CBT for depression: a pilot RCT comparing mobile phone vs. computer
Tóm tắt
This paper reports the results of a pilot randomized controlled trial comparing the delivery modality (mobile phone/tablet or fixed computer) of a cognitive behavioural therapy intervention for the treatment of depression. The aim was to establish whether a previously validated computerized program (The Sadness Program) remained efficacious when delivered via a mobile application.
35 participants were recruited with Major Depression (80% female) and randomly allocated to access the program using a mobile app (on either a mobile phone or iPad) or a computer. Participants completed 6 lessons, weekly homework assignments, and received weekly email contact from a clinical psychologist or psychiatrist until completion of lesson 2. After lesson 2 email contact was only provided in response to participant request, or in response to a deterioration in psychological distress scores. The primary outcome measure was the Patient Health Questionnaire 9 (PHQ-9). Of the 35 participants recruited, 68.6% completed 6 lessons and 65.7% completed the 3-months follow up. Attrition was handled using mixed-model repeated-measures ANOVA.
Both the Mobile and Computer Groups were associated with statistically significantly benefits in the PHQ-9 at post-test. At 3 months follow up, the reduction seen for both groups remained significant.
These results provide evidence to indicate that delivering a CBT program using a mobile application, can result in clinically significant improvements in outcomes for patients with depression.
Australian New Zealand Clinical Trials Registry ACTRN 12611001257954
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Tài liệu tham khảo
Andrews G, Titov N: Depression is very disabling. Lancet. 2007, 370: 808-809. 10.1016/S0140-6736(07)61393-2.
Cuijpers P, Smit F: Excess mortality in depression: a meta-analysis of community studies. J Affect Disord. 2002, 72: 227-236. 10.1016/S0165-0327(01)00413-X.
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007, 370: 851-858. 10.1016/S0140-6736(07)61415-9.
Murray CJL, Lopez AD: The Global Burden of Disease. 1996, Geneva: World Health Organization, Harvard School of Public Health, World Bank
Kessler D, Lewis G, Kaur S, Wiles N, King M, Weich S, Peters T: Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial. Lancet. 2009, 374: 628-634. 10.1016/S0140-6736(09)61257-5.
Kupfer DJ, Frank E, Phillips ML: Major depressive disorder: new clinical, neurobiological, and treatment perspectives. Lancet. 2012, 379: 1045-1055. 10.1016/S0140-6736(11)60602-8.
Ham C, Dixon A, Brooke B: Transforming the delivery of health and social care. The case for fundamental change. 2012, London, England: The King’s Fund
Kessler RC: The costs of depression. Psychiatr Clin North Am. 2012, 35: 1-14. 10.1016/j.psc.2011.11.005.
Cuijpers P, Donker T, van Straten A, Li J, Andersson G: Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies. Psychol Med. 2010, 40: 14-
Hedman E, Andersson G, Ljótsson B, Andersson E, Rück C, Mörtberg E, Lindefors N: Internet-based cognitive behaviour therapy vs. Cognitive behavioural group therapy for social anxiety disorder: a randomized controlled Non-inferiority trial. PLoS One. 2011, 6 (3): e18001-10.1371/journal.pone.0018001.
Johansson R, Andersson G: Internet-based psychological treatments for depression. Expert Rev Neurother. 2012, 12 (7): 861-870. 10.1586/ERN.12.63.
Perini S, Titov N, Andrews G: Clinician-assisted Internet-based treatment is effective for depression: Randomized controlled trial. The Royal Australian and New Zealand College of Psychiatrists. 2009, 43: 7-
Titov N, Andrews G, Johnston L, Robinson E, Spence J: Transdiagnostic internet treatment for anxiety disorders: a randomized controlled trial. Behav Res Ther. 2010, 48: 890-899. 10.1016/j.brat.2010.05.014.
Rizvi SL, Dimeff LA, Skutch J, Carroll D, Linehan MM: A pilot study of the DBT coach: an interactive mobile phone application for individuals with borderline personality disorder and substance Use of disorder. Behaviour Therapy. 2011, 42: 589-600. 10.1016/j.beth.2011.01.003.
Morris ME, Kathawala Q, Leen TK, Gorenstein EE, Guilak F, Labhard M, Deleeuw W: Mobile therapy: case study evaluations of a cell phone application for emotional self-awareness. Journal Of Medical Internet Research. 2010, 12: 2 e10-e10.
International Telecommunication Union: The World in 2011 ICT Facts and Figures. 2011, Geneva, Switzerland: ITU, 1-8.
Bang M, Timpka T, Eriksson H, Holm E, Nordin C: Mobile phone computing for in-situ cognitive behavioural therapy. Studies in Health Technology Informatics. 2007, 129: 1078-1082.
Reid SC, Kauer SD, Hearps SJC, Crooke AHD, Khor AS, Sanci LA, Patton GC: A mobile phone application for the assessment and management of youth mental health problems in primary care: a randomised controlled trial. BMC Fam Pract. 2011, 12: 131-doi:10.1186/1471-2296-12-131.
Proudfoot J, Parker G, Pavlovic JD, Manicavasagar V, Adler E, Whitton A: Community attitudes to the appropriation of mobile phones for monitoring and managing depression. Anxiety and stress. J Med Internet Res. 2010, 12: 4-10.2196/jmir.1376.
Larson R, Csikszentimihalyi M: The experience sampling method: new directions for methodology. Social Behavioural Science. 1980, 15: 1-15.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Dunbar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998, 59: 22-33.
World Health Organization: Composite International Diagnostic Interview. 1990, Geneva, Switzerland: World Health Organization
Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, Zaslavsky AM: Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med. 2002, 32: 959-976. 10.1017/S0033291702006074.
Kroenke K, Spitzer RL, Williams J: The PHQ-9. Validity of a brief depression severity measure. JGIM: Journal of General Internal Medicine. 2001, 16: 606-613. 10.1046/j.1525-1497.2001.016009606.x.
Zuithoff N, Vergouwe Y, King M, Nazareth I, van Wezep M, Moons K, Geerlings M: The Patient Health Questionnaire-9 for detection of major depressive disorder in primary care: consequences of current thresholds in a crosssectional study. BMC Fam Pract. 2010, 11: 98-10.1186/1471-2296-11-98.
Wittkampf KA, Naeije L, Schene AH, Huyser J, van Weert HC: Diagnostic accuracy of the mood module of the Patient Health Questionnaire: a systematic review. Gen Hosp Psychiatry. 2007, 29: 338-395.
Furukawa T, Kessler RC, Slade T, Andrews G: The performance of the K6 and K10 screening scales for psychological distress in the Australian national survey of mental health and well-being. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences. 2003, 33: 357-362. 10.1017/S0033291702006700.
Beck AT, Steer RA, Brown GK: Beck Depression Inventory-II manual. 1996, San Antonio, TX: Harcourt Brace, 2
Devilly GJ, Borkovec TD: Psychometric properties of the credibility/expectancy questionnaire. Journal of Behaviour Therapy and Experimental Psychiatry. 2000, 31: 73-86. 10.1016/S0005-7916(00)00012-4.