Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled TrialReportar como inadecuado


Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial


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Publication Date: 2017-05-31

Journal Title: JMIR Mental Health

Publisher: JMIR Publications

Volume: 4

Issue: 2

Number: e16

Language: English

Type: Article

This Version: VoR

Metadata: Show full item record

Citation: Simblett, S., Yates, M., Wagner, A., Watson, P., Gracey, F., Ring, H., & Bateman, A. (2017). Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial. JMIR Mental Health, 4 (2. e16)https://doi.org/10.2196/mental.6022

Abstract: $\textbf{Background:}$ Depression and anxiety are common complications following stroke. Symptoms could be treatable with psychological therapy, but there is little research on its efficacy. $\textbf{Objectives:}$ The aim of this study was to investigate (1) the acceptability and feasibility of computerized cognitive behavioral therapy (cCBT) to treat symptoms of depression and anxiety and (2) a trial design for comparing the efficacy of cCBT compared with an active comparator. $\textbf{Methods:}$ Of the total 134 people screened for symptoms of depression and anxiety following stroke, 28 were cluster randomized in blocks with an allocation ratio 2:1 to cCBT (n=19) or an active comparator of computerized cognitive remediation therapy (cCRT, n=9). Qualitative and quantitative feedback was sought on the acceptability and feasibility of both interventions, alongside measuring levels of depression, anxiety, and activities of daily living before, immediately after, and 3 months post treatment. $\textbf{Results:}$ Both cCBT and cCRT groups were rated as near equally useful (mean = 6.4 vs 6.5, $d$=0.05), while cCBT was somewhat less relevant (mean = 5.5 vs 6.5, $d$=0.45) but somewhat easier to use (mean = 7.0 vs 6.3, $d$=0.31). Participants tolerated randomization and dropout rates were comparable with similar trials, with only 3 participants discontinuing due to potential adverse effects; however, dropout was higher from the cCBT arm (7/19, 37% vs 1/9, 11% for cCRT). The trial design required small alterations and highlighted that future-related studies should control for participants receiving antidepressant medication, which significantly differed between groups ($P$=.05). Descriptive statistics of the proposed outcome measures and qualitative feedback about the cCBT intervention are reported. $\textbf{Conclusions:}$ A pragmatic approach is required to deliver computerized interventions to accommodate individual needs. We report a preliminary investigation to inform the development of a full randomized controlled trial for testing the efficacy of computerized interventions for people with long-term neurological conditions such as stroke and conclude that this is a potentially promising way of improving accessibility of psychological support.

Keywords: anxiety, cognitive therapy, depression, stroke, technology

Sponsorship: National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England (EoE) at Cambridgeshire and Peterborough NHS Foundation Trust

Embargo Lift Date: 2100-01-01

Identifiers:

External DOI: https://doi.org/10.2196/mental.6022

This record's URL: https://www.repository.cam.ac.uk/handle/1810/265139



Rights: Attribution 4.0 International

Licence URL: http://creativecommons.org/licenses/by/4.0/





Autor: Simblett, SKYates, MWagner, APWatson, PGracey, FRing, H Bateman, A

Fuente: https://www.repository.cam.ac.uk/handle/1810/265139



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