1/2-Efficacy of Computer-Assisted Cognitive Behavior Therapy for Depression

1/2-计算机辅助认知行为疗法治疗抑郁症的疗效

• 批准号: 7889534
• 负责人: MICHAEL E THASE
• 金额: $ 49.71万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-06-16 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7889534
• 关键词: Acute; Attitude; Characteristics; Clinical; Cognitive; Cognitive Therapy; Computer Assisted; Computer-Assisted Therapy; Data; Data Analyses; Disease remission; Elements; Female; Health Care Costs; Individual; Knowledge; Major Depressive Disorder; Measures; Mental Depression; Methods; Modeling; Mood Disorders; Outcome; Outpatients; Patient Preferences; Phase; Protocols documentation; Psychotherapy; Public Health; Quality of life; Randomized; Randomized Controlled Trials; Research; Research Design; Research Personnel; Services; Site; Social Functioning; Staging; Supervision; Testing; Therapeutic; Thinking; Time; Training; Treatment outcome; base; behavior change; clinically significant; comparative efficacy; cost; cost effectiveness; depressive symptoms; design; effective therapy; experience; follow-up; male; meetings; public health relevance; research study; response

DESCRIPTION (provided by applicant): We propose a two center, randomized controlled trial evaluating the efficacy and cost-effectiveness of computer-assisted cognitive-behavior therapy (CCBT) for outpatients with major depressive disorder (MDD). Results of a preliminary study indicated that, despite reducing the amount of therapist contact by about 50%, CCBT was at least as effective as an 8 week course of conventional individual CBT on depression outcomes, with greater effects on dysfunctional attitudes and knowledge about CBT. We now propose to conduct a more rigorous test of the therapeutic equivalence and cost-effectiveness of CCBT versus a full 16 week, 20 session course of individual CBT, which provides three times the amount of therapeutic contact. A total of 172 male and female outpatients (86 per site) meeting SCID/DSM-IV criteria for MDD will be randomized across five years. Outcomes will be assessed by independent evaluators without knowledge of the treatment received. The study is designed to have the statistical power to test the equivalence of CCBT and the full course of CBT at both the end of acute phase therapy and across 6 months of follow-up. In addition to effects on depressive symptoms and categorical outcomes (i.e., response and remission rates), dependent variables will include measures of dysfunctional attitudes, social functioning, quality of life, and health care costs and utilization. It is predicted that: 1) CCBT will be equivalent to CBT at week 16 and across the 6 month follow-up; and 2) CCBT will be significantly more cost-effective than CBT. Secondary aims include testing potential moderators of treatment outcome and the predicted absence of site differences (as an indicator of disseminability). This trial has significant implications for the public health because it will provide a rigorous test the clinical utility of CCBT against a model of conventional individual therapy that offers three times as much clinical contact. If equivalence and cost- effectiveness are demonstrated, the proposed research will set the stage for larger scale studies evaluating broader dissemination of CCBT. PUBLIC HEALTH RELEVANCE: Although Cognitive Behavior Therapy (CBT) is an effective treatment for major depressive disorder, its utility is limited by cost and availability of trained therapists. Computer-assisted delivery of this therapy (CCBT) has shown promise and may offer similar benefits as CBT with as little as one third the amount of therapist time. The proposed study will test the therapeutic equivalence and cost-effectiveness of CCBT versus CBT across a 16 week acute phase and a 6 month follow-up.

描述（由申请人提供）：我们提出了一个两个中心，随机对照试验，评估计算机辅助认知行为疗法（CCBT）对患有重度抑郁症（MDD）的门诊病人的疗效和成本效益。一项初步研究的结果表明，尽管将治疗师接触的数量减少了约50％，但CCBT至少与8周的常规个体CBT对抑郁症结果的效果一样有效，对功能障碍的态度和对CBT的了解的影响更大。现在，我们建议对CCBT的治疗等效性和成本效益进行更严格的测试，而单个CBT的整个16周，20个会话课程，这提供了三倍的治疗接触量。在五年中，总共符合SCID/DSM-IV标准的172名男性和女性门诊患者（每个站点86）将随机分配SCID/DSM-IV标准。结果将由独立评估者评估，而不必了解接受的治疗。该研究旨在具有测试CCBT等效性和在急性期治疗结束和随访6个月后的CCBT等效性的统计能力。除了对抑郁症状和分类结果（即响应率和缓解率）的影响外，因变量还将包括态度功能失调，社会功能，生活质量以及医疗保健成本和利用率的度量。可以预测：1）CCBT等同于第16周以及在6个月的随访中等同于CBT； 2）CCBT将比CBT明显更具成本效益。次要目的包括测试治疗结果的潜在主持人和预测缺乏现场差异（作为分散性的指标）。该试验对公共卫生具有重要意义，因为它将为CCBT的临床效用提供严格的测试，该临床实用性与传统的个人疗法模型，该模型提供了三倍的临床接触。如果证明了等效性和成本效益，则拟议的研究将为评估CCBT更广泛传播的大规模研究奠定基础。 公共卫生相关性：尽管认知行为疗法（CBT）是对重度抑郁症的有效治疗方法，但其效用受到训练有素的治疗师的成本和可用性的限制。该疗法的计算机辅助输送（CCBT）已表现出希望，并且可能提供类似于CBT的好处，而治疗师时间的数量仅为三分之一。拟议的研究将在16周的急性阶段和6个月的随访中测试CCBT与CBT的治疗等效性和成本效益。