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针对惊恐障碍患者的“混合式”认知行为疗法(CBT)的探索性研究:结果与患者体验

[An exploratory study of 'blended' cognitive behavioural therapy (CBT) for patients with a panic disorder: results and patients' experiences].

作者信息

Bruinsma A, Kampman M, Exterkate C C, Hendriks G J

出版信息

Tijdschr Psychiatr. 2016;58(5):361-70.

Abstract

BACKGROUND

Digital technology (e-health or 'blended' care), combined with evidence-based face-to-face CBT, is becoming increasingly implemented into mental health care and is expected to result in improved effectiveness and efficiency.

AIM

To explore the feasibility of blended CBT for patients with a panic disorder.

METHOD

Nine face-to-face sessions of blended CBT (n = 18), supplemented with the digital support of a tabletcomputer and three e-mail contacts, were compared with 12 weekly sessions of regular CBT (n = 18). Primary outcomes were panic frequency and avoidance behaviour; the secondary outcome was general functioning. Patients' experiences of the treatment were collected in the form of a structured interview.

RESULTS

The effect sizes found in both the regular and the blended CBT were medium to high (Cohen's d 0.42-1.60). In both types of treatment there was a significant reduction in patients' symptoms. There were no big differences in patient satisfaction regarding the treatment received. The therapists registered 39 face-to-face minutes in the blended treatment but they registered in total 41 fewer face-to-face minutes; this represented a time reduction of 4%.

CONCLUSION

Blended CBT with help of a tablet computer seems to be a suitable method for treating panic disorder psychologically, although the time saved is only moderate. Much more research is needed to ascertain the feasibility and the cost effectiveness of blended CBT.

摘要

背景

数字技术(电子健康或“混合”护理)与循证面对面认知行为疗法(CBT)相结合,正越来越多地应用于精神卫生保健领域,有望提高有效性和效率。

目的

探讨混合认知行为疗法治疗惊恐障碍患者的可行性。

方法

将九次混合认知行为疗法面对面治疗(n = 18),辅以平板电脑数字支持和三次电子邮件联系,与十二次定期认知行为疗法每周治疗(n = 18)进行比较。主要结局为惊恐发作频率和回避行为;次要结局为总体功能。以结构化访谈的形式收集患者对治疗的体验。

结果

常规认知行为疗法和混合认知行为疗法的效应量均为中等至高(科恩d值为0.42 - 1.60)。两种治疗方式下患者症状均有显著减轻。患者对所接受治疗的满意度无显著差异。在混合治疗中,治疗师记录的面对面治疗时间为39分钟,但总共记录的面对面治疗时间少了41分钟;这意味着时间减少了4%。

结论

借助平板电脑的混合认知行为疗法似乎是心理治疗惊恐障碍的一种合适方法,尽管节省的时间不多。需要更多研究来确定混合认知行为疗法的可行性和成本效益。

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