Components of smartphone cognitive-behavioural therapy for subthreshold depression among 1093 university students: a factorial trial.

IF 6.6 2区 医学 Q1 PSYCHIATRY Evidence Based Mental Health Pub Date : 2022-12-01 Epub Date: 2022-05-16 DOI:10.1136/ebmental-2022-300455
Masatsugu Sakata, Rie Toyomoto, Kazufumi Yoshida, Yan Luo, Yukako Nakagami, Teruhisa Uwatoko, Tomonari Shimamoto, Aran Tajika, Hidemichi Suga, Hiroshi Ito, Michihisa Sumi, Takashi Muto, Masataka Ito, Hiroshi Ichikawa, Masaya Ikegawa, Nao Shiraishi, Takafumi Watanabe, Ethan Sahker, Yusuke Ogawa, Steven D Hollon, Linda M Collins, Edward R Watkins, James Wason, Hisashi Noma, Masaru Horikoshi, Taku Iwami, Toshi A Furukawa
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Abstract

Background: Internet-based cognitive-behavioural therapy (iCBT) is effective for subthreshold depression. However, which skills provided in iCBT packages are more effective than others is unclear. Such knowledge can inform construction of more effective and efficient iCBT programmes.

Objective: To examine the efficacy of five components of iCBT for subthreshold depression.

Methods: We conducted an factorial trial using a smartphone app, randomly allocating presence or absence of five iCBT skills including self-monitoring, behavioural activation (BA), cognitive restructuring (CR), assertiveness training (AT) and problem-solving. Participants were university students with subthreshold depression. The primary outcome was the change on the Patient Health Questionnaire-9 (PHQ-9) from baseline to week 8. Secondary outcomes included changes in CBT skills.

Findings: We randomised a total of 1093 participants. In all groups, participants had a significant PHQ-9 reduction from baseline to week 8. Depression reduction was not significantly different between presence or absence of any component, with corresponding standardised mean differences (negative values indicate specific efficacy in favour of the component) ranging between -0.04 (95% CI -0.16 to 0.08) for BA and 0.06 (95% CI -0.06 to 0.18) for AT. Specific CBT skill improvements were noted for CR and AT but not for the others.

Conclusions: There was significant reduction in depression for all participants regardless of the presence and absence of the examined iCBT components.

Clinical implication: We cannot yet make evidence-based recommendations for specific iCBT components. We suggest that future iCBT optimisation research should scrutinise the amount and structure of components to examine.

Trial registration number: UMINCTR-000031307.

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针对 1093 名大学生的亚阈值抑郁症的智能手机认知行为疗法的组成部分:因子试验。
背景:基于互联网的认知行为疗法(iCBT基于互联网的认知行为疗法(iCBT)对阈值以下抑郁症很有效。然而,目前还不清楚 iCBT 套件中提供的哪些技能比其他技能更有效。这些知识可以为制定更有效、更高效的 iCBT 方案提供参考:研究 iCBT 的五个组成部分对阈下抑郁的疗效:我们使用智能手机应用程序进行了一项因子试验,随机分配是否使用五种iCBT技能,包括自我监控、行为激活(BA)、认知重组(CR)、自信训练(AT)和问题解决。参与者为患有亚阈值抑郁症的大学生。主要结果是患者健康问卷-9(PHQ-9)从基线到第 8 周的变化。次要结果包括 CBT 技能的变化:我们共随机抽取了 1093 名参与者。从基线到第 8 周,所有组别参与者的 PHQ-9 都有显著下降。抑郁程度的降低在有无任何成分之间没有明显差异,相应的标准化均值差异(负值表示有利于该成分的特定疗效)为:BA 为 -0.04 (95% CI -0.16 to 0.08) ,AT 为 0.06 (95% CI -0.06 to 0.18)。CR和AT的特定CBT技能有所改善,但其他技能则没有:结论:所有参与者的抑郁程度都有明显降低,而与是否采用 iCBT 方法无关:临床意义:我们还不能针对 iCBT 的具体内容提出循证建议。我们建议,未来的 iCBT 优化研究应仔细审查要检查的成分的数量和结构:uminctr-000031307.
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来源期刊
CiteScore
18.10
自引率
7.70%
发文量
31
期刊介绍: Evidence-Based Mental Health alerts clinicians to important advances in treatment, diagnosis, aetiology, prognosis, continuing education, economic evaluation and qualitative research in mental health. Published by the British Psychological Society, the Royal College of Psychiatrists and the BMJ Publishing Group the journal surveys a wide range of international medical journals applying strict criteria for the quality and validity of research. Clinicians assess the relevance of the best studies and the key details of these essential studies are presented in a succinct, informative abstract with an expert commentary on its clinical application.Evidence-Based Mental Health is a multidisciplinary, quarterly publication.
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