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Simblett SK, Yates M, Wagner AP, Watson P, Gracey F, Ring H, Bateman A. Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial. JMIR Ment Health 2017; 4:e16. [PMID: 28566265 PMCID: PMC5471343 DOI: 10.2196/mental.6022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and anxiety are common complications following stroke. Symptoms could be treatable with psychological therapy, but there is little research on its efficacy. OBJECTIVES The aim of this study was to investigate (1) the acceptability and feasibility of computerized cognitive behavioral therapy (cCBT) to treat symptoms of depression and anxiety and (2) a trial design for comparing the efficacy of cCBT compared with an active comparator. METHODS Of the total 134 people screened for symptoms of depression and anxiety following stroke, 28 were cluster randomized in blocks with an allocation ratio 2:1 to cCBT (n=19) or an active comparator of computerized cognitive remediation therapy (cCRT, n=9). Qualitative and quantitative feedback was sought on the acceptability and feasibility of both interventions, alongside measuring levels of depression, anxiety, and activities of daily living before, immediately after, and 3 months post treatment. RESULTS Both cCBT and cCRT groups were rated as near equally useful (mean = 6.4 vs 6.5, d=0.05), while cCBT was somewhat less relevant (mean = 5.5 vs 6.5, d=0.45) but somewhat easier to use (mean = 7.0 vs 6.3, d=0.31). Participants tolerated randomization and dropout rates were comparable with similar trials, with only 3 participants discontinuing due to potential adverse effects; however, dropout was higher from the cCBT arm (7/19, 37% vs 1/9, 11% for cCRT). The trial design required small alterations and highlighted that future-related studies should control for participants receiving antidepressant medication, which significantly differed between groups (P=.05). Descriptive statistics of the proposed outcome measures and qualitative feedback about the cCBT intervention are reported. CONCLUSIONS A pragmatic approach is required to deliver computerized interventions to accommodate individual needs. We report a preliminary investigation to inform the development of a full randomized controlled trial for testing the efficacy of computerized interventions for people with long-term neurological conditions such as stroke and conclude that this is a potentially promising way of improving accessibility of psychological support.
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Affiliation(s)
- Sara K Simblett
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King's College London, London, United Kingdom.,Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom
| | - Matthew Yates
- Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United Kingdom
| | - Adam P Wagner
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Peter Watson
- MRC Cognition and Brain Sciences Unit, Cambridge, United Kingdom
| | - Fergus Gracey
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom.,Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United Kingdom.,Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Howard Ring
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom
| | - Andrew Bateman
- Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.,National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) East of England, Cambridgeshire & Peterborough Foundation NHS Trust, Cambridge, United Kingdom.,Oliver Zangwill Centre for Neuropsychological Rehabilitation, Ely, United Kingdom
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Charova E, Dorstyn D, Tully P, Mittag O. Web-based interventions for comorbid depression and chronic illness: a systematic review. J Telemed Telecare 2015; 21:189-201. [PMID: 25712111 DOI: 10.1177/1357633x15571997] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 01/13/2015] [Indexed: 11/17/2022]
Abstract
Web-based interventions offer potential benefits for managing and treating depression in the context of chronic physical illness, however their use with this population has yet to be quantitatively assessed. The present systematic review examined the biopsychosocial data from 11 independent studies (N = 1348 participants), including randomised controlled and quasi-experimental designs most commonly performed with diabetes and multiple sclerosis. Study quality was evaluated using the Downs and Black (1998) index, with most studies being statistically underpowered although internal validity was demonstrated. Treatment outcomes were quantified using Cohen's d effect sizes. Results indicated significant short-term improvements in depression severity (d w = 0.36, CI = 0.20-0.52, p < 0.01), in addition to quality of life, problem-solving skills, functional ability, anxiety and pain-related cognitions (d range = 0.23 to 1.10). Longer-term outcomes could not be determined based on the limited data. Further robust studies are required before wider adoption of web techniques takes place.
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Affiliation(s)
- Ekaterina Charova
- University of Adelaide School of Psychology, Adelaide, South Australia, Australia
| | - Diana Dorstyn
- University of Adelaide School of Psychology, Adelaide, South Australia, Australia
| | - Phillip Tully
- University of Adelaide, Discipline of Medicine, Adelaide, South Australia, Australia
| | - Oskar Mittag
- Medical Center - University of Freiburg, Institute for Quality Management and Social Medicine, Germany
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