针对强迫症、惊恐障碍和社交焦虑障碍患者，通过视频会议提供实时治疗师支持的基于互联网的认知行为疗法：单臂试验试点

Internet-Based Cognitive Behavioral Therapy With Real-Time Therapist Support via Videoconference for Patients With Obsessive-Compulsive Disorder, Panic Disorder, and Social Anxiety Disorder: Pilot Single-Arm Trial.

作者信息

Matsumoto Kazuki, Sutoh Chihiro, Asano Kenichi, Seki Yoichi, Urao Yuko, Yokoo Mizue, Takanashi Rieko, Yoshida Tokiko, Tanaka Mari, Noguchi Remi, Nagata Shinobu, Oshiro Keiko, Numata Noriko, Hirose Motohisa, Yoshimura Kensuke, Nagai Kazue, Sato Yasunori, Kishimoto Taishiro, Nakagawa Akiko, Shimizu Eiji

机构信息

United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan.

Research Center for Child Mental Development, Graduate School of Medicine, Chiba University, Chiba, Japan.

出版信息

J Med Internet Res. 2018 Dec 17;20(12):e12091. doi: 10.2196/12091.

DOI:10.2196/12091

PMID:30559094

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6315259/

Abstract

BACKGROUND

Cognitive behavioral therapy (CBT) is the first-line treatment for adults with obsessive-compulsive disorder (OCD), panic disorder (PD), and social anxiety disorder (SAD). Patients in rural areas can access CBT via the internet. The effectiveness of internet-delivered cognitive behavioral therapy (ICBT) has been consistently shown, but no clinical studies have demonstrated the feasibility of ICBT with real-time therapist support via videoconference for OCD, PD, and SAD at the same time.

OBJECTIVES

This study aimed to evaluate the feasibility of videoconference-delivered CBT for patients with OCD, PD, or SAD.

METHODS

A total of 30 Japanese participants (mean age 35.4 years, SD 9.2) with OCD, SAD, or PD received 16 sessions of individualized videoconference-delivered CBT with real-time support of a therapist, using tablet personal computer (Apple iPad Mini 2). Treatment involved individualized CBT formulations specific to the presenting diagnosis; all sessions were provided by the same therapist. The primary outcomes were reduction in symptomatology, using the Yale-Brown obsessive-compulsive scale (Y-BOCS) for OCD, Panic Disorder Severity Scale (PDSS) for PD, and Liebowitz Social Anxiety Scale (LSAS) for SAD. The secondary outcomes included the EuroQol-5 Dimension (EQ-5D) for Quality of Life, the Patient Health Questionnaire (PHQ-9) for depression, the Generalized Anxiety Disorder (GAD-7) questionnaire for anxiety, and Working Alliance Inventory-Short Form (WAI-SF). All primary outcomes were assessed at baseline and at weeks 1 (baseline), 8 (midintervention), and 16 (postintervention) face-to-face during therapy. The occurrence of adverse events was observed after each session. For the primary analysis comparing between pre- and posttreatments, the participants' points and 95% CIs were estimated by the paired t tests with the change between pre- and posttreatment.

RESULTS

A significant reduction in symptom of obsession-compulsion (Y-BOCS=-6.2; Cohen d=0.74; 95% CI -9.4 to -3.0, P=.002), panic (PDSS=-5.6; Cohen d=0.89; 95% CI -9.83 to -1.37; P=.02), social anxiety (LSAS=-33.6; Cohen d=1.10; 95% CI -59.62 to -7.49, P=.02) were observed. In addition, depression (PHQ-9=-1.72; Cohen d=0.27; 95% CI -3.26 to -0.19; P=.03) and general anxiety (GAD-7=-3.03; Cohen d=0.61; 95% CI -4.57 to -1.49, P<.001) were significantly improved. Although there were no significant changes at 16 weeks from baseline in EQ-5D (0.0336; Cohen d=-0.202; 95% CI -0.0198 to 0.00869; P=.21), there were high therapeutic alliance (ie, WAI-SF) scores (from 68.0 to 73.7) throughout treatment, which significantly increased (4.14; 95% CI 1.24 to 7.04; P=.007). Of the participants, 86% (25/29) were satisfied with videoconference-delivered CBT, and 83% (24/29) preferred videoconference-delivered CBT to face-to-face CBT. An adverse event occurred to a patient with SAD; the incidence was 3% (1/30).

CONCLUSIONS

Videoconference-delivered CBT for patients with OCD, SAD, and SAD may be feasible and acceptable.

摘要

背景

认知行为疗法（CBT）是成人强迫症（OCD）、惊恐障碍（PD）和社交焦虑障碍（SAD）的一线治疗方法。农村地区的患者可以通过互联网获得CBT治疗。互联网提供的认知行为疗法（ICBT）的有效性已得到持续证实，但尚无临床研究证明通过视频会议获得实时治疗师支持的ICBT同时用于强迫症、惊恐障碍和社交焦虑障碍的可行性。

目的

本研究旨在评估通过视频会议提供的CBT对强迫症、惊恐障碍或社交焦虑障碍患者的可行性。

方法

共有30名患有强迫症、社交焦虑障碍或惊恐障碍的日本参与者（平均年龄35.4岁，标准差9.2），使用平板电脑（苹果iPad Mini 2），在治疗师的实时支持下，接受了16节个性化视频会议形式的CBT治疗。治疗采用针对所呈现诊断的个性化CBT方案；所有疗程均由同一位治疗师提供。主要结局是症状减轻，使用耶鲁-布朗强迫症量表（Y-BOCS）评估强迫症，惊恐障碍严重程度量表（PDSS）评估惊恐障碍，利博维茨社交焦虑量表（LSAS）评估社交焦虑障碍。次要结局包括用于评估生活质量的欧洲五维健康量表（EQ-5D）、用于评估抑郁的患者健康问卷（PHQ-9）、用于评估焦虑的广泛性焦虑障碍问卷（GAD-7）以及工作联盟量表简版（WAI-SF）。所有主要结局在基线时以及治疗期间第1周（基线）、第8周（干预中期）和第16周（干预后）进行面对面评估。每次疗程后观察不良事件的发生情况。对于治疗前后比较的主要分析，通过配对t检验估计参与者的得分和95%置信区间，比较治疗前后的变化。

结果

观察到强迫症状（Y-BOCS=-6.2；Cohen d=0.74；95%置信区间-9.4至-3.0，P=0.002）、惊恐症状（PDSS=-5.6；Cohen d=0.89；95%置信区间-9.83至-1.37；P=0.02）、社交焦虑症状（LSAS=-33.6；Cohen d=1.10；95%置信区间-59.62至-7.49，P=0.02）显著减轻。此外，抑郁（PHQ-9=-1.72；Cohen d=0.27；95%置信区间-3.26至-0.19；P=0.03）和广泛性焦虑（GAD-7=-3.03；Cohen d=0.61；95%置信区间-4.57至-1.49，P<0.001）也有显著改善。虽然EQ-5D从基线到16周无显著变化（0.0336；Cohen d=-0.202；95%置信区间-0.0198至0.00869；P=0.21），但整个治疗过程中治疗联盟（即WAI-SF）得分较高（从68.0到73.7），且显著增加（4.14；95%置信区间1.24至7.04；P=0.007）。86%（25/29）的参与者对视频会议形式的CBT治疗满意，83%（24/29）的参与者更喜欢视频会议形式的CBT治疗而非面对面CBT治疗。一名社交焦虑障碍患者发生了不良事件；发生率为3%（1/30）。