| 其他摘要 | Adolescent depression has attracted the attention of the whole society day by day. However, many teenagers who are suffering from depression can not get effective help. Internet-based cognitive behavioural treatment (ICBT) is a new intervention method. Existing studies abroad have found that it can improve the depression of adolescents, but the research on its regulatory effect and mediating mechanism is not mature, and there are still few studies in China. Based on these situations, this study was carried out.
Objective: Develop a localized ICBT program aimed at the current situation of depression among Chinese adolescents, and verify its intervention effect on depression; And the moderating effects of guiding, compliance, learning style and personality traits on the intervention effect were analyzed, and the mediating effects of automated thinking and cognitive skills in ICBT were explored; Finally, based on the Normalization Process Theory (NPT), this paper explores the influencing factors of each link in the implementation process of ICBT in schools.
Methods: In study I, a randomized controlled experiment was conducted to recruit young students with obvious depression in two middle schools. They were randomly divided into four groups: Guided ICBT group, self-help ICBT group, health education group and control group, with 74 people in each group. The self-developed adolescent depression ICBT program was used to intervene the two ICBT groups for 4 weeks and twice a week. The Guided ICBT group gave additional one-to-one conversation support to the counselor every week. The health education group synchronously distributed the self-help book materials of depression that were similar to the program content but more simplified for self reading. The Beck Depression Inventory (BDI-II), Beck Anxiety Inventory (BAI), Neuroticism and Conscientiousness questionnaire in Five一Factor Inventory(NEO), Automatic Thoughts Questionnaire(ATQ) and the Frequency of Thoughts and Actions Scale(FATS)were used to evaluate all subjects at baseline and after intervention.
Referring to the results and research background of study 1，study 2 was conducted to explore the promotion factors and obstacles in the implementation process using qualitative research methods. Interviews were conducted with 4 ICBT school implementers (implementers) and 13 students (recipients) who participated in program learning. NVivo 12 software was used to analyze the text transcribed from the interview recordings, and the theme analysis method was used for analysis, and the sub themes were summarized according to the NPT framework.
Results: After the 4-week intervention of study I, there was a statistically significant difference in the change of BDI-II scores of the four groups (p <0.001), and there was a statistically significant difference in the pre-test and post test of BDI-II both in the two ICBT groups (p<0.001). The course completion rate of the Guided group was higher than that of the self-help group, but there was no statistically significant difference in the improvement of depression （）p=0.85); The course completion rate of subjects in centralized learning was higher than that of subjects in autonomous learning, but there was no significant difference in the improvement of depression (p=0.64); The influence of neuroticism and conscientiousness on the intervention results was not statistically significant (neuroticism, (p=0.35; conscientiousness, p=0.57). The difference between the pre-test and post test scores of atq and fat in the two ICBT groups was statistically significant (p<0.001), and the mediating effect of the changes of atq and fat on the reduction of BDI一II score was statistically significant.
The sub themes generated by the thematic analysis method in Study）II can be summarized into four core themes (Coherence, Cognitive participation, Collective action and Reflexive monitoring) according to the NPT. All participants basically agree with the value of ICBT. Recipients think that the program is interesting, meets their own needs, and is easy to operate. But participation motivation and academic pressure will affect their input and benefit. The leader's support and the implementer's voice are insufficient, and the role of the head teacher has not been fully played; Collective learning is conducive to the implementation and management of ICBT, but privacy and autonomy also need to be taken into account; There is a lack of collection and Reflection on the implementation process and the feelings of the recipients.
Conclusion: The 4-week ICBT intervention can significantly improve adolescent depression. Weekly counselor support and centralized learning can improve compliance, but have no significant impact on the intervention effect. At the same time, automated thinking and cognitive skills play an intermediary role in adolescent depression ICBT. The implementation of ICBT in schools is supported by participants, and the specific implementation mode and the selection of participants need to be further optimized. |
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