Nissen Eva Rames, Zachariae Robert, O'Connor Maja, Kaldo Viktor, Jørgensen Carsten René, Højris Inger, Borre Michael, Mehlsen Mimi
Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark.
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Internet Interv. 2021 Jan 14;23:100365. doi: 10.1016/j.invent.2021.100365. eCollection 2021 Mar.
The present study investigates possible predictors of treatment response in an Internet-delivered Mindfulness-Based Cognitive Therapy (iMBCT) intervention with therapist support. This iMBCT program, a fully online delivered intervention with asynchronous therapist support, has previously been shown to be efficacious in reducing symptoms of anxiety and depression in women treated for breast cancer and men treated for prostate cancer.
Eighty-two breast- and prostate cancer survivors experiencing psychological distress received 8 weeks of therapist-guided iMBCT. Primary outcomes were improvement in anxiety and depression scores from baseline to post-treatment and from baseline to six-months follow-up. Clinical predictors included levels of depression and anxiety at the time of screening and at baseline, as well as time since diagnosis. Demographic predictors included age and educational level. Therapy-related predictors included working alliance, self-compassion, and five facets of mindfulness. Mixed Linear Models were employed to test the prediction effects over time.
Higher levels of baseline depression were associated with increased treatment response in anxiety at post-treatment, and lower levels of self-compassion were associated with increased treatment response in depression at post-treatment. None of the proposed predictors significantly predicted treatment response at six-months follow-up.
The findings suggest that iMBCT can be provided for cancer survivors regardless of their age, educational level, and time since diagnosis (up to five years) and that therapeutic alliance is not crucial for treatment response. We did not identify characteristics predicting treatment response, although many factors were tested. Still, other characteristics may be predictors, and given the relatively small sample size and a large number of statistical tests, the results should be interpreted with caution.
本研究调查了在有治疗师支持的基于正念的认知疗法（iMBCT）互联网干预中治疗反应的可能预测因素。这种iMBCT项目是一种完全在线提供且有异步治疗师支持的干预措施，此前已被证明在减轻乳腺癌女性患者和前列腺癌男性患者的焦虑和抑郁症状方面有效。
82名经历心理困扰的乳腺癌和前列腺癌幸存者接受了为期8周的治疗师指导的iMBCT。主要结局是从基线到治疗后以及从基线到六个月随访时焦虑和抑郁评分的改善情况。临床预测因素包括筛查时和基线时的抑郁和焦虑水平，以及诊断后的时间。人口统计学预测因素包括年龄和教育水平。与治疗相关的预测因素包括工作联盟、自我同情和正念的五个方面。采用混合线性模型来测试随时间的预测效果。
较高的基线抑郁水平与治疗后焦虑治疗反应的增加相关，较低的自我同情水平与治疗后抑郁治疗反应的增加相关。在六个月随访时，所提出的预测因素均未显著预测治疗反应。
研究结果表明，无论癌症幸存者的年龄、教育水平和诊断后的时间（长达五年）如何，都可以提供iMBCT，并且治疗联盟对治疗反应并不关键。尽管测试了许多因素，但我们并未确定预测治疗反应的特征。不过，其他特征可能是预测因素，鉴于样本量相对较小且进行了大量统计测试，结果应谨慎解释。
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