Department of Behavioural Sciences and Learning, Linköping University , Linköping , Sweden.
PeerJ. 2013 Jul 9;1:e102. doi: 10.7717/peerj.102. Print 2013.
Background. Psychodynamic psychotherapy is a psychological treatment approach that has a growing empirical base. Research has indicated an association between therapist-facilitated affective experience and outcome in psychodynamic therapy. Affect-phobia therapy (APT), as outlined by McCullough et al., is a psychodynamic treatment that emphasizes a strong focus on expression and experience of affect. This model has neither been evaluated for depression nor anxiety disorders in a randomized controlled trial. While Internet-delivered psychodynamic treatments for depression and generalized anxiety disorder exist, they have not been based on APT. The aim of this randomized controlled trial was to investigate the efficacy of an Internet-based, psychodynamic, guided self-help treatment based on APT for depression and anxiety disorders. Methods. One hundred participants with diagnoses of mood and anxiety disorders participated in a randomized (1:1 ratio) controlled trial of an active group versus a control condition. The treatment group received a 10-week, psychodynamic, guided self-help treatment based on APT that was delivered through the Internet. The treatment consisted of eight text-based treatment modules and included therapist contact (9.5 min per client and week, on average) in a secure online environment. Participants in the control group also received online therapist support and clinical monitoring of symptoms, but received no treatment modules. Outcome measures were the 9-item Patient Health Questionnaire Depression Scale (PHQ-9) and the 7-item Generalized Anxiety Disorder Scale (GAD-7). Process measures were also included. All measures were administered weekly during the treatment period and at a 7-month follow-up. Results. Mixed models analyses using the full intention-to-treat sample revealed significant interaction effects of group and time on all outcome measures, when comparing treatment to the control group. A large between-group effect size of Cohen's d = 0.77 (95% CI: 0.37-1.18) was found on the PHQ-9 and a moderately large between-group effect size d = 0.48 (95% CI: 0.08-0.87) was found on the GAD-7. The number of patients who recovered (had no diagnoses of depression and anxiety, and had less than 10 on both the PHQ-9 and the GAD-7) were at post-treatment 52% in the treatment group and 24% in the control group. This difference was significant, χ(2)(N = 100, d f = 1) = 8.3, p < .01. From post-treatment to follow-up, treatment gains were maintained on the PHQ-9, and significant improvements were seen on the GAD-7. Conclusion. This study provides initial support for the efficacy of Internet-delivered psychodynamic therapy based on the affect-phobia model in the treatment of depression and anxiety disorders. The results support the conclusion that psychodynamic treatment approaches may be transferred to the guided self-help format and delivered via the Internet.
精神动力心理疗法是一种具有越来越多实证基础的心理治疗方法。研究表明，治疗师促进的情感体验与精神动力治疗的结果之间存在关联。麦卡洛等人提出的恐惧情感疗法（APT）是一种精神动力治疗方法，强调强烈关注情感的表达和体验。这种模式尚未在随机对照试验中针对抑郁症和焦虑症进行评估。虽然存在针对抑郁症和广泛性焦虑症的互联网提供的精神动力治疗，但它们并非基于 APT。本随机对照试验的目的是调查基于 APT 的基于互联网的精神动力、引导自助治疗对抑郁症和焦虑症的疗效。方法：100 名患有情绪和焦虑障碍的参与者参加了一项针对活跃组与对照组的随机（1:1 比例）对照试验。治疗组接受了为期 10 周的基于 APT 的精神动力、引导自助治疗，通过互联网提供。该治疗包括八个基于文本的治疗模块，并包括在安全的在线环境中与治疗师进行联系（平均每位客户和每周 9.5 分钟）。对照组的参与者也接受了在线治疗师支持和症状的临床监测，但未接受任何治疗模块。结果测量指标为 9 项患者健康问卷抑郁量表（PHQ-9）和 7 项广泛性焦虑症量表（GAD-7）。还包括过程测量指标。在治疗期间以及 7 个月的随访期间，每周进行所有测量。结果：使用完整意向治疗样本的混合模型分析显示，在将治疗与对照组进行比较时，组和时间对所有结果测量指标均存在显著的交互作用。PHQ-9 的组间效应量较大，Cohen's d = 0.77（95%CI：0.37-1.18），GAD-7 的组间效应量中等，d = 0.48（95%CI：0.08-0.87）。治疗组在治疗后有 52%的患者（没有抑郁症和焦虑症的诊断，PHQ-9 和 GAD-7 的得分均低于 10），而对照组为 24%。这一差异具有统计学意义，χ(2)(N = 100，df = 1) = 8.3，p <.01。从治疗后到随访，PHQ-9 的治疗效果得到维持，GAD-7 的治疗效果显著改善。结论：本研究初步支持基于恐惧情感模型的互联网提供的精神动力治疗对抑郁症和焦虑症的疗效。结果支持这样的结论，即精神动力治疗方法可以转移到引导自助格式，并通过互联网提供。
