Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom.
JMIR Ment Health. 2024 Nov 27;11:e63234. doi: 10.2196/63234.
Routine process and outcome monitoring interventions added to psychotherapy are known to improve treatment outcomes, although they vary in format and effectiveness.
This study aimed to evaluate whether a therapist-independent, internet-based routine process monitoring and feedback system could significantly reduce psychological distress and enhance the quality of the therapeutic relationship compared with a treatment-as-usual control group among individuals already engaged in individual psychotherapy.
We randomized 475 participants into either the intervention group, which received access to an internet-based routine process monitoring and feedback system in addition to psychotherapy, or the control group, which received only psychotherapy. The trial lasted for 10 weeks. Follow-up assessments at 5 weeks and 10 weeks used the Clinical Outcomes in Routine Evaluation-Outcome Measure as the primary outcome, with the Working Alliance Inventory-Short Revised and the Real Relationship Inventory-Client form as secondary outcomes.
Per-protocol analyses (n=166) showed that psychological distress decreased in both groups, but there was no significant advantage for the intervention group. The intervention group experienced a decline in the genuineness dimension score of the real relationship, with an effect size of d=-0.27, compared with d=0.01 in the control group. In the intervention group (but not in the control group), dropouts showed significantly lower real relationship levels (P=.002), working alliance quality (P=.051), and emotional disclosure (P=.01) compared with those who completed the study. Additionally, logistic regression revealed distinct predictors of dropout within the control group and intervention group.
The findings do not provide conclusive evidence for the efficacy of the new internet-based intervention in enhancing self-monitoring and prompting reflection on patients' emotional responses to their therapists. However, the intervention appears to influence patients' perceptions of the genuineness dimension in the therapeutic relationship, warranting further investigation. We hypothesize that this alteration in the genuineness dimension could be attributed to the intervention facilitating a more realistic and accurate perception of the therapeutic relationship among participants.
ClinicalTrials.gov NCT06038747; https://clinicaltrials.gov/study/NCT06038747.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): RR2-10.2196/55369.
已知在心理治疗中加入常规流程和结果监测干预措施可以改善治疗效果，但这些措施在形式和效果上有所不同。
本研究旨在评估一种独立于治疗师的基于互联网的常规流程监测和反馈系统是否可以显著降低心理困扰，并增强已经接受个体心理治疗的个体的治疗关系质量，与常规治疗对照组相比。
我们将 475 名参与者随机分为干预组和对照组，干预组在接受心理治疗的同时还可以使用基于互联网的常规流程监测和反馈系统，对照组仅接受心理治疗。试验持续 10 周。在第 5 周和第 10 周的随访评估中，使用临床结果在常规评估中的结果测量作为主要结果，使用工作联盟量表-短修订版和真实关系量表-客户版作为次要结果。
按方案分析（n=166）显示，两组的心理困扰均有所减轻，但干预组没有明显优势。与对照组（d=0.01）相比，干预组的真实关系的真诚维度评分下降，效应量为 d=-0.27。在干预组（但不在对照组）中，辍学者的真实关系水平（P=.002）、工作联盟质量（P=.051）和情绪披露（P=.01）明显低于完成研究的患者。此外，逻辑回归显示控制组和干预组的辍学有明显不同的预测因素。
这些发现并没有为新的基于互联网的干预措施增强自我监测和提示患者对治疗师的情绪反应的能力提供确凿的证据。然而，该干预措施似乎影响了患者对治疗关系中真诚维度的看法，值得进一步研究。我们假设，这种真诚维度的改变可能归因于干预措施促进了参与者对治疗关系的更现实和准确的感知。
ClinicalTrials.gov NCT06038747；https://clinicaltrials.gov/study/NCT06038747。
国际注册报告标识符（IRRID）：RR2-10.2196/55369。
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