Therapist-guided, Internet-delivered cognitive behaviour therapy for adolescents with body dysmorphic disorder: A feasibility trial with long-term follow-up

IF 3.6 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Internet Interventions-The Application of Information Technology in Mental and Behavioural Health Pub Date : 2023-11-16 DOI:10.1016/j.invent.2023.100688

Daniel Rautio , Per Andrén , Martina Gumpert , Maral Jolstedt , Amita Jassi , Georgina Krebs , Markus Jansson-Fröjmark , Tobias Lundgren , Eva Serlachius , David Mataix-Cols , Lorena Fernández de la Cruz

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引用次数: 0

Abstract

Body dysmorphic disorder (BDD) is a prevalent and impairing psychiatric condition that typically debuts in adolescence and is associated with risky behaviours. The disorder can be effectively treated with cognitive behaviour therapy (CBT). However, CBT for BDD is seldom available primarily due to a shortage of trained therapists. Internet-delivered CBT (ICBT) can be a way to increase treatment availability. The aim of this feasibility trial was to evaluate the feasibility, safety, and preliminary efficacy of a CBT protocol for adolescents with BDD, adapted to be delivered over the Internet with minimal therapist support. A total of 20 participants (12–17-year-olds) meeting criteria for BDD were recruited nationally to a specialist outpatient clinic in Stockholm, Sweden. One participant withdrew consent and their data could not be analysed. Nineteen participants were offered 12 modules of therapist-guided ICBT for BDD and were followed up to 12 months post-treatment. Preliminary efficacy was measured at the a priori primary endpoint (3-month follow-up) and at the 12-month follow-up with the clinician-rated Yale-Brown Obsessive Compulsive Scale Modified for BDD for Adolescents. The treatment was rated as both credible and satisfactory and was associated with a large and statistically significant reduction in BDD symptom severity (d = 2.94). The proportion of participants classified as responders at the primary endpoint was 73.7%, and the proportion of full or partial remitters was 63.2%. The average therapist support time was 8 min per participant per week. Treatment gains continued to accrue up to the 12-month follow-up. Two participants attempted suicide and another two reported non-suicidal self-injuries during the study period. ICBT with minimal therapist support is a feasible, potentially efficacious, and durable treatment for adolescents with BDD. Risky behaviours typical of this patient group should be carefully monitored during treatment.

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治疗师指导，互联网提供的青少年身体畸形障碍认知行为治疗:长期随访的可行性试验

身体畸形障碍(BDD)是一种普遍和有害的精神疾病，通常在青春期首次出现，并与危险行为有关。这种疾病可以通过认知行为疗法(CBT)有效治疗。然而，由于缺乏训练有素的治疗师，治疗BDD的CBT很少可用。互联网提供的CBT (ICBT)是增加治疗可用性的一种方法。这项可行性试验的目的是评估CBT治疗青少年BDD的可行性、安全性和初步疗效，该治疗方案适合在最少的治疗师支持下通过互联网进行。共有20名符合BDD标准的参与者(12 - 17岁)被招募到瑞典斯德哥尔摩的一家专科门诊诊所。一位参与者撤回了同意，他们的数据无法分析。19名参与者接受了12个治疗师指导的BDD ICBT模块，并在治疗后随访12个月。初步疗效是在一个先验的主要终点(3个月的随访)和12个月的随访中，用临床评定的耶鲁-布朗强迫症量表修正青少年BDD。该治疗被评为可信且令人满意，并与BDD症状严重程度的显著降低相关(d = 2.94)。在主要终点，应答者的比例为73.7%，完全或部分缓解者的比例为63.2%。平均治疗师支持时间为每位参与者每周8分钟。治疗效果持续累积到12个月的随访。在研究期间，两名参与者试图自杀，另外两名报告了非自杀性自残。ICBT在极少的治疗师支持下是一种可行的、潜在有效的、持久的治疗青少年BDD的方法。在治疗期间应仔细监测这一患者群体的典型危险行为。

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来源期刊

Internet Interventions-The Application of Information Technology in Mental and Behavioural Health Medicine-Health Informatics

CiteScore

6.50

自引率

9.30%

发文量

审稿时长

6 weeks

期刊介绍： Official Journal of the European Society for Research on Internet Interventions (ESRII) and the International Society for Research on Internet Interventions (ISRII). The aim of Internet Interventions is to publish scientific, peer-reviewed, high-impact research on Internet interventions and related areas. Internet Interventions welcomes papers on the following subjects: • Intervention studies targeting the promotion of mental health and featuring the Internet and/or technologies using the Internet as an underlying technology, e.g. computers, smartphone devices, tablets, sensors • Implementation and dissemination of Internet interventions • Integration of Internet interventions into existing systems of care • Descriptions of development and deployment infrastructures • Internet intervention methodology and theory papers • Internet-based epidemiology • Descriptions of new Internet-based technologies and experiments with clinical applications • Economics of internet interventions (cost-effectiveness) • Health care policy and Internet interventions • The role of culture in Internet intervention • Internet psychometrics • Ethical issues pertaining to Internet interventions and measurements • Human-computer interaction and usability research with clinical implications • Systematic reviews and meta-analysis on Internet interventions