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在线治疗和混合治疗的优缺点:心理治疗师评估结果的复制与扩展

Advantages and disadvantages of online and blended therapy: Replication and extension of findings on psychotherapists' appraisals.

作者信息

Schuster Raphael, Topooco Naira, Keller Antonia, Radvogin Ella, Laireiter Anton-Rupert

机构信息

Outpatient Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria.

Department of Psychology, University of Salzburg, Salzburg, Austria.

出版信息

Internet Interv. 2020 May 7;21:100326. doi: 10.1016/j.invent.2020.100326. eCollection 2020 Sep.

Abstract

Therapists hold a key role for the uptake of digital mental health interventions (DMHI) within regular care services but have demonstrated cautious attitudes towards such interventions. It is relevant to explore in detail what factors may positively influence therapists' perception when considering DMHI implementation within routine care. We recently assessed therapist views towards Internet-based and blended treatment in Austria (low implementation level). The present study aims at testing the reliability of previous findings, and moreover, it compares therapists' appraisals to a country with advanced DMHI implementation (Sweden). An online survey was conducted February through June of 2019. Respondents were recruited via email and social media. The survey assessed first-hand experience with Internet-based treatment (IT) and blended treatment (BT). To start, the survey presented a short informational video to half of the respondents, then assessed therapists' views on 17 advantages and 13 disadvantages of IT and BT on 6-point Likert scales. In total  = 300 therapists responded to the invitation, of which  = 165 provided full survey data (Germany 114/220, 52%; Sweden 51/80, 64%). German therapists rated the advantages of IT and BT as neutral (IT, M = 3.6; BT, M = 3.8) and to some extent agreed with disadvantages of IT (IT, M = 4.5; BT, M = 3.5). In comparison, Swedish therapists rated significantly greater advantages (IT, M = 4.6; BT, M = 4.5) and less disadvantages (IT, M = 3.2; BT, M = 2.8). Effect sizes ranged from d = 0.89 to d = 1.83; all P's < .001. Those with first-hand experience with DMHI reported more positive appraisals in both countries. No significant effect was found for exposure to the short informational video. The German sample represented essential characteristics of current German therapists; in comparison Swedish respondents skewed towards younger less experienced therapists (P's < .001). Those confounders accounted for a small non-significant proportion of variance (0.1-4.7%). We found that therapists considered blended treatment to have less disadvantages than Internet treatment, and that first-hand experience with DMHI, but not exposure to an acceptance facilitating video clip, predicted greater acceptability on individual level. The responses among German therapists closely resembled findings from our preceding study in Austria, indicating that reliable results can be achieved in small survey studies if sample and population parameters correspond. Swedish therapists held significantly more favorable attitudes towards both interventions. The comparison between countries, however, is limited by a number of potential confounding variables.

摘要

治疗师在常规护理服务中对数字心理健康干预措施(DMHI)的采用起着关键作用,但他们对这类干预措施表现出谨慎的态度。详细探究在常规护理中考虑实施DMHI时,哪些因素可能对治疗师的认知产生积极影响是很有必要的。我们最近评估了奥地利治疗师对基于互联网和混合治疗的看法(实施水平较低)。本研究旨在检验先前研究结果的可靠性,此外,还将治疗师的评估结果与DMHI实施先进的国家(瑞典)进行比较。2019年2月至6月进行了一项在线调查。通过电子邮件和社交媒体招募受访者。该调查评估了基于互联网治疗(IT)和混合治疗(BT)的第一手经验。首先,调查向一半的受访者播放了一段简短的信息视频,然后在6点李克特量表上评估治疗师对IT和BT的17个优点和13个缺点的看法。共有300名治疗师回复了邀请,其中165名提供了完整的调查数据(德国114/220,52%;瑞典51/80,64%)。德国治疗师对IT和BT的优点评价为中性(IT,M = 3.6;BT,M = 3.8),并在一定程度上认同IT的缺点(IT,M = 4.5;BT,M = 3.5)。相比之下,瑞典治疗师对优点的评价明显更高(IT,M = 4.6;BT,M = 4.5),对缺点的评价更低(IT,M = 3.2;BT,M = 2.8)。效应大小范围从d = 0.89到d = 1.83;所有P值<0.001。在两个国家中,有DMHI第一手经验的人报告了更积极的评价。未发现观看简短信息视频有显著影响。德国样本代表了当前德国治疗师的基本特征;相比之下,瑞典受访者倾向于更年轻、经验更少的治疗师(P值<0.001)。这些混杂因素在方差中所占比例较小且不显著(0.1 - 4.7%)。我们发现治疗师认为混合治疗的缺点比互联网治疗少,并且DMHI的第一手经验,而不是观看一段促进接受的视频片段,在个体层面上预测了更高的可接受性。德国治疗师的回答与我们之前在奥地利的研究结果非常相似,这表明如果样本和总体参数相符,在小型调查研究中可以获得可靠的结果。瑞典治疗师对这两种干预措施的态度明显更积极。然而,国家之间的比较受到一些潜在混杂变量的限制。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/0b62/7251770/5b27a0473d4e/gr1.jpg

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