抑郁症是全球性的重要公共健康问题,抑郁症的网络化认知行为治疗近年来备受关注。本研究采用随机对照组试验考察抑郁症网络化干预程序Mood GYM中文版对中国大学生抑郁患者的在线干预效果,并且使用多重中介模型同时探索了基于临床实践提出的认知歪曲（ATQ和DAS）与认知领域研究发现的解释偏差（SST）在抑郁症网络化认知行为治疗中的作用机制。结果发现：（1）相较之对照组,Mood GYM对中国大学生抑郁的网络化自助干预具有中到大的效果量（CES-D,d=0.93;PHQ-9,d=0.79）;（2）Mood GYM也显著降低抑郁患者的负性自动思维（ATQ）、消极解释偏差（SST）和功能失调性态度（DAS）;（3）自动思维（ATQ）和消极解释偏差（SST）二者的改变在抑郁症网络化认知行为治疗效果中起中介作用,功能失调性态度改变的中介效应不显著。抑郁症的网络化干预还存在着诸如脱落率较高等多种局限,推荐作为传统心理治疗的额外补充手段,也可作为梯度治疗模型的自助式初级干预。

Depression is an important global public health issue, for which the intemet cognitive-behavioral therapy （ICBT） is drawing increasingly broad attention in recent years. This intervention model is still in its infancy in China, whose validity, though, has already been tested by various studies in western countries. Beijing Suicide Research and Prevention Center （BSRPC） first introduced MoodGYM, a ICBT program for depression in 2014, and later made it available in Chinese.  The aim of the present study is twofold： （1） to test the online intervention validity of the computerized intervention program of MoodGYM among college students with depression with randomized controlled trials （RCT）; （2） to simultaneously explore the mechanism of cognitive distortion, a finding from clinic practice, and interpretation bias, a discovery in cognitive research, in ICBT for depression with multiple mediation model. The sample consisted of 62 college student subjects, who were randomly divided into either a MoodGYM intervention group （n = 47） and a delayed intervention group （n = 15）, with a 3：1 proportion as the weighted random selection demands. This study uses the complete-case analysis, and the result of intention-to-treat analysis （ITT） is also reported. The results suggest that the computerized self-help intervention of MoodGYM on Chinese college students with depression indicates a statistically significant difference in the MoodGYM group after intervention （Center for Epidemiological Studies Depression Scale, CES-D, d = 0.93; Patient Health Questionnaire, PHQ-9, d = 0.79）, regardless of whether complete-case analysis or intention-to-treat analysis was used. Meanwhile, clinical significance was also found in the validity of ICBT for depression. When compared to the control group, ICBT not only promoted the reduction of negative automatic thoughts as measured through the explicit self-report scale （Automatic Thoughts Questionnaire, ATQ）, but resulted in a decrease of negative interpretation biases obtained from the implicit cognitive measure （Scrambled Sentences Test, SST） as well, and thus led to depressive symptom relief. In addition, while ICBT for depression enhanced the improvement of participants＇ dysfunctional attitudes, no significance was observed in tests of mediation effect.  Despite the limitations of the using computerized intervention for depression there are often too little professional staff for student counseling centers to meet the need of large student populations, whereas the self-help ICBT shows encouraging therapeutic effects and advantages to assist in the care of large numbers of users. Consequently, ICBT may well serve as a supplement to traditional psychotherapies, or as a self-help intervention in the gradient treatment model.