在常规成瘾治疗中引入和评估在线认知行为疗法治疗赌博障碍的效果：比较队列研究。

Introducing and Evaluating the Effectiveness of Online Cognitive Behavior Therapy for Gambling Disorder in Routine Addiction Care: Comparative Cohort Study.

机构信息

Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.

Department of Psychology, Uppsala University, Uppsala, Sweden.

出版信息

J Med Internet Res. 2024 Sep 18;26:e54754. doi: 10.2196/54754.

DOI:10.2196/54754

PMID:39293054

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11447416/

Abstract

BACKGROUND

Several treatment-related challenges exist for gambling disorder, in particular at-scale dissemination in health care settings.

OBJECTIVE

This study describes the introduction of a newly developed internet-delivered cognitive behavioral therapy (iCBT) program for gambling disorder (GD), provided with therapist support in routine addiction care, in a nationally recruited sample in Sweden. The study details the introduction of the iCBT program, evaluates its effectiveness and acceptability, and compares registry outcomes among iCBT patients with other patients with GD at the clinic who received face-to-face psychological treatment as usual.

METHODS

The study site was the Stockholm Addiction eClinic, which offers digital interventions for addictive disorders in routine care. The iCBT program was introduced nationally for treatment-seeking patients through the Swedish eHealth platform. After approximately 2 years of routine treatment provision, we conducted a registry study, including ordinary patients in routine digital care (n=218), and a reference sample receiving face-to-face psychological treatment for GD (n=216).

RESULTS

A statistically significant reduction in the Gambling Symptom Assessment Scale scores during the treatment was observed (B=-1.33, SE=0.17, P<.001), corresponding to a large within-group Cohen d effect size of d=1.39. The iCBT program was rated high for satisfaction. A registry-based survival analysis, controlling for psychiatric comorbidity, showed that patients receiving iCBT exhibited posttreatment outcomes (re-engagement in outpatient addiction care, receiving new psychiatric prescriptions, enrollment in psychiatric inpatient care, and care events indicative of contact with social services) similar to comparable patients who underwent face-to-face treatment-as-usual.

CONCLUSIONS

A lack of randomized allocation notwithstanding, the iCBT program for GD evaluated in this study was well-received by patients in routine addiction care, was associated with the expected symptom decrease during treatment, and appears to result in posttreatment registry outcomes similar to face-to-face treatment. Future studies on treatment mechanisms and moderators are warranted.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.1186/s40814-020-00647-5.

摘要

背景

赌博障碍存在多种与治疗相关的挑战，特别是在医疗保健环境中大规模推广。

目的

本研究描述了一种新开发的互联网认知行为疗法（iCBT）项目在瑞典全国招募的样本中，在常规成瘾治疗中提供治疗师支持，用于治疗赌博障碍（GD）。该研究详细介绍了 iCBT 项目的引入，评估了其效果和可接受性，并将 iCBT 患者与诊所中接受常规面对面心理治疗的其他 GD 患者的登记结果进行了比较。

方法

研究地点是斯德哥尔摩成瘾电子诊所，该诊所为常规治疗中提供数字干预治疗成瘾障碍。iCBT 项目通过瑞典电子健康平台向寻求治疗的患者在全国范围内推广。在常规治疗提供约 2 年后，我们进行了一项登记研究，包括常规数字治疗中的普通患者（n=218）和接受 GD 面对面心理治疗的参考样本（n=216）。

结果

在治疗过程中，赌博症状评估量表评分有统计学意义的降低（B=-1.33，SE=0.17，P<.001），对应于大组内 Cohen d 效应大小 d=1.39。iCBT 项目的满意度评分很高。基于登记的生存分析，控制精神共病，表明接受 iCBT 的患者在治疗后（重新参与门诊成瘾治疗、接受新的精神科处方、入住院精神科治疗以及表明与社会服务接触的治疗事件）的结果与接受常规面对面治疗的可比患者相似。