in a primary care setting, where patients (n = 136) completed the programme under the supervision of primary care clinicians.
The RCT showed that the iCBT programme was more effective than WLC, with large within- and between-groups effect sizes found (>0.8). Adherence was also high (89%), and gains were maintained at 3-month follow-up. In study 2 in primary care, adherence to the iCBT programme was low (41%), yet effect sizes were large (>0.8). Of the non-completers, 30% experienced benefit.
Together, the results show that iCBT is effective and adherence is high in research settings, but there is a problem of adherence when translated into the 'real world'. Future efforts need to be placed on developing improved adherence to iCBT in primary care settings.
在内在障碍群中，重度抑郁症（MDD）和广泛性焦虑症（GAD）的共病率最高，但目前尚无针对两者联合治疗的基于互联网的认知行为疗法（iCBT）方案。
我们设计了一个六节课的混合焦虑和抑郁治疗师辅助 iCBT 方案。研究 1 为随机对照试验（RCT），比较 iCBT 方案（n=46）与等待名单对照（WLC；n=53）对通过结构临床访谈诊断为 MDD、GAD 或共病 GAD/MDD 的患者的疗效。主要结局指标为患者健康问卷 9 项量表（抑郁）、广泛性焦虑症 7 项量表（广泛性焦虑）、凯斯勒 10 项心理困扰量表（困扰）和世界卫生组织残疾评估量表 II 12 项（残疾）。iCBT 组在治疗后 3 个月进行随访。在研究 2 中，我们在初级保健环境中调查了相同方案的依从性和疗效，患者（n=136）在初级保健临床医生的监督下完成了该方案。
RCT 表明，iCBT 方案比 WLC 更有效，发现组内和组间的效果均较大（>0.8）。依从性也很高（89%），在 3 个月随访时仍保持获益。在初级保健的研究 2 中，iCBT 方案的依从性较低（41%），但效果较大（>0.8）。未完成治疗的患者中，有 30%的患者受益。
总的来说，结果表明 iCBT 在研究环境中有效且依从性高，但在转化为“现实世界”时存在依从性问题。未来需要努力提高 iCBT 在初级保健环境中的依从性。
