If your doctor is not preventing your depression by having 100% recovery protocols, then you don't have a functioning stroke doctor. Your doctor has known since medical school that stroke needed to be solved to 100% recovery and has done nothing in the ensuing years. In my opinion, that is complete incompetence!
Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression
A Randomized Optimization Trial
Question Which specific components within internet-delivered cognitive behavioral therapy (CBT) for depression are active ingredients that reduce symptoms?
Findings In this randomized optimization trial that included 767 adults with depression, 6 treatment components (activity scheduling, thought challenging, relaxation, concreteness training, functional analysis, and self-compassion training) did not show a significant main effect on depression. However, the presence of the absorption component outperformed its absence in reducing depression at 6-month follow-up.
Meaning The findings suggest that the majority of treatment benefit from internet-delivered CBT is likely to accrue from factors common to all CBT components and/or from generic factors common to all therapies, with the possible exception of absorption.
Importance There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable.
Objective To test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients.
Design, Setting, and Participants This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire−9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023.
Interventions Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training).
Main Outcomes and Measures The primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning.
Results Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, −7.79 [90% CI, −8.21 to −7.37]; 6-month follow-up difference in PHQ-9 score, −8.63 [90% CI, −9.04 to −8.22]). A baseline score–adjusted analysis of covariance model using effect-coded intervention variables (−1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], −0.09 [90% CI, −0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], −0.18 [90% CI, −0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, −0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, −0.54, [90% CI, −0.97 to −0.11]).
Conclusions and Relevance In this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers.
Trial Registration isrctn.org Identifier: ISRCTN24117387
No comments:
Post a Comment