Background: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. Objective: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. Methods: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. Results: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. Conclusions: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming.

中文翻译：

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比较向受过创伤的退伍军人提供的混合疗法中治疗师支持与互联网会话的比率：准实验比较研究

背景：融合了互联网和面对面方法元素的混合治疗模型已被证明是有效的，但治疗师和患者表示担心面对面治疗课程少于自我指导的互联网课程可能与较低的治疗联盟、较低的项目完成率和较差的结果有关。客观的：一项在常规临床护理中实施的具有非劣效性设计的多站点准实验比较研究被用于评估 webSTAIR，这是一种源自 STAIR（情感和人际调节技能培训）的 10 模块混合疗法，用于每周 10 次治疗师提供的创伤暴露个体课程（称为 Coach10）与 5 个双周课程（Coach5）相比。据推测，Coach5 在一系列结果上与 Coach10 一样好。方法：共有 202 名退伍军人参加了这项研究，其中 101 名分配给了 Coach5，101 名分配给了 Coach10。在治疗前、治疗中和治疗后以及 3 个月的随访中收集了创伤后应激障碍 (PTSD) 症状、抑郁、情绪调节、人际关系问题和社会功能测量。对症状结果测量进行非劣效性分析。对参与者和治疗师活动的连续和分类测量进行了比较。结果：参与者报告了中度至重度基线 PTSD、抑郁或两者兼有。在治疗后和 3 个月的随访中，所有症状测量均显着降低。Coach5在任何结果上都不逊色于Coach10。在两种治疗条件下，治疗联盟处于同等水平；完成率和网络使用率相似。Coach5 治疗师的总疗程时间大大少于 Coach10 治疗师。这两个项目都与少量但相同数量的治疗师活动相关，这些活动与日程安排和危机或激励课程有关。结论：在具有中度至重度症状的个体中，提供 5 次治疗师支持的混合模型不劣于 10 次治疗。未来的研究将患者特征确定为具有高剂量和低剂量治疗师支持的结果的调节因素，将有助于创建灵活的、基于技术的干预计划。