Spence Susan H, March Sonja, Donovan Caroline L
Griffith University, Australia.
The University of Southern Queensland, School of Psychology and Counselling, Australia.
Internet Interv. 2019 Aug 22;18:100268. doi: 10.1016/j.invent.2019.100268. eCollection 2019 Dec.
Although self-help, internet-based cognitive behaviour therapy (ICBT) can produce significant reductions in anxiety for many young people, a sizable proportion show low program adherence and continue to show anxiety problems after treatment. It is important that we identify factors that predict those most likely to complete program sessions and benefit from self-help ICBT so that we can better match interventions to individual needs, and inform program design and development.
This study examined the role of social support in predicting treatment adherence and outcome among youth enrolled in an open-access, internet-delivered, CBT intervention targeting anxiety.
Participants were 3684 young people (aged 7 to 17 years) who reported elevated levels of anxiety symptoms when registering for the program. Treatment adherence was assessed as number of treatment sessions completed. Treatment response was evaluated as change in self-reported anxiety symptoms. Youth-reported social support (from friends, family and a special person) at pre-treatment was examined as a hypothesized predictor of adherence and outcome after controlling for baseline anxiety, gender, and age, with age being examined as a moderator.
Linear regression analyses showed that participants with greater social support, from all sources, tended to show greater program adherence, although the proportion of explained variance was small. Age moderated the effect of family support upon adherence, such that greater family support was associated with greater number of sessions completed only for older youth. Greater family and total support were associated with greater reductions in anxiety, irrespective of participant age, but again the percent of variance explained was small. Younger participants were more likely to complete more sessions and to show greater reductions in anxiety. Those with higher pre-treatment anxiety tended to complete fewer sessions but demonstrated greater reductions in anxiety.
The findings highlight the need to consider ways to enhance treatment adherence and outcome of those engaging in self-help ICBT for youth anxiety problems, particularly when social support is low.
尽管基于互联网的自助式认知行为疗法（ICBT）能使许多年轻人的焦虑感显著降低，但仍有相当一部分人治疗依从性较低，且治疗后仍存在焦虑问题。识别那些最有可能完成治疗课程并从自助式ICBT中获益的预测因素非常重要，这样我们就能更好地使干预措施与个体需求相匹配，并为项目设计和开发提供参考。
本研究探讨了社会支持在预测参加以焦虑为目标的开放式互联网认知行为疗法干预的青少年治疗依从性和治疗效果方面的作用。
参与者为3684名7至17岁的青少年，他们在报名参加该项目时报告焦虑症状水平较高。治疗依从性通过完成的治疗课程数量来评估。治疗反应通过自我报告的焦虑症状变化来评估。在控制了基线焦虑、性别和年龄后，将青少年报告的治疗前来自朋友、家人和一个特殊人物的社会支持作为依从性和治疗效果的假设预测因素进行检验，年龄作为调节变量进行考察。
线性回归分析表明，来自所有来源的社会支持较多的参与者往往治疗依从性更高，尽管解释的方差比例较小。年龄调节了家庭支持对依从性的影响，即只有年龄较大的青少年，更多的家庭支持才与完成更多课程相关。更多的家庭支持和总体支持与焦虑水平的更大降低相关，与参与者年龄无关，但同样解释的方差百分比很小。较年轻的参与者更有可能完成更多课程并表现出焦虑水平的更大降低。治疗前焦虑水平较高的人往往完成的课程较少，但焦虑水平降低幅度更大。
研究结果凸显了需要考虑如何提高针对青少年焦虑问题进行自助式ICBT治疗的依从性和治疗效果，尤其是在社会支持较低的情况下。
