Walton Carla J, Gonzalez Sharleen, Cooney Emily B, Leigh Lucy, Szwec Stuart
Centre for Psychotherapy, Hunter New England Mental Health Service, 2300, PO Box 833, Newcastle, NSW, Australia.
Department of Psychological Medicine, Wellington Medical School, University of Otago (Te Whare, Wānanga o Otāgo ki Te Whanga-Nui-a-Tara), Newtown, Wellington, New Zealand.
Borderline Personal Disord Emot Dysregul. 2023 May 20;10(1):16. doi: 10.1186/s40479-023-00221-4.
While the COVID-19 crisis has had numerous global negative impacts, it has also presented an imperative for mental health care systems to make digital mental health interventions a part of routine care. Accordingly, through necessity, many Dialectical Behaviour Therapy (DBT) programs transitioned to telehealth, despite little information on clinical outcomes compared with face-to-face treatment delivery. This study examined differences in client engagement (i.e. attendance) of DBT: delivered face-to-face prior to the first COVID-19 lockdown in Australia and New Zealand; delivered via telehealth during the lockdown; and delivered post-lockdown. Our primary outcomes were to compare: [1] client attendance rates of DBT individual therapy delivered face-to-face with delivery via telehealth, and [2] client attendance rates of DBT skills training delivered face-to-face compared with delivery via telehealth.
DBT programs across Australia and New Zealand provided de-identified data for a total of 143 individuals who received DBT treatment provided via telehealth or face-to-face over a six-month period in 2020. Data included attendance rates of DBT individual therapy sessions; attendance rates of DBT skills training sessions as well as drop-out rates and First Nations status of clients.
A mixed effects logistic regression model revealed no significant differences between attendance rates for clients attending face-to-face sessions or telehealth sessions for either group therapy or individual therapy. This result was found for clients who identified as First Nations persons and those who didn't identify as First Nations persons.
Clients were as likely to attend their DBT sessions over telehealth as they were face-to-face during the first year of the Covid-19 pandemic. These findings provide preliminary evidence that providing DBT over telehealth may be a viable option to increase access for clients, particularly in areas where face-to-face treatment is not available. Further, based on the data collected in this study, we can be less concerned that offering telehealth treatment will compromise attendance rates compared to face-to-face treatment. Further research is needed comparing clinical outcomes between treatments delivered face-to-face compared delivery via telehealth.
虽然新冠疫情危机在全球产生了诸多负面影响，但它也促使精神卫生保健系统必须将数字心理健康干预措施纳入常规护理。因此，许多辩证行为疗法（DBT）项目因形势所需转向了远程医疗，尽管与面对面治疗相比，关于临床结果的信息很少。本研究调查了DBT在不同阶段的患者参与度（即出勤率）差异：在澳大利亚和新西兰首次实施新冠疫情封锁之前面对面提供；在封锁期间通过远程医疗提供；以及在封锁后提供。我们的主要结果是比较：[1]面对面提供的DBT个体治疗与通过远程医疗提供的患者出勤率，以及[2]面对面提供的DBT技能培训与通过远程医疗提供的患者出勤率。
澳大利亚和新西兰的DBT项目提供了去识别化数据，涉及2020年六个月内通过远程医疗或面对面接受DBT治疗的143名患者。数据包括DBT个体治疗课程的出勤率；DBT技能培训课程的出勤率以及患者的退出率和原住民身份。
混合效应逻辑回归模型显示，无论是团体治疗还是个体治疗，参加面对面课程或远程医疗课程的患者出勤率之间没有显著差异。这一结果在自认为是原住民的患者和不认为自己是原住民的患者中均成立。
在新冠疫情大流行的第一年，患者通过远程医疗参加DBT课程的可能性与面对面参加的可能性相同。这些发现提供了初步证据，表明通过远程医疗提供DBT可能是增加患者可及性的可行选择，特别是在无法提供面对面治疗的地区。此外，根据本研究收集的数据，我们不必过于担心提供远程医疗治疗会比面对面治疗降低出勤率。需要进一步研究比较面对面治疗与通过远程医疗提供的治疗之间的临床结果。
