Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes
Objective:Previous trials have demonstrated the efficacy and durability of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to standard outpatient care in a range of treatment-seeking populations. In this study, the authors evaluated the efficacy and safety of CBT4CBT as a virtual...
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| Veröffentlicht in: | The American journal of psychiatry 2018-09, Vol.175 (9), p.853-863 |
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| container_title | The American journal of psychiatry |
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| creator | Kiluk, Brian D Nich, Charla Buck, Matthew B Devore, Kathleen A Frankforter, Tami L LaPaglia, Donna M Muvvala, Srinivas B Carroll, Kathleen M |
| description | Objective:Previous trials have demonstrated the efficacy and durability of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to standard outpatient care in a range of treatment-seeking populations. In this study, the authors evaluated the efficacy and safety of CBT4CBT as a virtual stand-alone treatment, delivered with minimal clinical monitoring, and clinician-delivered cognitive-behavioral therapy (CBT) compared with treatment as usual in a heterogeneous sample of treatment-seeking outpatients with substance use disorders.Method:This was a randomized clinical trial in which 137 individuals who met DSM-IV-TR criteria for current substance abuse or dependence were randomly assigned to receive treatment as usual, weekly individual CBT, or CBT4CBT with brief weekly monitoring.Results:Rates of treatment exposure differed by group, with the best retention in the CBT4CBT group and the poorest in the individual CBT group. Participants who received CBT or CBT4CBT reduced their frequency of substance use significantly more than those who received treatment as usual. Six-month follow-up outcomes indicated continuing benefit of CBT4CBT (plus monitoring) over treatment as usual, but not for clinician-delivered CBT over treatment as usual. Analysis of secondary outcomes indicated that participants in the CBT4CBT group demonstrated the best learning of cognitive and behavioral concepts, as well as the highest satisfaction with treatment.Conclusions:This first trial of computerized CBT as a virtual stand-alone intervention delivered in a clinical setting to a diverse sample of patients with current substance use disorders indicated that it was safe, effective, and durable relative to standard treatment approaches and was well-liked by participants. Clinician-delivered individual CBT, while efficacious within the treatment period, was unexpectedly associated with a higher dropout rate and lower effects at follow-up. |
| doi_str_mv | 10.1176/appi.ajp.2018.17090978 |
| format | Article |
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In this study, the authors evaluated the efficacy and safety of CBT4CBT as a virtual stand-alone treatment, delivered with minimal clinical monitoring, and clinician-delivered cognitive-behavioral therapy (CBT) compared with treatment as usual in a heterogeneous sample of treatment-seeking outpatients with substance use disorders.Method:This was a randomized clinical trial in which 137 individuals who met DSM-IV-TR criteria for current substance abuse or dependence were randomly assigned to receive treatment as usual, weekly individual CBT, or CBT4CBT with brief weekly monitoring.Results:Rates of treatment exposure differed by group, with the best retention in the CBT4CBT group and the poorest in the individual CBT group. Participants who received CBT or CBT4CBT reduced their frequency of substance use significantly more than those who received treatment as usual. Six-month follow-up outcomes indicated continuing benefit of CBT4CBT (plus monitoring) over treatment as usual, but not for clinician-delivered CBT over treatment as usual. Analysis of secondary outcomes indicated that participants in the CBT4CBT group demonstrated the best learning of cognitive and behavioral concepts, as well as the highest satisfaction with treatment.Conclusions:This first trial of computerized CBT as a virtual stand-alone intervention delivered in a clinical setting to a diverse sample of patients with current substance use disorders indicated that it was safe, effective, and durable relative to standard treatment approaches and was well-liked by participants. Clinician-delivered individual CBT, while efficacious within the treatment period, was unexpectedly associated with a higher dropout rate and lower effects at follow-up.</description><identifier>ISSN: 0002-953X</identifier><identifier>EISSN: 1535-7228</identifier><identifier>DOI: 10.1176/appi.ajp.2018.17090978</identifier><identifier>PMID: 29792052</identifier><language>eng</language><publisher>United States: American Psychiatric Association</publisher><subject>Adult ; Ambulatory Care - methods ; Behavior modification ; Clinical trials ; Cognitive Behavioral Therapy - methods ; Cognitive therapy ; Drug abuse ; Drug addiction ; Female ; Follow-Up Studies ; Humans ; Male ; Substance use disorder ; Substance-Related Disorders - therapy ; Therapy, Computer-Assisted - methods ; Treatment Outcome</subject><ispartof>The American journal of psychiatry, 2018-09, Vol.175 (9), p.853-863</ispartof><rights>Copyright © 2018 by the American Psychiatric Association 2018</rights><rights>Copyright American Psychiatric Association Sep 1, 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-a459t-fab5ed6792c957d08b6d39ef136fed5d990de97b46ccff0bf4da6c8d7d73823f3</citedby><cites>FETCH-LOGICAL-a459t-fab5ed6792c957d08b6d39ef136fed5d990de97b46ccff0bf4da6c8d7d73823f3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://psychiatryonline.org/doi/epdf/10.1176/appi.ajp.2018.17090978$$EPDF$$P50$$Gappi$$H</linktopdf><linktohtml>$$Uhttps://psychiatryonline.org/doi/full/10.1176/appi.ajp.2018.17090978$$EHTML$$P50$$Gappi$$H</linktohtml><link.rule.ids>315,782,786,2859,21635,21636,21637,27933,27934,77804,77809</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29792052$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kiluk, Brian D</creatorcontrib><creatorcontrib>Nich, Charla</creatorcontrib><creatorcontrib>Buck, Matthew B</creatorcontrib><creatorcontrib>Devore, Kathleen A</creatorcontrib><creatorcontrib>Frankforter, Tami L</creatorcontrib><creatorcontrib>LaPaglia, Donna M</creatorcontrib><creatorcontrib>Muvvala, Srinivas B</creatorcontrib><creatorcontrib>Carroll, Kathleen M</creatorcontrib><title>Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes</title><title>The American journal of psychiatry</title><addtitle>Am J Psychiatry</addtitle><description>Objective:Previous trials have demonstrated the efficacy and durability of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to standard outpatient care in a range of treatment-seeking populations. In this study, the authors evaluated the efficacy and safety of CBT4CBT as a virtual stand-alone treatment, delivered with minimal clinical monitoring, and clinician-delivered cognitive-behavioral therapy (CBT) compared with treatment as usual in a heterogeneous sample of treatment-seeking outpatients with substance use disorders.Method:This was a randomized clinical trial in which 137 individuals who met DSM-IV-TR criteria for current substance abuse or dependence were randomly assigned to receive treatment as usual, weekly individual CBT, or CBT4CBT with brief weekly monitoring.Results:Rates of treatment exposure differed by group, with the best retention in the CBT4CBT group and the poorest in the individual CBT group. Participants who received CBT or CBT4CBT reduced their frequency of substance use significantly more than those who received treatment as usual. Six-month follow-up outcomes indicated continuing benefit of CBT4CBT (plus monitoring) over treatment as usual, but not for clinician-delivered CBT over treatment as usual. Analysis of secondary outcomes indicated that participants in the CBT4CBT group demonstrated the best learning of cognitive and behavioral concepts, as well as the highest satisfaction with treatment.Conclusions:This first trial of computerized CBT as a virtual stand-alone intervention delivered in a clinical setting to a diverse sample of patients with current substance use disorders indicated that it was safe, effective, and durable relative to standard treatment approaches and was well-liked by participants. Clinician-delivered individual CBT, while efficacious within the treatment period, was unexpectedly associated with a higher dropout rate and lower effects at follow-up.</description><subject>Adult</subject><subject>Ambulatory Care - methods</subject><subject>Behavior modification</subject><subject>Clinical trials</subject><subject>Cognitive Behavioral Therapy - methods</subject><subject>Cognitive therapy</subject><subject>Drug abuse</subject><subject>Drug addiction</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Substance use disorder</subject><subject>Substance-Related Disorders - therapy</subject><subject>Therapy, Computer-Assisted - methods</subject><subject>Treatment Outcome</subject><issn>0002-953X</issn><issn>1535-7228</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkctu1DAYRi0EokPhFSpLrDP4ktgxO5hSQKpURGcEu8iJfwuPkjjYThG8Hi-GMzMty258kc93bOtD6IKSNaVSvNHT5NZ6P60ZofWaSqKIkvUTtKIVrwrJWP0UrQghrFAV_36GXsS4z1vCJXuOzpiSipGKrdDfr3o0fnB_wOBN70bX6R5vg8ujt3jjh2lOEA7HGTwhTo_FJfTuDsISe7_FbjywOrjoR_zNpR_4NuWADgbfzGnSycGYshh0GpaV9QHfzm3MUAd4FwFf5mgwEOJb_CW4QYffB48bi_-p5QlXvu_9r2I3LeLODxBfomdW9xFeneZztLv6sN18Kq5vPn7evLsudFmpVFjdVmBE_nmnKmlI3QrDFVjKhQVTGaWIASXbUnSdtaS1pdGiq400kteMW36OXh-9U_A_Z4ip2fs5jPnKhlFWSlEqSR-nWC3KTIkj1QUfYwDbTMdPN5Q0S8PN0nCTG26Whpv7hnPw4qSf2wHMQ-y-0gzwI3AQPNz9iPYfv1G4fg</recordid><startdate>20180901</startdate><enddate>20180901</enddate><creator>Kiluk, Brian D</creator><creator>Nich, Charla</creator><creator>Buck, Matthew B</creator><creator>Devore, Kathleen A</creator><creator>Frankforter, Tami L</creator><creator>LaPaglia, Donna M</creator><creator>Muvvala, Srinivas B</creator><creator>Carroll, Kathleen M</creator><general>American Psychiatric Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope></search><sort><creationdate>20180901</creationdate><title>Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes</title><author>Kiluk, Brian D ; Nich, Charla ; Buck, Matthew B ; Devore, Kathleen A ; Frankforter, Tami L ; LaPaglia, Donna M ; Muvvala, Srinivas B ; Carroll, Kathleen M</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-a459t-fab5ed6792c957d08b6d39ef136fed5d990de97b46ccff0bf4da6c8d7d73823f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Ambulatory Care - methods</topic><topic>Behavior modification</topic><topic>Clinical trials</topic><topic>Cognitive Behavioral Therapy - methods</topic><topic>Cognitive therapy</topic><topic>Drug abuse</topic><topic>Drug addiction</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Humans</topic><topic>Male</topic><topic>Substance use disorder</topic><topic>Substance-Related Disorders - therapy</topic><topic>Therapy, Computer-Assisted - methods</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kiluk, Brian D</creatorcontrib><creatorcontrib>Nich, Charla</creatorcontrib><creatorcontrib>Buck, Matthew B</creatorcontrib><creatorcontrib>Devore, Kathleen A</creatorcontrib><creatorcontrib>Frankforter, Tami L</creatorcontrib><creatorcontrib>LaPaglia, Donna M</creatorcontrib><creatorcontrib>Muvvala, Srinivas B</creatorcontrib><creatorcontrib>Carroll, Kathleen M</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>The American journal of psychiatry</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kiluk, Brian D</au><au>Nich, Charla</au><au>Buck, Matthew B</au><au>Devore, Kathleen A</au><au>Frankforter, Tami L</au><au>LaPaglia, Donna M</au><au>Muvvala, Srinivas B</au><au>Carroll, Kathleen M</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes</atitle><jtitle>The American journal of psychiatry</jtitle><addtitle>Am J Psychiatry</addtitle><date>2018-09-01</date><risdate>2018</risdate><volume>175</volume><issue>9</issue><spage>853</spage><epage>863</epage><pages>853-863</pages><issn>0002-953X</issn><eissn>1535-7228</eissn><abstract>Objective:Previous trials have demonstrated the efficacy and durability of computer-based cognitive-behavioral therapy (CBT4CBT) as an add-on to standard outpatient care in a range of treatment-seeking populations. In this study, the authors evaluated the efficacy and safety of CBT4CBT as a virtual stand-alone treatment, delivered with minimal clinical monitoring, and clinician-delivered cognitive-behavioral therapy (CBT) compared with treatment as usual in a heterogeneous sample of treatment-seeking outpatients with substance use disorders.Method:This was a randomized clinical trial in which 137 individuals who met DSM-IV-TR criteria for current substance abuse or dependence were randomly assigned to receive treatment as usual, weekly individual CBT, or CBT4CBT with brief weekly monitoring.Results:Rates of treatment exposure differed by group, with the best retention in the CBT4CBT group and the poorest in the individual CBT group. Participants who received CBT or CBT4CBT reduced their frequency of substance use significantly more than those who received treatment as usual. Six-month follow-up outcomes indicated continuing benefit of CBT4CBT (plus monitoring) over treatment as usual, but not for clinician-delivered CBT over treatment as usual. Analysis of secondary outcomes indicated that participants in the CBT4CBT group demonstrated the best learning of cognitive and behavioral concepts, as well as the highest satisfaction with treatment.Conclusions:This first trial of computerized CBT as a virtual stand-alone intervention delivered in a clinical setting to a diverse sample of patients with current substance use disorders indicated that it was safe, effective, and durable relative to standard treatment approaches and was well-liked by participants. 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| source | MEDLINE; American Psychiatric Publishing Journals (1997-Present); Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals |
| subjects | Adult Ambulatory Care - methods Behavior modification Clinical trials Cognitive Behavioral Therapy - methods Cognitive therapy Drug abuse Drug addiction Female Follow-Up Studies Humans Male Substance use disorder Substance-Related Disorders - therapy Therapy, Computer-Assisted - methods Treatment Outcome |
| title | Randomized Clinical Trial of Computerized and Clinician-Delivered CBT in Comparison With Standard Outpatient Treatment for Substance Use Disorders: Primary Within-Treatment and Follow-Up Outcomes |
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