ABSTRACT

Given that over 20 million adults each year do not receive care for their mental health difficulties, it is imperative to improve system-level capacity issues by increasing treatment efficiency. The present study aimed to collect feasibility/acceptability data on two strategies for increasing the efficiency of cognitive behavioral therapy: (1) personalized skill sequences and (2) personalized skill selections. Participants (N = 70) with anxiety and depressive disorders were enrolled in a pilot sequential multiple assignment randomized trial (SMART). Patients were randomly assigned to receive skill modules from the Unified Protocol in one of three sequencing conditions: standard, sequences that prioritized patients’ relative strengths, and sequences that prioritized relative deficits. Participants also underwent a second-stage randomization to either receive 6 sessions or 12 sessions of treatment. Participants were generally satisfied with the treatment they received, though significant differences favored the Capitalization and Full duration conditions. There were no differences in trajectories of improvement as a function of sequencing condition. There were also no differences in end-of-study outcomes between brief personalized treatment and full standard treatment. Thus, it may be feasible to deliver CBT for personalized durations, though this may not substantially impact trajectories of change in anxiety or depressive symptoms.

摘要

鉴于每年有超过 2000 万成年人因心理健康问题得不到治疗，必须通过提高治疗效率来改善系统层面的能力问题。本研究旨在收集关于提高认知行为疗法效率的两种策略的可行性/可接受性数据：(1) 个性化技能序列和 (2) 个性化技能选择。患有焦虑症和抑郁症的参与者 (N = 70) 被纳入一项试验序贯多分配随机试验 (SMART)。患者被随机分配到接受来自统一协议的技能模块的三种排序条件之一：标准、优先考虑患者相对优势的序列，以及优先考虑相对缺陷的序列。参与者还接受了第二阶段随机化，接受 6 次或 12 次治疗。参与者普遍对他们收到的待遇感到满意，尽管显着差异有利于资本化和完整期限条件。作为测序条件的函数，改进轨迹没有差异。简短的个性化治疗和完整的标准治疗之间的研究结束结果也没有差异。因此，在个性化持续时间内提供 CBT 可能是可行的，尽管这可能不会显着影响焦虑或抑郁症状的变化轨迹。尽管显着差异有利于资本化和完整期限条件。作为测序条件的函数，改进轨迹没有差异。简短的个性化治疗和完整的标准治疗之间的研究结束结果也没有差异。因此，在个性化持续时间内提供 CBT 可能是可行的，尽管这可能不会显着影响焦虑或抑郁症状的变化轨迹。尽管显着差异有利于资本化和完整期限条件。作为测序条件的函数，改进轨迹没有差异。简短的个性化治疗和完整的标准治疗之间的研究结束结果也没有差异。因此，在个性化持续时间内提供 CBT 可能是可行的，尽管这可能不会显着影响焦虑或抑郁症状的变化轨迹。