Imamura Kotaro, Kawakami Norito, Furukawa Toshi A, Matsuyama Yutaka, Shimazu Akihito, Umanodan Rino, Kawakami Sonoko, Kasai Kiyoto
Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Departments of Health Promotion and Human Behavior and of Clinical Epidemiology, Graduate School of Medicine/School of Public Health, Kyoto University, Kyoto, Japan.
PLoS One. 2014 May 20;9(5):e97167. doi: 10.1371/journal.pone.0097167. eCollection 2014.
The purpose of this study was to develop a new Internet-based computerized cognitive behavior therapy (iCBT) program in Manga format, the Japanese cartoon, for workers and to examine the effects of the iCBT program on improving subthreshold depression using a randomized controlled trial (RCT) design among workers employed in private companies in Japan.
All workers in a company (n = 290) and all workers in three departments (n = 1,500) at the headquarters of another large company were recruited by an invitation e-mail. Participants who fulfilled the inclusion criteria were randomly allocated to intervention or control groups (N = 381 for each group). A six-week, six-lesson iCBT program using Manga (Japanese comic) story was developed. The program included several CBT skills: self-monitoring, cognitive restructuring, assertiveness, problem solving, and relaxation. The intervention group studied the iCBT program at a frequency of one lesson per week. Depression (Beck Depression Inventory II; BDI-II) was assessed as a primary outcome at baseline, and three- and six-month follow-ups for both intervention and control groups were performed.
The iCBT program showed a significant intervention effect on BDI-II (t = -1.99, p<0.05) with small effect sizes (Cohen's d: -0.16, 95% Confidence Interval: -0.32 to 0.00, at six-month follow-up).
The present study first demonstrated that a computerized cognitive behavior therapy delivered via the Internet was effective in improving depression in the general working population. It seems critical to improve program involvement of participants in order to enhance the effect size of an iCBT program.
UMIN Clinical Trials Registry UMIN000006210.
本研究旨在为员工开发一种以日本漫画形式呈现的新型基于互联网的计算机化认知行为疗法（iCBT）项目，并采用随机对照试验（RCT）设计，在日本私营企业员工中检验该iCBT项目对改善阈下抑郁的效果。
通过邀请电子邮件招募了一家公司的所有员工（n = 290）以及另一家大公司总部三个部门的所有员工（n = 1500）。符合纳入标准的参与者被随机分配到干预组或对照组（每组N = 381）。开发了一个为期六周、共六节课的使用漫画故事的iCBT项目。该项目包括几种认知行为疗法技能：自我监测、认知重构、自信训练、问题解决和放松。干预组每周学习一节课的iCBT项目。将抑郁（贝克抑郁量表第二版；BDI-II）作为基线时的主要结局进行评估，并对干预组和对照组进行三个月和六个月的随访。
iCBT项目对BDI-II显示出显著的干预效果（t = -1.99，p<0.05），效应量较小（科恩d值：-0.16，95%置信区间：-0.32至0.00，在六个月随访时）。
本研究首次证明，通过互联网提供的计算机化认知行为疗法对改善一般工作人群的抑郁有效。为了提高iCBT项目的效应量，提高参与者对项目的参与度似乎至关重要。
UMIN临床试验注册中心UMIN000006210。
