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Acceptability of Computerized Cognitive Behavioral Therapy for Adults: Umbrella Review
JMIR Mental Health ( IF 5.2 ) Pub Date : 2021-07-06 , DOI: 10.2196/23091
Charlene J Treanor 1 , Anne Kouvonen 1, 2 , Tea Lallukka 3 , Michael Donnelly 1
Affiliation  

Background: Mental ill-health presents a major public health problem. A potential part solution that is receiving increasing attention is computer-delivered psychological therapy, particularly during the COVID-19 pandemic as health care systems moved to remote service delivery. However, computerized cognitive behavioral therapy (cCBT) requires active engagement by service users, and low adherence may minimize treatment effectiveness. Therefore, it is important to investigate the acceptability of cCBT to understand implementation issues and maximize potential benefits. Objective: This study aimed to produce a critical appraisal of published reviews about the acceptability of cCBT for adults. Methods: An umbrella review informed by the Joanna Briggs Institute (JBI) methodology identified systematic reviews about the acceptability of cCBT for common adult mental disorders. Acceptability was operationalized in terms of uptake of, dropping out from, or completion of cCBT treatment; factors that facilitated or impeded adherence; and reports about user, carer, and health care professional experience and satisfaction with cCBT. Databases were searched using search terms informed by relevant published research. Review selection and quality appraisal were guided by the JBI methodology and the AMSTAR tool and undertaken independently by 2 reviewers. Results: The systematic searches of databases identified 234 titles, and 9 reviews (covering 151 unique studies) met the criteria. Most studies were comprised of service users with depression, anxiety, or specifically, panic disorder or phobia. Operationalization of acceptability varied across reviews, thereby making it difficult to synthesize results. There was a similar number of guided and unguided cCBT programs; 34% of guided and 36% of unguided users dropped out; and guidance included email, telephone, face-to-face, and discussion forum support. Guided cCBT was completed in full by 8%-74% of the participants, while 94% completed one module and 67%-84% completed some modules. Unguided cCBT was completed in full by 16%-66% of participants, while 95% completed one module and 54%-93% completed some modules. Guided cCBT appeared to be associated with adherence (sustained via telephone). A preference for face-to-face CBT compared to cCBT (particularly for users who reported feeling isolated), internet or computerized delivery problems, negative perceptions about cCBT, low motivation, too busy or not having enough time, and personal circumstances were stated as reasons for dropping out. Yet, some users favored the anonymous nature of cCBT, and the capacity to undertake cCBT in one’s own time was deemed beneficial but also led to avoidance of cCBT. There was inconclusive evidence for an association between sociodemographic variables, mental health status, and cCBT adherence or dropping out. Users tended to be satisfied with cCBT, reported improvements in mental health, and recommended cCBT. Overall, the results indicated that service users’ preferences were important considerations regarding the use of cCBT. Conclusions: The review indicated that “one size did not fit all” regarding the acceptability of cCBT and that individual tailoring of cCBT is required in order to increase population reach, uptake, and adherence and therefore, deliver treatment benefits and improve mental health.

中文翻译:

成人计算机化认知行为疗法的可接受性:总览

背景:精神疾病是一个主要的公共卫生问题。一个越来越受到关注的潜在部分解决方案是计算机提供的心理治疗,特别是在 COVID-19 大流行期间,因为医疗保健系统转向远程服务提供。然而,计算机化认知行为疗法 (cCBT) 需要服务使用者的积极参与,而依从性低可能会降低治疗效果。因此,重要的是调查 cCBT 的可接受性以了解实施问题并最大限度地提高潜在收益。目标:本研究旨在对已发表的关于成人 cCBT 可接受性的评论进行批判性评估。方法:由乔安娜布里格斯研究所 (JBI) 方法提供的总体审查确定了关于 cCBT 对常见成人精神障碍的可接受性的系统审查。可接受性在 cCBT 治疗的接受、退出或完成方面进行了操作;促进或阻碍依从性的因素;以及有关用户、护理人员和医疗保健专业经验以及对 cCBT 的满意度的报告。使用相关已发表研究提供的搜索词来搜索数据库。审查选择和质量评估以 JBI 方法论和 AMSTAR 工具为指导,并由 2 名审查员独立进行。结果:对数据库的系统搜索确定了 234 篇标题,9 篇综述(涵盖 151 项独特研究)符合标准。大多数研究由患有抑郁症、焦虑症,或者特别是恐慌症或恐惧症的服务使用者组成。可接受性的操作因审查而异,因此难以综合结果。有指导和无指导的 cCBT 项目数量相似;34% 的引导用户和 36% 的非引导用户退出;指导包括电子邮件、电话、面对面和论坛支持。8%-74% 的参与者完全完成了引导式 cCBT,而 94% 的参与者完成了一个模块,67%-84% 的参与者完成了一些模块。16%-66% 的参与者完全完成了无指导的 cCBT,而 95% 的参与者完成了一个模块,54%-93% 的参与者完成了一些模块。指导性 cCBT 似乎与依从性有关(通过电话维持)。与 cCBT 相比,更喜欢面对面的 CBT(特别是对于报告感到孤立的用户)、互联网或计算机化交付问题、对 cCBT 的负面看法、动力不足、太忙或没有足够的时间以及个人情况被表述为辍学的原因。然而,一些用户喜欢 cCBT 的匿名性质,在自己的时间进行 cCBT 的能力被认为是有益的,但也导致避免使用 cCBT。没有确凿的证据表明社会人口学变量、心理健康状况和 cCBT 依从性或辍学之间存在关联。用户往往对 cCBT 感到满意,报告了心理健康的改善,并推荐了 cCBT。全面的,结论:审查表明,关于 cCBT 的可接受性“一刀切”,需要对 cCBT 进行个体化定制,以增加人群覆盖率、吸收率和依从性,从而提供治疗益处并改善心理健康。
更新日期:2021-07-06
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