Online Therapy Unit, Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
Swiss Research Institute for Public Health and Addiction, University of Zurich, Konradstrasse 32, 8005, Zurich, Switzerland.
Addict Sci Clin Pract. 2024 Apr 20;19(1):30. doi: 10.1186/s13722-024-00456-8.
Alcohol misuse is common and causes substantial harm. Internet-delivered cognitive behaviour therapy (ICBT) is effective in reducing alcohol misuse; however, the literature investigating how treatment outcomes are impacted by patients' preferences for therapist- versus self-guided ICBT for alcohol misuse is sparse.
In this preference trial, 74 eligible patients (who reported ≥ 14 drinks in the previous week and obtained scores suggesting hazardous or harmful drinking) chose between enrolling in either therapist- or self-guided ICBT for alcohol misuse. We investigated whether those who chose therapist- versus self-guided ICBT differed in their (a) drinking outcomes-as measured by Timeline Follow-Back (TLFB) and heavy drinking days (HDD) at post-treatment and 3-month follow-up-and (b) post-treatment ICBT engagement and satisfaction.
The majority (81.1%) of eligible patients chose therapist-guided ICBT. These patients reported higher psychotropic medication use, drinking difficulties, and anxiety symptoms. For both the therapist- and self-guided patients, a modified intention-to-treat analysis revealed large within-group treatment effects for TLFB (β = - 2.64, SE 0.66; p < 0.001) and HDD (β = - 0.34, SE 0.07; p < 0.001), with large pre-to-post-treatment Cohen's effect sizes of d = 0.97 (95% CI [0.49, 1.45]) for TLFB and d = 1.19 (95% CI [0.69, 1.68]) for HDD. The interaction comparing the effects of therapist- to self-guided ICBT over time was not significant for TLFB (p = 0.34) or HDD (p = 0.06). With treatment, for both therapist- and self-guided patients, there was a significant improvement in drinking difficulties, cravings, and confidence with controlling cravings, as well as in anxiety, depression, and functional impairment. Further, the majority (75.7%) of patients completed five or more lessons, as well as reported overall satisfaction with the treatment (88.9%) and increased confidence in managing their symptoms (86.7%); these outcomes also did not differ between therapist- and self-guided patients.
The current study shows that ICBT for alcohol misuse is associated with reduced drinking and comorbid mental health difficulties over time, irrespective of whether patients chose to complete the course on their own or with therapist guidance.
NCT04611854 ( https://clinicaltrials.gov/ct2/show/NCT04611854 ).
酒精滥用很常见，会造成严重危害。互联网认知行为疗法（ICBT）在减少酒精滥用方面非常有效；然而，关于治疗结果如何受到患者对治疗师指导与自我指导的 ICBT 治疗酒精滥用的偏好影响的文献却很少。
在这项偏好试验中，74 名符合条件的患者（在前一周报告了≥14 次饮酒，并且得分表明存在危险或有害饮酒）选择参加治疗师指导或自我指导的 ICBT 治疗酒精滥用。我们调查了那些选择治疗师指导与自我指导的患者在以下方面是否存在差异：（a）通过时间线随访（TLFB）和重度饮酒天数（HDD）在治疗后和 3 个月随访时的饮酒结果；（b）治疗后的 ICBT 参与度和满意度。
大多数（81.1%）符合条件的患者选择了治疗师指导的 ICBT。这些患者报告了更高的精神药物使用、饮酒困难和焦虑症状。对于治疗师指导和自我指导的患者，一项修改后的意向治疗分析显示，TLFB（β=−2.64，SE 0.66；p<0.001）和 HDD（β=−0.34，SE 0.07；p<0.001）的组内治疗效果很大，TLFB 的治疗前到治疗后的 Cohen's 效应大小为 d=0.97（95%CI [0.49, 1.45]），HDD 的效应大小为 d=1.19（95%CI [0.69, 1.68]）。TLFB（p=0.34）或 HDD（p=0.06）的治疗师指导与自我指导的时间交互作用不显著。随着治疗的进行，对于治疗师指导和自我指导的患者，饮酒困难、渴望和控制渴望的信心以及焦虑、抑郁和功能障碍都有显著改善。此外，大多数（75.7%）患者完成了五节或更多课程，并报告对治疗的总体满意度（88.9%）和对管理症状的信心增加（86.7%）；这些结果在治疗师指导和自我指导的患者之间也没有差异。
目前的研究表明，随着时间的推移，ICBT 治疗酒精滥用与减少饮酒和共病心理健康问题有关，无论患者选择自行完成课程还是在治疗师的指导下完成。
NCT04611854（https://clinicaltrials.gov/ct2/show/NCT04611854）。
