Georgia Salivar Emily J, Rothman Karen, Roddy McKenzie K, Doss Brian D
College of Psychology, Nova Southeastern University, Fort Lauderdale, FL.
Department of Psychology, University of Miami, Coral Gables, FL.
Fam Process. 2020 Mar;59(1):66-80. doi: 10.1111/famp.12414. Epub 2018 Dec 10.
While the efficacy of couple therapy has been repeatedly demonstrated, most distressed couples do not seek treatment. To improve reach and overcome barriers to therapy, Integrative Behavioral Couple Therapy (IBCT) was translated into a web-based program, OurRelationship (OR). While both IBCT and OR have been shown to improve relationship and individual functioning, the goal of the present study was to compare the relative cost effectiveness of these two treatment modalities. In IBCT, 74% of couples experienced reliable improvement, compared to 55% of couples in OR. Within-group Cohen's d effect sizes during treatment for relationship satisfaction were d = 0.87 for IBCT and d = 0.96 for OR. Relative cost effectiveness analyses revealed that even at the highest expense estimates for OR and the lowest expense estimates for IBCT, OR was more cost effective in creating reliable improvement once at least 229 couples were served and was more cost effective in creating large-size effects once at least 153 couples were served. Cost-effectiveness increases for both IBCT and OR as more couples are served; however, this cost savings occurs at a much more rapid rate for OR. These findings demonstrate that despite higher initial development costs, Internet programs are a cost-effective option for dissemination either as a stand-alone service or as an initial intervention in a stepped care model with more intensive in-person services.
虽然夫妻治疗的疗效已得到反复证明，但大多数处于困扰中的夫妻并未寻求治疗。为了扩大覆盖面并克服治疗障碍，整合行为夫妻治疗（IBCT）被转化为一个基于网络的项目“我们的关系”（OR）。虽然IBCT和OR都已被证明能改善关系和个人功能，但本研究的目的是比较这两种治疗方式的相对成本效益。在IBCT中，74%的夫妻有可靠的改善，而在OR中这一比例为55%。治疗期间关系满意度的组内科恩d效应量，IBCT为d = 0.87，OR为d = 0.96。相对成本效益分析显示，即使按照OR的最高费用估计和IBCT的最低费用估计，一旦至少为229对夫妻提供服务，OR在产生可靠改善方面更具成本效益，一旦至少为153对夫妻提供服务，OR在产生大效应方面更具成本效益。随着服务的夫妻数量增加，IBCT和OR的成本效益都会提高；然而，OR的成本节约速度要快得多。这些发现表明，尽管初始开发成本较高，但互联网项目作为独立服务或在逐步护理模式中作为初始干预措施，与更密集的面对面服务相结合，是一种具有成本效益的传播选择。
