Tulbure Bogdan Tudor, Rusu Andrei, Sava Florin Alin, Sălăgean Nastasia, Farchione Todd J
Psychology Department, West University of Timisoara, Timisoara, Romania.
Center for Anxiety and Related Disorders, Department of Psychology, Boston University, Boston, MA, United States.
JMIR Ment Health. 2018 May 24;5(2):e36. doi: 10.2196/mental.8901.
Research increasingly supports a transdiagnostic conceptualization of emotional disorders (ie applying the same underlying treatment principles across mental disorders, without tailoring the protocol to specific diagnoses), and many international researchers are currently investigating this issue.
The aim of this study was to evaluate the efficacy and acceptability of a Web-based transdiagnostic program using a sample of Romanian adults diagnosed with anxiety and/or depression.
Volunteer participants registered for the study and completed a series of online self-report measures. Participants who fulfilled basic inclusion criteria on these measures were contacted for a telephone diagnostic interview using the Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, 4th Edition Axis I Disorders (SCID-I). Enrolled participants were randomized to either the active treatment group (N=69) or the wait-list control group (N=36) using a 2:1 ratio. The transdiagnostic treatment was based on the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP; Barlow et al, 2011) that addresses common underlying mechanisms of anxiety and depression. Participants randomized to the active treatment condition received 10 weeks of Web-based treatment based on the UP. Throughout treatment, graduate students in clinical psychology provided guidance that consisted of asynchronous written communication on a secure Web platform. After the intervention, participants in both study conditions were invited to complete a set of self-report measures and a postintervention SCID-I interview conducted by a different team of graduate students blinded to participants' group and diagnostic status. Six months later, participants in the active treatment group were invited to complete an online follow-up assessment.
During the intervention, active treatment participants completed on average 19 homework assignments (SD 12.10), and we collected data from 79.0% (83/105) at postintervention and 51% (35/69) at follow-up for self-report measures. Postintervention SCID-I interviews were collected from 77.1% (81/105) participants. Relative to the wait-list control group, the transdiagnostic intervention yielded overall medium to large effect sizes for the primary outcome measures (within-group Hedges g=0.52-1.34 and between-group g=0.39-0.86), and also for anxiety sensitivity (g=0.80), symptom interference (g=0.48), and quality of life (g=0.38). Significant within-groups effects only were reported for the active treatment group on Panic Disorder Severity Scale-Self Report (PDSS-SR, g=0.58-0.65) and Yale-Brown Obsessive Compulsive Scale (Y-BOCS, g=0.52-0.58).
Insignificant between-group differences for the Y-BOCS and PDSS-SR could be explained by the small number of participants with the associated primary diagnostic (eg, only 3 participants with obsessive compulsive disorder) by the choice of outcome measure (PDSS-SR was not rated among the evidence-based measures) and by the fact that these disorders may be more difficult to treat. However, the overall results suggest that the transdiagnostic intervention tested in this study represents an effective treatment option that may prove easier to disseminate through the use of Web-based delivery systems.
ClinicalTrials.gov CT02739607; https://clinicaltrials.gov/ct2/show/study/NCT02739607 (Archived by WebCite at http://www.webcitation.org/6yY1VeYIZ).
越来越多的研究支持对情绪障碍进行跨诊断概念化（即对各种精神障碍应用相同的潜在治疗原则，而不针对特定诊断定制方案），目前许多国际研究人员正在调查这一问题。
本研究旨在以罗马尼亚被诊断患有焦虑症和/或抑郁症的成年人为样本，评估基于网络的跨诊断项目的疗效和可接受性。
志愿者参与者注册参加研究并完成一系列在线自我报告测量。对在这些测量中符合基本纳入标准的参与者进行电话诊断访谈，使用《精神障碍诊断与统计手册》第四版轴I障碍的结构性临床访谈（SCID-I）。使用2:1的比例将入选的参与者随机分为积极治疗组（N = 69）或等待名单对照组（N = 36）。跨诊断治疗基于情绪障碍跨诊断治疗统一方案（UP；Barlow等人，2011年），该方案针对焦虑和抑郁的共同潜在机制。随机分配到积极治疗组的参与者接受了为期10周的基于UP的网络治疗。在整个治疗过程中，临床心理学研究生提供指导，包括在安全的网络平台上进行异步书面交流。干预后，邀请两个研究组的参与者完成一组自我报告测量，并由另一组对参与者的分组和诊断状态不知情的研究生进行干预后SCID-I访谈。六个月后，邀请积极治疗组的参与者完成在线随访评估。
在干预期间，积极治疗组的参与者平均完成了19项家庭作业（标准差12.10），我们在干预后收集了79.0%（83/105）参与者的数据，在随访时收集了51%（35/69）参与者的自我报告测量数据。干预后SCID-I访谈收集了77.1%（81/105）参与者的数据。相对于等待名单对照组，跨诊断干预对主要结局指标产生了总体中等至较大的效应量（组内Hedges g = 0.52 - 1.34，组间g = 0.39 - 0.86），对焦虑敏感性（g = 0.80）、症状干扰（g = 0.48）和生活质量（g = 0.38）也有显著影响。仅在积极治疗组中报告了在惊恐障碍严重程度量表-自我报告（PDSS-SR，g = 0.58 - 0.65）和耶鲁-布朗强迫量表（Y-BOCS，g = 0.52 - 0.58）上有显著的组内效应。
Y-BOCS和PDSS-SR组间差异不显著可能是由于相关原发性诊断的参与者数量较少（例如，只有3名强迫症患者）、结局测量的选择（PDSS-SR未被列为循证测量）以及这些障碍可能更难治疗。然而，总体结果表明，本研究中测试的跨诊断干预是一种有效的治疗选择，通过基于网络的交付系统进行传播可能更容易。
ClinicalTrials.gov CT02739607；https://clinicaltrials.gov/ct2/show/study/NCT02739607（由WebCite存档于http://www.webcitation.org/6yY1VeYIZ）。
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