Tao Tiffany Junchen, Lim Teck Kuan, Yeung Ernest Tsun Fung, Liu Huinan, Shris Phoenix Bibha, Ma Lawrence Ka Yin, Lee Tatia Mei Chun, Hou Wai Kai
Centre for Psychosocial Health, The Education University of Hong Kong, Hong Kong SAR, China.
Department of Special Education and Counselling, The Education University of Hong Kong, Hong Kong SAR, China.
NPJ Digit Med. 2023 Apr 28;6(1):80. doi: 10.1038/s41746-023-00809-8.
Positive adjustment to chronic diseases reduces psychiatric comorbidity and enhances quality of life. Very little is known about the benefit of internet-based and mobile-based Cognitive Behavioral Therapy (IM-CBT) on physical outcomes and its reciprocal interactions with psychiatric outcomes, the active therapeutic elements, and effect moderators among people with major chronic medical conditions. In this systematic review and meta-analysis (PROSPERO: CRD42022265738), CINAHL of Systematic Reviews, MEDLINE, PsycINFO, PubMed, Web of Science are systematically searched up to 1 June 2022, for randomized controlled trials (RCTs) comparing IM-CBT against non-CBT control condition(s) among people with chronic disease(s). Primary outcomes include improvements in psychiatric symptoms (depressive, anxiety, PTSD symptoms, general psychological distress) from baseline to post-intervention and follow-ups. Secondary outcomes include improvements in physical distress (physical symptoms, functional impairment, self-rated ill health, objective physiological dysfunction). Among 44 RCTs (5077 patients with seven different chronic diseases), IM-CBT improves depressive symptoms, anxiety symptoms, and general psychological distress at post-intervention and across follow-ups, and improves physical distress and functional impairment at post-intervention. Preliminary evidence suggests that behavioral modification and problem-solving could be necessary components to reduce psychiatric symptoms in IM-CBT, whereas cognitive restructuring, psychoeducation, and mindfulness elements relate to reduced physical distress. IM-CBT shows stronger benefits in chronic pain, cancer, arthritis, and cardiovascular disease, relative to other conditions. Changes in psychiatric symptoms and physical distress prospectively predict each other over time. IM-CBT is an effective intervention for comprehensive symptom management among people with chronic diseases.
对慢性病的积极调适可降低精神疾病共病率并提高生活质量。对于基于互联网和移动设备的认知行为疗法（IM-CBT）对身体状况的益处及其与精神状况、积极治疗要素以及患有主要慢性疾病人群的效应调节因素之间的相互作用，我们知之甚少。在这项系统评价和荟萃分析（PROSPERO：CRD42022265738）中，截至2022年6月1日，系统检索了CINAHL系统评价、MEDLINE、PsycINFO、PubMed、科学网，以查找比较IM-CBT与慢性病患者非CBT对照条件的随机对照试验（RCT）。主要结局包括从基线到干预后及随访期间精神症状（抑郁、焦虑、创伤后应激障碍症状、一般心理困扰）的改善。次要结局包括身体困扰（身体症状、功能障碍、自评健康不佳、客观生理功能障碍）的改善。在44项RCT（5077例患有七种不同慢性病的患者）中，IM-CBT在干预后及随访期间可改善抑郁症状、焦虑症状和一般心理困扰，并在干预后改善身体困扰和功能障碍。初步证据表明，行为改变和问题解决可能是IM-CBT减轻精神症状的必要组成部分，而认知重构、心理教育和正念要素与减轻身体困扰有关。相对于其他疾病，IM-CBT在慢性疼痛、癌症、关节炎和心血管疾病中显示出更强的益处。随着时间的推移，精神症状和身体困扰的变化可相互前瞻性预测。IM-CBT是一种有效干预措施，可用于慢性病患者的综合症状管理。
