Hermes Eric D A, Rosenheck Robert A
Dr. Hermes and Dr. Rosenheck are with the New England Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Affairs (VA) Connecticut Healthcare System, West Haven, Connecticut, and with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail:
Psychiatr Serv. 2016 Feb;67(2):176-83. doi: 10.1176/appi.ps.201400532. Epub 2015 Dec 1.
Computer-based psychotherapy interventions (CBPIs) are increasingly offered as first-level access to evidence-based mental health treatment. However, their implementation has not been evaluated in public-sector outpatient settings.
An evidence-based CBPI for insomnia was implemented with provider and patient education sessions, on-site Internet access, and clinician telephone support. Persons receiving care at a Veterans Health Administration substance abuse treatment clinic were screened for chronic insomnia and offered CBPI access. The feasibility of this strategy was evaluated in a pre-post design, which assessed engagement and completion rates, participant-reported acceptability, and clinical outcomes.
Of 100 veterans referred, 51 enrolled in the program, of whom 22 (43%) completed all sessions, 13 (26%) partially completed the program, and 16 (31%) did not engage. There were no statistically significant differences between these three groups in baseline characteristics. In the total sample, Insomnia Severity Index (ISI) scores decreased (improved) by 32% (mean±SD of 6.3±6.2 points, t=6.82, df=44, p<.001). Veterans who completed all six sessions displayed clinically and statistically significant improvements on the ISI compared with those who did not engage, as shown in a regression analysis that controlled for baseline insomnia severity, time between assessments, and sedative-hypnotic medication use (F=3.87, df=4 and 40, p≤.004). Among all participants, 67% agreed that they would engage in another CBPI in the future. When questioned about potential barriers, 36% of the full sample endorsed a preference for face-to-face therapy.
A strategy of brief provider and patient education, on-site Internet access, and telephone support was feasible and effective for implementing CBPIs in outpatient substance abuse treatment settings for veterans.
基于计算机的心理治疗干预措施（CBPI）越来越多地被作为循证心理健康治疗的一级途径。然而，其在公共部门门诊环境中的实施情况尚未得到评估。
实施一项针对失眠的循证CBPI，包括开展提供者和患者教育课程、提供现场互联网接入以及临床医生电话支持。在退伍军人健康管理局药物滥用治疗诊所接受治疗的人员接受慢性失眠筛查，并获得CBPI治疗机会。在一项前后设计中评估了该策略的可行性，该设计评估了参与率和完成率、参与者报告的可接受性以及临床结果。
在被转诊的100名退伍军人中，51人参加了该项目，其中22人（43%）完成了所有课程，13人（26%）部分完成了该项目，16人（31%）未参与。这三组在基线特征方面无统计学显著差异。在总样本中，失眠严重程度指数（ISI）得分下降（改善）了32%（平均±标准差为6.3±6.2分，t = 6.82，自由度 = 44，p <.001）。与未参与的退伍军人相比，完成所有六个课程的退伍军人在ISI上显示出临床和统计学上的显著改善，如在一项控制了基线失眠严重程度、评估之间的时间以及镇静催眠药物使用情况的回归分析中所示（F = 3.87，自由度 = 4和40，p≤.004）。在所有参与者中，67%同意他们未来会参与另一项CBPI。当被问及潜在障碍时，36%的总样本表示更喜欢面对面治疗。
简短的提供者和患者教育、现场互联网接入以及电话支持策略对于在退伍军人门诊药物滥用治疗环境中实施CBPI是可行且有效的。
