杂志文章%@ 1438- 8871% I JMIR出版物%V 20% 卡塔尔世界杯8强波胆分析N 9% P e10743% T基于网络的认知行为疗法结合面对面治疗重度抑郁症:随机对照试验%A Nakao,Shigetsugu %A Nakagawa,Atsuo %A Oguchi,Yoshiyo %A Mitsuda,Dai %A Kato,Noriko %A Nakagawa,Yuko %A Tamura,Noriko %A工藤，Yuka %A Abe,Takayuki %A Hiyama,Mitsunori %A Iwashita,Satoru %A Ono,Yutaka %A Mimura,Masaru %+庆应义塾大学医院临床和翻译研究中心，东京，160-8582，日本，81 3 3353 1211，anakagawa@keio.jp %K混合认知行为疗法%K认知行为疗法%K重度抑郁症%K随机对照试验%D 2018 %7 21.9.2018 %9原始论文%J J医学互联网Res %G英文%X背景:几项随机对照试验的元分析表明，认知行为疗法(CBT)与抗抑郁药物具有相当的疗效，但治疗师的可用性和成本-效益是一个问题。目的:本研究旨在评估基于网络的CBT与面对面治疗相结合的有效性，以减少对抗抑郁药物无反应的重度抑郁症患者的治疗师时间。方法:在东京的3家医疗机构进行了一项为期12周、评估者蒙面、平行组、等待名单对照、随机试验。年龄20-65岁，主要诊断为重度抑郁症的门诊患者，服用≥1种足够剂量的抗抑郁药物≥6周，网格-汉密尔顿抑郁评分量表(GRID-Hamilton depression Rating Scale, HAMD) 17项评分≥14，使用计算机分配系统随机(1:1)分配到混合CBT组或等候名单组，按研究地点采用最小化方法分层，以平衡年龄和基线网格-HAMD评分。CBT干预以一种组合形式进行，包括一个基于网络的程序和12个45分钟的面对面会话。因此，在12周内，参与者可以与治疗师进行长达540分钟的接触，这大约是传统CBT协议中治疗师接触时间的三分之二，传统CBT协议通常提供16次50分钟的会话。主要结局是抑郁症状的缓解，通过GRID-HAMD总评分从基线(随机分组)到治疗后(12周)的变化来衡量。此外，在探索性分析中，我们调查了在治疗后评估后3个月的随访中，干预的预期积极效果是否持续。 Analyses were performed on an intention-to-treat basis, and the primary outcome was analyzed using a mixed-effects model for repeated measures. Results: We randomized 40 participants to either blended CBT (n=20) or waiting-list (n=20) groups. All patients completed the 12-week treatment protocol and were included in the intention-to-treat analyses. Participants in the blended CBT group had significantly alleviated depressive symptoms at week 12, as shown by greater least squares mean changes in the GRID-HAMD score, than those in the waiting list group (−8.9 points vs −3.0 points; mean between-group difference=−5.95; 95% CI −9.53 to −2.37; P<.001). The follow-up effects within the blended CBT group, as measured by the GRID-HAMD score, were sustained at the 3-month follow-up (week 24) and posttreatment (week 12): posttreatment, 9.4 (SD 5.2), versus follow-up, 7.2 (SD 5.7); P=.009. Conclusions: Although our findings warrant confirmation in larger and longer term studies with active controls, these suggest that a combined form of CBT is effective in reducing depressive symptoms in patients with major depression who are unresponsive to antidepressant medications. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry: UMIN000009242; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000010852 (Archived by WebCite at http://www.webcitation. org/729VkpyYL) %M 30249583 %R 10.2196/10743 %U //www.mybigtv.com/2018/9/e10743/ %U https://doi.org/10.2196/10743 %U http://www.ncbi.nlm.nih.gov/pubmed/30249583