在一个中下等收入国家开展无指导的、计算机化的认知行为疗法干预（TreadWill）：实用随机对照试验。
An Unguided, Computerized Cognitive Behavioral Therapy Intervention (TreadWill) in a Lower Middle-Income Country: Pragmatic Randomized Controlled Trial.
机构信息
Department of Biological Sciences and Bioengineering, Indian Institute of Technology Kanpur, Kanpur, India.
Department of Cognitive Science, Indian Institute of Technology Kanpur, Kanpur, India.
出版信息
J Med Internet Res. 2023 Apr 26;25:e41005. doi: 10.2196/41005.
BACKGROUND
Globally, most individuals who are susceptible to depression do not receive adequate or timely treatment. Unguided computerized cognitive behavioral therapy (cCBT) has the potential to bridge this treatment gap. However, the real-world effectiveness of unguided cCBT interventions, particularly in low- and middle-income countries (LMICs), remains inconclusive.
OBJECTIVE
In this study, we aimed to report the design and development of a new unguided cCBT-based multicomponent intervention, TreadWill, and its pragmatic evaluation. TreadWill was designed to be fully automated, engaging, easy to use, and accessible to LMICs.
METHODS
To evaluate the effectiveness of TreadWill and the engagement level, we performed a double-blind, fully remote, and randomized controlled trial with 598 participants in India and analyzed the data using a completer's analysis.
RESULTS
The users who completed at least half of the modules in TreadWill showed significant reduction in depression-related (P=.04) and anxiety-related (P=.02) symptoms compared with the waitlist control. Compared with a plain-text version with the same therapeutic content, the full-featured version of TreadWill showed significantly higher engagement (P=.01).
CONCLUSIONS
Our study provides a new resource and evidence for the use of unguided cCBT as a scalable intervention in LMICs.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03445598; https://clinicaltrials.gov/ct2/show/NCT03445598.
背景
在全球范围内，大多数易患抑郁症的人没有得到足够或及时的治疗。无指导的计算机化认知行为疗法（cCBT）有可能弥补这一治疗差距。然而，无指导 cCBT 干预措施的实际效果，特别是在中低收入国家（LMICs），仍不确定。
目的
在这项研究中，我们旨在报告一种新的基于无指导 cCBT 的多组分干预措施 TreadWill 的设计和开发及其实用评估。TreadWill 旨在实现完全自动化、引人入胜、易于使用且适用于 LMICs。
方法
为了评估 TreadWill 的有效性和参与度，我们在印度进行了一项双盲、完全远程、随机对照试验，共有 598 名参与者，采用完整应答者分析对数据进行分析。
结果
与候补对照组相比，完成 TreadWill 至少一半模块的用户的抑郁相关症状（P=.04）和焦虑相关症状（P=.02）显著减轻。与具有相同治疗内容的纯文本版本相比，TreadWill 的全功能版本显示出显著更高的参与度（P=.01）。
结论
我们的研究为在 LMICs 中使用无指导 cCBT 作为可扩展干预措施提供了新的资源和证据。
试验注册
ClinicalTrials.gov NCT03445598；https://clinicaltrials.gov/ct2/show/NCT03445598。
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