Knowles Sarah E, Toms Gill, Sanders Caroline, Bee Penny, Lovell Karina, Rennick-Egglestone Stefan, Coyle David, Kennedy Catriona M, Littlewood Elizabeth, Kessler David, Gilbody Simon, Bower Peter
NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, United Kingdom.
School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, United Kingdom.
PLoS One. 2014 Jan 17;9(1):e84323. doi: 10.1371/journal.pone.0084323. eCollection 2014.
Computerised therapies play an integral role in efforts to improve access to psychological treatment for patients with depression and anxiety. However, despite recognised problems with uptake, there has been a lack of investigation into the barriers and facilitators of engagement. We aimed to systematically review and synthesise findings from qualitative studies of computerised therapies, in order to identify factors impacting on engagement.
Systematic review and meta-synthesis of qualitative studies of user experiences of computer delivered therapy for depression and/or anxiety.
8 studies were included in the review. All except one were of desktop based cognitive behavioural treatments. Black and minority ethnic and older participants were underrepresented, and only one study addressed users with a co-morbid physical health problem. Through synthesis, we identified two key overarching concepts, regarding the need for treatments to be sensitive to the individual, and the dialectal nature of user experience, with different degrees of support and anonymity experienced as both positive and negative. We propose that these factors can be conceptually understood as the 'non-specific' or 'common' factors of computerised therapy, analogous to but distinct from the common factors of traditional face-to-face therapies.
Experience of computerised therapy could be improved through personalisation and sensitisation of content to individual users, recognising the need for users to experience a sense of 'self' in the treatment which is currently absent. Exploiting the common factors of computerised therapy, through enhancing perceived connection and collaboration, could offer a way of reconciling tensions due to the dialectal nature of user experience. Future research should explore whether the findings are generalisable to other patient groups, to other delivery formats (such as mobile technology) and other treatment modalities beyond cognitive behaviour therapy. The proposed model could aid the development of enhancements to current packages to improve uptake and support engagement.
计算机化疗法在努力改善抑郁症和焦虑症患者获得心理治疗的机会方面发挥着不可或缺的作用。然而，尽管人们认识到在采用方面存在问题，但对于参与的障碍和促进因素却缺乏研究。我们旨在系统地回顾和综合计算机化疗法定性研究的结果，以确定影响参与的因素。
对计算机提供的抑郁症和/或焦虑症治疗的用户体验定性研究进行系统回顾和元综合分析。
该综述纳入了8项研究。除一项研究外，其余均为基于桌面的认知行为治疗。黑人和少数族裔以及老年参与者的代表性不足，只有一项研究涉及患有合并身体疾病的用户。通过综合分析，我们确定了两个关键的总体概念，即治疗需要对个体敏感，以及用户体验的辩证性质，不同程度的支持和匿名既被视为积极的，也被视为消极的。我们认为，这些因素在概念上可以理解为计算机化疗法的“非特定”或“共同”因素，类似于但不同于传统面对面疗法的共同因素。
通过使内容个性化并使其对个体用户敏感，可以改善计算机化疗法的体验，认识到用户在目前缺乏的治疗中需要体验一种“自我”感。通过增强感知到的联系与协作来利用计算机化疗法的共同因素，可以提供一种调和因用户体验的辩证性质而产生的紧张关系的方法。未来的研究应探索这些发现是否适用于其他患者群体、其他交付形式（如移动技术）以及认知行为疗法以外的其他治疗方式。所提出的模型可以帮助改进当前软件包，以提高采用率并支持参与度。
