Research Unit for Digital Psychiatry, Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
Centre for Digital Psychiatry, Mental Health Services, Region of Southern Denmark, Odense, Denmark.
J Med Internet Res. 2024 Oct 23;26:e47083. doi: 10.2196/47083.
Harmful alcohol consumption has been identified as a major contributor to disease, mortality, and social harm, accounting for 5.3% of worldwide deaths annually. In Denmark, an estimated 150,000 people suffer from alcohol use disorder (AUD), but a low proportion seek treatment due to person- and treatment-related barriers. Internet-based cognitive behavioral therapy (iCBT) has shown positive effects on the treatment gap, with patients reporting benefits such as increased knowledge and flexibility. However, there is a lack of research on blended cognitive behavioral therapy (bCBT), which combines face-to-face CBT (FtF CBT) and iCBT for AUD.
This study aims to investigate user experiences of bCBT. More specifically, it seeks to explore the advantages and disadvantages that users have experienced with bCBT for AUD, as well as their motivations for choosing this treatment format.
A total of 30 patients who had participated in the Blend-A (Blending Internet Treatment into Conventional Face-to-Face Treatment for AUD) study and received the intervention were contacted and offered the opportunity to participate in semistructured individual telephone interviews. Of these, 12 patients consented to participate. Furthermore, an additional participant was approached at a municipal clinic and agreed to engage in an individual FtF interview. Thus, the final sample consisted of 13 patients. The interviews explored their background, experiences with digital technology, motivations for choosing internet-based treatment, and experiences with the program during AUD treatment. The interviews were audio-recorded and transcribed in full length and analyzed using thematic analysis. All data were anonymized and securely stored.
We found that users experienced several advantages of iCBT over a larger part of the treatment course, including increased anonymity and privacy. Most importantly, it offered flexibility, allowing patients to focus on their rehabilitation process at their own pace. Patients appreciated the availability of written text in the online program, finding it helpful for gaining knowledge and understanding of AUD and its impact on the individual with the condition. They emphasized how the assignments helped them fully engage in treatment by first acknowledging their problem with alcohol and then dedicating time to self-reflection before FtF sessions, allowing for more in-depth discussions with the therapist. They also appreciated the reminders, which motivated them to complete their assignments.
Overall, patients perceived more benefits than disadvantages in using bCBT. Essentially, bCBT offers a form of assisted autonomy that cannot be fully achieved through iCBT or FtF CBT alone. It is only through their combination that patients can fully appreciate the benefits of the treatment, as they have time for self-reflection, with guidance from the therapist between FtF CBT sessions.
ClinicalTrials.gov NCT04535258; https://clinicaltrials.gov/ct2/show/NCT04535258.
有害饮酒已被确定为导致疾病、死亡和社会危害的主要因素，占全球每年死亡人数的 5.3%。在丹麦，估计有 15 万人患有酒精使用障碍（AUD），但由于人与治疗相关的障碍，只有少数人寻求治疗。基于互联网的认知行为疗法（iCBT）已显示出对治疗差距的积极影响，患者报告称增加了知识和灵活性等益处。然而，对于混合认知行为疗法（bCBT）的研究还很缺乏，这种疗法将面对面认知行为疗法（FtF CBT）与 AUD 的 iCBT 相结合。
本研究旨在探讨用户对 bCBT 的体验。更具体地说，它旨在探讨用户在 AUD 中使用 bCBT 所经历的优点和缺点，以及他们选择这种治疗形式的动机。
共联系了 30 名参加 Blend-A（将互联网治疗融入 AUD 的常规面对面治疗）研究并接受干预的患者，并为他们提供了参加半结构化个人电话访谈的机会。其中，有 12 名患者同意参加。此外，在一个市诊所又联系了一名额外的参与者，他同意进行面对面的 FtF 访谈。因此，最终样本由 13 名患者组成。访谈内容包括他们的背景、数字技术体验、选择基于互联网治疗的动机以及在 AUD 治疗期间对该方案的体验。访谈进行了录音并完整记录，然后进行主题分析。所有数据都经过匿名化处理并安全存储。
我们发现，与治疗过程的大部分时间相比，用户体验到了 iCBT 的几个优势，包括增加了匿名性和隐私性。最重要的是，它提供了灵活性，使患者能够按照自己的节奏专注于康复过程。患者赞赏在线项目中提供的书面文字，认为这有助于了解 AUD 及其对患者的影响，并获得相关知识和理解。他们强调了作业如何通过首先承认他们的饮酒问题，并在 FtF 治疗前花时间进行自我反思，然后与治疗师进行更深入的讨论，从而帮助他们全面参与治疗。他们还赞赏提醒功能，这激发了他们完成作业的动力。
总的来说，患者在使用 bCBT 时认为其好处多于坏处。本质上，bCBT 提供了一种辅助自主性的形式，这是单纯使用 iCBT 或 FtF CBT 无法完全实现的。只有通过它们的结合，患者才能充分体会到治疗的益处，因为他们有时间进行自我反思，并在 FtF CBT 治疗期间得到治疗师的指导。
ClinicalTrials.gov NCT04535258；https://clinicaltrials.gov/ct2/show/NCT04535258。
