Department of Clinical Psychology and Psychotherapy.
Department of Clinical Psychology and Psychotherapy, Freie Universitaet Berlin.
Psychotherapy (Chic). 2014 Jun;51(2):207-19. doi: 10.1037/a0032527. Epub 2013 Sep 16.
Internet-delivered self-help with minimal therapist guidance has shown promising results for a number of diagnoses. Most of the evidence comes from studies evaluating standardized disorder-specific treatments. A recent development in the field includes transdiagnostic and tailored Internet-based treatments that address comorbid symptoms and a broader range of patients. This study evaluated an Internet-based tailored guided self-help treatment, which targeted symptoms of social anxiety disorder, panic disorder with or without agoraphobia, and generalized anxiety disorder. The tailored treatment was compared both with standardized disorder-specific Internet-based treatment and with a wait-list control group. Both active treatment conditions were based on cognitive-behavioral therapy and lasted for 8 weeks. A total of 132 individuals meeting diagnostic criteria for at least one of the anxiety disorders were randomly assigned to 1 of the 3 conditions. Both treatment groups showed significant symptom reductions as compared with the wait-list control group on primary disorder-unspecific measures of anxiety, depression, and general symptomatology and on secondary anxiety disorder-specific measures. Based on the intention-to-treat sample, mean between-group effect sizes were d = 0.80 for the tailored treatment and d = 0.82 for the standardized treatment, versus wait-list controls. Treatment gains were maintained at 6-month follow-up. No differences were found between the 2 active treatment conditions on any of the measures, including a telephone-administered diagnostic interview conducted at posttreatment. The findings suggest that both Internet-based tailored guided self-help treatments and Internet-based standardized treatments are promising treatment options for several anxiety disorders.
互联网自助治疗在有最少治疗师指导的情况下,对许多诊断结果都显示出了有前景的效果。大多数证据都来自评估标准化特定障碍治疗的研究。该领域的一个最新发展包括跨诊断和量身定制的基于互联网的治疗方法,可解决共病症状和更广泛的患者群体。本研究评估了一种基于互联网的量身定制的指导自助治疗方法,该方法针对社交焦虑障碍、伴有或不伴有广场恐怖症的惊恐障碍和广泛性焦虑障碍的症状。量身定制的治疗方法分别与标准化特定障碍的基于互联网的治疗方法和等待名单对照组进行了比较。两种积极的治疗条件均基于认知行为疗法,持续 8 周。共有 132 名符合至少一种焦虑障碍诊断标准的个体被随机分配到 3 种条件之一。与等待名单对照组相比,两种治疗组在主要的非特定障碍的焦虑、抑郁和一般症状的测量上以及在次要的特定障碍的焦虑测量上,均显示出显著的症状减轻。根据意向治疗样本,针对量身定制的治疗的组间平均效应大小为 d = 0.80,针对标准化治疗的组间平均效应大小为 d = 0.82,与等待名单对照组相比。在 6 个月的随访中,治疗效果得到了维持。在任何测量上,包括在治疗后进行的电话管理的诊断访谈,都没有发现两种积极治疗条件之间的差异。研究结果表明,基于互联网的量身定制的指导自助治疗和基于互联网的标准化治疗都是几种焦虑障碍的有前途的治疗选择。