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Ando M, Kao YC, Lee YC, Tai SA, Mendez SR, Sasaki K, Tang W, Papatheodorou S. Remote cognitive behavioral therapy for older adults with anxiety symptoms: A systematic review and meta-analysis. J Telemed Telecare 2024; 30:1376-1385. [PMID: 36794548 DOI: 10.1177/1357633x231151788] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
INTRODUCTION In-person cognitive behavioral therapy (CBT) can reduce self-reported anxiety in older adults. However, studies are limited for remote CBT. We assessed the effectiveness of remote CBT in mitigating self-reported anxiety in older adults. METHODS We conducted a systematic review and meta-analysis based on a literature search of PubMed, Embase, PsycInfo, and Cochrane databases up to March 31, 2021, for randomized controlled clinical trials comparing the effectiveness of remote CBT versus non-CBT controls on mitigating self-reported anxiety in older adults. We calculated within-group pre-to-post-treatment standardized mean difference using Cohen's d, obtained the difference between a remote CBT group and a non-CBT control group as our effect size for cross-study comparison, and conducted a random-effects meta-analysis. Changes in scores on self-reported anxiety symptoms (Generalized Anxiety Disorder-7 item Scale, Penn State Worry Questionnaire, or Penn State Worry Questionnaire - Abbreviated), and self-reported depressive symptoms (Patient Health Questionnaire-9 item Scale or Beck Depression Inventory) were primary and secondary outcomes, respectively. RESULTS Six eligible studies, containing 633 participants with a pooled mean age of 66.6 years, were included in the systematic review and meta-analysis. There was a significant mitigating effect of intervention on self-reported anxiety, favoring remote CBT over non-CBT controls (between-group effect size: -0.63; 95% CI: -0.99 to -0.28). We also found a significant mitigating effect of intervention on self-reported depressive symptoms (between-group effect size: -0.74; 95% CI: -1.24 to -0.25). DISCUSSION Remote CBT is more effective in reducing self-reported anxiety and depressive symptoms than non-CBT control in older adults.
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Affiliation(s)
- Mariko Ando
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Ying-Chia Kao
- Department of Occupational Therapy, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Yu-Chien Lee
- Department of Family Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA
| | - Sung-An Tai
- Department of Otolaryngology-Head and Neck Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Samuel R Mendez
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kosuke Sasaki
- Department of Mathematics and Statistics, Boston University, Boston, MA, USA
| | - Wenze Tang
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Hadjistavropoulos H, Peynenburg V, Sapkota R, Titov N, Dear B. Evaluation of additional resources used in therapist-assisted transdiagnostic internet-delivered cognitive behaviour therapy. Internet Interv 2024; 37:100758. [PMID: 39100100 PMCID: PMC11295926 DOI: 10.1016/j.invent.2024.100758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/29/2024] [Accepted: 07/04/2024] [Indexed: 08/06/2024] Open
Abstract
Background In internet-delivered cognitive behavioural therapy (ICBT) programs, beyond standardized core ICBT lessons, brief additional resources are sometimes available to clients to address comorbid concerns or offer additional information/strategies. These resources remain understudied in terms of how they are selected and perceived by clients, as well as their relationship to satisfaction and outcomes. Methods Among clients (N = 793) enrolled in a 5-lesson transdiagnostic ICBT course, we examined client use and perceptions of 18 additional resources at 8 weeks in terms of whether clients found resources informative (yes/no) and or helpful (yes/no). Resources elaborated on cognitive strategies (managing beliefs, risk calculation) or on managing specific problems (agricultural stress, alcohol misuse, anger, assertiveness, chronic conditions, communication, grief, health anxiety, motivation, pain, panic, postpartum depression/anxiety, PTSD, sleep, workplace accomodations, worry). Clients also completed symptom measures and ICBT satisfaction questions at 8 weeks. Results Approximately 50 % (n = 398) of clients rated the resources and, on average, clients reported that 3.35 (SD = 3.34) resources were informative and 2.35 (SD = 2.52) resources were helpful as measured by direct questions developed for this study. Higher pre-treatment PTSD and GAD scores were related to a greater number of resources perceived as informative and or helpful. Rating more resources as informative and or helpful had a weak but positive association with ICBT satisfaction and depression, anxiety, PTSD and insomnia change scores. Limitations of the study include that 31 % (n = 245) did not respond to questions about use of resources and 18.9 % (n = 150) said they did not review resources. Conclusions There is considerable use of diverse additional resources in ICBT in routine care. Associations suggest that clients are using resources to personalize treatment to their needs and these resources are associated with treatment satisfaction and outcomes. The correlational associations between symptoms and perceived helpfulness of resources can help inform personalization algorithms to optimize ICBT delivery for clients. Further research on how to match clients with, encourage use of, and maximize benefits of resources would be beneficial.
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Affiliation(s)
- H.D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - V. Peynenburg
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - R.P. Sapkota
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - N. Titov
- MindSpot Clinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - B.F. Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
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Qiu YF, Wu M, Liu JL, Li CY, Yu YQ, Zeng LJ, Yang BX, Yang F. Effectiveness of digital intelligence interventions on depression and anxiety in older adults: A systematic review and meta-analysis. Psychiatry Res 2024; 342:116166. [PMID: 39243439 DOI: 10.1016/j.psychres.2024.116166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 08/25/2024] [Accepted: 08/29/2024] [Indexed: 09/09/2024]
Abstract
BACKGROUND Depression and anxiety are common mental disorders in later life. Digital intelligence interventions overcome the limitations of conventional psychotherapy and offer new treatments for depression and anxiety. However, the effectiveness among older adults remains unclear. METHODS Databases including Pubmed, Web of Science, the Cochrane Library, Medline, CINAHL, PsycINFO, and Embase were searched for Randomized Controlled Trials (RCTs) from inception to November 22, 2023. Statistical analyses were conducted using Stata 18.0 and Review Manager 5.4. RESULTS The initial search found 9369 papers, with 21 meeting the inclusion criteria (e.g., RCTs involving older adults aged 50 and older that assessed digital intelligence interventions on depression and anxiety symptoms). Meta-analyses revealed that, compared to control groups, digital intelligence interventions significantly reduced depression symptoms (SMD: -0.58; 95 % CI: -0.80, -0.35) and anxiety symptoms (SMD: -0.39; 95 % CI: -0.58, -0.19). Subgroup analysis revealed that internet-based Cognitive Behavioral Therapy (iCBT), interventions lasting 7 to 10 weeks, and the use of the Patient Health Questionnaire (PHQ) and Generalized Anxiety Disorder-7 (GAD-7) scales, especially in other regions, had the most pronounced effects. CONCLUSIONS Digital intelligence interventions reduce depressive and anxious symptoms in older adults, supporting the development of evidence-based treatment guidelines in the digital era.
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Affiliation(s)
- Yu-Fei Qiu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Man Wu
- Department of Gastroenterology, the Third People's Hospital of Chengdu, Chengdu 610014, China
| | - Jia-Li Liu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Chao-Yang Li
- Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yi-Qing Yu
- School of Nursing, Hubei University of Chinese Medicine, Wuhan 430065, China
| | - Li-Juan Zeng
- School of Nursing, Hubei University of Chinese Medicine, Wuhan 430065, China
| | | | - Fen Yang
- School of Nursing, Hubei University of Chinese Medicine, Wuhan 430065, China; Hubei Shizhen Laboratory, Wuhan 430065, China.
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Xiang X, Turner S, Ruiz-Sierra S, Zheng C, Ash S, Kodkany N, Dimoji A, Gosdzinski C, Kubicek G. Older Adults Experience with a Layperson-Supported Digital Mental Health Intervention for Depression: Qualitative Insights on Engagement. Clin Gerontol 2024:1-12. [PMID: 39193792 DOI: 10.1080/07317115.2024.2395890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2024]
Abstract
OBJECTIVES This qualitative study examines the experiences of older adults with Empower@Home, an older adult-centered, layperson-supported internet-based cognitive behavioral therapy (iCBT) program for depression, with a focus on engagement-related factors. METHODS Adults aged 50 or older with at least mild depressive symptoms were recruited from multiple resources. A random subset of participants was invited for a semi-structured qualitative interview during a post-intervention assessment conducted over the phone (N = 148). Interviews were recorded and transcribed verbatim. Transcripts were coded in a multi-phase, team-based approach utilizing inductive coding techniques, followed by thematic analysis to identify key themes. RESULTS Six key themes regarding engagement emerged: the importance of a structured, skills-based, and self-paced approach; the essential role of weekly coaching for accountability, web interface's ease of use and accessibility; narrative engagement dynamics; enhanced learning through multimodal instruction; and tailoring challenges in iCBT. CONCLUSIONS Older adult-centered, layperson-supported, and multimodal iCBT can effectively engage older adults in managing their mental health. CLINICAL IMPLICATIONS iCBT programs can be integrated into various community aging settings. By leveraging each setting's strengths and involving a range of professionals, these programs can play an important role in enhancing older adults' mental health.
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Affiliation(s)
- Xiaoling Xiang
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Skyla Turner
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Sofia Ruiz-Sierra
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Chuxuan Zheng
- Department of Human Centered Design & Engineering, University of Washington, Seattle, Washington, USA
| | - Samson Ash
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
| | - Nicole Kodkany
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Asha Dimoji
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Carly Gosdzinski
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Glory Kubicek
- School of Social Work, University of Michigan, Ann Arbor, Michigan, USA
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Schmidt A, Grey N, Strauss C, Gaysina D. Predictors of treatment outcome of psychological therapies for common mental health problems (CMHP) in older adults: A systematic literature review. Clin Psychol Rev 2024; 112:102463. [PMID: 38968690 DOI: 10.1016/j.cpr.2024.102463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/25/2024] [Accepted: 06/25/2024] [Indexed: 07/07/2024]
Abstract
Identifying factors that impact psychological treatment outcomes in older people with common mental health problems (CMHP) has important implications for supporting healthier and longer lives. The aim of the present study was to synthesise the evidence on predictors of psychological treatment outcomes in older people (aged 65+). PubMed, Scopus, Web of Science and PsycINFO were searched and 3929 articles were identified and screened, with 42 studies (N = 7978, M age = 68.9, SD age = 2.85) included: depression: k = 21, anxiety: k = 11, panic disorder: k = 3, mixed anxiety & depression: k = 3, PTSD: k = 2, various CMHP: k = 2, with CBT being the most common treatment (71%). The review identified 28 factors reported as significant predictors of treatment outcome in at least one study, across different domains: psychosocial (n = 9), clinical (n = 6), treatment-related (n = 6), socio-demographic (n = 4), neurobiological (n = 3). Homework completion was the most consistent predictor of positive treatment outcome. Baseline symptom severity was the most frequently studied significant predictor and across all conditions, with higher baseline symptom severity largely linked to worse treatment outcomes. No significant effects on treatment outcome were reported for gender, income and physical comorbidities. For a large majority of factors evidence was mixed or inconclusive. Further studies are required to identify factors affecting psychological treatment outcomes, which will be important for the development of personalised treatment approaches.
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Affiliation(s)
| | - Nick Grey
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, Worthing, West Sussex, UK
| | - Darya Gaysina
- School of Psychology, University of Sussex, Brighton, UK
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Hendriks GJ, Janssen N, Robertson L, van Balkom AJ, van Zelst WH, Wolfe S, Oude Voshaar RC, Uphoff E. Cognitive behavioural therapy and third-wave approaches for anxiety and related disorders in older people. Cochrane Database Syst Rev 2024; 7:CD007674. [PMID: 38973756 PMCID: PMC11229394 DOI: 10.1002/14651858.cd007674.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/09/2024]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is the most researched psychological therapy for anxiety disorders in adults, and known to be effective in this population. However, it remains unclear whether these results apply to older adults, as most studies include participants between 18 and 55 years of age. This systematic review aims to provide a comprehensive and up-to-date synthesis of the available evidence on CBT and third wave approaches for older adults with anxiety and related disorders. OBJECTIVES To assess the effects of Cognitive Behavioural Therapy (CT, BT, CBT and third-wave CBT interventions) on severity of anxiety symptoms compared with minimal management (not providing therapy) for anxiety and related disorders in older adults, aged 55 years or over. To assess the effects of CBT and related therapies on severity of anxiety symptoms compared with other psychological therapies for anxiety and related disorders in older adults, aged 55 years or over. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled studies Register (CCMDCTR), CENTRAL, Ovid MEDLINE, Ovid Embase and Ovid PsycINFO to 21 July 2022. These searches were updated on 2 February 2024. We also searched the international studies registries, including Clinicalstudies.gov and the WHO International Clinical Trials Registry Platform (ICTRP), to identify additional ongoing and unpublished studies. These sources were manually searched for studies up to 12 February 2024. SELECTION CRITERIA We included randomised controlled trials (RCTs) in older adults (≥ 55 years) with an anxiety disorder, or a related disorder, including obsessive compulsive disorder (OCD), acute stress disorder and post-traumatic stress disorder (PTSD), that compared CBT to either minimal management or an active (non-CBT) psychological therapy. Eligible studies had to have an anxiety-related outcome. DATA COLLECTION AND ANALYSIS Several authors independently screened all titles identified by the searches. All full texts were screened for eligibility according to our prespecified selection criteria. Data were extracted and the risk of bias was assessed using the Cochrane tool for RCTs. The certainty of evidence was evaluated using GRADE. Meta-analyses were performed for outcomes with quantitative data from more than one study. MAIN RESULTS We included 21 RCTs on 1234 older people allocated to either CBT or control conditions. Ten studies focused on generalised anxiety disorder; others mostly included a mix of clinical diagnoses. Nineteen studies focused on the comparison between CBT and minimal management. Key issues relating to risk of bias were lack of blinding of participants and personnel, and participants dropping out of studies, potentially due to treatment preference and allocation. CBT may result in a small-to-moderate reduction of anxiety post-treatment (SMD -0.51, 95% CI -0.66 to -0.36, low-certainty evidence). However, compared to this benefit with CBT immediately after treatment, at three to six months post-treatment, there was little to no difference between CBT and minimal management (SMD -0.29, 95% CI -0.59 to 0.01, low-certainty evidence). CBT may have little or no effect on clinical recovery/ improvement post-treatment compared to minimal management, but the evidence is very uncertain (RR 1.56, 95% CI 1.20 to 2.03, very low-certainty evidence). Results indicate that five people would need to receive treatment for one additional person to benefit (NNTB = 5). Compared to minimal management, CBT may result in a reduction of comorbid depression symptoms post-treatment (SMD -0.57, 95% CI -0.74 to -0.40, low-certainty evidence). There was no difference in dropout rates post-treatment, although the certainty of the evidence was low (RR 1.19, 95% CI 0.80 to 1.78). Two studies reported adverse events, both of which related to medication in the control groups (very low-certainty evidence, no quantitative estimate). Only two studies compared CBT to other psychological therapies, both of which only included participants with post-traumatic stress disorder. Low-certainty evidence showed no difference in anxiety severity post-treatment and at four to six months post-treatment, symptoms of depression post-treatment, and dropout rates post-treatment. Other outcomes and time points are reported in the results section of the manuscript. AUTHORS' CONCLUSIONS CBT may be more effective than minimal management in reducing anxiety and symptoms of worry and depression post-treatment in older adults with anxiety disorders. The evidence is less certain longer-term and for other outcomes including clinical recovery/improvement. There is not enough evidence to determine whether CBT is more effective than alternative psychological therapies for anxiety in older adults.
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Affiliation(s)
- Gert-Jan Hendriks
- "Overwaal" Centre of Expertise for Anxiety Disorders, OCD and PTSD, Institute for Integrated Mental Health Care "Pro Persona, Nijmegen, Netherlands
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Noortje Janssen
- Behavioural Science Institute, Radboud University, Nijmegen, Netherlands
| | | | - Anton J van Balkom
- Department of Psychiatry, Amsterdam University Medical Centre Vrije Universiteit, Amsterdam Public Health Institute and GGZ inGeest, Amsterdam, Netherlands
| | - Willeke H van Zelst
- Department of Psychiatry, University Medical Centre Groningen, Groningen, Netherlands
| | - Samantha Wolfe
- Tees, Esk and Wear Valleys NHS Foundation Trust, Durham, UK
| | | | - Eleonora Uphoff
- Centre for Reviews and Dissemination, University of York, York, UK
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Rubel J, Väth T, Hanraths S, Pruessner L, Timm C, Hartmann S, Barnow S, Lalk C. Evaluation of an online-based self-help program for patients with generalized anxiety disorder - A randomized controlled trial. Internet Interv 2024; 35:100716. [PMID: 38328275 PMCID: PMC10847028 DOI: 10.1016/j.invent.2024.100716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 12/07/2023] [Accepted: 01/17/2024] [Indexed: 02/09/2024] Open
Abstract
Objectives This study aimed to evaluate the effects of an online self-help intervention for generalized anxiety disorder (GAD). Our primary outcomes were generalized anxiety symptoms, measured using the Generalized Anxiety Disorder - 7 (GAD-7; Spitzer et al., 2006), and wellbeing based on the World Health Organization Wellbeing Index - 5 (WHO-5; Topp et al., 2015). Methods A total of 156 German-speaking patients aged 18 to 65 with a diagnosis of GAD and internet access were included in this randomized controlled trial. The intervention group (N = 78) received access to a 12-week online self-help program, while the waitlist control group (N = 78) received access after the 12-week waiting period. Results The intervention group showed a significant improvement in generalized anxiety symptoms compared to the control group (t(df = 123.73) = 4.52, p < .001) with a large effect size (d = 0.88, 95 %-CI: 0.50; 1.26). Additionally, the intervention group demonstrated a significant increase in wellbeing compared to the control group (t(df = 87,86) = 3.48, p < .001), with a moderate effect size (d = 0.62, 95 % CI: 0.27; 0.98). However, no significant effects were observed for secondary outcomes of functional impairments, work productivity, mental health literacy, and healthcare demands. For exploratory outcomes, improvement was found for anxiety and worry symptoms. Conclusions These findings suggest that an online-based self-help intervention effectively reduces GAD symptoms and improves overall wellbeing. Future research should explore the long-term effects of this intervention and investigate potential mechanisms underlying its efficacy. Public health implications Online-based self-help programs provide a promising treatment option for individuals with GAD who face barriers to traditional face-to-face therapy.
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Affiliation(s)
- J. Rubel
- Department of Humanities, Institute of Psychology, Osnabrück University, Germany
| | - T. Väth
- Department of Humanities, Institute of Psychology, Osnabrück University, Germany
| | - S. Hanraths
- Department of Humanities, Institute of Psychology, Osnabrück University, Germany
| | - L. Pruessner
- Department of Psychology, Heidelberg University, Germany
| | - C. Timm
- Department of Psychology, Heidelberg University, Germany
| | - S. Hartmann
- Department of Psychology, Heidelberg University, Germany
| | - S. Barnow
- Department of Psychology, Heidelberg University, Germany
| | - C. Lalk
- Department of Humanities, Institute of Psychology, Osnabrück University, Germany
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Wuthrich VM, Dickson SJ, Pehlivan M, Chen JTH, Zagic D, Ghai I, Neelakandan A, Johnco C. Efficacy of low intensity interventions for geriatric depression and anxiety - A systematic review and meta-analysis. J Affect Disord 2024; 344:592-599. [PMID: 37858732 DOI: 10.1016/j.jad.2023.10.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 10/13/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND This systematic review and meta-analysis examined the efficacy of low intensity psychological interventions for older adults (60+ years) with clinical anxiety and/or depressive disorders. METHOD Systematic review and meta-analysis of randomised control trials of low-intensity psychological interventions for anxiety and/or depression with an active or passive control condition (e.g., waitlist, treatment-as-usual or active control) in any setting. Low intensity psychological interventions (e.g., cognitive behaviour therapy [CBT]) targeted anxiety and/or depression as primary outcomes, were primarily self-help, and included support from trained practitioners/facilitators with <6 h total contact time (typically <30 min p/contact). RESULTS Seven studies consisting of 304 older adults (65-78 years, Mage = 70, SD = 4) were identified and six included in the meta-analysis of depression outcomes and three for anxiety. A random effects meta-analysis of group differences in symptom change from pre-post treatment found evidence favouring low intensity psychological interventions over passive control groups for the treatment of depressive and anxiety symptoms, with moderate effect sizes for depression (Cohen's d = -0.62) and large effect sizes for anxiety (Cohen's d = -0.84) at post-treatment. LIMITATIONS Results are limited by study design of included studies such that the efficacy of interventions compared to treatment-as-usual, non-CBT approaches, in adults >80 years and long-term effects are unknown. CONCLUSIONS There is some evidence supporting the clinical benefits of low intensity psychological interventions for depressive and anxiety symptoms in older adults compared to passive controls. More research is needed to examine efficacy compared to active control conditions, and among those over 80 years.
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Affiliation(s)
- Viviana M Wuthrich
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia.
| | - Sophie J Dickson
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Melissa Pehlivan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Jessamine T-H Chen
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Dino Zagic
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Ishaan Ghai
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Aswathi Neelakandan
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
| | - Carly Johnco
- Macquarie University Lifespan Health & Wellbeing Research Centre, Macquarie University, Sydney 2109, Australia
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Peng R, Guo Y, Zhang C, Li X, Huang J, Chen X, Feng H. Internet-delivered psychological interventions for older adults with depression: A scoping review. Geriatr Nurs 2024; 55:97-104. [PMID: 37976561 DOI: 10.1016/j.gerinurse.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Depression is prevalent among older adults, and internet-delivered psychological interventions (IDPIs) have emerged as a promising solution. AIM To explore the landscape of IDPIs for late-life depression, examining current characteristics, psychotherapies, intervention strategies, facilitators, and barriers. METHOD Guided by a PRISMA-guided scoping review, we systematically searched five electronic databases. RESULTS 25 relevant studies were identified. IDPIs were used for treatment, prevention, and assessment. Internet-based cognitive behavioral therapy was the most common psychotherapy. Seven strategies to provide tailored services include psychotherapy courses, professional involvement, mood and progress tracking, virtual community, timed reminders, additional learning resources, and gamification elements. Barriers contained cognitive impairment, low digital literacy, device inaccessibility, limited depression awareness, adherence issues, and acclimation time, while facilitators included prior treatment experience, real-life character stories, strong client-worker bonds, and integration into daily care routines. CONCLUSION IDPIs present an accessible and convenient avenue for older adults. Future directions suggest exploring minimalist interventions, diverse strategies, and optimized implementation to amplify IDPIs impact among this vulnerable group.
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Affiliation(s)
- Ruotong Peng
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Yongzhen Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Chi Zhang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xiaoyang Li
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Jundan Huang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xi Chen
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hui Feng
- Xiangya School of Nursing, Central South University, Changsha, China; Oceanwide Health Management Institute, Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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Vernmark K, Buhrman M, Carlbring P, Hedman-Lagerlöf E, Kaldo V, Andersson G. From research to routine care: A historical review of internet-based cognitive behavioral therapy for adult mental health problems in Sweden. Digit Health 2024; 10:20552076241287059. [PMID: 39381804 PMCID: PMC11459524 DOI: 10.1177/20552076241287059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Accepted: 09/10/2024] [Indexed: 10/10/2024] Open
Abstract
This narrative historical review examines the development of internet-based cognitive behavioral therapy (ICBT) in Sweden, describing its progression within both academic and routine care settings. The review encompasses key publications, significant scientific findings, and contextual factors in real-world settings. Over 25 years ago, Sweden emerged as a pioneering force in internet-delivered treatment research for mental health. Since then, Swedish universities, in collaboration with research partners, have produced substantial research demonstrating the efficacy of ICBT across various psychological problems, including social anxiety disorder, panic disorder, generalized anxiety disorder, and depression. Although research conducted in clinical settings has been less frequent than in academic contexts, it has confirmed the effectiveness of therapist-supported ICBT programs for mild-to-moderate mental health problems in routine care. Early on, ICBT was provided as an option for patients at both the primary care level and in specialized clinics, using treatment programs developed by both public and private providers. The development of a national platform for delivering internet-based treatment and the use of procurement in selecting ICBT programs and providers are factors that have shaped the current routine care landscape. However, gaps persist in understanding how to optimize the integration of digital treatment in routine care, warranting further research and the use of specific implementation frameworks and outcomes. This historical perspective on the research and delivery of ICBT in Sweden over two decades offers insights for the international community into the development and broad dissemination of a specific digital mental health intervention within a national context.
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Affiliation(s)
- Kristofer Vernmark
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Moncia Buhrman
- Department of Psychology, Uppsala University, Uppsala, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Viktor Kaldo
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
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Karlsson-Good M, Kaldo V, Lundberg L, Kraepelien M, Anthony SA, Holländare F. Increasing the accessibility to internet-based cognitive behavioural therapy for depression: A single-blind randomized controlled trial of condensed versus full-text versions. Internet Interv 2023; 34:100678. [PMID: 37840646 PMCID: PMC10570001 DOI: 10.1016/j.invent.2023.100678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/17/2023] Open
Abstract
Background Research shows that internet-based cognitive behavioural therapy (iCBT) is an effective treatment for depression. However, little is known about how the length of the text material in iCBT affects outcomes. Objective The aim of this study was to test whether a condensed iCBT version for depression would be non-inferior to the existing full-text version in reducing depressive symptoms at post-treatment. We also wanted to test non-inferiority for secondary outcomes and explore reading speed and ADHD symptoms as potential moderators. Method A single-blind randomized controlled trial was conducted (N = 267) comparing two versions of guided iCBT for depression; full-text (around 60,000 words) and condensed (around 30,000 words, with the option to listen to the text). Estimated between-group effect sizes and their confidence intervals for depression, anxiety and quality of life, were compared to a pre-determined non-inferiority margin (ES = 0.4). Moderation analyses of reading speed and ADHD symptoms were conducted. Results The condensed version of iCBT was non-inferior to the full-text version on post-treatment measures for depressive symptoms (95 % CI = -0.42-0.24), anxiety symptoms (95 % CI = -0.24-0.32), and quality of life (95 % CI = -0.09-0.49). Non-inferiority was inconclusive for depressive symptoms at the one-year follow-up (95 % CI = -0.60-0.47). There was no significant moderation effects of reading speed (p = 0.06) or ADHD symptoms (p = 0.11) on depressive symptoms. Conclusion These results indicate that a condensed version of iCBT for depression is as effective at treating depression as the full-text version. By shortening texts, iCBT may be made available to more people. Due to unequal dropout rates between the groups, these results are preliminary and need to be replicated.
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Affiliation(s)
- Magnus Karlsson-Good
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden
| | | | - Martin Kraepelien
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Susanne A. Anthony
- Department of Pediatrics, Skåne University Hospital, Region Skåne, Malmö, Sweden
| | - Fredrik Holländare
- Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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Lin Z, Cheng L, Han X, Wang H, Liao Y, Guo L, Shi J, Fan B, Teopiz KM, Jawad MY, Zhang H, Chen Y, Lu C, McIntyre RS. The Effect of Internet-Based Cognitive Behavioral Therapy on Major Depressive Disorder: Randomized Controlled Trial. J Med Internet Res 2023; 25:e42786. [PMID: 37738092 PMCID: PMC10559190 DOI: 10.2196/42786] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 01/10/2023] [Accepted: 07/31/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Many people living with major depressive disorder (MDD) in China do not receive treatment owing to a lack of mental health services, along with significant stigma toward mental illness. Internet-based cognitive behavioral therapy (ICBT) has been proposed to increase access to mental health care for people with MDD. OBJECTIVE The aims of this study were to (1) evaluate the efficacy of ICBT for depressive symptoms in patients with MDD; (2) evaluate the effect of ICBT on anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social function, and health-related quality of life (HRQoL); and (3) explore the acceptability of and satisfaction with the ICBT program among participants. METHODS Patients with MDD were enrolled and randomized to the ICBT group or the waiting-list control (WLC) group. The ICBT group received ICBT delivered through a WeChat mini-program with general support by nonspecialists. Participants in the 2 groups were self-evaluated online at baseline and posttreatment for changes in the primary outcome (ie, depressive symptoms) and secondary outcomes (ie, anxiety symptoms, nonspecific psychological distress, general self-efficacy, depression stigma, social functional impairment, and HRQoL). Changes in outcomes were measured by changes in overall scores on respective scales, and response and remission rates were calculated based on depressive symptoms. The acceptability of and satisfaction with the ICBT program were measured by treatment adherence and participants' feelings (ie, modules seriously completed, perceived benefit, and satisfaction). RESULTS We included 40 patients who were randomly assigned to the ICBT group and 44 who were assigned to the WLC group. Compared with the WLC group, the ICBT group had fewer depressive symptoms, fewer anxiety symptoms, less nonspecific psychological distress, and greater general self-efficacy. Moreover, the ICBT group had higher response (18/31, 58%) and remission rates (17/31, 55%). The adherence rate in the ICBT group was 78% (31/40), and the majority of participants who completed all ICBT modules were satisfied with the ICBT program. CONCLUSIONS ICBT demonstrated greater improvements in depressive symptoms, anxiety symptoms, nonspecific psychological distress, and general self-efficacy among selected patients with MDD in comparison with the findings in waiting-list controls. The ICBT program in this study had good acceptability and satisfaction among participants. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR2100046425); https://tinyurl.com/bdcrj4zv.
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Affiliation(s)
- Ziyi Lin
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Lu Cheng
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Xue Han
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Hongqiong Wang
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Yuhua Liao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Lan Guo
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Jingman Shi
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Beifang Fan
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Kayla M Teopiz
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
| | - Muhammad Youshay Jawad
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Huimin Zhang
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Yan Chen
- Department of Psychiatry, Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China
| | - Ciyong Lu
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Food, Nutrition and Health, Sun Yat-sen University, Guangzhou, China
- Guangdong Engineering Technology Research Center of Nutrition Translation, Guangzhou, China
| | - Roger S McIntyre
- Brain and Cognition Discovery Foundation, Toronto, ON, Canada
- Department of Pharmacology, University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Maj A, Michalak N, Graczykowska A, Andersson G. The effect of internet-delivered cognitive behavioral therapy for depression and anxiety on quality of life: A meta-analysis of randomized controlled trials. Internet Interv 2023; 33:100654. [PMID: 37555075 PMCID: PMC10404731 DOI: 10.1016/j.invent.2023.100654] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 07/15/2023] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Abstract
Although numerous studies have examined the effects of internet-delivered cognitive behavioral therapy (iCBT) for depression and anxiety on quality of life, no meta-analysis has yet been conducted to integrate the results of these studies. We conducted systematic searches in PubMed, Cochrane, and PsycInfo, which included terms for treatment type, modality of delivery, condition, and main outcome. We included studies that met the following inclusion criteria: (a) randomized controlled trials, (b) patients allocated to some form of the control condition, (c) patients receiving some type of treatment of anxiety and/or depression involving Internet-delivered Cognitive Behavioral Therapy, (d) use of a validated outcome measure assessing the level of quality of life, (e) conducted with adult participants diagnosed with anxiety disorder and/or unipolar depression, (f) papers written in English. We analyzed 40 randomized controlled trials with a total of 4289 participants that met inclusion criteria. The pooled between-group effect size for the quality of life overall score was small (g = 0.35, 95 % CI: 0.26-0.44, p = .0001), favoring iCBT over the control conditions. Regarding the distinct quality of life domains measured by the World Health Organization Quality of Life Assessment, a statistically significant difference between iCBT and control conditions was found only for the physical health domain (g = 0.56, 95 % CI: 0.06-1.07, p = .029), in favor of iCBT. In both cases, heterogeneity was moderate. While the effect on the quality of life is small (the overall quality of life score) to moderate (the physical health domain score), we conclude that iCBT for depression and anxiety may be a promising approach for improving the quality of life of patients.
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Affiliation(s)
- Anna Maj
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Natalia Michalak
- Faculty of Psychology, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Agata Graczykowska
- Faculty of Design, SWPS University of Social Sciences and Humanities, Warsaw, Poland
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning; Department of Biomedical and Clinical Sciences, Linköping University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Ribba B, Peck R, Hutchinson L, Bousnina I, Motti D. Digital Therapeutics as a New Therapeutic Modality: A Review from the Perspective of Clinical Pharmacology. Clin Pharmacol Ther 2023; 114:578-590. [PMID: 37392464 DOI: 10.1002/cpt.2989] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/24/2023] [Indexed: 07/03/2023]
Abstract
The promise of transforming digital technologies into treatments is what drives the development of digital therapeutics (DTx), generally known as software applications embedded within accessible technologies-such as smartphones-to treat, manage, or prevent a pathological condition. Whereas DTx solutions that successfully demonstrate effectiveness and safety could drastically improve the life of patients in multiple therapeutic areas, there is a general consensus that generating therapeutic evidence for DTx presents challenges and open questions. We believe there are three main areas where the application of clinical pharmacology principles from the drug development field could benefit DTx development: the characterization of the mechanism of action, the optimization of the intervention, and, finally, its dosing. We reviewed DTx studies to explore how the field is approaching these topics and to better characterize the challenges associated with them. This leads us to emphasize the role that the application of clinical pharmacology principles could play in the development of DTx and to advocate for a development approach that merges such principles from development of traditional therapeutics with important considerations from the highly attractive and fast-paced world of digital solutions.
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Affiliation(s)
- Benjamin Ribba
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Richard Peck
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center Basel, F. Hoffmann-La Roche Ltd., Basel, Switzerland
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Lucy Hutchinson
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Imein Bousnina
- Genentech, A Member of the Roche Group, Washington, DC, USA
| | - Dario Motti
- Roche Information Solutions, F. Hoffmann-La Roche Ltd., Basel, Switzerland
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Efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults: a systematic review. Int Psychogeriatr 2023; 35:131-141. [PMID: 35603891 DOI: 10.1017/s1041610222000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Older adults experience symptoms of depression, leading to suffering and increased morbidity and mortality. Although we have effective depression therapies, physical distancing and other public health measures have severely limited access to in-person interventions. OBJECTIVE To describe the efficacy of virtual interventions for reducing symptoms of depression in community-dwelling older adults. DESIGN Systematic review. SETTING We searched MEDLINE, EMBASE, Cochrane Libraries, PsycINFO, and gray literature from inception to July 5, 2021. PARTICIPANTS AND INTERVENTIONS We included randomized trials (RCTs) comparing the efficacy of virtual interventions to any other virtual intervention or usual care in community-dwelling adults ≥60 years old experiencing symptoms of depression or depression as an outcome. MEASUREMENTS The primary outcome was change in symptoms of depression measured by any depression scale. RESULTS We screened 12,290 abstracts and 830 full text papers. We included 15 RCTs (3100 participants). Five RCTs examined persons with depression symptoms at baseline and ten examined depression as an outcome only. Included studies demonstrated feasibility of interventions such as internet or telephone cognitive behavioral therapy with some papers showing statistically significant improvement in depressive symptoms. CONCLUSIONS There is a paucity of studies examining virtual interventions in older adults with depression. Given difficulty in accessing in-person therapies in a pandemic and poor access for people living in rural and remote regions, there is an urgent need to explore efficacy, effectiveness, and implementation of virtual therapies.
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Bücker L, Berger T, Bruhns A, Westermann S. Motive-Oriented, Personalized, Internet-Based Interventions for Depression: Nonclinical Experimental Study. JMIR Form Res 2022; 6:e37287. [PMID: 36098989 PMCID: PMC9516365 DOI: 10.2196/37287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 06/07/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The low level of adherence in internet-based self-help interventions for depression suggests that in many existing programs, the motivational fit between the program and the user is unsatisfactory (eg, the user seeks autonomy, but the program provides directive guidance). Personalized, motive-oriented, self-help interventions could enable participants who interact with a program and its contents to have more engaging and less aversive experiences and thus increase adherence. OBJECTIVE In an experimental study with a nonclinical analogue sample, we aimed to test the hypotheses that a better motivational person-program fit is linked with higher anticipated adherence, working alliance, and satisfaction with the program. METHODS Motivational person-program fit was examined with respect to the 2 contrasting motives being autonomous and being supported. The hypotheses were tested by specifically varying the motivational person-program fit in a nonclinical sample (N=55), where participants were asked to work on, and subsequently evaluate, a limited set of individual pages of a self-help program with guidance (in the form of text messages) for depression. The sections of the self-help program were redesigned to either particularly address the autonomy motive or the support motive. For the quasi-experimental variation of the motivational person-program characteristics, we divided the 55 participants into 2 groups (autonomy group: n=27, 49%; support group: n=28, 51%) by screening method (using the Inventory of Approach and Avoidance Motivation), corresponding to the 2 motives. Both groups evaluated (in randomized order) 2 excerpts of the program-one that matched their motive (fit) and one that was contrary to it (no fit). Immediately after the evaluation of each excerpt, anticipated adherence, working alliance, and treatment satisfaction were assessed. RESULTS Regarding being supported, the satisfaction with or violation of this motive had an impact on (optimal) anticipated adherence as well as working alliance and satisfaction with the intervention; a congruent person-program fit resulted in significantly higher anticipated adherence (t27=3.00; P=.006), working alliance (t27=3.20; P=.003), and satisfaction (t27=2.86; P=.008) than a noncongruent fit. However, a similar impact could not be found for the motive being autonomous. Several correlations were found that supported our hypotheses (eg, for the congruent person-program fit autonomy motive and autonomy group, support satisfaction negatively correlated with optimal anticipated adherence). CONCLUSIONS This first experimental study gives reason to assume that motive orientation may have a positive influence on adherence, working alliance, and satisfaction in internet-based self-help interventions for depression and other mental disorders. Future studies should conduct randomized controlled trials with clinical samples and assess clinical outcomes.
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Affiliation(s)
- Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Alina Bruhns
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Westermann
- Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
- Department of Psychology, University of California, Berkeley, CA, United States
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Raue PJ, Fridling N, Song J, Hull TD, Alexopoulos GS, Arean PA. Message-based psychotherapy for older adults: A cohort comparison study. Front Psychiatry 2022; 13:951354. [PMID: 36090371 PMCID: PMC9453249 DOI: 10.3389/fpsyt.2022.951354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
Objective Digital Mental Health Interventions (DMHI) can diminish inequities in mental health care provision. As DMHIs increase in popularity, however, older adults may be unintentionally excluded due to barriers such as lack of awareness, internet access, digital tools, technological socialization and education, physiological accessibility, and communication technology infrastructure. The aim of this study was to examine longitudinal treatment engagement patterns and 15-week clinical outcomes of depressed and anxious older adults compared to a matched cohort of younger adults seeking treatment from a large asynchronous telemedicine provider. Methods The 2,470 older adults (55+ years) and a matched cohort of younger adults (26-35 years) diagnosed with depression or anxiety were treated by licensed therapists via messaging 5 days a week. Patterns of treatment engagement on the platform were compared across groups by examining total number of days in treatment, days actively messaging on the platform, and average words and messages per week sent by patients over the entire period they remained in treatment. Symptoms were assessed every 3 weeks using the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder Scale (GAD-7), and changes were compared across age groups over 15 weeks. Results Older patients attended more days in treatment than younger patients, but there were no differences in number of days actively messaging on the platform, number of messages per week, or word count per week. The two age groups did not differ in their final anxiety or depressive symptoms when controlling for total number of weeks attended. Patients in the younger age group experienced a quicker rate of reduction than older adults in their anxiety, but not depressive symptoms. Conclusions Among individuals willing to initiate care through a DMHI, older adults had overall similar engagement as younger adults and they showed similar improvement in symptoms of depression and anxiety. Given the advantages of message-based care for aiding a mental health workforce in serving larger numbers of individuals in need and the expected growth of the aging population, these findings could help healthcare systems in evaluating a variety of treatment options and delivery media for meeting the healthcare needs of the future.
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Affiliation(s)
- Patrick J. Raue
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
| | | | - Jiyoung Song
- Department of Psychology, University of California, Berkeley, Berkeley, CA, United States
| | | | - George S. Alexopoulos
- Department of Psychiatry, Weill Cornell Medical College, White Plains, NY, United States
| | - Patricia A. Arean
- Department of Psychiatry & Behavioral Sciences, University of Washington Medical Center, Seattle, WA, United States
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Cremers G, Taylor E, Hodge L, Quigley A. Effectiveness and Acceptability of Low-intensity Psychological Interventions on the Well-being of Older Adults: A Systematic Review. Clin Gerontol 2022; 45:214-234. [PMID: 31507251 DOI: 10.1080/07317115.2019.1662867] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objectives: Growth in the older adult population and healthcare inequities mean there is a global need to increase access to early intervention in mental healthcare for older adults. This systematic review synthesized the evidence for the efficacy and acceptability of low-intensity psychological interventions (self-help, psychoeducation, bibliotherapy, internet cognitive-behavioral therapy: iCBT) for older adults with mild-to-moderate mental health problems.Methods: Ovid, EBSCOhost and ProQuest were searched for articles describing low-intensity psychological interventions. Pre and post outcome measures and a mean age of at least 50 (age range ≥40) were required for inclusion.Results: 26 articles (23 studies) described various interventions. Most studies were good quality and reported improvements in participant's mental health scores post intervention. Participants were more likely to be female, aged 60-70 and to be highly educated. Eight studies reported obtaining participant satisfaction ratings. Three studies included participants from rural areas.Conclusions: Low-intensity psychological interventions can be effective for older adults with mild-to-moderate mental health problems, but generalizability is constrained.Clinical Implications: Guided iCBT and bibliotherapy may be beneficial for adults in their 60s and 70s experiencing mild-to-moderate levels of depression. CBT may also be beneficial for reducing symptoms of mild-to-moderate anxiety. Providing the option of low-intensity psychological intervention, particularly iCBT, may help increase engagement with treatment.
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Affiliation(s)
- Gwendolyn Cremers
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK.,Psychological Services, NHS Borders, Melrose, UK
| | - Emily Taylor
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
| | - Lorna Hodge
- Clinical Psychology, School of Health in Social Science, University of Edinburgh, Edinburgh, UK
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Aemissegger V, Lopez-Alcalde J, Witt CM, Barth J. Comparability of Patients in Trials of E-Health and Face-To-Face Psychotherapeutic Interventions for Depression: a Meta-Synthesis (Preprint). J Med Internet Res 2022; 24:e36978. [PMID: 36103217 PMCID: PMC9520399 DOI: 10.2196/36978] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 05/16/2022] [Accepted: 07/28/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Vera Aemissegger
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Jesus Lopez-Alcalde
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Faculty of Health Sciences, Universidad Francisco de Vitoria, Madrid, Spain
- Unidad de Bioestadística Clínica, Hospital Universitario Ramón y Cajal, IRYCIS, CIBERESP, Madrid, Spain
| | - Claudia M Witt
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Berlin Institute of Health, Institute of Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
- Center for Integrative Medicine, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Jürgen Barth
- Institute for Complementary and Integrative Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Dworschak C, Heim E, Maercker A. Efficacy of internet-based interventions for common mental disorder symptoms and psychosocial problems in older adults: A systematic review and meta-analysis. Internet Interv 2022; 27:100498. [PMID: 35141136 PMCID: PMC8810404 DOI: 10.1016/j.invent.2022.100498] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although a high proportion of older adults suffer from common mental disorder symptoms and psychosocial problems, only a small number of older individuals seek psychological treatment. Internet-based interventions have the potential to bridge this treatment gap. However, while there is extensive literature on internet-based treatments in younger to middle-aged adults, research on older individuals is lacking. OBJECTIVE We aimed to summarize narratively and empirically the existing literature on the efficacy of internet-based interventions for the treatment of common mental disorder symptoms and psychosocial problems (loneliness, stress) in older individuals. METHODS This systematic review and meta-analysis was registered in PROSPERO (registration number: CRD42021235129). Systematic literature searches were conducted in PsycInfo, Ageline, Medline, CINHAL, and Psyndex. Studies were eligible for inclusion if they a) focused on older adults, b) assessed the efficacy of an internet-delivered psychological intervention, c) included a control condition and d) assessed common mental disorder symptoms or psychosocial problems as outcomes. Meta-analyses were conducted based on studies that included a passive, minimally active or placebo control condition to estimate pooled effects on overall symptom severity as well as on specific psychological outcomes. RESULTS 11 Studies met inclusion criteria, with the majority of interventions focusing on depression or anxiety symptoms and being based on CBT principles. Significant large effect of internet-based interventions for older adults were found for overall symptom severity (depression, anxiety, PTSD, stress) as well as for depression symptom severity. No significant effects were found for anxiety symptom severity. DISCUSSION Our findings provide preliminary support that internet-based interventions might be a feasible and effective intervention method for the treatment of common mental disorder symptoms and stress in older adults. However, research in this area is still at an early stage. More studies are needed to shed light on the role of various treatment and patient characteristics in the efficacy of internet-delivered treatments.
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Affiliation(s)
- Christine Dworschak
- University of Zurich, Binzmühlestrasse 14/17, 8050 Zurich, Switzerland
- Corresponding author.
| | - Eva Heim
- University of Lausanne, Institute of Psychology, Quartier UNIL-Mouline, 1015 Lausanne, Switzerland
| | - Andreas Maercker
- University of Zurich, Binzmühlestrasse 14/17, 8050 Zurich, Switzerland
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21
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Witlox M, Kraaij V, Garnefski N, Bohlmeijer E, Smit F, Spinhoven P. Cost-effectiveness and cost-utility of an Acceptance and Commitment Therapy intervention vs. a Cognitive Behavioral Therapy intervention for older adults with anxiety symptoms: A randomized controlled trial. PLoS One 2022; 17:e0262220. [PMID: 35081130 PMCID: PMC8791485 DOI: 10.1371/journal.pone.0262220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 12/02/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A previous randomized controlled trial in older adults with anxiety symptoms found no differences between a brief blended Acceptance and Commitment Therapy (ACT) intervention and brief face-to-face Cognitive Behavior Therapy (CBT) regarding anxiety symptom severity at posttreatment and 12-month follow-up. A health-economic evaluation comparing these interventions has not yet been conducted. OBJECTIVE This study examined the one-year cost-effectiveness and cost-utility of blended ACT compared to face-to-face CBT for older adults with anxiety symptoms. METHODS The economic evaluation was embedded in a randomized controlled trial comparing blended ACT to CBT in 314 older adults with mild to moderately severe anxiety symptoms. Data were collected at baseline and 3, 6 and 12 months post baseline. For the cost-effectiveness analysis, treatment response was defined as a reliable improvement in anxiety symptom severity (measured with the Generalized Anxiety Disorder-7) between baseline and 12-month follow-up. To assess cost-utility, quality-adjusted life years (QALYs) were computed using EuroQol-5 Dimensions-5 Levels-5 utility scores. Analyses took the societal perspective, including both healthcare costs and productivity costs. Incremental cost-effectiveness ratios were calculated using 2500 bootstraps of seemingly unrelated regression equations of costs and effects. Sensitivity analyses were performed to assess the robustness of the findings. RESULTS Differences between the blended ACT group and CBT group in treatment response and QALYs were statistically insignificant and clinically irrelevant. The ACT intervention was associated with an average per-participant cost reduction of €466 ($593) compared to CBT, which resulted from lower productivity costs in the blended ACT group. From a healthcare perspective, the ACT intervention was associated with higher costs (by €71 ($90)) than CBT. CONCLUSIONS The results do not indicate that from a health-economic perspective blended ACT should be preferred over CBT in the treatment of older adults with anxiety symptoms. The findings support a model of shared decision making, where clinicians and patients collaboratively decide on the preferred intervention, based on ethical-medical, practical and personal considerations. TRIAL REGISTRATION Netherlands Trial Register: TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131.
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Affiliation(s)
- Maartje Witlox
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Vivian Kraaij
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Nadia Garnefski
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Filip Smit
- Department of Mental Health & Prevention, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Philip Spinhoven
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, The Netherlands
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22
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Ying Y, Ji Y, Kong F, Chen Q, Lv Y, Hou Y, Zhu L, Miao P, Yu L, Li L, Kuang W, Jiang L, Zhu X, Liu X, Xu L, Mi Y, Lou Z, Ruan L. Internet-based cognitive behavioral therapy for psychological distress in older adults without cognitive impairment living in nursing homes during the COVID-19 pandemic: A feasibility study. Internet Interv 2021; 26:100461. [PMID: 34631432 PMCID: PMC8487764 DOI: 10.1016/j.invent.2021.100461] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/17/2021] [Accepted: 09/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a detrimental effect on the mental health of older adults living in nursing homes. Very few studies have examined the effects of Internet-based Cognitive Behavioral Therapy (ICBT) on older adults living in nursing homes during the pandemic. We conducted a feasibility study using a single-group design, to explore the effectiveness of ICBT on psychological distress in 137 older adults (without cognitive impairment) from 8 nursing homes in 4 southeast cities in China, between January and March 2020. METHODS Symptoms of depression, anxiety, general psychological distress, and functional disability were measured at baseline, post-treatment (5 weeks) and at a 1-month follow-up. Mixed-effects model was used to assess the effects of ICBT. RESULTS Statistically significant changes with large effect sizes were observed from pre- to post-treatment on the PHQ-9 (p < .001, Cohen's d = 1.74), GAD-7 (p < .001, d = 1.71), GDS (p < .001, d = 1.30), K-10 (p < .001, d = 1.93), and SDS (p < .001, d = 2.03). Furthermore, improvements in treatment outcomes were sustained at 1-month follow-up, and high levels of adherence and satisfaction were indicated. CONCLUSION ICBT was effective in reducing psychological distress in older adults without cognitive impairments living in nursing homes during the COVID-19 pandemic. Thus, it could be applied in improving the mental health of this vulnerable group during the pandemic.
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Key Words
- CBT, cognitive behavioral therapy
- CIs, confidence intervals
- COVID-19
- DSM-IV, The Diagnostic and Statistical Manual of Mental Disorders-4th edition
- Feasibility study
- GAD-7, Generalized Anxiety Disorder 7-item
- GDS, Geriatric Depression Scale
- ICBT, Internet-based cognitive behavioral therapy
- ITT, intention-to-treat
- Internet-based cognitive behavioral therapy
- K-10, 10-item Kessler Psychological Distress Scale
- LOCF, last observation carried forward
- MMRM, mixed-effects model for repeated measure
- Mental health
- Older adults
- PHQ-9, Patient Health Questionnaire 9-item
- Psychological distress
- RCT, randomized controlled trials
- REML, restricted maximum likelihood
- SD, standard deviation
- SDS, Sheehan Disability Scales
- UN, unstructured
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Affiliation(s)
- Yuchen Ying
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
- School of Medicine, Ningbo University, Ningbo, Zhejiang, PR China
| | - Yunxin Ji
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
| | - Fanqian Kong
- Department of Medical Record and Statistics, Ningbo Medical Center Lihuili Hospital, Ningbo, Zhejiang, PR China
| | - Qiqi Chen
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Yueer Lv
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Yanbin Hou
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
| | - Lijie Zhu
- Department of Statistics and Programming, Jiangsu Hengrui Pharmaceuticals Co. Ltd, Shanghai, PR China
| | - Pingping Miao
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
| | - Libo Yu
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Laiyou Li
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Wei Kuang
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Lingli Jiang
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Xiaozhuo Zhu
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Xiaozhuang Liu
- Department of Elderly Health Care and Management, School of Health Services and Management, Ningbo College of Health Sciences, Ningbo, Zhejiang, PR China
| | - Le Xu
- School of Medicine, Ningbo University, Ningbo, Zhejiang, PR China
| | - Yuwei Mi
- School of Medicine, Ningbo University, Ningbo, Zhejiang, PR China
| | - Zhongze Lou
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
- Central Laboratory of the Medical Research Center, Ningbo First Hospital, Ningbo, Zhejiang, PR China
- Corresponding authors at: Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, 59 Liuting Street, Haishu District, Ningbo, Zhejiang 315211, PR China.
| | - Liemin Ruan
- Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, Ningbo, Zhejiang, PR China
- Corresponding authors at: Department of Psychosomatic Medicine, Ningbo First Hospital, Ningbo Hospital of Zhejiang University, 59 Liuting Street, Haishu District, Ningbo, Zhejiang 315211, PR China.
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23
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Mohr DC, Azocar F, Bertagnolli A, Choudhury T, Chrisp P, Frank R, Harbin H, Histon T, Kaysen D, Nebeker C, Richards D, Schueller SM, Titov N, Torous J, Areán PA. Banbury Forum Consensus Statement on the Path Forward for Digital Mental Health Treatment. Psychiatr Serv 2021; 72:677-683. [PMID: 33467872 PMCID: PMC8822332 DOI: 10.1176/appi.ps.202000561] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A major obstacle to mental health treatment for many Americans is accessibility: the United States faces a shortage of mental health providers, resulting in federally designated shortage areas. Although digital mental health treatments (DMHTs) are effective interventions for common mental disorders, they have not been widely adopted by the U.S. health care system. National and international expert stakeholders representing health care organizations, insurance companies and payers, employers, patients, researchers, policy makers, health economists, and DMHT companies and the investment community attended two Banbury Forum meetings. The Banbury Forum reviewed the evidence for DMHTs, identified the challenges to successful and sustainable implementation, investigated the factors that contributed to more successful implementation internationally, and developed the following recommendations: guided DMHTs should be offered to all patients experiencing common mental disorders, DMHT products and services should be reimbursable to support integration into the U.S. health care landscape, and an evidence standards framework should be developed to support decision makers in evaluating DMHTs.
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Affiliation(s)
- David C Mohr
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Francisca Azocar
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Andrew Bertagnolli
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Tanzeem Choudhury
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Paul Chrisp
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Richard Frank
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Henry Harbin
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Trina Histon
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Debra Kaysen
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Camille Nebeker
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Derek Richards
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Stephen M Schueller
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Nickolai Titov
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - John Torous
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
| | - Patricia A Areán
- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
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- Department of Preventive Medicine, Center for Behavioral Intervention Technologies, Northwestern University, Chicago (Mohr); Optum, Eden Prairie, Minnesota (Azocar); One Medical and Alliant International University, San Francisco (Bertagnolli); Information Science, Cornell Tech, New York City (Choudhury); National Institute for Health and Care Excellence, Manchester, England (Chrisp); Department of Health Care Policy (Frank) and Department of Psychiatry (Torous), Harvard Medical School, Boston; health care consultant, Baltimore (Harbin); Care Management Institute, Kaiser Permanente, Oakland, California (Histon); Department of Psychiatry and Behavioral Sciences, Stanford University, and National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, California (Kaysen); Department of Family Medicine and Public Health, University of California, San Diego (Nebeker); E-Mental Health Research Group, School of Psychology, Trinity College, University of Dublin, Dublin, and Department of Clinical Research and Innovation, SilverCloud Health, Boston (Richards); Department of Psychological Science, University of California, Irvine (Schueller); MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, New South Wales, Australia (Titov); Department of Psychiatry, University of Washington, Seattle (Areán)
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24
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Witlox M, Garnefski N, Kraaij V, de Waal MWM, Smit F, Bohlmeijer E, Spinhoven P. Blended Acceptance and Commitment Therapy Versus Face-to-face Cognitive Behavioral Therapy for Older Adults With Anxiety Symptoms in Primary Care: Pragmatic Single-blind Cluster Randomized Trial. J Med Internet Res 2021; 23:e24366. [PMID: 33769293 PMCID: PMC8088844 DOI: 10.2196/24366] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/23/2020] [Accepted: 01/20/2021] [Indexed: 01/16/2023] Open
Abstract
Background Anxiety symptoms in older adults are prevalent and disabling but often go untreated. Most trials on psychological interventions for anxiety in later life have examined the effectiveness of face-to-face cognitive behavioral therapy (CBT). To bridge the current treatment gap, other treatment approaches and delivery formats should also be evaluated. Objective This study is the first to examine the effectiveness of a brief blended acceptance and commitment therapy (ACT) intervention for older adults with anxiety symptoms, compared with a face-to-face CBT intervention. Methods Adults aged between 55-75 years (n=314) with mild to moderately severe anxiety symptoms were recruited from general practices and cluster randomized to either blended ACT or face-to-face CBT. Assessments were performed at baseline (T0), posttreatment (T1), and at 6- and 12-month follow-ups (T2 and T3, respectively). The primary outcome was anxiety symptom severity (Generalized Anxiety Disorder-7). Secondary outcomes were positive mental health, depression symptom severity, functional impairment, presence of Diagnostic and Statistical Manual of Mental Disorders V anxiety disorders, and treatment satisfaction. Results Conditions did not differ significantly regarding changes in anxiety symptom severity during the study period (T0-T1: B=.18, P=.73; T1-T2: B=−.63, P=.26; T1-T3: B=−.33, P=.59). Large reductions in anxiety symptom severity (Cohen d≥0.96) were found in both conditions post treatment, and these were maintained at the 12-month follow-up. The rates of clinically significant changes in anxiety symptoms were also not different for the blended ACT group and CBT group (χ21=0.2, P=.68). Regarding secondary outcomes, long-term effects on positive mental health were significantly stronger in the blended ACT group (B=.27, P=.03, Cohen d=0.29), and treatment satisfaction was significantly higher for blended ACT than CBT (B=3.19, P<.001, Cohen d=0.78). No other differences between the conditions were observed in the secondary outcomes. Conclusions The results show that blended ACT is a valuable treatment alternative to CBT for anxiety in later life. Trial Registration Netherlands Trial Register TRIAL NL6131 (NTR6270); https://www.trialregister.nl/trial/6131
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Affiliation(s)
- Maartje Witlox
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Nadia Garnefski
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Vivian Kraaij
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
| | - Margot W M de Waal
- Department Public Health & Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | - Filip Smit
- Department of Mental Health & Prevention, Netherlands Institute of Mental Health and Addiction, Utrecht, Netherlands.,Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, Netherlands.,Department of Epidemiology & Biostatistics, Amsterdam University Medical Centers, VU University Medical Center, Amsterdam, Netherlands
| | - Ernst Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands
| | - Philip Spinhoven
- Faculty of Social and Behavioural Sciences, Section of Clinical Psychology, Institute of Psychology, Leiden University, Leiden, Netherlands
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Abstract
AbstractTransdiagnostic treatments span a heterogeneous group of interventions that target a wider range of disorders and can be applied to treat several disorders simultaneously. Several meta-analyses have highlighted the evidence base of these novel therapies. However, these meta-analyses adopt different definitions of transdiagnostic treatments, and the growing field of transdiagnostic therapies has become increasingly difficult to grasp. The current narrative review proposes a distinction of “one size fits all” unified and “my size fits me” individualized approaches within transdiagnostic therapies. Unified treatments are applied as “broadband” interventions to a range of disorders without tailoring to the individual, while individualized treatments are tailored to the specific problem presentation of the individual, e.g., by selecting modules within modular treatments. The underlying theoretical foundation and relevant empirical evidence for these different transdiagnostic approaches are examined. Advantages and limitations of the transdiagnostic treatments as well as future developments are discussed.
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26
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Lindegaard T, Seaton F, Halaj A, Berg M, Kashoush F, Barchini R, Ludvigsson M, Sarkohi A, Andersson G. Internet-based cognitive behavioural therapy for depression and anxiety among Arabic-speaking individuals in Sweden: a pilot randomized controlled trial. Cogn Behav Ther 2020; 50:47-66. [DOI: 10.1080/16506073.2020.1771414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tomas Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Felicia Seaton
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Asala Halaj
- Department of Psychology, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Matilda Berg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Fatima Kashoush
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Mikael Ludvigsson
- Department of Psychiatry in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Acute Internal Medicine and Geriatrics in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Ali Sarkohi
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
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27
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De Vito AN, Ahmed M, Mohlman J. Cognitive Enhancement Strategies to Augment Cognitive-Behavioral Therapy for Anxiety and Related Disorders: Rationale and Recommendations for Use With Cognitively Healthy Older Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2019.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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28
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Johansson P, Westas M, Andersson G, Alehagen U, Broström A, Jaarsma T, Mourad G, Lundgren J. An Internet-Based Cognitive Behavioral Therapy Program Adapted to Patients With Cardiovascular Disease and Depression: Randomized Controlled Trial. JMIR Ment Health 2019; 6:e14648. [PMID: 31584000 PMCID: PMC7020777 DOI: 10.2196/14648] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/09/2019] [Accepted: 07/27/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Depression is a common cause of reduced well-being and prognosis in patients with cardiovascular disease (CVD). However, there is a lack of effective intervention strategies targeting depression. OBJECTIVE The study aimed to evaluate the effects of a nurse-delivered and adapted internet-based cognitive behavioral therapy (iCBT) program aimed at reducing depression in patients with CVD. METHODS A randomized controlled trial was conducted. A total of 144 patients with CVD with at least mild depression (Patient Health Questionnaire-9 [PHQ-9] score ≥5) were randomized 1:1 to a 9-week program of iCBT (n=72) or an active control participating in a Web-based discussion forum (online discussion forum [ODF], n=72). The iCBT program, which included 7 modules, was adapted to fit patients with CVD. Nurses with an experience of CVD care provided feedback and a short introduction to cognitive behavioral therapy. The primary outcome, depression, was measured using PHQ-9. Secondary outcomes were depression measured using the Montgomery-Åsberg Depression Rating Scale-self-rating version (MADRS-S), health-related quality of life (HRQoL) measured using Short Form 12 (SF-12) survey and EuroQol Visual Analogue Scale (EQ-VAS), and the level of adherence. An intention-to-treat analysis with multiple imputations was used. Between-group differences in the primary and secondary outcomes were determined by the analysis of covariance, and a sensitivity analysis was performed using mixed models. RESULTS Compared with ODF, iCBT had a significant and moderate treatment effect on the primary outcome depression (ie, PHQ-9; mean group difference=-2.34 [95% CI -3.58 to -1.10], P<.001, Cohen d=0.62). In the secondary outcomes, compared with ODF, iCBT had a significant and large effect on depression (ie, MADRS-S; P<.001, Cohen d=0.86) and a significant and moderate effect on the mental component scale of the SF-12 (P<.001, Cohen d=0.66) and the EQ-VAS (P<.001, Cohen d=0.62). Overall, 60% (n=43) of the iCBT group completed all 7 modules, whereas 82% (n=59) completed at least half of the modules. No patients were discontinued from the study owing to a high risk of suicide or deterioration in depression. CONCLUSIONS Nurse-delivered iCBT can reduce depression and improve HRQoL in patients with CVD, enabling treatment for depression in their own homes and at their preferred time. TRIAL REGISTRATION ClinicalTrials.gov NCT02778074; https://clinicaltrials.gov/ct2/show/NCT02778074.
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Affiliation(s)
- Peter Johansson
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.,Department of Internal Medicine, Department of Medical Health Sciences, Linköping University, Norrköping, Sweden
| | - Mats Westas
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Urban Alehagen
- Department of Medical Health Sciences, Linköping University, Linköping, Sweden
| | - Anders Broström
- Department of Nursing, Jönköping University, Jönköping, Sweden
| | - Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Ghassan Mourad
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
| | - Johan Lundgren
- Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden
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29
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Andersson G, Titov N, Dear BF, Rozental A, Carlbring P. Internet-delivered psychological treatments: from innovation to implementation. World Psychiatry 2019; 18:20-28. [PMID: 30600624 PMCID: PMC6313242 DOI: 10.1002/wps.20610] [Citation(s) in RCA: 313] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, Australia
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F Dear
- MindSpot Clinic, Macquarie University, Sydney, Australia
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Alexander Rozental
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
- Institute of Child Health, University College London, London, UK
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden
- Department of Psychology, University of Southern Denmark, Odense, Denmark
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30
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Andersson G, Carlbring P, Rozental A. Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis. Front Psychiatry 2019; 10:749. [PMID: 31708813 PMCID: PMC6823683 DOI: 10.3389/fpsyt.2019.00749] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/18/2019] [Indexed: 12/20/2022] Open
Abstract
Background: Internet-delivered cognitive behavior therapy (ICBT) was developed over 20 years ago and has since undergone a number of controlled trials, as well as several systematic reviews and meta-analyses. However, the crucial question of response rates remains to be systematically investigated. The aim of this individual patient meta-analysis (IPDMA) was to use a large dataset of trials conducted in Sweden to determine reliable change and recovery rates across trials for a range of conditions. Methods: We used previously collected and aggregated data from 2,866 patients in 29 Swedish clinical trials of ICBT for three categories of conditions: anxiety disorders, depression, and others. Raw scores at pre-treatment and post-treatment were used in an IPDMA to determine the rate of reliable change and recovery. Jacobson and Truax's, (1991) reliable change index (RCI) was calculated for each primary outcome measure in the trials as well as the recovery rates for each patient, with the additional requirement of having improved substantially. We subsequently explored potential predictors using binomial logistic regression. Results: In applying an RCI of z = 1.96, 1,162 (65.6%) of the patients receiving treatment were classified as achieving recovery, and 620 (35.0%) were classified as reaching remission. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline [odds ratio (OR) = 1.36] and being female (OR = 2.22) increased the odds of responding to treatment. Having an anxiety disorder was found to decrease the response to treatment (OR = 0.51). Remission was predicted by diagnosis in the same direction (OR = 0.28), whereas symptom severity was inversely predictive of worse outcome (OR = 0.81). Conclusions: Response seems to occur among approximately half of all clients administered ICBT, whereas about a third reach remission. This indicates that the efficacy of ICBT is in line with that of CBT based in prior trials, with a possible caveat being the lower remission rates. Having more symptoms and being female might increase the chances of improvement, and a small negative effect of having anxiety disorder versus depression and other conditions may also exist. A limitation of the IPDMA was that only studies conducted in Sweden were included.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Stockholm, Sweden.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Alexander Rozental
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Institute of Child Health, University College London, London, United Kingdom
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31
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Andersson G. Internet interventions: Past, present and future. Internet Interv 2018; 12:181-188. [PMID: 30135782 PMCID: PMC6096319 DOI: 10.1016/j.invent.2018.03.008] [Citation(s) in RCA: 150] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 03/30/2018] [Accepted: 03/30/2018] [Indexed: 02/07/2023] Open
Abstract
Internet interventions have been around now for about 20 years. While the field still suffers from a scattered terminology a large number of programs and studies exist. In the present paper I present an overview of my experiences of studying internet-supported cognitive-behaviour therapy (ICBT), but also mention other approaches including the use of smartphones. The paper covers the history of ICBT, short-term effects in controlled trials for a range of conditions, long-term effects, comparisons against face-to-face therapy, effectiveness studies, prediction studies, how the treatment is perceived, critique, and finally future directions. I conclude that we have now reached a stage in which we have numerous evidence-based treatments and procedures, and increasingly internet interventions including ICBT are disseminated.
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Affiliation(s)
- Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Campus Valla, SE-581 83 Linköping, Sweden.
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