互联网为大学生提供认知行为疗法：随机因子试验研究动机访谈和强化课程。
Internet-Delivered Cognitive Behavioral Therapy for Postsecondary Students: Randomized Factorial Trial for Examining Motivational Interviewing and Booster Lessons.
机构信息
Department of Psychology, University of Regina, Regina, SK, Canada.
eCentre Clinic, Department of Psychology, Macquarie University, Sydney, Australia.
出版信息
J Med Internet Res. 2022 Sep 7;24(9):e40637. doi: 10.2196/40637.
BACKGROUND
Internet-delivered cognitive behavioral therapy (ICBT) can improve access to mental health care for students, although high attrition rates are concerning and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face cognitive behavioral therapy.
OBJECTIVE
This study aimed to examine the use of pretreatment MI exercises and booster lessons in ICBT for postsecondary students.
METHODS
In this factorial trial (factor 1: web-based MI before treatment; factor 2: self-guided booster lesson 1 month after treatment), 308 clients were randomized to 1 of 4 treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from before treatment to after treatment and at the 1-month and 3-month follow-ups.
RESULTS
Overall, 54% (150/277) of students completed treatment and reported large improvements in symptoms of depression and anxiety and small improvements in academic functioning after treatment, which were maintained at the 1-month and 3-month follow-ups. Pretreatment MI did not contribute to better treatment completion or engagement, although small between-group effects favored MI for reductions in depression (Cohen d=0.23) and anxiety (Cohen d=0.25) after treatment. Only 30.9% (43/139) of students randomized to one of the booster conditions accessed the booster. Overall, no main effects were found for the booster. Subanalyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen d=0.31) at the 3-month follow-up. No interactions were found between MI and the booster.
CONCLUSIONS
Rather than offering MI before treatment, clients may experience more benefits from MI exercises later in ICBT when motivation wanes. The low uptake of the self-guided booster limited our conclusions regarding its effectiveness. Future research should examine offering a booster for a longer duration after treatment, with therapist support and a longer follow-up period.
TRIAL REGISTRATION
ClinicalTrials.gov NCT04264585; https://clinicaltrials.gov/ct2/show/NCT04264585.
背景
互联网提供的认知行为疗法（ICBT）可以改善学生获得心理健康护理的机会，尽管高脱落率令人担忧，但对长期结果知之甚少。动机访谈（MI）练习和助推课程可以提高面对面认知行为疗法的参与度和效果。
目的
本研究旨在检查在针对大学生的 ICBT 中使用治疗前 MI 练习和助推课程。
方法
在这项析因试验（因素 1：治疗前基于网络的 MI；因素 2：治疗后 1 个月的自我指导助推课程 1）中，308 名患者被随机分配到 4 种治疗条件之一，其中 277 名（89.9%）患者开始接受治疗。所有患者均接受了为期 5 周的跨诊断 ICBT 课程（UniWellbeing 课程）。主要结局包括从治疗前到治疗后以及治疗后 1 个月和 3 个月随访时抑郁、焦虑和感知学业功能的变化。
结果
总体而言，54%（150/277）的学生完成了治疗，并报告称在治疗后症状明显改善，抑郁和焦虑症状明显减轻，学业功能略有改善，在治疗后 1 个月和 3 个月的随访中保持不变。治疗前的 MI 并不能提高治疗完成率或参与度，尽管在治疗后抑郁（Cohen d=0.23）和焦虑（Cohen d=0.25）方面，小的组间效应有利于 MI。仅 30.9%（43/139）随机分配到助推条件之一的学生访问了助推课程。总体而言，助推课程没有产生主要效果。亚分析显示，访问助推课程的患者在治疗后 3 个月时抑郁症状的下降幅度更大（Cohen d=0.31）。未发现 MI 和助推之间存在交互作用。
结论
与其在治疗前提供 MI，当动机减弱时，患者可能会从 ICBT 后期的 MI 练习中获得更多益处。自我指导的助推课程的低参与度限制了我们对其有效性的结论。未来的研究应考虑在治疗后更长时间内提供更长时间的助推课程，并提供治疗师的支持和更长的随访期。
试验注册
ClinicalTrials.gov NCT04264585；https://clinicaltrials.gov/ct2/show/NCT04264585。
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