临床医师辅助的计算机心理干预对共病精神健康和物质使用问题的可接受性:来自随机对照试验的治疗坚持性数据% a Kay-Lambkin,Frances % a Baker,Amanda % a Lewin,Terry % a Carr,Vaughan %+新南威尔士大学国家药物和酒精研究中心，兰德威克，22-32国王街，新南威尔士州，2032,61 240335690电脑认知行为疗法%K短暂干预%K共病%K抑郁%K酒精使用问题%D 2011 %7 27.01.2011 %9原论文%J J医学互联网Res %G英文%X背景:电脑提供的心理治疗有很大的潜力，特别是对那些不能使用传统方法的个人。人们对计算机提供治疗的可接受性知之甚少，特别是在那些有精神健康和药物使用问题共病的患者中。目的:本研究的目的是评估临床医生辅助计算机(CAC)心理治疗(在临床环境下通过DVD提供)对共病抑郁症和酒精或大麻使用问题的可接受性，相对于治疗师提供的等效治疗和简短干预对照。方法:我们比较了治疗师提供的心理治疗和CAC心理治疗在治疗退出/参与和治疗联盟方面的治疗可接受性。我们将97名目前患有抑郁症和有问题的酒精/大麻使用的参与者随机分配到三种条件下:简短干预(BI，一个面对面的单独疗程)，治疗师提供(一个初始的面对面疗程加上一个治疗师提供的9个单独疗程)和CAC干预(一个初始的面对面疗程加上9个单独的CAC疗程)。在基线和提供初始疗程后进行随机化，并在初始疗程结束后从参与者中获得治疗联盟评级，在治疗师提供的和CAC条件下的第5和第10疗程中获得评级。结果:治疗师提供的治疗和CAC条件下的治疗保留率和出勤率相等，51%(34/67)完成所有10个治疗疗程。在大多数治疗联盟亚量表中，在治疗的任何时间点，治疗师提供的和CAC状态的参与者之间不存在显著差异。 However, relative to therapist-delivered treatment, the subscale of Client Initiative was rated significantly higher among participants allocated to the BI (F2,54 = 4.86, P = .01) and CAC participants after session 5 (F1,29 = 9.24, P = .005), and this domain was related to better alcohol outcomes. Linear regression modeled therapeutic alliance over all sessions, with treatment allocation, retention, other demographic factors, and baseline symptoms exhibiting no predictive value. Conclusions: Participants in a trial of CAC versus therapist-delivered treatment were equally able to engage, bond, and commit to treatment, despite comorbidity typically being associated with increased treatment dropout, problematic engagement, and complexities in treatment planning. The extent to which a client feels that they are directing therapy (Client initiative) may be an important component of change in BI and CAC intervention, especially for hazardous alcohol use. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12607000437460; http://www.anzctr.org.au/trial_view.aspx?ID=82228 (Archived by WebCite at http://www.webcitation.org/5ubuRsULu) %M 21273184 %R 10.2196/jmir.1522 %U //www.mybigtv.com/2011/1/e11/ %U https://doi.org/10.2196/jmir.1522 %U http://www.ncbi.nlm.nih.gov/pubmed/21273184