Wojnarowski Caroline, Simmonds-Buckley Melanie, Kellett Stephen
University of Sheffield, Sheffield, UK.
Swallownest Court, Rotherham, Doncaster and South Humber NHS Foundation Trust, Doncaster, UK.
Br J Clin Psychol. 2025 Jun;64(2):355-370. doi: 10.1111/bjc.12508. Epub 2024 Oct 23.
Given the ubiquity in routine services of low-intensity guided self-help (GSH) psychological interventions, better patient selection for these brief interventions would be organizationally efficient. This study therefore sought to define who would respond best to two different types of GSH for anxiety to enable better future treatment matching.
The study used outcome data from a patient preference trial (N = 209) comparing cognitive analytic therapy-guided self-help (CAT-GSH) with cognitive behavioural therapy-guided self-help (CBT-GSH). Elastic Net regularization and Boruta random forest variable selection methods were applied. Regression models calculated the patient advantage index (PAI) to designate which GSH was likely the most effective for each patient. Outcomes were compared for those receiving their PAI-indicated optimal and non-optimal GSH.
Lower baseline depression and anxiety severity predicted better outcomes for both types of GSH. Patient preference status was not associated with outcome during either GSH. Sixty-three % received their model indicating optimal GSH and these had significantly higher rates of reliable and clinically significant reductions in anxiety at both post-treatment (35.9% vs. 16.6%) and follow-up (36.6% vs. 19.2%). No single patient with a large PAI had a reliable and clinically significant reduction in anxiety at post-treatment or follow-up when they did not receive their optimal GSH.
Treatment matching algorithms have the potential to support evidenced-based treatment selection for GSH. Treatment selection and supporting patient choice needs to be integrated. Future research needs to investigate the use of the PAI for GSH treatment matching, but with larger and more balanced samples.
鉴于低强度引导式自助（GSH）心理干预在常规服务中普遍存在，为这些简短干预更好地选择患者将提高组织效率。因此，本研究旨在确定谁对两种不同类型的焦虑症GSH反应最佳，以便未来能更好地匹配治疗。
该研究使用了一项患者偏好试验（N = 209）的结果数据，比较了认知分析疗法引导式自助（CAT-GSH）和认知行为疗法引导式自助（CBT-GSH）。应用了弹性网络正则化和Boruta随机森林变量选择方法。回归模型计算患者优势指数（PAI），以确定哪种GSH对每位患者可能最有效。比较了接受PAI指示的最佳和非最佳GSH患者的结果。
较低的基线抑郁和焦虑严重程度预示着两种类型的GSH都有更好的结果。在任何一种GSH治疗期间，患者的偏好状态与结果均无关联。63%的患者接受了其模型指示的最佳GSH，这些患者在治疗后（35.9%对16.6%）和随访时（36.6%对19.2%）焦虑可靠且临床上显著降低的发生率明显更高。没有一个PAI值高的患者在未接受最佳GSH时，在治疗后或随访时焦虑有可靠且临床上显著的降低。
治疗匹配算法有可能支持基于证据的GSH治疗选择。治疗选择和支持患者选择需要整合。未来的研究需要调查PAI在GSH治疗匹配中的应用，但要有更大且更均衡的样本。
