The authors evaluated the efficacy and durability of a therapist-supported method for computer-assisted cognitive-behavioral therapy (CCBT) in comparison to standard cognitive-behavioral therapy (CBT).

A total of 154 medication-free patients with major depressive disorder seeking treatment at two university clinics were randomly assigned to either 16 weeks of standard CBT (up to 20 sessions of 50 minutes each) or CCBT using the “Good Days Ahead” program. The amount of therapist time in CCBT was planned to be about one-third that in CBT. Outcomes were assessed by independent raters and self-report at baseline, at weeks 8 and 16, and at posttreatment months 3 and 6. The primary test of efficacy was noninferiority on the Hamilton Depression Rating Scale at week 16.

Approximately 80% of the participants completed the 16-week protocol (79% in the CBT group and 82% in the CCBT group). CCBT met a priori criteria for noninferiority to conventional CBT at week 16. The groups did not differ significantly on any measure of psychopathology. Remission rates were similar for the two groups (intent-to-treat rates, 41.6% for the CBT group and 42.9% for the CCBT group). Both groups maintained improvements throughout the follow-up.

The study findings indicate that a method of CCBT that blends Internet-delivered skill-building modules with about 5 hours of therapeutic contact was noninferior to a conventional course of CBT that provided over 8 additional hours of therapist contact. Future studies should focus on dissemination and optimizing therapist support methods to maximize the public health significance of CCBT.

作者评估了治疗师支持的计算机辅助认知行为治疗 (CCBT) 方法与标准认知行为治疗 (CBT) 的有效性和持久性。

共有 154 名在两所大学诊所寻求治疗的未接受药物治疗的重度抑郁症患者被随机分配接受 16 周的标准 CBT（最多 20 次疗程，每次 50 分钟）或使用“Good Days Ahead”计划的 CCBT。CCBT 中的治疗师时间预计约为 CBT 的三分之一。由独立评估者和自我报告在基线、第 8 周和第 16 周以及治疗后第 3 个月和第 6 个月对结果进行评估。疗效的主要测试是第 16 周汉密尔顿抑郁量表的非劣效性。

大约 80% 的参与者完成了为期 16 周的方案（CBT 组为 79%，CCBT 组为 82%）。在第 16 周时，CCBT 满足了不劣于传统 CBT 的先验标准。各组在任何精神病理学指标上都没有显着差异。两组的缓解率相似（意向治疗率，CBT 组为 41.6%，CCBT 组为 42.9%）。两组在整个后续过程中都保持了进步。

研究结果表明，将互联网提供的技能培养模块与约 5 小时的治疗接触相结合的 CCBT 方法并不逊色于提供额外 8 小时以上治疗师接触的传统 CBT 课程。未来的研究应侧重于传播和优化治疗师支持方法，以最大限度地发挥 CCBT 的公共卫生意义。