Rozental Alexander, Andersson Gerhard, Carlbring Per
Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
Institute of Child Health, University College London, London, United Kingdom.
Front Psychol. 2019 Mar 29;10:589. doi: 10.3389/fpsyg.2019.00589. eCollection 2019.
Negative effects of psychological treatments have recently received increased attention in both research and clinical practice. Most investigations have focused on determining the occurrence and characteristics of deterioration and other adverse and unwanted events, such as interpersonal issues, indicating that patients quite frequently experience such incidents in treatment. However, non-response is also negative if it might have prolonged an ongoing condition and caused unnecessary suffering. Yet few attempts have been made to directly explore non-response in psychological treatment or its plausible causes. Internet-based cognitive behavior therapy (ICBT) has been found effective for a number of diagnoses but has not yet been systematically explored with regard to those patients who do not respond. The current study collected and aggregated data from 2,866 patients in 29 clinical randomized trials of ICBT for three categories of diagnoses: anxiety disorders, depression, and other (erectile dysfunction, relationship problems, and gambling disorder). Raw scores from each patient variable were used in an individual patient data meta-analysis to determine the rate of non-response on the primary outcome measure for each clinical trial, while its potential predictors were examined using binomial logistic regression. The reliable change index (RCI) was used to classify patients as non-responders. Of the 2,118 patients receiving treatment, and when applying a RCI of ≥ 1.96, 567 (26.8%) were classified as non-responders. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline, Odds Ratio () = 2.04, having a primary anxiety disorder ( = 5.75), and being of male gender ( = 1.80), might have higher odds of not responding to treatment. Non-response seems to occur among approximately a quarter of all patients in ICBT, with predictors related to greater symptoms, anxiety disorders, and gender indicating increasing the odds of not responding. However, the results need to be replicated before establishing their clinical relevance, and the use of the RCI as a way of determining non-response needs to be validated by other means, such as by interviewing patients classified as non-responders.
心理治疗的负面影响最近在研究和临床实践中都受到了越来越多的关注。大多数调查都集中在确定病情恶化以及其他不良和意外事件（如人际关系问题）的发生情况和特征，这表明患者在治疗过程中相当频繁地经历此类事件。然而，如果无反应可能延长了持续的病情并造成了不必要的痛苦，那么它也是负面的。然而，很少有人尝试直接探究心理治疗中的无反应情况或其可能的原因。基于互联网的认知行为疗法（ICBT）已被发现对多种诊断有效，但尚未对无反应的患者进行系统研究。本研究收集并汇总了29项ICBT临床随机试验中2866名患者的数据，这些试验涉及三类诊断：焦虑症、抑郁症和其他疾病（勃起功能障碍、关系问题和赌博障碍）。在个体患者数据荟萃分析中，使用每个患者变量的原始分数来确定每项临床试验主要结局指标的无反应率，同时使用二项逻辑回归分析其潜在预测因素。可靠变化指数（RCI）用于将患者分类为无反应者。在接受治疗的2118名患者中，当应用RCI≥1.96时，567名（26.8%）被分类为无反应者。在预测因素方面，基线时主要结局指标症状严重程度较高的患者，优势比（OR）=2.04，患有原发性焦虑症（OR=5.75），以及男性（OR=1.80），可能对治疗无反应的几率更高。在ICBT的所有患者中，约四分之一似乎会出现无反应情况，与症状更严重、焦虑症和性别相关的预测因素表明无反应的几率增加。然而，在确定其临床相关性之前，结果需要重复验证，并且使用RCI作为确定无反应的方法需要通过其他手段进行验证，例如通过采访被分类为无反应者的患者。
