“调整支撑轮”——一项关于患者对低强度认知行为疗法的体验和看法的定性研究。
"Unrigging the support wheels" - A qualitative study on patients' experiences with and perspectives on low-intensity CBT.
机构信息
Department of Clinical Psychology and Psychotherapy Research, University of Zurich, Zurich, Switzerland.
Department of Psychology, University of Zurich, Binzmühlestrasse 14/16, Zurich, Switzerland.
出版信息
BMC Health Serv Res. 2019 Oct 9;19(1):686. doi: 10.1186/s12913-019-4495-1.
BACKGROUND
Low-intensity treatments imply reduced therapist contact due to an emphasis on self-help and the use of technologies to deliver treatment. The role of the remoteness, the reduced therapist contact, and the interplay of these components has not been differentiated from a patients' perspective so far. This study's purpose is to capture patients' experiences with telephone-based self-help cognitive behavioural therapy (tel-CBT).
METHODS
A subsample of mildly to moderately depressed patients (N = 13) who finished tel-CBT as part of a larger randomised controlled trial (RCT) in routine care were interviewed using a semi-structured questionnaire. Interviews were audiotaped, transcribed verbatim, and independently coded by two coders blind to treatment outcome. Using qualitative content analysis with deductive and inductive procedures, a two-level category system was established.
RESULTS
The category system contains four category clusters regarding expectations, self-help related aspects, telephone-related aspects, and implications for patients' treatment pathway, and subsumes a total of 15 categories. Self-help related aspects circulate around the interplay between written materials and professional input, trust and support in the therapeutic relationship and its relation to the initial personal contact, as well as CBT principles. Telephone-related aspects entail perceived advantages and disadvantages of the telephone on an organisational and content level as well as a discourse around distance and closeness in the interaction. Although patients raised doubts regarding the long-term effect of the intervention on symptomatology, patients expressed satisfaction with the treatment and reported an immediate as well as a longer lasting personal impact of the treatment. These results indicate user acceptance with tel-CBT.
CONCLUSIONS
This qualitative analysis captures patients' experiences with tel-CBT and the perceived helpfulness of the diverse treatment components. This can facilitate refining aspects of low-intensity treatments and might improve dissemination.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02667366. Registered on 3 December 2015.
背景
低强度治疗意味着由于强调自助和使用技术来提供治疗，治疗师的接触减少。迄今为止，还没有从患者的角度区分这种距离、治疗师接触减少以及这些因素相互作用的作用。本研究的目的是捕捉患者对基于电话的自助认知行为疗法（tel-CBT）的体验。
方法
作为在常规护理中进行的更大随机对照试验（RCT）的一部分，完成 tel-CBT 的轻度至中度抑郁患者（N=13）的一个亚组接受了半结构化问卷采访。采访被录音、逐字转录，并由两个对治疗结果不知情的编码员进行独立编码。使用具有演绎和归纳程序的定性内容分析，建立了一个两级类别系统。
结果
类别系统包含四个类别集群，涉及期望、自助相关方面、电话相关方面以及对患者治疗途径的影响，总共有 15 个类别。自助相关方面围绕书面材料和专业投入之间的相互作用、治疗关系中的信任和支持及其与初始个人接触的关系以及 CBT 原则循环。电话相关方面涉及组织和内容层面上电话的感知优势和劣势，以及围绕互动中的距离和亲近感的论述。尽管患者对干预对症状的长期效果表示怀疑，但患者对治疗表示满意，并报告了治疗的即时和更持久的个人影响。这些结果表明患者对 tel-CBT 的接受程度。
结论
这项定性分析捕捉了患者对 tel-CBT 的体验以及对各种治疗成分的感知有用性。这可以促进改进低强度治疗的方面，并可能改善传播。
试验注册
ClinicalTrials.gov NCT02667366。于 2015 年 12 月 3 日注册。
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