基于互联网的认知行为疗法治疗健康焦虑的效果和坚持治疗的预测：常规精神科护理中的队列研究

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 : 2024-10-16 DOI:10.1016/j.invent.2024.100780

Susanna Österman , Erland Axelsson , Erik Forsell , Cecilia Svanborg , Nils Lindefors , Erik Hedman-Lagerlöf , Volen Z. Ivanov

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引用次数: 0

摘要

目标健康焦虑症又称疑病症，是一种常见的精神疾病，会给患者带来极大的痛苦，并造成高昂的社会成本。基于互联网的健康焦虑认知行为疗法（ICBT）已在随机对照试验（RCT）中证明了其疗效，但对其在现实环境中的有效性了解有限。本研究旨在评估在常规精神科治疗中采用引导式 ICBT 治疗健康焦虑的临床效果，包括症状变化、治疗依从性和潜在的负面影响。此外，我们还探讨了治疗依从性的预测因素。方法在 2018 年至 2020 年期间，在一家专门从事 ICBT 的精神科门诊中，447 名患者参加了为期 12 周的 ICBT 健康焦虑纵向队列研究。主要结果测量指标为14项健康焦虑短量表（SHAI-14），并采用重复测量的组内设计进行主要分析。结果参与者从治疗前到治疗后都有显著改善（d = 1.61）。在治疗后，60%（95% CI 58-62）的患者出现了统计上可靠的变化（RCI），44%（95% CI 42-46）的患者病情得到缓解。参与者平均完成了 12 个治疗模块中的 7 个（SD = 4）。每多完成一个治疗模块，SHAI-14 的平均得分就会降低 0.31 分（95 % CI 0.10 至 0.54 分）。研究表明，ICBT 的疗效与 RCT 的疗效相当，而且治疗依从性越高，焦虑症的治疗效果越好。综合治疗焦虑症可用于增加有效治疗焦虑症的机会。

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Effectiveness and prediction of treatment adherence to guided internet-based cognitive behavioral therapy for health anxiety: A cohort study in routine psychiatric care

Objective

Health anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence.

Method

A longitudinal cohort study of 447 patients enrolled in 12 weeks of ICBT for health anxiety between 2018 and 2020 in an outpatient psychiatric clinic specializing in ICBT. Primary outcome measure was the 14-item Short Health Anxiety Inventory (SHAI-14) and a within-group design with repeated measures was utilized for the primary analysis.

Results

Participants showed significant improvements from pre- to post-treatment (d = 1.61). At post-treatment, 60 % (95 % CI 58–62) demonstrated statistically reliable change (RCI), and 44 % (95 % CI 42–46) were in remission. On average, participants completed 7 (SD = 4) out of 12 treatment modules. For each additional completed module, the mean reduction was 0.31 (95 % CI 0.10 to 0.54) points on the SHAI-14.

Conclusions

Guided ICBT for health anxiety can be effective when delivered within the context of routine psychiatric care. The study suggests that effect sizes are comparable with those in RCTs and higher treatment adherence is associated with better outcomes in health anxiety. ICBT could be used to increase availability to effective therapy for health anxiety.

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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