¿Es la terapia cognitivo conductual asistida por ordenador una solución viable para los problemas de Difusión de la Terapia Cognitiva?




La terapia cognitiva-conductual (CBT) es la forma más ampliamente estudiado de la psicoterapia para el trastorno depresivo mayor. (1,2) Los metaanálisis de ensayos controlados han establecido que, a través de 12-16 semanas de tratamiento, la eficacia de la TCC es comparable a la medicación antidepresiva, (3-5) con un menor riesgo de recaída después del tratamiento se detiene. (6,7) CBT también puede mejorar significativamente los resultados del tratamiento cuando se usa en combinación con la farmacoterapia, (8,9),  a pesar de estas justificaciones convincentes, existen barreras importantes que limitan el uso de la TCC en la práctica contemporánea.


Uno de los obstáculos es que no hay suficientes terapeutas entrenados, particularmente en centros de salud mental rurales y públicos. (12) Otro pertenece al costo de la terapia. Una tercera barrera es el resultado de las molestias y el tiempo involucrado en la programación y asistir a un gran número de sesiones durante un período de tres a cuatro meses

Si, la terapia conductual cognitiva asistida por ordenador es efectiva (CCBT) podría ayudar a hacer frente a todas estas limitaciones. (14) A pesar de que la primera forma de CCBT se introdujo hace más de 20 años, (15,16) la investigación y desarrollo se ha disparado en el última década, sobre todo porque a los programas multimedia más sofisticados se puede acceder ahora a través de Internet, tales como los de www.amindterapia.com, los primeros programas de psicoterapia asististida por ordenador disponibles en Español,  los metaanálisis de una literatura de investigación floreciente han documentado la eficacia de estos diversos modelos de CCBT. (20-24)


References

1. American Psychiatric Association. Practice guideline for the treatment of patients with major depressive disorder, Third edition, Arlington, VA. [Available at http://www.guideline.gov/content.aspx?id=24158. Accessed November 27, 2016.]

2. Parikh SV, Quilty LC, Ravitz P, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2016 Clinical Guidelines for the Management of Adults with Major Depressive Disorder: Section 2. Psychological Treatments. Can J Psychiatry. 2016;61(9):524-539.

3. Cuijpers P, Berking M, Andersson G, Quigley L, Kleiboer A, Dobson KS. A meta-analysis of cognitive-behavioural therapy for adult depression, alone and in comparison with other treatments. Can J Psychiatry. 2013;58(7):376-385

4. Cuijpers P, van Straten A, van Oppen P, Andersson G. Are psychological and pharmacologic interventions equally effective in the treatment of adult depressive disorders? A meta-analysis of comparative studies. J Clin Psychiatry. 2008;69(11):1675-1685.

5. Weitz ES, Hollon SD, Twisk J, et al. Baseline Depression Severity as Moderator of Depression Outcomes Between Cognitive Behavioral Therapy vs Pharmacotherapy: An Individual Patient Data Meta-analysis. JAMA Psychiatry. 2015;72(11):1102-1109.

6. Vittengl JR, Clark LA, Dunn TW, Jarrett RB. Reducing relapse and recurrence in unipolar depression: a comparative meta-analysis of cognitive-behavioral therapy's effects. J Consult Clin Psychol. 2007;75(3):475-488.

7. Biesheuvel-Leliefeld KE, Kok GD, Bockting CL, et al. Effectiveness of psychological interventions in preventing recurrence of depressive disorder: meta-analysis and meta-regression. J Affect Disord. 2015;174:400-410.

8. Cuijpers P, Sijbrandij M, Koole SL, Andersson G, Beekman AT, Reynolds CF III. Adding psychotherapy to antidepressant medication in depression and anxiety disorders: a meta-analysis. World Psychiatry. 2014;13(1):56-67.

9. Karyotaki E, Smit Y, Holdt Henningsen K, et al. Combining pharmacotherapy and psychotherapy or monotherapy for major depression? A meta-analysis on the long-term effects. J Affect Disord. 2016;194:144-152.

10. Hollon SD, DeRubeis RJ, Fawcett J, et al. Effect of cognitive therapy with antidepressant medications vs antidepressants alone on the rate of recovery in major depressive disorder: a randomized clinical trial. JAMA Psychiatry. 2014;71(10):1157-1164.

11. Wiles N, Thomas L, Abel A, et al. Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. Lancet. 2013;381(9880):375-384.

12. Kaltenthaler E, Sutcliffe P, Parry G, Beverley C, Rees A, Ferriter M. The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review. Psychol Med. 2008;38(11):1521-1530.

13. Marcus SC, Olfson. National trends in the treatment for depression from 1998 to 2007. Arch Gen Psychiatry. 2010;67(12):1265-1273.

14. Eells TD, Barrett MS, Wright JH, Thase ME. Computer-assisted cognitive-behavior therapy for depression. Psychotherapy. 2014;51(2):191-197.

15. Griest JH. Computer interviews for depression management. J Clin Psychiatry. 1998;59(suppl 16):20-42.

16. Wright JH, Wright A. Computer assisted psychotherapy. J Psychother Pract Res. 1997;6(4):315-329.

17. Beating the Blues™ US – Helping you to manage your emotional well-being. http://beatingthebluesus.com/ Accessed November 27, 2016.

18. MoodGYM training program. https://moodgym.anu.edu.au/welcome Accessed November 27, 2016.

19. Empower interactive. Good Days Ahead. http://www.empower-interactive.com/solutions/good-days-ahead/ Accessed November 27, 2016.

20. Andersson G, Topooco N, Havik O, Nordgreen T. Internet-supported versus face-to-face cognitive behavior therapy for depression. Expert Rev Neurother. 2016; 16(1):55-60.

21. Richards D, Richardson T. Computer-based psychological treatments for depression: a systematic review and meta-analysis. Clin Psychol Rev. 2012;32(4):329-342.

22. Arnberg FK, Linton SJ, Hultcrantz M, Heintz E, Jonsson U. Internet-delivered psychological treatments for mood and anxiety disorders: a systematic review of their efficacy, safety, and cost-effectiveness. PLoS One. 2014;9(5):e98118.

23. So M, Yamaguchi S, Hashimoto S, et al. Is computerized CBT really helpful for adult depression? A meta-analytic re-evaluation of CCBT for adult depression in terms of clinical implementation and methodological validity. BMC Psychiatry. 2013;13:113.

24. Rozental A, Magnusson K, Boettcher J, Andersson G, Carlbring P. For better or worse: an individual patient data meta-analysis of deterioration among participants receiving internet-based cognitive behavior therapy. J Consult Clin Psychol. 2016. [Epub ahead of print 10.1037/ccp0000158].

25. Gilbody S, Littlewood E, Hewitt C, et al. Computerised cognitive behavior therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomized controlled trial. BMJ. 2015;351:h5627.

26. Wright JH, Wright AS, Salmon P, et al. Development and initial testing of a multimedia program for computer-assisted cognitive therapy. Am J Psychother. 2002;56(1):76-86.

27. Kim DR, Hantsoo L, Thase ME, Sammel M, Epperson CN. Computer-assisted cognitive behavioral therapy for pregnant women with major depressive disorder. J Womens Health (Larchmt). 2014;23(10):842-848.


28. Wright JH, Wright AS, Albano AM, et al. Computer-assisted cognitive therapy for depression: maintaining efficacy while reducing therapist time. Am J Psychiatry. 2005;162(6):1158-1164

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