Johansson Peter, Svensson Erland, Andersson Gerhard, Lundgren Johan
Department of Health, Medicine and Caring Sciences, Linköping University, Sweden.
Department of Internal Medicine, Linköping University, Sweden.
Eur J Cardiovasc Nurs. 2021 Feb 1;20(2):124-131. doi: 10.1177/1474515120947250.
There is a lack of knowledge about internet-based cognitive behavioural therapy in patients with cardiovascular disease, and its effects on depressive symptoms and physical activity.
To examine trajectories of depressive symptoms and physical activity, and to explore if these trajectories are linked with the delivery of internet-based cognitive behavioural therapy.
A secondary-analysis of data collected in a randomised controlled trial that evaluated the effects of a 9-week internet-based cognitive behavioural therapy programme compared to an online discussion forum on depressive symptoms in cardiovascular disease patients. Data were collected at baseline, once weekly during the 9-week intervention period and at the 9-week follow-up. The Montgomery Åsberg depression rating scale - self-rating (MADRS-S) was used to measure depressive symptoms. Two modified items from the physical activity questionnaire measuring frequency and length of physical activity were merged to form a physical activity factor.
After 2 weeks the internet-based cognitive behavioural therapy group had a temporary worsening in depressive symptoms. At 9-week follow-up, depressive symptoms (P<0.001) and physical activity (P=0.02) had improved more in the internet-based cognitive behavioural therapy group. Only in the internet-based cognitive behavioural therapy group, was a significant correlation (r=-0.39, P=0.002) between changes in depressive symptoms and changes in physical activity found. Structural equation analyses revealed that internet-based cognitive behavioural therapy decreased depressive symptoms, and that a decrease in depression, in turn, resulted in an increase in physical activity.
Internet-based cognitive behavioural therapy was more effective than an online discussion forum to decrease depressive symptoms and increase physical activity. Importantly, a decrease in depressive symptoms needs to precede an increase in physical activity.
心血管疾病患者对基于互联网的认知行为疗法缺乏了解，且不清楚其对抑郁症状和身体活动的影响。
研究抑郁症状和身体活动的轨迹，并探讨这些轨迹是否与基于互联网的认知行为疗法的实施有关。
对一项随机对照试验收集的数据进行二次分析，该试验评估了一个为期9周的基于互联网的认知行为疗法项目与一个在线讨论论坛相比，对心血管疾病患者抑郁症状的影响。在基线、9周干预期内每周一次以及9周随访时收集数据。使用蒙哥马利-奥斯伯格抑郁评定量表自评版（MADRS-S）来测量抑郁症状。将身体活动问卷中测量身体活动频率和时长的两个修改项目合并，形成一个身体活动因子。
2周后，基于互联网的认知行为疗法组的抑郁症状出现暂时恶化。在9周随访时，基于互联网的认知行为疗法组的抑郁症状（P<0.001）和身体活动（P=0.02）改善得更多。仅在基于互联网的认知行为疗法组中，发现抑郁症状变化与身体活动变化之间存在显著相关性（r=-0.39，P=0.002）。结构方程分析表明，基于互联网的认知行为疗法可减轻抑郁症状，而抑郁症状的减轻反过来又会导致身体活动增加。
基于互联网的认知行为疗法在减轻抑郁症状和增加身体活动方面比在线讨论论坛更有效。重要的是，身体活动的增加需要在抑郁症状减轻之后。
