Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatric Research, Norra Stationsgatan 69, 113 64, Stockholm, Sweden.
Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden.
Addict Sci Clin Pract. 2022 Jul 23;17(1):37. doi: 10.1186/s13722-022-00319-0.
Internet-delivered cognitive behavioral therapy (ICBT) for alcohol misuse has potential to radically improve access to evidence-based care, and there is a need to investigate ways to optimize its delivery in clinical settings. Guidance from a clinician has previously been shown to improve drinking outcomes in ICBT, and some studies suggest that pre-treatment assessments may contribute in initiating early change. The objective of this study was to investigate the added and combined effects of a pre-treatment assessment interview and guidance on the outcomes of ICBT for alcohol misuse delivered in an online therapy clinic.
A 2X2 factorial randomized controlled trial was conducted where participants received access to an 8-week ICBT program, and either a pre-treatment assessment interview (Factor 1), guidance (Factor 2), a combination of these, or neither of these. Participants were 270 individuals (66.8% female, mean age = 46.5) scoring 8 or more on the Alcohol Use Disorders Identification Test and consuming 14 standard drinks or more in the preceding week. Primary outcomes were number of drinks consumed and number of heavy drinking days during the preceding week, 3 months post-treatment.
Large within-group effects were found in terms of alcohol reductions (d ≥ 0.82, p < 0.001), but neither of the factors significantly improved drinking outcomes. Guidance was associated with greater adherence (i.e. completed modules).
Neither a pre-treatment assessment interview nor guidance from a clinician appears to improve drinking outcomes resulting from internet-delivered cognitive behaviour therapy for alcohol misuse when delivered in a routine online therapy clinic.
NCT03984786. Registered 13 June 2019, https://clinicaltrials.gov/ct2/show/NCT03984786.
互联网提供的认知行为疗法（ICBT）治疗酒精滥用具有彻底改善获得循证治疗的潜力，因此需要研究如何在临床环境中优化其提供方式。临床医生的指导先前已被证明可以改善 ICBT 中的饮酒结果，并且一些研究表明，治疗前评估可能有助于启动早期改变。本研究的目的是调查在在线治疗诊所中提供的酒精滥用 ICBT 中，治疗前评估访谈和指导的附加和综合效果。
进行了一项 2x2 析因随机对照试验，其中参与者获得了 8 周的 ICBT 计划的访问权限，并且接受了治疗前评估访谈（因素 1）、指导（因素 2）、这些的组合或两者都没有。参与者是 270 名个体（66.8%为女性，平均年龄为 46.5），在酒精使用障碍识别测试中得分 8 分或以上，并且在前一周内饮用 14 标准饮品或更多。主要结局是治疗后 3 个月内每周饮用的饮料数量和每周重度饮酒天数。
在酒精减少方面发现了较大的组内效应（d≥0.82，p<0.001），但两个因素都没有显著改善饮酒结果。指导与更高的依从性（即完成模块）相关。
当在常规在线治疗诊所中提供时，治疗前评估访谈或临床医生的指导似乎都不能改善互联网提供的认知行为疗法治疗酒精滥用的饮酒结果。
NCT03984786。于 2019 年 6 月 13 日注册，https://clinicaltrials.gov/ct2/show/NCT03984786。
