Silverman Alexandra L, Ferguson IreLee, Bullis Jacqueline R, Bajwa Harris, Mei Sara, Beard Courtney
Division of Depression and Anxiety, McLean Hospital, Belmont, MA, USA.
Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
J Mood Anxiety Disord. 2025 Jan 9;9:100106. doi: 10.1016/j.xjmad.2025.100106. eCollection 2025 Mar.
SilverCloud and THIS WAY UP (TWU) are two internet-delivered cognitive-behavioral therapy (iCBT) programs that have demonstrated effectiveness for anxiety and depression, yet little is known about their comparative effectiveness. This non-randomized program evaluation compared client satisfaction, subjective engagement, and treatment outcomes between the SilverCloud and TWU programs. Participants were 195 adult patients (106 using TWU and 89 using SilverCloud) enrolled in a digital CBT clinic who completed assessment measures at pre-treatment, mid-treatment, post-treatment, and one-, two-, three-, and four-month follow-ups. As hypothesized (preregistration: osf.io/x6bmy), patients in both programs reported high client satisfaction, and experienced improvements in depression (s = -0.79 and -0.78), anxiety (s = -0.95 and -0.84), and functional impairment (s = -0.42 and -0.45), from pre- to post-treatment that were maintained at four-month follow-up. However, according to exploratory analyses, the slope of change in treatment outcomes was not significantly different between programs during the treatment and follow-up phases. As hypothesized, patients who used SilverCloud self-reported significantly greater subjective engagement with their iCBT program compared to patients who used TWU (=0.36). However, contrary to hypotheses, client satisfaction was not significantly different between programs. This non-randomized program evaluation offers minimal evidence that one program was better than the other, though findings require replication in a randomized controlled trial and larger sample. Results provide further support for iCBT as a viable option to extend access to high-quality treatment for anxiety and depression.
SilverCloud和THIS WAY UP(TWU)是两个通过互联网提供的认知行为疗法(iCBT)项目,已证明对焦虑和抑郁有效,但对它们的相对有效性知之甚少。这项非随机项目评估比较了SilverCloud和TWU项目之间的客户满意度、主观参与度和治疗效果。参与者为195名成年患者(106名使用TWU,89名使用SilverCloud),他们参加了一家数字认知行为疗法诊所,并在治疗前、治疗中期、治疗后以及1个月、2个月、3个月和4个月随访时完成了评估测量。正如假设的那样(预注册:osf.io/x6bmy),两个项目的患者都报告了较高的客户满意度,并且在抑郁(效应量分别为-0.79和-0.78)、焦虑(效应量分别为-0.95和-0.84)和功能损害(效应量分别为-0.42和-0.45)方面从治疗前到治疗后都有改善,并且在4个月随访时得以维持。然而,根据探索性分析,在治疗和随访阶段,两个项目在治疗效果变化斜率上没有显著差异。正如假设的那样,与使用TWU的患者相比,使用SilverCloud的患者自我报告对其iCBT项目的主观参与度显著更高(效应量=0.36)。然而,与假设相反,两个项目之间的客户满意度没有显著差异。这项非随机项目评估提供了极少的证据表明一个项目比另一个项目更好,尽管研究结果需要在随机对照试验和更大样本中进行重复验证。结果进一步支持了iCBT作为一种可行的选择,以扩大获得焦虑和抑郁高质量治疗的机会。
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