Duffy Daniel, Enrique Angel, Connell Sarah, Connolly Conor, Richards Derek
Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland.
E-Mental Health Research Group, School of Psychology, Trinity College, Dublin, Ireland.
Front Psychiatry. 2020 Jan 9;10:902. doi: 10.3389/fpsyt.2019.00902. eCollection 2019.
The UK's Improving Access to Psychological Therapies (IAPT) program is a stepped-care model treating individuals with depression and anxiety disorders. Internet-delivered cognitive behavioral therapy (iCBT) is routinely offered to individuals with mild to moderate symptoms, but its applicability to individuals with severe clinical symptoms and requiring a high-intensity intervention is relatively unknown. The current study sought to investigate the potential impacts of using iCBT as a prequel for patients requiring high-intensity treatment (HIT; face-to-face) for depression and anxiety in IAPT. The study utilized an open study design. One hundred and twenty-four participants who were on a waiting list for high-intensity, face-to-face psychological treatment were offered iCBT. Psychometric data on symptoms of depression, anxiety, and functioning were collected from participants before starting and on finishing iCBT and at the point of service exit. Therapeutic alliance data were collected from patients and clinicians during treatment. Patient pathway data, such as number of treatment sessions and time in treatment, was also collected and incorporated into the analysis. Significant reductions across primary outcome measures of depression and anxiety, as well as improved functioning, were observed from baseline to iCBT treatment exit, and from iCBT exit to service exit. Analysis of the therapeutic alliance data for patients and clinicians illustrated differences in outcome for those who dropped out and those who completed treatment. This study illustrates the potential for using iCBT as a prequel to high-intensity therapy for depression and anxiety disorders and is the first of its kind to do so within IAPT stepped care. The results show that iCBT is a valuable option reducing waiting times and enhancing clinical efficiency. The study contributes to the well-established evidence on online psychological treatments worldwide, but further clinical and service development research is necessary to scale these treatments appropriately.
英国的改善心理治疗可及性（IAPT）项目是一种针对抑郁症和焦虑症患者的分级护理模式。对于症状较轻至中度的个体，常规会提供互联网认知行为疗法（iCBT），但其对具有严重临床症状且需要高强度干预的个体的适用性相对未知。本研究旨在调查在IAPT中，将iCBT用作需要高强度治疗（HIT；面对面治疗）的抑郁症和焦虑症患者的前期治疗的潜在影响。该研究采用了开放式研究设计。为124名在等待高强度面对面心理治疗的参与者提供了iCBT。在开始和结束iCBT之前以及服务结束时，收集了参与者关于抑郁、焦虑症状及功能状况的心理测量数据。在治疗期间收集了患者和临床医生的治疗联盟数据。还收集了患者治疗路径数据，如治疗疗程数和治疗时间，并纳入分析。从基线到iCBT治疗结束，以及从iCBT结束到服务结束，观察到抑郁和焦虑的主要结局指标显著降低，功能状况得到改善。对患者和临床医生的治疗联盟数据分析表明，退出治疗者和完成治疗者在结局方面存在差异。本研究说明了将iCBT用作抑郁症和焦虑症高强度治疗的前期治疗的潜力，并且是IAPT分级护理中首个这样做的研究。结果表明，iCBT是减少等待时间和提高临床效率的有价值选择。该研究为全球范围内关于在线心理治疗的充分证据做出了贡献，但需要进一步的临床和服务开发研究来适当推广这些治疗方法。
