2023-07-13 カロリンスカ研究所(KI)
◆カロリンスカ研究所とストックホルム地域の研究者は、インターネットを通じた感情調整療法が若者の自己傷害を減少させる効果があるかどうかを調査しました。この研究は、JAMA Network Openに掲載され、その療法が効果的であることを示しています。若者の自己傷害行動は、瞬間的に感情を調整するために行われることが多いが、多くの悪影響をもたらします。この治療法は、若者が感情をより適応的に扱い調整する手助けをすることで、自己傷害行動を減らすことを目的としています。研究では、166人の13歳から17歳の自己傷害を行った若者とその保護者が参加し、療法の効果が評価されました。IERITAを通常の治療に追加したグループは、自己傷害エピソードが82%減少し、治療後の感情調整能力と機能レベルが改善されました。この療法の効果は、3か月後のフォローアップでも有意でした。今後は、インターネット形式の療法がより多くの地域で利用できるようになるよう取り組んでいます。
<関連情報>
- https://news.ki.se/internet-based-therapy-effective-against-self-harm-in-adolescents
- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2807193
非自傷性自傷障害の青年に対するインターネット配信による情動調節個別療法の効果 無作為化臨床試験 Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder A Randomized Clinical Trial
Johan Bjureberg, livia Ojala, Hugo Hesser, Henrike Häbel, Hanna Sahlin, Kim L. Gratz, Matthew T. Tull, Emma Claesdotter Knutsson, Erik Hedman-Lagerlöf, Brjánn Ljótsson, Clara Hellner
JAMA Network Open Published:July 13, 2023
DOI:10.1001/jamanetworkopen.2023.22069
Key Points
Question What are the efficacy and mechanisms of change of a therapist-guided, internet-delivered emotion regulation therapy for nonsuicidal self-injury among adolescents?
Findings In this randomized clinical trial that included 166 adolescents, internet-delivered emotion regulation individual therapy delivered adjunctive to treatment as usual resulted in an 82% reduction in masked assessor-rated nonsuicidal self-injury frequency (vs a 47% reduction in treatment as usual only), a statistically significant difference. Improvements in emotion regulation mediated improvements in nonsuicidal self-injury.
Meaning A therapist-guided emotion regulation treatment delivered online may overcome common treatment barriers and increase availability of evidence-based psychological treatments for adolescents with nonsuicidal self-injury.
Abstract
Importance Nonsuicidal self-injury is prevalent in adolescence and associated with adverse clinical outcomes. Effective interventions that are brief, transportable, and scalable are lacking.
Objective To test the hypotheses that an internet-delivered emotion regulation individual therapy for adolescents delivered adjunctive to treatment as usual is superior to treatment as usual only in reducing nonsuicidal self-injury and that improvements in emotion regulation mediate these treatment effects.
Design, Setting, and Participants This 3-site, single-masked, randomized superiority trial enrolled participants from November 20, 2017, to April 9, 2020. Eligible participants were aged between 13 and 17 years and met diagnostic criteria for nonsuicidal self-injury disorder; they were enrolled as a mixed cohort of consecutive patients and volunteers. Parents participated in parallel to their children. The primary end point was at 1 month after treatment. Participants were followed up at 3 months posttreatment. Data collection ended in January 2021.
Interventions Twelve weeks of therapist-guided, internet-delivered emotion regulation individual therapy delivered adjunctive to treatment as usual vs treatment as usual only.
Main Outcomes and Measures Primary outcome was the youth version of the Deliberate Self-harm Inventory, both self-reported by participants prior to treatment, once every week during treatment, and for 4 weeks posttreatment, and clinician-rated by masked assessors prior to treatment and at 1 and 3 months posttreatment.
Results A total of 166 adolescents (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) were randomized to internet-delivered emotion regulation therapy plus treatment as usual (84 participants) or treatment as usual only (82 participants). The experimental intervention was superior to the control condition in reducing clinician-rated nonsuicidal self-injury (82% vs 47% reduction; incidence rate ratio, 0.34; 95% CI, 0.20-0.57) from pretreatment to 1-month posttreatment. These results were maintained at 3-month posttreatment. Improvements in emotion dysregulation mediated improvements in self-injury during treatment.
Conclusions and Relevance In this randomized clinical trial, a 12-week, therapist-guided, internet-delivered emotion regulation therapy delivered adjunctive to treatment as usual was efficacious in reducing self-injury, and mediation analysis supported the theorized role of emotion regulation as the mechanism of change in this treatment. This treatment may increase availability of evidence-based psychological treatments for adolescents with nonsuicidal self-injury.
Trial Registration ClinicalTrials.gov Identifier: NCT03353961
