Bernstein Emily E, Greenberg Jennifer L, Weingarden Hilary, Snorrason Ivar, Summers Berta, Williams Jasmine, Quist Rachel, Curtiss Joshua, Harrison Oliver, Wilhelm Sabine
Massachusetts General Hospital, United States of America.
Harvard Medical School, United Kingdom.
Internet Interv. 2024 Apr 18;36:100743. doi: 10.1016/j.invent.2024.100743. eCollection 2024 Jun.
Body dysmorphic disorder (BDD) is severe and undertreated. Digital mental health could be key to expanding access to evidence-based treatments, such as cognitive behavioral therapy for BDD (CBT-BDD). Coach guidance is posited to be essential for effective uptake of digital interventions. However, little is known about how different patients may use coaching, what patterns correspond to meaningful outcomes, and how to match coaching to patient needs.
Participants were 77 adults who received a 12-week guided smartphone CBT-BDD. Bachelor's-level coaches were available via asynchronous messaging. We analyzed the 400 messages sent by users to coaches during treatment. Message content was coded using the efficiency model of support (i.e., usability, engagement, fit, knowledge, and implementation). We aimed to clarify when and for what purposes patients with BDD used coaching, and if we can meaningfully classify patients by these patterns. We then assessed potential baseline predictors of coach usage, and whether distinct patterns relate to clinical outcomes.
Users on average sent 5.88 messages (SD = 4.51, range 1-20) and received 9.84 (SD = 5.74, range 2-30). Regarding frequency of sending messages, latent profile analysis revealed three profiles, characterized by: (1) peak mid-treatment (16.88 %), (2) bimodal/more communication early and late in treatment (10.39 %), and (3) consistent low/no communication (72.73 %). Regarding content, four profiles emerged, characterized by mostly (1) engagement (51.95 %), (2) fit (15.58 %), (3) knowledge (15.58 %), and (4) miscellaneous/no messages (16.88 %). There was a significant relationship between frequency profile and age, such that the early/late peak group was older than the low communication group, and frequency profile and adherence, driven by the mid-treatment peak group completing more modules than the low contact group. Regarding content, the engagement and knowledge groups began treatment with more severe baseline symptoms than the fit group. Content profile was associated with dropout, suggesting higher dropout rates in the miscellaneous/no contact group and reduced rates in the engagement group. There was no relationship between profile membership and other outcomes.
The majority of participants initiated little contact with their coach and the most common function of communications was to increase engagement. Results suggest that older individuals may prefer or require more support than younger counterparts early in treatment. Additionally, whereas individuals using coaching primarily for engagement may be at lower risk of dropping out, those who do not engage at all may be at elevated risk. Findings can support more personalized, data-driven coaching protocols and more efficient allocation of coaching resources.
身体变形障碍（BDD）病情严重且治疗不足。数字心理健康可能是扩大循证治疗可及性的关键，例如针对BDD的认知行为疗法（CBT-BDD）。教练指导被认为是有效采用数字干预措施的关键。然而，对于不同患者如何使用教练指导、何种模式对应有意义的结果以及如何使教练指导与患者需求相匹配，我们知之甚少。
参与者为77名成年人，他们接受了为期12周的智能手机引导式CBT-BDD治疗。本科水平的教练可通过异步消息提供指导。我们分析了用户在治疗期间发送给教练的400条消息。消息内容使用支持效率模型进行编码（即可用性、参与度、适配性、知识和实施）。我们旨在阐明BDD患者何时以及为何使用教练指导，以及我们是否可以根据这些模式对患者进行有意义的分类。然后，我们评估了教练使用的潜在基线预测因素，以及不同模式是否与临床结果相关。
用户平均发送5.88条消息（标准差=4.51，范围1-20），接收9.84条消息（标准差=5.74，范围2-30）。关于发送消息的频率，潜在类别分析揭示了三种模式，其特点分别为：（1）治疗中期达到峰值（16.88%），（2）治疗早期和晚期呈双峰/更多交流（10.39%），以及（3）持续低交流/无交流（72.73%）。关于内容，出现了四种模式，其特点主要分别为：（1）参与度（51.95%），（2）适配性（15.58%），（3）知识（15.58%），以及（4）其他/无消息（16.88%）。频率模式与年龄之间存在显著关系，即早期/晚期峰值组比低交流组年龄更大，频率模式与依从性之间也存在显著关系，这是由治疗中期峰值组比低接触组完成更多模块所驱动的。关于内容，参与度和知识组开始治疗时的基线症状比适配组更严重。内容模式与退出率相关，表明其他/无接触组的退出率较高，而参与度组的退出率较低。模式归属与其他结果之间没有关系。
大多数参与者与他们的教练很少联系，通信的最常见功能是提高参与度。结果表明，在治疗早期老年人可能比年轻人更喜欢或需要更多支持。此外，虽然主要为提高参与度而使用教练指导的个体退出风险可能较低，但那些完全不参与的个体退出风险可能较高。研究结果可以支持更个性化、数据驱动的教练指导方案以及更有效地分配教练资源。
