Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients.
<bold>Objective: </bold>This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment fai...
| Publicado en: | American Journal of Psychiatry Vol. 176; no. 4; pp. 315 - 324 |
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| Autores principales: | , , , , , , , |
| Formato: | journal article |
| Publicado: |
American Psychiatric Publishing, Inc.
Apr2019
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| Materias: | |
| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ssf&AN=135642673&site=ehost-live header: @attributes: shortDbName: ssf uiTerm: 135642673 longDbName: Social Sciences Full Text (H.W. Wilson) uiTag: AN controlInfo: bkinfo: jinfo: jid: 0002953X API jtl: American Journal of Psychiatry issn: 0002953X maglogo: N pubinfo: dt: Apr2019 vid: 176 iid: 4 pid: 37323 pub: American Psychiatric Publishing, Inc. artinfo: ui: 135642673 10.1176/appi.ajp.2018.18060699 ppf: 315 ppct: 9 formats: tig: atl: Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT: A Single-Blind Randomized Clinical Trial With Insomnia Patients. aug: au: Forsell, Erik Jernelöv, Susanna Blom, Kerstin Kraepelien, Martin Svanborg, Cecilia Andersson, Gerhard Lindefors, Nils Kaldo, Viktor affil: Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Huddinge Hospital, Stockholm (Forsell, Jernelöv, Blom, Kraepelien, Svanborg, Andersson, Lindefors, Kaldo) su: Cognitive therapy Clinical trials Therapeutics Blind experiment Internet Randomized controlled trials Proof of concept Insomniacs Classification algorithms Tumor classification Insomnia treatment Evaluation research Computers in medicine Research methodology Research Treatment failure Comparative studies Algorithms sug: subj: Cognitive therapy Clinical trials Therapeutics Blind experiment Internet Randomized controlled trials Research and Development in the Physical, Engineering, and Life Sciences (except Biotechnology) Internet Publishing and Broadcasting and Web Search Portals Wired Telecommunications Carriers Proof of concept Insomniacs Classification algorithms Tumor classification Insomnia treatment Evaluation research Computers in medicine Research methodology Research Treatment failure Comparative studies Algorithms keyword: Behavior Therapy Computers Diagnosis And Classification Psychotherapy Sleep Behavior Therapy Computers Diagnosis And Classification Psychotherapy Sleep ab: <bold>Objective: </bold>This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment failure.<bold>Methods: </bold>A semiautomated algorithm assessed risk of treatment failure early in treatment in 251 patients undergoing ICBT for insomnia with therapist guidance. At-risk patients were randomly assigned to continue standard ICBT or to receive adapted ICBT. The primary outcome was self-rated insomnia symptoms using the Insomnia Severity Index in a linear mixed-effects model. The main secondary outcome was treatment failure (having neither responded nor remitted at the posttreatment assessment).<bold>Results: </bold>A total of 102 patients were classified as at risk and randomly assigned to receive adapted ICBT (N=51) or standard ICBT (N=51); 149 patients were classified as not at risk. Patients not at risk had significantly greater score reductions on the Insomnia Severity Index than at-risk patients given standard ICBT. Adapted ICBT for at-risk patients was significantly more successful in reducing symptoms compared with standard ICBT, and it decreased the risk of failing treatment (odds ratio=0.33). At-risk patients receiving adapted ICBT were not more likely to experience treatment failure than those not at risk (odds ratio=0.51), though they were less likely to experience remission. Adapted treatment required, on average, 14 more minutes of therapist-patient time per remaining week.<bold>Conclusions: </bold>An adaptive treatment strategy can increase treatment effects for at-risk patients and reduce the number of failed treatments. Future studies should improve accuracy in classification algorithms and identify key factors that boost the effect of adapted treatments. pubtype: Academic Journal doctype: journal article src: R language: English refInfo: copyright: @attributes: flag: N holdings: @attributes: islocal: N |
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