| ObjectiveMild symptoms depression is common in the population and most of them are not treated.This study broke the diagnostic limit and selected the patients with minor depressive disorder,mild depression and dysthymia.The patients were randomly divided into internet video group and face-to-face intervention group to compare the difference of efficacy between the two groups.The qualitative research method was used to explore the experience of patients in internet-based structured group cognitive behavior therapy(I-GCBT),and to provide a new choice for the treatment of mild depressive disorder.Method1.92 patients were randomly divided into I-GCBT(n=54)and GCBT(n=38)according to the proportion of 2:1 and received 12 times GCBT.17 Hamilton depression scale(HAMD17)and 16 items quick inventory of depressive symptomatology-self report(QIDS-SR16)were used to assess the severity of depression before treatment,4th week,8th week and 12 th week.Hamilton anxiety scale(HAMA),global assessment of functioning scale(GAF)and 6 items quality of life scale(Qol-6)were used to evaluate the anxiety degree and social function level of patients.Repeated measurement analysis of variance was used to compare the difference of efficacy between the two groups.2.Perceived social support scale(PSSS)and stigma scale for mental illness(SSMI-C)were used to evaluate the scores of social support and shame of the patients before treatment and 12 th week.The difference of reduction score between the two groups was compared by independent sample t test.3.24 patients in I-GCBT were chosen to receive semi-structured interviews before treatment and 12 th week for acquainting their experience in I-GCBT.During the treatment,recording the times of patient’s participation,the involving in the treatment and homework completion to assess the patient’s participation.All interviews were permitted to be recorded and were transcribed verbatim.Then the transcriptions were analyzed by interpretative phenomenological analysis.Results1.A total of 74 patients were included in the study,43 in I-GCBT and 31 in GCBT.The group and time interaction of the two groups in HAMD17,HAMA and QIDS-SR16 were not significant.The main effects of time were significant in HAMD17,HAMA and QIDS-SR16(HAMD17: F=40.07,P<0.01、HAMA: F=31.32,P<0.01;QIDS-SR16: F=6.19,P=0.01)and the main effects were not significant.The group and time interaction in GAF was significant(F=3.05,P=0.04).The interaction of the two groups and the main effect in Qol-6 scale were not significant.2.The minus score of SSMI-C total scores in the two groups of patients who completed the 12 weeks treatment were compared,and the results were significant(t=3.64,P=0.01).The minus scores in IGCBT of SSMI-C three subscales were also significantly higher than those in GCBT(Discrimination: t = 2.51,P = 0.02;Disclosure: t=2.52,P=0.02;Positive Aspects: t=4.26,P<0.01).The minus scores of PSSS total score and two subscales of the two groups were not significant,but the minus score of family support in IGCBT was higher than GCBT(t=2.44,P=0.02).3.24 patients were divided into three groups for treatment,there were 5 patients dropped-out from the treatment.22 patients received pre-treatment interviews with an average interview duration of 26.63 min(SD = 14.37);19 patients received post-treatment interviews with an average interview duration of 30.05 min(SD = 18.34).4.Pre-treatment interviews extracted three high-level themes and eight sub-themes.They were(1)“negative experience of disease”,including “social discrimination”,“patient stigma” and “not being understood”.The negative experience of the disease makes the patient resistant to treatment,and the form of treatment on the internet weaken the patient’s negative experience of the disease.(2)“The worries for participating a group”,including three sub-themes: “limited expression”,“be affected by others” and “privacy disclosure”.Group members worried about that he or she takes up too much time in group and the negative emotions in the group would influence their own emotion.At the same time,there were concerns about exposure to privacy,which may interrupt their life.(3)"Contradictory attitudes towards the internet",including two sub-themes.The first was contradictory between the convenience and loss of information and "the second is contradictory relationship between less interpersonal pressure and strong sense of distance".It showed that although the internet is convenient,it is not as efficient and direct as face-to-face.Patient felt less group pressure than face-to-face.But members thought that the connection between them is weak and the distance is strong.5.Post-treatment interviews extracted 6 advanced topics and 18 sub-themes.They were:(1)“Group Therapeutic Factors” including three sub-themes: “universality”,“mutual benefit” and “learning reflection”.Patients felt the universality of the disease during treatment and began to face and accept their own diseases.Getting advices from others and tried to provide support to feel the mutual benefit in the group.When they saw their own shadow when others shared something,they would begin to reflect on their own problems.Then they would know the necessary to adjust their cognition.(2)The barrier function of Internet-based therapy,including two sub-themes: superficial interpersonal relationship and sense of control.The form of Internet-based therapy was not only as a wall,hindering the deeper communication of members,but also as a safeguard which increased patients’ autonomy.(3)The instability of therapeutic environment,including the diversity of therapeutic spaces,interrupting to therapy and speed of internet or equipment problems.On internet therapy,the restrictions declined,so patients can choose the therapeutic environment.There were many places for them to receive therapy,such as in bedroom,living room,corner of a garden,car,offices and so on.The speed of internet,or equipment problems,will hinder members devoting into treatment.There were also many interruptions during therapy.For example,someone or pets suddenly entered the therapeutic space.These unstable factors that impact on the participation of treatment need to overcome.(4)Difficulties in completing homework,mainly including 5 aspects: Firstly,patients didn’t understand the importance of homework.Secondly,some homework was too complicated to finish.Thirdly,some homework was too difficult to finish.Fourthly,the homework was not particularly targeted.Fifthly,doing homework was not convenient.(5)There are two main reasons for the absence of treatment: one is the realistic conflict that the time or place can not be coordinated.The other was that patients didn’t pay enough attention to treatment.(6)The reasons for drop-out from treatment mainly include three aspects.First,patients’ emotions were better,so the treatment was not important for them.The second reason was that the treatment was not suitable for patients.And the third reason was patients felt the heavy pressure in the group.ConclusionThe Internet-based group therapy is still in a preliminary exploratory stage.This research showed the efficacy and feasibility of I-GCBT and analyzed the issues in I-GCBT.Because of the complexity of the group and the barrier of Internet form,group therapeutic factors were weakened or delayed,so we should spend a longer time to establish the group.The convenience of the Internet makes patients generally accept the therapy,which makes up for its disadvantages.However,it is necessary to ensure the stability of treatment settings and reduce the impact of uncertain factors on groups. |
PDF Full Text Request