NIHR ARC West, Bristol, UK.
Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
Health Expect. 2024 Aug;27(4):e70002. doi: 10.1111/hex.70002.
CBT is an effective treatment for depression, but access varies across the United Kingdom. Online CBT increases access. The INTERACT platform was designed to support patient engagement in CBT, enabling therapists to deliver high-intensity CBT via typed instant messaging and allowing patients and therapists access to an integrated online library of resources during and between sessions.
The INTERACT trial aimed to evaluate this integrated approach to delivering CBT for primary care patients with depression. A nested qualitative study was conducted within the trial. Interviews were conducted with 20 patients who received the intervention, 9 therapists who delivered it and 3 therapist supervisors. Data were analysed using thematic analysis.
The combination of receiving support from a therapist and having access to integrated online CBT resources enabled patients to better manage their depression. Platform benefits included the opportunity to review transcripts to clarify how to complete homework tasks and track progress in managing their depression. The typing process allowed reflection and a focused discussion. However, less could be covered than during an in-person session, which reduced therapists' expectations around goal setting. Patients who did not complete therapy struggled with the typing and found the CBT approach too demanding.
Findings highlight the importance of establishing patient and therapist goals and expectations about what can be achieved in CBT mediated by typing. Some patients are comfortable communicating via typing and are motivated to utilise online resources in between sessions. Exploring the benefits and challenges of typed CBT with patients will enable them to make an informed choice about referral for this novel approach to therapy.
Patients, service users and members of the public were involved in the study design and management. Substantial pilot work gathered stakeholder feedback and informed the design of the intervention, before undertaking the RCT. Coauthor P.L. is a service user representative co-applicant and member of the management group responsible for developing the intervention and the trial. Two PPI members sit on the Independent Steering Committee. PPI members provided valuable feedback on the study resources and documents.
认知行为疗法（CBT）是一种有效的抑郁症治疗方法，但在英国各地的可及性存在差异。在线 CBT 增加了可及性。INTERACT 平台旨在支持患者参与 CBT，使治疗师能够通过打字即时消息提供高强度 CBT，并允许患者和治疗师在治疗期间和治疗之间访问集成的在线资源库。
INTERACT 试验旨在评估这种为初级保健患者提供抑郁症 CBT 的综合方法。在试验中进行了嵌套定性研究。对接受干预的 20 名患者、提供干预的 9 名治疗师和 3 名治疗师主管进行了访谈。使用主题分析对数据进行了分析。
接受治疗师的支持和访问集成在线 CBT 资源的结合使患者能够更好地管理他们的抑郁症。平台的好处包括有机会查看转录本以澄清如何完成家庭作业任务并跟踪管理抑郁症的进展。打字过程允许反思和集中讨论。但是，由于时间限制，打字讨论的内容比面对面讨论要少，这降低了治疗师对目标设定的期望。没有完成治疗的患者在打字方面遇到困难，并且发现 CBT 方法要求过高。
研究结果强调了在通过打字进行的 CBT 中，建立患者和治疗师关于可以实现的目标和期望的重要性。一些患者愿意通过打字进行交流，并愿意在治疗之间使用在线资源。与患者探讨打字 CBT 的好处和挑战将使他们能够对这种新的治疗方法做出明智的选择。
患者、服务用户和公众参与了研究设计和管理。在进行 RCT 之前，进行了大量的试点工作，收集了利益相关者的反馈，并为干预措施的设计提供了信息。合著者 P.L. 是服务用户代表共同申请人，也是负责开发干预措施和试验的管理小组成员。两名 PPI 成员担任独立指导委员会成员。PPI 成员对研究资源和文件提供了宝贵的反馈。
