اثربخشی بالینی و هزینه کم درمان اینترنتی در مقابل رفتاردرمانی شناختی مبتنی بر گروه برای اختلال اضطراب اجتماعی: 4 سال پیگیری آزمایشات تصادفی
|کد مقاله||سال انتشار||مقاله انگلیسی||ترجمه فارسی||تعداد کلمات|
|30202||2014||10 صفحه PDF||سفارش دهید||8962 کلمه|
Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)
Journal : Behaviour Research and Therapy, Volume 59, August 2014, Pages 20–29
Social anxiety disorder (SAD) is common, debilitating and associated with high societal costs. The disorder can be effectively treated with Internet-based cognitive behavior therapy (ICBT), but no previous study has investigated the long-term clinical or health economic effects of ICBT for SAD in comparison to an evidence-based control treatment. The aim of the study was to investigate the clinical effectiveness and cost-effectiveness of ICBT compared to cognitive behavioral group therapy (CBGT) four years post-treatment. We conducted a 4-year follow-up study of participants who had received ICBT or CBGT for SAD within the context of a randomized controlled non-inferiority trial. The cost-effectiveness analyses were conducted taking a societal perspective. Participants in both treatment groups made large improvements from baseline to 4-year follow-up on the primary outcome measure (d = 1.34–1.48) and the 95% CI of the mean difference on the primary outcome was well within the non-inferiority margin. ICBT and CBGT were similarly cost-effective and both groups reduced their indirect costs. We conclude that ICBT for SAD yields large sustainable effects and is at least as long-term effective as CBGT. Intervention costs of both treatments are offset by net societal cost reductions in a short time.
Social anxiety disorder (SAD) has an early onset, follows a chronic course if untreated, leads to functional impairment and is highly prevalent (Kessler et al., 2005a, Kessler et al., 2005b, Wittchen and Fehm, 2003 and Yonkers et al., 2001). The disorder is associated with an increased risk of unemployment and disability pension and the annual societal costs of SAD has been estimated to more than $350 million per one million inhabitants (Acarturk et al., 2009, Bruch et al., 2003, Dahl and Dahl, 2010 and Fehm et al., 2005), which translates to about $111 billion annually in the US. Cognitive behavioral group therapy (CBGT) has been shown to be effective in the treatment of SAD in at least 12 randomized controlled trials (e.g. Blanco et al., 2010 and Heimberg et al., 1990). Access to treatment is however limited (Cavanagh, 2013) and stigma, costs, and difficulty to take time off from work to attend therapy sessions are common barriers to treatment (Mewton et al., 2014 and Moritz et al., 2013). Recently, Internet-based cognitive behavior therapy (ICBT) has emerged as an empirically supported treatment for SAD with effect sizes on par with those of CBGT and tested in at least 16 randomized controlled trials (Berger et al., 2009, Hedman et al., 2012 and Titov et al., 2008). In short, ICBT can be described as online bibliotherapy with therapist support through a secure Internet-based treatment platform (Andersson, 2009). One important advantage of ICBT is that the treatment requires less therapist time, often about 10–15 min weekly per patient (Hedman, Andersson, Ljótsson, Andersson, Ruck, Mortberg, et al., 2011), and is thus a promising means to increase accessibility to effective treatment. In a previously reported randomized non-inferiority trial we found that ICBT for SAD can be at least as effective as CBGT when delivered in a psychiatric setting (Hedman, Andersson, Ljótsson, Andersson, Ruck, Mortberg, et al., 2011). Also, both treatments led to substantial societal indirect cost reductions at 6-month follow-up compared to baseline (Hedman, Andersson, Ljótsson, Andersson, Ruck, & Lindefors, 2011). Although ICBT for SAD has been tested in many trials only two studies have investigated its long-term effects. These studies demonstrated maintenance of improvement from ICBT up to five years after completed treatment (Carlbring et al., 2009 and Hedman et al., 2011c), which is similar to the long-term effects of CBGT (Heimberg, Salzman, Holt, & Blendell, 1993). However, both studies investigating ICBT lacked control groups. In a study on depression it was found that ICBT was as effective as conventional CBT at three-year follow-up (Andersson et al., 2013), but to our knowledge no study has compared the long-term effects of ICBT for SAD to an active treatment. When it comes to cost-effectiveness, we have found two studies demonstrating that ICBT is likely to be cost-effective compared to conventional CBT (Hedman et al., 2011a and Titov et al., 2009), but the knowledge on health economic effects of psychological treatment for SAD is scarce. Given the disabling effects of SAD, effectiveness and health economic effects are important to investigate in order to determine long-term societal benefits. The aim of the present study was to investigate the long-term clinical effectiveness and cost-effectiveness of ICBT vs. CBGT for SAD in a 4-year follow-up study of a randomized controlled non-inferiority trial (Hedman, Andersson, Ljótsson, Andersson, Ruck, Mortberg, et al., 2011). We hypothesized that ICBT would be at least as effective as CBGT in reducing social anxiety and secondary psychiatric symptoms in terms of depression, general anxiety, and anxiety sensitivity. Also, we expected that both treatments would lead to societal cost reductions.
نتیجه گیری انگلیسی
Internet-based CBT for SAD is as long-term effective as CBT delivered face-to-face in a group format and both treatments lead to large improvements that last at least four years post-treatment. From a societal perspective, the two treatments are similarly cost-effective in the longer run and the intervention costs are offset by reduced indirect costs. The study presents compelling evidence that ICBT can be used to increase accessibility to effective psychological treatment for SAD.