The Efficacy of Computer-Assisted Cognitive Behavioral Therapy on Psychobiological Responses in Patients Undergoing Functional Endoscopic Sinus Surgery: A Randomized-controlled Clinical Trial
Authors: Yang Yang , Li Yuling , Zhang Haibin , Xu Yong , Wang Binquan 
Published: October 2020

Abstract
BackgroundPrevious reports have shown computer-assisted cognitive behavioral therapy (CCBT) could improve mood and sleep for chronic health conditions and some anesthetics can help reduce preoperative anxiety, stabilize hemodynamics and lessen hormone response. But it is unclear whether CCBT could help adults with short-lived acute stressor (e.g. surgery) to experience similar responses.ObjectiveThis study aimed to assess the effects of CCBT on surgery-related physiological and psychological indices (mood, insomnia, vital signs and stress hormone) in patients undergoing functional endoscopic sinus surgery (FESS) during the perioperative period. MethodsParticipants were randomly assigned to a usual care (UC: disease care and psychological care) group (n = 50) or a computer-assisted cognition behavior intervention (CCBT: cognitive therapy and behavioral relaxation) group (n = 50). The primary outcome was state anxiety measured at baseline (T1) using the State Anxiety Inventory (SAI), with repeat assessment conducted 1 hour before anesthesia administration (T2) and post-intervention (T4). Secondary outcomes, including symptoms of depression and insomnia, were recorded at T1, 48 hours after surgery (T3), and T4. The stress hormone were assayed at T1 and T2, and participant satisfaction with intervention was assessed at T4. Blood pressure, and heart rate were collected at above four time points. Repeated-measure ANOVA models were then used to compare results between-two groups and analyze changes in anxiety, depression, and insomnia levels among participants.ResultsAt T2/T3 and T4, compared to the UC group, the CCBT group showed reduced anxiety (F = 17.10, p < .01 and F = 38.54, p < .01), and relieved insomnia symptoms (F = 10.10, P = .002 and F = 9.46, P = .003). Furthermore, the secondary analysis revealed a significant reducer in the participants falling above the clinical cut-off scores in the CCBT group as compared with UC group in SAI scores at T2 (72% vs 88%, p = .04) and in AIS scores at T4 (4% vs 22%, p = .01). For stress hormone, not only the increase in cortisol levels in the UC group was significantly higher at T2 compared to T1 ( p = .001); but also cortisol levels for UC group compared to the CCBT group was found to have a significant effect ( p = .024) at T2. For vital signs, the change of BP and HR were different significantly between-two group at T2 (p < .01). Moreover, the CCBT group showed higher satisfaction scores with Psychological care, Psychosomatic management and total score than the UC group.ConclusionThe CCBT appeared to reduce anxiety level and insomnia symptom, stabilize preoperative hemodynamics and cortisol level in patients undergoing FESS under general anesthesia. Participants also evaluated the CCBT positively, suggesting that it may represent an effective adjunct in preparing patients for surgery.Trial stateThe study was registered with the Chinese Clinical Trial Registry (ChiCTR1900025994) on September 17, 2019. http://www.chictr.org.cn/listbycreater.aspx/ChiCTR1900025994 The study protocol was conducted with the consent of the Ethics Committee of First Hospital of Shanxi Medical University in China on July 31, 2019 (document number [2019]K-SK028)