边缘型人格障碍在线辩证行为治疗的接受度、安全性和效应量:介入性先导研究。

IF 2 Q3 HEALTH CARE SCIENCES & SERVICES
Ruben Vonderlin, Tali Boritz, Carola Claus, Büsra Senyüz, Saskia Mahalingam, Rachel Tennenhouse, Stefanie Lis, Christian Schmahl, Jürgen Margraf, Tobias Teismann, Nikolaus Kleindienst, Shelley McMain, Martin Bohus
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引用次数: 0

摘要

背景:远程医疗心理治疗(即通过基于网络的视频平台在线提供治疗)的潜力正受到越来越多的关注。然而,对于高情绪和行为失调患者的接受度、安全性和有效性,人们持怀疑态度。目的:研究边缘型人格障碍(BPD)患者远程健康辩证行为治疗(DBT)治疗前后症状变化的初始效应量,以及远程健康辩证行为治疗(DBT)的接受度和安全性。方法:共有39名符合DSM-5(精神障碍诊断与统计手册[第五版])BPD标准的个体在德国和加拿大的3个地点接受了1年的门诊远程健康DBT。使用BPD症状、分离和生活质量的前后测量来评估效应量估计。通过分析自杀企图和自残来评估安全性。此外,从治疗师和患者的角度评估了远程医疗形式的接受度和可行性、治疗满意度、可用性和治疗联盟的质量。所有分析均针对意向治疗(ITT)和按方案治疗(ATP)样本进行。结果:分析显示BPD症状的前后效应显著(ITT样本的d=1.13, ATP样本的d=1.44;结论:远程健康DBT治疗BPD对BPD症状和生活质量有较大的前后效应。虽然远程保健形式似乎可行并得到广泛接受,但辍学率相对较高。未来的研究应该在随机对照试验中比较远程健康DBT与面对面DBT的疗效。总之,远程保健DBT可能提供一种潜在有效的替代治疗方案,提高治疗的可及性。但是,应该考虑减少辍学的策略。试验注册:德国临床试验注册中心DRKS00027824;https://drks.de/search/en/trial/DRKS00027824。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Acceptance, Safety, and Effect Sizes in Online Dialectical Behavior Therapy for Borderline Personality Disorder: Interventional Pilot Study.

Background: The potential of telehealth psychotherapy (ie, the online delivery of treatment via a video web-based platform) is gaining increased attention. However, there is skepticism about its acceptance, safety, and efficacy for patients with high emotional and behavioral dysregulation.

Objective: This study aims to provide initial effect size estimates of symptom change from pre- to post treatment, and the acceptance and safety of telehealth dialectical behavior therapy (DBT) for individuals diagnosed with borderline personality disorder (BPD).

Methods: A total of 39 individuals meeting the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition]) criteria for BPD received 1 year of outpatient telehealth DBT at 3 sites in Germany and Canada. Effect size estimates were assessed using pre-post measures of BPD symptoms, dissociation, and quality of life. Safety was evaluated by analyzing suicide attempts and self-harm. Additionally, acceptance and feasibility, satisfaction with treatment, useability of the telehealth format, and the quality of the therapeutic alliance were assessed from both therapists' and patients' perspectives. All analyses were conducted on both the intention-to-treat (ITT) and according-to-protocol (ATP) samples.

Results: Analyses showed significant and large pre-post effect sizes for BPD symptoms (d=1.13 in the ITT sample and d=1.44 in the ATP sample; P<.001) and for quality of life (d=0.65 in the ITT sample and d=1.24 in the ATP sample). Dissociative symptoms showed small to nonsignificant reductions. Self-harm behaviors decreased significantly from 80% to 28% of all patients showing at least 1 self-harm behavior in the last 10 weeks (risk ratio 0.35). A high dropout rate of 38% was observed. One low-lethality suicide attempt was reported. Acceptance, feasibility, and satisfaction measures were high, although therapists reported only moderate useability of the telehealth format.

Conclusions: Telehealth DBT for BPD showed large pre-post effect sizes for BPD symptoms and quality of life. While the telehealth format appeared feasible and well-accepted, the dropout rate was relatively high. Future research should compare the efficacy of telehealth DBT with in-person formats in randomized controlled trials. Overall, telehealth DBT might offer a potentially effective alternative treatment option, enhancing treatment accessibility. However, strategies for decreasing drop-out should be considered.

Trial registration: German Clinical Trials Register DRKS00027824; https://drks.de/search/en/trial/DRKS00027824.

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来源期刊
JMIR Formative Research
JMIR Formative Research Medicine-Medicine (miscellaneous)
CiteScore
2.70
自引率
9.10%
发文量
579
审稿时长
12 weeks
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