J. Med. Internet Res. - Development and initial evaluation of an Internet-based support system for face-to-face cognitive behavior therapy: a proof of concept study.


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CKGROUND: Evidence-based psychological treatments, such as cognitive behavior therapy (CBT), have been found to be effective in treating several anxiety and mood disorders. Nevertheless, issues regarding adherence are common, such as poor patient compliance on homework assignments and therapists' drifting from strictly evidence-based CBT. The development of Internet-delivered CBT (ICBT) has been intensive in the past decade and results show that guided ICBT can be as effective as face-to-face CBT but also indicate a need to integrate the two forms of CBT delivery.OBJECTIVE: In this study, we developed and tested a new treatment format in which ICBT and face-to-face therapy were blended. We designed a support system accessible via the Internet (using a computer or an Apple iPad) for patients and therapists delivering CBT face-to-face. The support system included basic CBT components and a library of interventions gathered from existing ICBT manuals.METHODS: The study involved 15 patients with mild to moderate anxiety or depression (or both). Eight therapists conducted the treatments. All participants were interviewed after the nine-week intervention. Further, patients provided self-reports on clinical measures pre- and post-trial, as well as at a 12-month follow-up.RESULTS: A reduction was found in symptom scores across all measures. The reliable change index ranged from 60% to 87% for depression and anxiety. Large effect sizes (Cohen's d) ranging from 1.62 (CI 95% 0.59-2.66) to 2.43 (CI 95% 1.12-3.74) were found. There were no missing data and no treatment dropouts. In addition, the results had been maintained at the 12-month follow-up. Qualitative interviews revealed that the users perceived the support system as beneficial.CONCLUSIONS: The results suggest that modern information technology can effectively blend with face-to-face treatments and be used to facilitate communication and structure in therapy, thus reducing therapist drift.

Resumo Limpo

ckground evidencebas psycholog treatment cognit behavior therapi cbt found effect treat sever anxieti mood disord nevertheless issu regard adher common poor patient complianc homework assign therapist drift strict evidencebas cbt develop internetdeliv cbt icbt intens past decad result show guid icbt can effect facetofac cbt also indic need integr two form cbt deliveryobject studi develop test new treatment format icbt facetofac therapi blend design support system access via internet use comput appl ipad patient therapist deliv cbt facetofac support system includ basic cbt compon librari intervent gather exist icbt manualsmethod studi involv patient mild moder anxieti depress eight therapist conduct treatment particip interview nineweek intervent patient provid selfreport clinic measur pre posttrial well month followupresult reduct found symptom score across measur reliabl chang index rang depress anxieti larg effect size cohen d rang ci ci found miss data treatment dropout addit result maintain month followup qualit interview reveal user perceiv support system beneficialconclus result suggest modern inform technolog can effect blend facetofac treatment use facilit communic structur therapi thus reduc therapist drift

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