Stjerneklar Silke, Hougaard Esben, Thastum Mikael
Department of Psychology and Behavioral Sciences, Aarhus BSS, Aarhus University, Bartholins Allé 9, 8000 Aarhus C, Denmark.
Internet Interv. 2019 Jan 31;15:116-125. doi: 10.1016/j.invent.2019.01.003. eCollection 2019 Mar.
Guided internet-based cognitive behavioral therapy (ICBT) has been found efficacious in reducing symptoms of anxiety in adolescents with anxiety disorders, but not all respond equally well.
In this study, we explored candidate predictors of ICBT treatment response within the frame of a randomized controlled trial.
Sixty-five adolescents (13-17 years) with anxiety disorders according to DSM-IV received 14 weeks of therapist-guided ICBT. Outcome was evaluated as improvement (continuous change score) from pre-treatment to 12-month follow-up according to self-reported anxiety symptoms and clinician-rated diagnostic severity. Clinical predictors included baseline self- and parent-reported anxiety symptom levels, baseline clinician-rated severity of primary diagnosis, summed baseline clinician-rated severity of all anxiety diagnoses, baseline self-rated depressive symptoms, age of onset, and primary diagnosis of social phobia. Demographic predictors included age, gender and computer comfortability. Therapy process-related predictors included number of completed modules and therapist phone calls, summed duration of therapist phone calls, degree of parent support, and therapeutic alliance. Multi-level models were used to test the prediction effects over time.
Higher levels of self- and clinician-rated baseline anxiety and self-rated depressive symptoms, female gender, and higher levels of computer comfortability were associated with increased treatment response. None of the proposed therapy process-related predictors significantly predicted treatment response.
The present findings indicate that ICBT may be an acceptable choice of treatment for youths, even those with relative high levels of anxiety and depressive symptoms.
基于互联网的认知行为疗法（ICBT）已被证明在减轻焦虑症青少年的焦虑症状方面有效，但并非所有患者的反应都同样良好。
在本研究中，我们在随机对照试验的框架内探索了ICBT治疗反应的候选预测因素。
65名符合《精神疾病诊断与统计手册》第四版（DSM-IV）标准的焦虑症青少年（13 - 17岁）接受了为期14周的治疗师指导的ICBT。根据自我报告的焦虑症状和临床医生评定的诊断严重程度，将治疗结果评估为从治疗前到12个月随访的改善情况（连续变化分数）。临床预测因素包括基线时自我和家长报告的焦虑症状水平、基线时临床医生评定的主要诊断严重程度、所有焦虑诊断的基线临床医生评定严重程度总和、基线时自我评定的抑郁症状、发病年龄以及社交恐惧症的主要诊断。人口统计学预测因素包括年龄、性别和计算机舒适度。与治疗过程相关的预测因素包括完成的模块数量和治疗师电话次数、治疗师电话总时长、家长支持程度以及治疗联盟。使用多层次模型来测试随时间的预测效果。
自我和临床医生评定的基线焦虑水平较高、自我评定的抑郁症状、女性性别以及较高的计算机舒适度与治疗反应增加相关。所提出的与治疗过程相关的预测因素均未显著预测治疗反应。
目前的研究结果表明，ICBT可能是青少年治疗的一种可接受选择，即使是那些焦虑和抑郁症状水平相对较高的青少年。
