Department of Psychology, Babeş-Bolyai University, Republicii 37, 400015, Cluj-Napoca, Romania; Department of Clinical Psychology and Psychotherapy, Bern University, Fabrikstrasse 8, 3012, Bern, Switzerland.
Department of Clinical Psychology and Psychotherapy, Bern University, Fabrikstrasse 8, 3012, Bern, Switzerland.
J Anxiety Disord. 2018 May;56:43-55. doi: 10.1016/j.janxdis.2018.03.009. Epub 2018 Mar 27.
A growing body of evidence suggests that Internet-based cognitive behavioral treatments (ICBT) are effective to treat anxiety disorders. However, the effect of therapist guidance in ICBT is still under debate and guided ICBT offered in a real-time audio-video communication format has not yet been systematically investigated. This three-arm RCT compared the efficacy of guided with unguided ICBT (12 weeks intervention) and a waitlist (WL). A total of 111 individuals meeting the diagnostic criteria for panic disorder (PD) were randomly assigned to one of three conditions. Primary outcomes were the severity of self-report panic symptoms and diagnostic status. Secondary outcomes were symptoms of depression, functional impairment, catastrophic cognitions, fear of sensations and body vigilance. At post-treatment, both active conditions showed superior outcomes regarding PD and associated symptoms (guided ICBT vs. WL: d = 1.04-1.36; unguided ICBT vs. WL: d = 0.70-1.06). At post-treatment, the two active conditions did not differ significantly in self-reported symptom reduction (d = 0.21-0.54, all ps > 0.05), but the guided treatment was superior to the unguided treatment in terms of diagnostic status (χ (1) = 13.15, p < 0.01). Treatment gains were maintained at successive follow-ups and the guided treatment became superior to the unguided treatment at 6 months follow-up (d = 0.72-1.05, all ps < 0.05).
越来越多的证据表明，基于互联网的认知行为治疗（ICBT）对于治疗焦虑症是有效的。然而，ICBT 中治疗师指导的效果仍存在争议，并且实时音频-视频通信格式提供的指导性 ICBT 尚未得到系统研究。这项三臂 RCT 比较了指导性 ICBT（12 周干预）与等待名单（WL）和非指导性 ICBT 的疗效。共有 111 名符合惊恐障碍（PD）诊断标准的个体被随机分配到三个条件之一。主要结局是自我报告的惊恐症状严重程度和诊断状况。次要结局是抑郁症状、功能障碍、灾难性认知、对感觉和身体警觉的恐惧。在治疗后，两种主动治疗在 PD 和相关症状方面均显示出更好的结果（指导性 ICBT 与 WL：d=1.04-1.36；非指导性 ICBT 与 WL：d=0.70-1.06）。在治疗后，两种主动治疗在自我报告的症状减轻方面没有显著差异（d=0.21-0.54，所有 p 值均大于 0.05），但指导性治疗在诊断状况方面优于非指导性治疗（χ(1)=13.15，p<0.01）。治疗效果在随后的随访中得到维持，并且在 6 个月随访时，指导性治疗优于非指导性治疗（d=0.72-1.05，所有 p 值均小于 0.05）。
