Department of Psychosomatic Medicine and Psychotherapy, University Medical Center, Johannes Gutenberg University Mainz, Mainz, Germany.
Psychother Psychosom. 2017;86(6):341-350. doi: 10.1159/000481177. Epub 2017 Nov 3.
Depression is one of the most frequent and costly mental disorders. While there is increasing evidence for the efficacy of online self-help to improve depression or prevent relapse, there is little evidence in blended care settings, especially combined with inpatient face-to-face psychotherapy. Therefore, we evaluated whether an evidence-based online self-help program improves the efficacy of inpatient psychotherapy.
A total of 229 depressed patients were randomly allocated either to an online self-help program (intervention group [IG]; Deprexis) or an active control group (CG; weekly online information on depression) in addition to inpatient psychodynamic psychotherapy. Both groups had access to their respective experimental intervention for 12 weeks, regardless of inpatient treatment duration. Reduction of depressive symptoms, as measured with the Beck Depression Inventory-II, was the primary outcome at the end of the intervention (T2).
Depressive symptoms were statistically significantly lower in the IG compared to the active CG at T2 with a moderate between-group effect size of d = 0.44. The same applied to anxiety (d = 0.33), quality of life (d = 0.34), and self-esteem (d = 0.38) at discharge from inpatient treatment (T1). No statistically significant differences were found regarding dysfunctional attitudes (d = 0.14) and work ability (d = 0.08) at T1.
This is the first evidence for blended treatment combining online self-help with inpatient psychotherapy. The study opens new and promising avenues for increasing the efficacy of inpatient psychotherapy. Future studies should determine how integration of online self-help into the therapeutic process can be developed further.
抑郁症是最常见且代价最高的精神障碍之一。虽然有越来越多的证据表明在线自助疗法可以有效改善抑郁症或预防复发，但在混合护理环境中，尤其是与住院面对面心理疗法相结合的情况下，证据却很少。因此，我们评估了基于证据的在线自助计划是否可以提高住院心理疗法的疗效。
共有 229 名抑郁患者被随机分配到在线自助计划（干预组[IG]；Deprexis）或积极对照组（CG；每周在线提供有关抑郁症的信息）中，同时接受住院精神动力心理疗法。无论住院治疗时间长短，两组都可以在 12 周内使用各自的实验性干预措施。以贝克抑郁量表第二版（Beck Depression Inventory-II）测量的抑郁症状减轻是干预结束时（T2）的主要结局。
IG 中的抑郁症状明显低于 CG，组间差异具有中等效应量 d = 0.44。在出院时（T1），焦虑（d = 0.33）、生活质量（d = 0.34）和自尊（d = 0.38）也存在同样的情况。在 T1 时，在功能失调性态度（d = 0.14）和工作能力（d = 0.08）方面未发现统计学上的显着差异。
这是首次将在线自助疗法与住院心理疗法相结合的混合治疗证据。该研究为提高住院心理疗法的疗效开辟了新的、有前途的途径。未来的研究应确定如何进一步整合在线自助疗法到治疗过程中。
