Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands.
Psychother Psychosom. 2016;85(5):297-307. doi: 10.1159/000447267. Epub 2016 Aug 11.
Patients with somatic conditions, such as psoriasis, frequently suffer from high burden of their disease in daily life and might benefit from internet-based cognitive behavioral therapy (ICBT) tailored to their adjustment problems. The aim of this multicenter randomized controlled trial was to examine the effects of therapist-guided, individually tailored ICBT in a clinical sample of patients with psoriasis.
A total of 131 patients with psoriasis, who were screened for a psychological risk profile, were randomized to either care as usual (CAU, n = 66) or ICBT in addition to CAU (n = 65). Participants filled out standardized self-report questionnaires assessing physical and psychological functioning and impact on daily activities at baseline, posttreatment assessment, and 6-month follow-up.
In covariate-controlled linear mixed-model analyses, significantly larger improvements in ICBT compared to CAU were found in the primary outcomes physical functioning (p = 0.03, d = 0.36) and impact on daily activities (p = 0.04, d = 0.35), but not in psychological functioning (p = 0.32), up to 6 months after treatment compared to baseline. In explorative analyses, the working alliance measured at the beginning of ICBT treatment predicted improved physical (p = 0.02) and psychological (p < 0.001) outcomes.
Results underline the promise of therapist-guided, individually tailored ICBT to improve physical functioning and reduce the impact of psoriasis on daily activities in patients with a psychological risk profile. Establishing a good therapeutic relationship early on may be an important factor that influences treatment outcomes in personalized ICBT interventions. Further research is needed to evaluate ICBT effectiveness in additional samples and to explore its underlying mechanisms.
患有躯体疾病（如银屑病）的患者在日常生活中常常承受着疾病的沉重负担，他们可能会受益于针对其适应问题的基于互联网的认知行为疗法（ICBT）。本多中心随机对照试验的目的是检验针对银屑病患者的临床样本，采用治疗师指导的、个体化定制的 ICBT 的效果。
共有 131 名银屑病患者接受了心理风险评估筛查，他们被随机分配到常规护理组（CAU，n=66）或在 CAU 的基础上接受 ICBT 组（n=65）。参与者在基线、治疗后评估和 6 个月随访时填写了评估身体和心理功能以及对日常生活影响的标准化自我报告问卷。
在协变量控制的线性混合模型分析中，与 CAU 相比，ICBT 在主要结局（身体功能：p=0.03，d=0.36；对日常生活的影响：p=0.04，d=0.35）方面的改善显著更大，但在心理功能方面没有差异（p=0.32），与治疗前相比，在治疗后 6 个月时得到了改善。在探索性分析中，ICBT 治疗开始时测量的工作联盟预测了身体功能（p=0.02）和心理功能（p<0.001）的改善。
研究结果强调了治疗师指导的、个体化定制的 ICBT 对改善身体功能和减轻有心理风险患者银屑病对日常生活的影响的潜力。在个性化的 ICBT 干预中，尽早建立良好的治疗关系可能是影响治疗效果的一个重要因素。需要进一步的研究来评估 ICBT 在其他样本中的有效性，并探讨其潜在机制。
