混合式接纳与承诺疗法与面对面认知行为疗法治疗初级保健中老年焦虑症状患者的比较：实用单盲群组随机试验。
Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial.
机构信息
Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands.
Department Public Health & Primary Care, Leiden University Medical Center, Leiden, Netherlands.
出版信息
J Med Internet Res. 2021 Mar 26;23(3):e24366. doi: 10.2196/24366.
BACKGROUND
Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated.
OBJECTIVE
This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention.
METHODS
Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction.
RESULTS
Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=-.63, P=.26; T1-T3: B=-.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes.
CONCLUSIONS
The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life.
TRIAL REGISTRATION
Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131.
背景
老年人的焦虑症状普遍存在且具有致残性，但往往得不到治疗。大多数关于晚年生活中针对焦虑的心理干预的试验都检验了面对面认知行为疗法（CBT）的有效性。为了弥补当前的治疗差距，还应评估其他治疗方法和提供方式。
目的
本研究首次检验了一种针对有焦虑症状的老年人的简短混合接受与承诺疗法（ACT）干预与面对面 CBT 干预相比的有效性。
方法
从普通诊所招募年龄在 55-75 岁之间（n=314）、有轻度至中度严重焦虑症状的成年人，并将他们按簇随机分配到混合 ACT 或面对面 CBT 组。在基线（T0）、治疗后（T1）以及 6 个月和 12 个月随访（分别为 T2 和 T3）时进行评估。主要结局是焦虑症状严重程度（广泛性焦虑障碍 7 项量表）。次要结局是积极心理健康、抑郁症状严重程度、功能障碍、出现《精神障碍诊断与统计手册》第 5 版焦虑障碍以及治疗满意度。
结果
在研究期间，两种条件下的焦虑症状严重程度变化没有显著差异（T0-T1：B=.18，P=.73；T1-T2：B=-.63，P=.26；T1-T3：B=-.33，P=.59）。两种条件在治疗后焦虑症状均有较大程度的减轻（Cohen d≥0.96），并且在 12 个月的随访中得到了维持。混合 ACT 组和 CBT 组焦虑症状的临床显著变化率也没有差异（χ=0.2，P=.68）。关于次要结局，混合 ACT 组的积极心理健康的长期影响明显更强（B=.27，P=.03，Cohen d=0.29），并且混合 ACT 的治疗满意度明显高于 CBT（B=3.19，P<.001，Cohen d=0.78）。在次要结局方面，两种条件之间没有观察到其他差异。
结论
结果表明，混合 ACT 是晚年焦虑症 CBT 的一种有价值的替代治疗方法。
试验注册
荷兰试验注册处 TRIAL NL6131（NTR6270）；https://www.trialregister.nl/trial/6131.
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