Background

Transdiagnostic iCBT has been shown to be effective for the treatment of emotional disorders. Less is known about the optimal level of therapist and patient involvement in these interventions. Specific characteristics of Internet-delivered interventions include treatment adherence (e.g., amount of review of the materials) and guidance (e.g., amount of therapist support). Exploring the importance of these elements in treatment outcome may help to maximize the efficiency of Internet-delivered psychological interventions.

Aim

In this study, we aimed to analyze the relationship between patient and therapist involvement (i.e., platform usage and amount of therapist guidance) in a sample of patients with emotional disorders who received transdiagnostic iCBT in Spanish public specialized mental healthcare services.

Method

This is a secondary analysis of a randomized controlled trial. The sample included 63 patients who completed transdiagnostic iCBT for emotional disorders. Platform usage metrics included number of logins into the platform and number of times the participants reviewed the modules. Therapist guidance was measured as the number of support phone calls with a therapist and their total duration (minutes). Logistic regressions and ROC analyses were performed to explore the predictive value of platform usage and therapist guidance in symptom reduction. Clinical outcomes included depressive and anxiety symptoms assessed at baseline and post-intervention. The bivariate relationship between the platform usage and therapist guidance variables was also explored.

Results

Overall, platform usage and therapist guidance were not associated with symptom improvement. However, the patient and therapist involvement parameters were intercorrelated. Specifically, the number of calls and their duration were associated with a greater number of logins (r = 0.61; p < .001) and more frequent reviews of the modules (0.46 ≤ r ≤ 0.60; p < .001). Higher baseline depression and anxiety were, respectively, associated with greater improvements in depression (r = −0.37, p = .003) and anxiety after treatment completion (r = −0.48, p < .001).

Discussion

The results suggest that there is no reliable cut-off point for platform usage and therapist guidance in predicting optimal symptom reduction. However, significant associations were found between platform usage and guidance variables that warrant additional research. More research on this topic is necessary to further clarify the role of these and other platform usage and guidance variables in Internet-delivered iCBT outcomes.

中文翻译：

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从患者和治疗师的参与预测情绪障碍对跨诊断 iCBT 的反应

背景

跨诊断 iCBT 已被证明可有效治疗情绪障碍。关于治疗师和患者参与这些干预的最佳水平知之甚少。互联网提供的干预措施的具体特征包括治疗依从性（例如，材料审查的数量）和指导（例如，治疗师支持的数量）。探索这些因素在治疗结果中的重要性可能有助于最大限度地提高互联网提供的心理干预的效率。

目标

在这项研究中，我们旨在分析在西班牙公共专业精神保健服务中接受跨诊断 iCBT 的情绪障碍患者样本中患者和治疗师参与（即平台使用和治疗师指导量）之间的关系。

方法

这是对随机对照试验的二次分析。样本包括 63 名完成情绪障碍跨诊断 iCBT 的患者。平台使用指标包括登录平台的次数和参与者查看模块的次数。治疗师指导以治疗师的支持电话数量及其总持续时间（分钟）来衡量。进行逻辑回归和 ROC 分析以探索平台使用和治疗师指导在减轻症状方面的预测价值。临床结果包括在基线和干预后评估的抑郁和焦虑症状。还探讨了平台使用和治疗师指导变量之间的双变量关系。

结果

总体而言，平台使用和治疗师指导与症状改善无关。然而，患者和治疗师的参与参数是相互关联的。具体来说，调用次数及其持续时间与更多的登录次数（r  = 0.61；p  < .001）和更频繁的模块审查（0.46 ≤  r  ≤ 0.60；p  < .001）相关。较高的基线抑郁和焦虑分别与抑郁（r  = -0.37，p  = .003）和治疗完成后焦虑（r  = -0.48，p  <.001）的更大改善相关。

讨论

结果表明，平台使用和治疗师指导在预测最佳症状减轻方面没有可靠的分界点。然而，在平台使用和指导变量之间发现了显着的关联，需要进一步研究。有必要对此主题进行更多研究，以进一步阐明这些和其他平台使用和指导变量在互联网提供的 iCBT 结果中的作用。