一项有指导的数字化认知行为干预可降低功能性胃肠病患者的焦虑和抑郁

A Coached Digital Cognitive Behavioral Intervention Reduces Anxiety and Depression in Adults With Functional Gastrointestinal Disorders.

机构信息

Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.

出版信息

Clin Transl Gastroenterol. 2021 Dec 7;12(12):e00436. doi: 10.14309/ctg.0000000000000436.

DOI:10.14309/ctg.0000000000000436

PMID:34874018

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8751763/

Abstract

INTRODUCTION

Traditional cognitive behavioral interventions (CBIs) improve mood and gastrointestinal symptom severity in patients with functional gastrointestinal disorders (FGIDs) but face substantial barriers to implementation. Integrating behavioral health technology into medical clinic workflows could overcome these barriers. We evaluated the feasibility and impact of a coached digital CBI (dCBI) as a first-line intervention in a prospective cohort of emotionally distressed patients with FGID.

METHODS

Patients with anxiety and/or depressive symptoms were offered a dCBI (an app called RxWell) during routine clinic visits. RxWell provides cognitive behavioral techniques enhanced by within-app text messaging with a health coach. Both gastroenterology and behavioral health-care providers electronically prescribed RxWell. We tracked patient interactions with RxWell, and patients completed anxiety (General Anxiety Disorder-7) and depression (Personal Health Questionniare Depression Scale) measures through the app. Our primary study outcome was the change in General Anxiety Disorder-7 and Personal Health Questionniare Depression Scale scores.

RESULTS

Of 364 patients with FGID (mean age 43 years [SD 16 years]; 73.1% women) prescribed the dCBI, 48.4% enrolled (median use, 3 techniques [interquartile range 1-14]). About half of RxWell enrollees communicated with health coaches. The mean baseline anxiety score was 11.4 (SD 5.5), and the depression score was 11.5 (SD 6.1). RxWell users experienced improvements in anxiety (mean change 2.71 [t = 3.7, df = 58; P < 0.001]) and depression (mean change 2.9 [t = 4.2, df = 45; P < 0.001]) at 4 months.

DISCUSSION

Patients with FGIDs and moderately severe anxiety and depressive symptoms are willing to use dCBI tools recommended by their providers. Our pilot data demonstrate that dCBI usage is associated with clinically and statistically significant mood symptom reductions.

摘要

简介

传统的认知行为干预（CBIs）可改善功能性胃肠疾病（FGIDs）患者的情绪和胃肠道症状严重程度，但在实施过程中面临着诸多障碍。将行为健康技术整合到医疗诊所的工作流程中可以克服这些障碍。我们评估了在 FGID 伴情绪困扰的前瞻性队列患者中，将辅导式数字 CBI（dCBI）作为一线干预措施的可行性和效果。

方法

在常规就诊期间，为焦虑和/或抑郁症状的患者提供 dCBI（名为 RxWell 的应用程序）。RxWell 通过应用内的文字信息与健康教练一起提供认知行为技术。胃肠病学和行为健康护理提供者都可通过电子方式为 RxWell 开处方。我们跟踪了患者与 RxWell 的互动情况，患者通过应用程序完成了焦虑（一般焦虑症-7）和抑郁（个人健康问卷抑郁量表）的评估。我们的主要研究结果是一般焦虑症-7 和个人健康问卷抑郁量表评分的变化。

结果

在接受 dCBI 处方的 364 名 FGID 患者中（平均年龄 43 岁[标准差 16 岁]；73.1%为女性），有 48.4%的患者参与了研究（中位数使用 3 种技术[四分位距 1-14]）。约一半的 RxWell 参与者与健康教练进行了沟通。RxWell 参与者的基线焦虑评分平均为 11.4（标准差 5.5），抑郁评分为 11.5（标准差 6.1）。RxWell 用户在 4 个月时的焦虑（平均变化 2.71[ t=3.7，df=58；P<0.001]）和抑郁（平均变化 2.9[ t=4.2，df=45；P<0.001]）均得到改善。