Capobianco Lora, Verbist Irini, Heal Calvin, Huey Dale, Wells Adrian
Greater Manchester Mental Health NHS Foundation Trust, Research and Innovation, Manchester, UK.
Greater Manchester Mental Health NHS Foundation Trust, Greater Manchester Improving Access to Psychological Therapy Services, Manchester, UK.
Br J Clin Psychol. 2023 Mar;62(1):312-324. doi: 10.1111/bjc.12410. Epub 2022 Dec 22.
COVID-19 had an immediate impact on the way Improving Access to Psychological Therapy (IAPT) services in the United Kingdom were delivered, requiring services to move to remote therapy. While remote therapy has been shown to be effective, little is known about the effects associated with moving to remote therapy delivered during COVID-19 within IAPT services.
The objective of the study was to assess the characteristics of those undergoing remote therapy and test the effects associated with the effect of remote delivery on anxiety and depression symptoms compared with in-person therapy before lockdown.
We conducted a retrospective, cross-sectional benchmark comparison of remote therapy across four IAPT services in Greater Manchester. Routinely collected measures of anxiety (GAD-7) and depression (PHQ-9) were used to compare effects across the two time periods. A mixed-effects model was conducted to assess within and between group changes in anxiety and depression, while controlling for pre-specified confounders.
Remote therapy did not appear to impact on service provision, with the number of sessions offered and attended being similar to those prior to COVID-19. Both face-to-face (pre-COVID-19) and remote therapy (during COVID-19) were associated with variable improvements in anxiety and depression with no significant difference between them. However, remote therapy was associated with a more rapid decrease in symptoms in comparison with face-to-face treatment. Mean improvement in symptoms was small and increased as number of sessions/time increased and analysis of rates of improvement indicated that both face-to-face and remote therapy might need more time to reach target cut-off points on measures.
Both face-to-face and remote therapies delivered under IAPT were associated with improvements in symptoms with no apparent difference apart from the finding that remote therapy was associated with more rapid change.
Remote therapy delivery in IAPT does not appear to confer a disadvantage over face-to-face contact, but at a group mean level the magnitude of improvement associated with both treatments was small. Remote therapy provision may widen patient access to and engagement with psychological services.
新冠疫情对英国改善心理治疗可及性（IAPT）服务的提供方式产生了直接影响，要求服务转向远程治疗。虽然远程治疗已被证明是有效的，但对于在IAPT服务中转向新冠疫情期间提供的远程治疗所带来的影响知之甚少。
本研究的目的是评估接受远程治疗者的特征，并测试与封锁前面对面治疗相比，远程治疗对焦虑和抑郁症状的影响。
我们对大曼彻斯特地区四个IAPT服务机构的远程治疗进行了回顾性横断面基准比较。使用常规收集的焦虑（广泛性焦虑障碍量表-7，GAD-7）和抑郁（患者健康问卷-9，PHQ-9）测量指标来比较两个时间段的效果。进行混合效应模型以评估组内和组间焦虑和抑郁的变化，同时控制预先指定的混杂因素。
远程治疗似乎并未影响服务提供，提供和参加的疗程数量与新冠疫情前相似。面对面治疗（新冠疫情前）和远程治疗（新冠疫情期间）均与焦虑和抑郁的不同程度改善相关，两者之间无显著差异。然而，与面对面治疗相比，远程治疗与症状更快减轻相关。症状的平均改善较小，且随着疗程数量/时间增加而增加，改善率分析表明，面对面治疗和远程治疗可能都需要更多时间才能达到测量指标上的目标临界点。
IAPT提供的面对面治疗和远程治疗均与症状改善相关，除了远程治疗与更快变化相关这一发现外，没有明显差异。
IAPT中的远程治疗似乎并不比面对面接触有劣势，但在组平均水平上，两种治疗相关的改善幅度都较小。远程治疗的提供可能会扩大患者获得心理服务的机会并提高其参与度。
