1
|
Lam RW, Kennedy SH, Adams C, Bahji A, Beaulieu S, Bhat V, Blier P, Blumberger DM, Brietzke E, Chakrabarty T, Do A, Frey BN, Giacobbe P, Gratzer D, Grigoriadis S, Habert J, Ishrat Husain M, Ismail Z, McGirr A, McIntyre RS, Michalak EE, Müller DJ, Parikh SV, Quilty LS, Ravindran AV, Ravindran N, Renaud J, Rosenblat JD, Samaan Z, Saraf G, Schade K, Schaffer A, Sinyor M, Soares CN, Swainson J, Taylor VH, Tourjman SV, Uher R, van Ameringen M, Vazquez G, Vigod S, Voineskos D, Yatham LN, Milev RV. Canadian Network for Mood and Anxiety Treatments (CANMAT) 2023 Update on Clinical Guidelines for Management of Major Depressive Disorder in Adults: Réseau canadien pour les traitements de l'humeur et de l'anxiété (CANMAT) 2023 : Mise à jour des lignes directrices cliniques pour la prise en charge du trouble dépressif majeur chez les adultes. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2024; 69:641-687. [PMID: 38711351 PMCID: PMC11351064 DOI: 10.1177/07067437241245384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
BACKGROUND The Canadian Network for Mood and Anxiety Treatments (CANMAT) last published clinical guidelines for the management of major depressive disorder (MDD) in 2016. Owing to advances in the field, an update was needed to incorporate new evidence and provide new and revised recommendations for the assessment and management of MDD in adults. METHODS CANMAT convened a guidelines editorial group comprised of academic clinicians and patient partners. A systematic literature review was conducted, focusing on systematic reviews and meta-analyses published since the 2016 guidelines. Recommendations were organized by lines of treatment, which were informed by CANMAT-defined levels of evidence and supplemented by clinical support (consisting of expert consensus on safety, tolerability, and feasibility). Drafts were revised based on review by patient partners, expert peer review, and a defined expert consensus process. RESULTS The updated guidelines comprise eight primary topics, in a question-and-answer format, that map a patient care journey from assessment to selection of evidence-based treatments, prevention of recurrence, and strategies for inadequate response. The guidelines adopt a personalized care approach that emphasizes shared decision-making that reflects the values, preferences, and treatment history of the patient with MDD. Tables provide new and updated recommendations for psychological, pharmacological, lifestyle, complementary and alternative medicine, digital health, and neuromodulation treatments. Caveats and limitations of the evidence are highlighted. CONCLUSIONS The CANMAT 2023 updated guidelines provide evidence-informed recommendations for the management of MDD, in a clinician-friendly format. These updated guidelines emphasize a collaborative, personalized, and systematic management approach that will help optimize outcomes for adults with MDD.
Collapse
Affiliation(s)
- Raymond W. Lam
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Sidney H. Kennedy
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Camelia Adams
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Anees Bahji
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Serge Beaulieu
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | - Venkat Bhat
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Pierre Blier
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | | | - Elisa Brietzke
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Trisha Chakrabarty
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - André Do
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
| | - Benicio N. Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Peter Giacobbe
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - David Gratzer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Jeffrey Habert
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - M. Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Zahinoor Ismail
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Alexander McGirr
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | - Roger S. McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Erin E. Michalak
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Daniel J. Müller
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sagar V. Parikh
- Department of Psychiatry, University of Michigan, Ann Arbour, MI, USA
| | - Lena S. Quilty
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Arun V. Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nisha Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Johanne Renaud
- Department of Psychiatry, McGill University, Montréal, QC, Canada
| | | | - Zainab Samaan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gayatri Saraf
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn Schade
- Office of Research Services, Huron University, London, ON, Canada
| | - Ayal Schaffer
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Mark Sinyor
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Jennifer Swainson
- Department of Psychiatry, University of Alberta, Edmonton, AB, Canada
| | - Valerie H. Taylor
- Department of Psychiatry, University of Calgary, Calgary, AB, Canada
| | | | - Rudolf Uher
- Department of Psychiatry, Dalhousie University, Halifax, NS, Canada
| | - Michael van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gustavo Vazquez
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| | - Simone Vigod
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Daphne Voineskos
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Lakshmi N. Yatham
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Roumen V. Milev
- Department of Psychiatry, Queen's University, Kingston, ON, Canada
| |
Collapse
|
2
|
Jiménez-Orenga N, Díaz-García A, García-Palacios A, Bretón-López J. Effectiveness of a blended group transdiagnostic treatment for emotional disorders: Study protocol for a randomized controlled trial. Internet Interv 2024; 37:100761. [PMID: 39188940 PMCID: PMC11345571 DOI: 10.1016/j.invent.2024.100761] [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: 12/21/2023] [Revised: 07/18/2024] [Accepted: 07/26/2024] [Indexed: 08/28/2024] Open
Abstract
Introduction Emotional disorders (ED) (mood and anxiety disorders) are very prevalent and disabling, and often appear in comorbid presentations. Although there are effective treatments for these disorders, there is still a large gap between the number of people who need them and those who actually receive them. The combination of three strategies may help in this regard, facilitating the dissemination and accessibility of treatment: the transdiagnostic perspective of ED, the group format, and the use of technologies in a blended format (i.e., the combination of online and face-to-face therapy elements). This study intends to compare the efficacy of a new ED intervention, a transdiagnostic group treatment protocol administered in a blended format, with that of a face-to-face treatment. This article describes the study protocol for the randomized controlled trial. Method and analyses A two-arm, parallel-group, randomized controlled clinical trial (RCT) will be conducted. Participants (N = 144) will be adult volunteers suffering from DSM-5 anxiety and/or depressive disorders and will be randomly assigned to one of two conditions: Face-to-face Group Transdiagnostic Protocol or Blended Group Transdiagnostic Protocol. The face-to-face condition will consist of a total of 16 weekly face-to-face group sessions, while the blended condition will consist of 8 biweekly face-to-face group sessions in combination with self-applied work through a web platform. Clinical and acceptability measures will be included in both groups. Assessments will be performed at baseline, during the treatment, at post-treatment, and at 3-, 6- and 12-month follow-ups. This study received the approval of the Ethics Committee of Universitat Jaume I in October 2021 (CD/91/2021). Intention-to-treat analyses will be performed. Statistical analyses will be carried out using SPSS version 28.0. The results will be reported in accordance with CONSORT recommendations. Discussion This is the first RCT to compare the effectiveness of an ED treatment protocol based on the transdiagnostic perspective and applied in group and blended format. It will offer relevant data to continue moving forward towards treatment alternatives that are cost-effective and more accessible, so that all patients with ED who require them can benefit. Trial registration ClinicalTrials.gov Identifier: NCT05569018. Registered 06 October 2022, https://clinicaltrials.gov/study/NCT05569018.
Collapse
Affiliation(s)
- Noelia Jiménez-Orenga
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
| | - Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza, Teruel, Spain
| | - Azucena García-Palacios
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| | - Juani Bretón-López
- Department of Basic, Clinical Psychology and Psychobiology, Universitat Jaume I, Castellón, Spain
- CIBER de Physiopathology of Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
3
|
Zandieh S, Abdollahzadeh SM, Sadeghirad B, Wang L, McCabe RE, Yao L, Inness BE, Pathak A, Couban RJ, Crandon H, Torabiardakani K, Bieling P, Busse JW. Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials. CMAJ 2024; 196:E327-E340. [PMID: 38499303 PMCID: PMC10948182 DOI: 10.1503/cmaj.230274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT. METHODS We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects. RESULTS We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD -0.02, 95% confidence interval -0.12 to 0.07). INTERPRETATION Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Systematic review registration: Open Science Framework (https://osf.io/7asrc).
Collapse
Affiliation(s)
- Sara Zandieh
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Seyedeh Maryam Abdollahzadeh
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Behnam Sadeghirad
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Li Wang
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Randi E McCabe
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Liam Yao
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Briar E Inness
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Ananya Pathak
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Rachel J Couban
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Holly Crandon
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Kian Torabiardakani
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Peter Bieling
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont
| | - Jason W Busse
- Department of Health Research Methods, Evidence, and Impact (Zandieh, Sadeghirad, Wang, Yao, Pathak, Busse), McMaster University, Hamilton, Ont.; Canadian Agency for Drugs and Technology in Health (Zandieh), Toronto, Ont.; Nutrition Research Center, School of Nutrition and Food Sciences (Abdollahzadeh), Shiraz University of Medical Sciences, Shiraz, Iran; Department of Anesthesia (Sadeghirad, Wang, Busse), McMaster University; The Michael G. DeGroote National Pain Centre (Wang, Torabiardakani, Busse), McMaster University; St. Joseph's Healthcare (McCabe, Bieling); Department of Psychiatry and Behavioural Neurosciences (McCabe, Inness, Bieling), McMaster University, Hamilton, Ont.; Institute for Management and Innovation (Crandon), University of Toronto, Mississauga, Ont.
| |
Collapse
|
4
|
Peake E, Miller I, Flannery J, Chen L, Lake J, Padmanabhan A. Preliminary Efficacy of a Digital Intervention for Adolescent Depression: Randomized Controlled Trial. J Med Internet Res 2024; 26:e48467. [PMID: 38324367 PMCID: PMC10882470 DOI: 10.2196/48467] [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: 04/26/2023] [Revised: 06/28/2023] [Accepted: 10/25/2023] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Adolescent depression is a significant public health concern; however, access to effective mental health care is limited. Digital therapeutics (DTx) can improve access to evidence-based interventions; however, their efficacy in adolescents is sparsely documented. OBJECTIVE This study aims to examine the efficacy of a mobile app DTx versus an active control as an adjunct treatment for adolescent depression symptoms. METHODS An internet-based open-label randomized control trial was conducted nationwide with a partial crossover design, and 168 adolescents aged 13 to 21 years with symptoms of depression were recruited between November 2020 and September 2021. Participants were randomized (1:1) to the cognitive behavioral therapy-based treatment app (Spark) or to a psychoeducational control app (control), which they would use for a duration of 5 weeks. The primary outcome was a between-group (Spark vs control) difference in the change in depression symptoms from baseline to postintervention, as measured by the Patient Health Questionnaire-8 (PHQ-8) using a linear mixed-effects analysis. The PHQ-8 ranges from 0 to 24, with scores of 5 to 9 indicating mild depression symptoms, scores of 10 to 14 indicating moderate symptoms, scores of 15 to 19 indicating moderately severe symptoms, and scores of 20 to 24 indicating severe symptoms. A minimal clinically important difference (5-point reduction between baseline and postintervention) in the Spark arm and group differences in remission and treatment response rates based on the PHQ-8 at postintervention were also investigated. RESULTS A total of 160 participants were randomized, 80 in the Spark arm (mean age 16.89, SD 2.5 y) and 80 in the control arm (mean age 16.79, SD 2.59 y). Data from 121 participants (Spark: n=63; control: n=58) with moderate to severe (PHQ-8≥10) symptoms at baseline were included in the primary analyses following a modified intention-to-treat principle. A linear mixed-effect analysis revealed a nonsignificant difference between the study arms in depression symptom change over the intervention period. The Spark arm met a minimal clinically important difference threshold (mean -5.08, 95% CI -6.72 to -3.42). The remission rate in the Spark arm was significantly higher than that in the control arm (11/63, 17% vs 2/58, 3%; χ21=6.2; P=.01; false discovery rate-adjusted P=.03). The treatment response rates were not significantly different between the study arms (P=.07; false discovery rate-adjusted P=.16). Post hoc analyses including participants with mild to severe (PHQ-8 score ≥5) symptoms at baseline revealed promising evidence that Spark is effective in those with mild to severe symptoms. CONCLUSIONS There is initial evidence that a self-guided, cognitive behavioral therapy-based DTx intervention may effectively treat mild to severe depression symptoms in adolescents. DTx may improve access to mental health care for adolescents or serve as an important adjunct to the standard of care. TRIAL REGISTRATION ClinicalTrials.gov NCT04524598; https://clinicaltrials.gov/study/NCT04524598.
Collapse
Affiliation(s)
- Emily Peake
- Limbix Health Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
| | - Ian Miller
- Limbix Health Inc, San Francisco, CA, United States
- Digital Medicine Society, Boston, MA, United States
| | - Jessica Flannery
- Limbix Health Inc, San Francisco, CA, United States
- Akili, Boston, MA, United States
| | - Lang Chen
- Neuroscience Unit, Santa Clara University, Santa Clara, CA, United States
| | - Jessica Lake
- Limbix Health Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
| | - Aarthi Padmanabhan
- Limbix Health Inc, San Francisco, CA, United States
- Big Health Inc, San Francisco, CA, United States
| |
Collapse
|
5
|
Kitay BM, Murphy E, Macaluso M, Corlett PR, Hershenberg R, Joormann J, Martinez-Kaigi V, Nikayin S, Rhee TG, Sanacora G, Shelton RC, Thase ME, Wilkinson ST. Cognitive behavioral therapy following esketamine for major depression and suicidal ideation for relapse prevention: The CBT-ENDURE randomized clinical trial study protocol. Psychiatry Res 2023; 330:115585. [PMID: 37935086 DOI: 10.1016/j.psychres.2023.115585] [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: 08/28/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/09/2023]
Abstract
In 2020, esketamine received a supplemental indication as a therapy for major depression with suicidal ideation (MDSI), based on protocols enrolling hospitalized patients. Given the high risk of suicide following hospital discharge and the high relapse rates following discontinuation of esketamine, the optimal long-term treatment approach remains unclear. Cognitive behavioral therapy (CBT) is highly effective in relapse prevention and has been shown to prevent suicide attempts in high-risk populations. Here we describe the study protocol for the CBT-ENDURE trial: Cognitive Behavioral Therapy Following Esketamine for Major Depression and SUicidal Ideation for RElapse Prevention. Patients with depression (N = 100) who are admitted to hospital or are outpatients with clinically significant suicidal ideation will be enrolled in the study. All patients will receive esketamine (twice weekly for four weeks) and will be randomly assigned (1:1 ratio) to receive a 16-week course of CBT plus treatment as usual (CBT group) or treatment as usual only (TAU only group). Patients are followed for a total of 6 months. Supported under a funding announcement from NIMH to conduct safety and feasibility trials for patients at high risk for suicide, the primary outcome of the CBT-ENDURE study is feasibility (as measured by recruitment and retention), with a key secondary outcome being relapse among those who experience substantial benefit following two weeks of esketamine.
Collapse
Affiliation(s)
- Brandon M Kitay
- Department of Psychiatry, Emory University School of Medicine, United States
| | - Eva Murphy
- Department of Psychiatry, Yale School of Medicine, United States
| | - Matthew Macaluso
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, 100 York St, STE 2J, New Haven, CT 06511, United States
| | - Philip R Corlett
- Department of Psychiatry, Yale School of Medicine, United States
| | - Rachel Hershenberg
- Department of Psychiatry, Emory University School of Medicine, United States
| | - Jutta Joormann
- Department of Psychology, Yale University, United States
| | | | - Sina Nikayin
- Department of Psychiatry, Yale School of Medicine, United States
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, United States; Department of Public Health Science, School of Medicine, University of Connecticut, United States
| | - Gerard Sanacora
- Department of Psychiatry, Yale School of Medicine, United States
| | - Richard C Shelton
- Department of Psychiatry and Behavioral Neurobiology, Heersink School of Medicine, University of Alabama at Birmingham, 100 York St, STE 2J, New Haven, CT 06511, United States
| | - Michael E Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, United States
| | | |
Collapse
|
6
|
Kalde J, Atik E, Stricker J, Schückes M, Neudeck P, Pittig A, Pietrowsky R. Enhancing the effectiveness of CBT for patients with unipolar depression by integrating digital interventions into treatment: A pilot randomized controlled trial. Psychother Res 2023:1-16. [PMID: 37922395 DOI: 10.1080/10503307.2023.2277866] [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: 11/05/2023] Open
Abstract
OBJECTIVE Blended cognitive behavioral therapy (bCBT) combines face-to-face therapy with digital elements, such as digital health apps. This pilot study aimed to explore the effectiveness and safety of a novel bCBT application for treating unipolar depression in adults combined with cognitive behavioral therapy (CBT) compared to CBT alone in routine care. METHODS Patients (N = 82) were randomly assigned to bCBT (n = 42) or CBT (n = 40) over 12 weeks. bCBT consisted of weekly CBT sessions accompanied by the elona therapy depression module (a bCBT application for unipolar depression) for use between sessions. Standard CBT consisted of weekly CBT sessions. Outcomes (6,12 weeks) were analyzed with linear mixed models. RESULTS Improvements in depressive symptoms (BDI-II, PHQ-9) were descriptively larger for the bCBT group. Yet, this difference did not reach statistical significance. bCBT was superior to standard CBT in secondary outcome measures of psychological health (d = .50) and generalized anxiety symptoms (d = -.45). In other secondary outcomes (BAI, PSWQ, GSE, WHOQOL-BREF), improvements were descriptively larger for bCBT compared to CBT. CONCLUSION This pilot study provided preliminary evidence that bCBT might be advantageous in comparison to CBT alone in the treatment of depression, but larger RCTs of the bCBT application are needed.
Collapse
Affiliation(s)
- Jan Kalde
- Department of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Ece Atik
- Elona Health GmbH, Düsseldorf, Germany
- Translational Psychotherapy, Georg-Elias-Mueller-Institute of Psychology, University of Goettingen, Göttingen, Germany
| | - Johannes Stricker
- Department of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | | | - Peter Neudeck
- Elona Health GmbH, Düsseldorf, Germany
- Department of Clinical Psychology, Technical University Chemnitz, Chemnitz, Germany
| | - Andre Pittig
- Translational Psychotherapy, Georg-Elias-Mueller-Institute of Psychology, University of Goettingen, Göttingen, Germany
| | - Reinhard Pietrowsky
- Department of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
7
|
Bielinski LL, Krieger T, Kley MA, Moggi F, Berger T. Blending an internet-based emotion regulation intervention with face-to-face psychotherapy: Findings from a pilot randomized controlled trial. Internet Interv 2023; 33:100650. [PMID: 37575677 PMCID: PMC10413058 DOI: 10.1016/j.invent.2023.100650] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 08/15/2023] Open
Abstract
Background Transdiagnostic interventions targeting shared mechanisms may improve treatment of mental health disorders. One way of providing such interventions is through blended treatment. This study examined the addition of an internet-based emotion regulation intervention to face-to-face psychotherapy in an outpatient setting. Methods In a pilot randomized controlled trial, 70 patients with a range of diagnoses were assigned to an internet-based program targeting emotion regulation + treatment as usual (face-to-face psychotherapy; TAU) (n = 35) or TAU (n = 35). Assessments occurred at baseline, after six, and after 12 weeks and included measures of symptom severity, emotion regulation, and various intervention feasibility parameters. Results ITT-analyses revealed no significant group-by-time interaction for the primary and almost all secondary outcomes. Descriptively, between-group effect sizes were in favor of the intervention group for almost all outcomes. Sensitivity analysis with patients who completed a minimum of three modules of the internet-based program showed a significant group-by-time interaction for the Difficulties in Emotion Regulation Scale in favor of the intervention group. The internet-based intervention showed good satisfaction ratings, user experience and usability. Findings from therapist measures complemented patient measures. Conclusion Preliminary results show that an internet-based emotion regulation intervention added to psychotherapy may not reduce symptom severity compared to psychotherapy alone. The intervention was rated positively by patients and therapists regarding several parameters, but certain features still need to be improved. An RCT powered to detect small between-group effect-sizes is necessary to consolidate findings.
Collapse
Affiliation(s)
- Laura Luisa Bielinski
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Tobias Krieger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Marijke Amanda Kley
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| |
Collapse
|
8
|
Atik E, Stricker J, Schückes M, Pittig A. Efficacy of a Brief Blended Cognitive Behavioral Therapy Program for the Treatment of Depression and Anxiety in University Students: Uncontrolled Intervention Study. JMIR Ment Health 2023; 10:e44742. [PMID: 37624631 PMCID: PMC10492172 DOI: 10.2196/44742] [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: 12/01/2022] [Revised: 05/25/2023] [Accepted: 06/25/2023] [Indexed: 08/26/2023] Open
Abstract
BACKGROUND Blended cognitive behavioral therapy (bCBT)-the combination of cognitive behavioral therapy and digital mental health applications-has been increasingly used to treat depression and anxiety disorders. As a resource-efficient treatment approach, bCBT appears promising for addressing the growing need for mental health care services, for example, as an early intervention before the chronification of symptoms. However, further research on the efficacy and feasibility of integrated bCBT interventions is needed. OBJECTIVE This study aimed to evaluate the efficacy of a novel bCBT program comprising short (25 min), weekly face-to-face therapy sessions combined with a smartphone-based digital health app for treating mild to moderate symptoms of depression or anxiety. METHODS This prospective uncontrolled trial comprised 2 measurement points (before and after treatment) and 2 intervention groups. We recruited university students with mild to moderate symptoms of depression or anxiety. On the basis of the primary symptoms, participants were assigned to either a depression intervention group (n=67 completers) or an anxiety intervention group (n=33 completers). Participants in each group received 6 weekly individual psychotherapy sessions via videoconference and completed modules tailored to their respective symptoms in the smartphone-based digital health app. RESULTS The depression group displayed medium to large improvements in the symptoms of depression (Cohen d=-0.70 to -0.90; P<.001). The anxiety group experienced significant improvements in the symptoms of generalized anxiety assessed with the Generalized Anxiety Disorder-7 scale with a large effect size (Cohen d=-0.80; P<.001) but not in symptoms of anxiety assessed with the Beck Anxiety Inventory (Cohen d=-0.35; P=.06). In addition, both groups experienced significant improvements in their perceived self-efficacy (Cohen d=0.50; P<.001 in the depression group and Cohen d=0.71; P<.001 in the anxiety group) and quality of life related to psychological health (Cohen d=0.87; P<.001 in the depression group and Cohen d=0.40; P=.03 in the anxiety group). Work and social adjustment of patients improved significantly in the depression group (Cohen d=-0.49; P<.001) but not in the anxiety group (Cohen d=-0.06; P=.72). Patients' mental health literacy improved in the anxiety group (Cohen d=0.45; P=.02) but not in the depression group (Cohen d=0.21; P=.10). Patient satisfaction with the bCBT program and ratings of the usability of the digital app were high in both treatment groups. CONCLUSIONS This study provides preliminary evidence for the feasibility and efficacy of a novel brief bCBT intervention. The intervention effects were generalized across a broad spectrum of patient-reported outcomes. Hence, the newly developed bCBT intervention appears promising for treating mild to moderate depression and anxiety in young adults.
Collapse
Affiliation(s)
- Ece Atik
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Johannes Stricker
- Clinical Psychology Research Group, Department of Experimental Psychology, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| |
Collapse
|
9
|
Forbes A, Keleher MR, Venditto M, DiBiasi F. Assessing Patient Adherence to and Engagement With Digital Interventions for Depression in Clinical Trials: Systematic Literature Review. J Med Internet Res 2023; 25:e43727. [PMID: 37566447 PMCID: PMC10457707 DOI: 10.2196/43727] [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: 10/24/2022] [Revised: 04/24/2023] [Accepted: 06/28/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND New approaches to the treatment of depression are necessary for patients who do not respond to current treatments or lack access to them because of barriers such as cost, stigma, and provider shortage. Digital interventions for depression are promising; however, low patient engagement could limit their effectiveness. OBJECTIVE This systematic literature review (SLR) assessed how participant adherence to and engagement with digital interventions for depression have been measured in the published literature, what levels of adherence and engagement have been reported, and whether higher adherence and increased engagement are linked to increased efficacy. METHODS We focused on a participant population of adults (aged ≥18 years) with depression or major depressive disorder as the primary diagnosis and included clinical trials, feasibility studies, and pilot studies of digital interventions for treating depression, such as digital therapeutics. We screened 756 unique records from Ovid MEDLINE, Embase, and Cochrane published between January 1, 2000, and April 15, 2022; extracted data from and appraised the 94 studies meeting the inclusion criteria; and performed a primarily descriptive analysis. Otsuka Pharmaceutical Development & Commercialization, Inc (Princeton, New Jersey, United States) funded this study. RESULTS This SLR encompassed results from 20,111 participants in studies using 47 unique web-based interventions (an additional 10 web-based interventions were not described by name), 15 mobile app interventions, 5 app-based interventions that are also accessible via the web, and 1 CD-ROM. Adherence was most often measured as the percentage of participants who completed all available modules. Less than half (44.2%) of the participants completed all the modules; however, the average dose received was 60.7% of the available modules. Although engagement with digital interventions was measured differently in different studies, it was most commonly measured as the number of modules completed, the mean of which was 6.4 (means ranged from 1.0 to 19.7) modules. The mean amount of time participants engaged with the interventions was 3.9 (means ranged from 0.7 to 8.4) hours. Most studies of web-based (34/45, 76%) and app-based (8/9, 89%) interventions found that the intervention group had substantially greater improvement for at least 1 outcome than the control group (eg, care as usual, waitlist, or active control). Of the 14 studies that investigated the relationship between engagement and efficacy, 9 (64%) found that increased engagement with digital interventions was significantly associated with improved participant outcomes. The limitations of this SLR include publication bias, which may overstate engagement and efficacy, and low participant diversity, which reduces the generalizability. CONCLUSIONS Patient adherence to and engagement with digital interventions for depression have been reported in the literature using various metrics. Arriving at more standardized ways of reporting adherence and engagement would enable more effective comparisons across different digital interventions, studies, and populations.
Collapse
Affiliation(s)
- Ainslie Forbes
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| | | | | | - Faith DiBiasi
- Otsuka Pharmaceutical Development & Commercialization, Inc, Princeton, NJ, United States
| |
Collapse
|
10
|
Bielinski LL, Wälchli G, Nissen C, Berger T, Moggi F. Does an Internet-Based Emotion Regulation Intervention Provide Added Value for Acute Psychiatric Inpatient Care? Protocol for a Randomized Controlled Pilot Trial. JMIR Res Protoc 2023; 12:e47656. [PMID: 37432724 PMCID: PMC10369307 DOI: 10.2196/47656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/31/2023] [Accepted: 05/31/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND There is a lack of studies on internet-based interventions in inpatient settings. This is especially true for studies of internet-based interventions in acute psychiatric inpatient care. Internet-based interventions in this specific setting may provide benefits such as patient empowerment and overall improved treatment outcomes. However, there may also be specific barriers to their implementation that are unique due to the complexity of acute psychiatric inpatient care. OBJECTIVE The aim of this study is to examine the feasibility and preliminary evidence for effectiveness of a web-based emotion regulation intervention provided as an add-on to acute psychiatric inpatient care. METHODS The goal is to randomly allocate 60 patients with a range of different diagnoses in a 1:1 ratio to either treatment as usual (TAU), which consists of acute psychiatric inpatient treatment, or to the intervention group, which will receive TAU plus access to a web-based intervention that focuses on reduction of emotion regulation difficulties and improvement of emotion regulation skills. The primary outcome is symptom severity, assessed with the short form of the Brief Symptom Inventory at baseline, after 4 weeks, after 8 weeks, and at hospital discharge. Secondary outcomes include 2 emotion regulation parameters, intervention use, usability, patient satisfaction, and reasons for patient loss to follow-up. RESULTS Participant recruitment started in August 2021 and as of March 2023 was ongoing. First publication of study results is expected in 2024. CONCLUSIONS This study protocol describes a study that intends to examine a web-based emotion regulation intervention in acute psychiatric inpatient care. The study will provide information on the feasibility of the intervention and possible effects on symptom severity and emotion regulation. The results will provide new insights on blended treatment, in this case the combination of a web-based intervention and face-to-face psychiatric treatment, in an understudied patient group and setting. TRIAL REGISTRATION ClinicalTrials.gov NCT04990674; https://clinicaltrials.gov/ct2/show/NCT04990674. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/47656.
Collapse
Affiliation(s)
- Laura Luisa Bielinski
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Gwendolyn Wälchli
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Christoph Nissen
- Division of Psychiatric Specialties, Geneva University Hospitals, Geneva, Switzerland
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Thomas Berger
- Department of Clinical Psychology and Psychotherapy, University of Bern, Bern, Switzerland
| | - Franz Moggi
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| |
Collapse
|
11
|
Smith EG, Grigorian HL. A System for Rapidly Yet Rigorously Evaluating the Quality of Randomized Controlled Trials. J Clin Psychopharmacol 2023; 43:306-312. [PMID: 37378832 DOI: 10.1097/jcp.0000000000001724] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
ABSTRACT This tutorial describes a system for rapidly yet rigorously assessing the quality of randomized controlled trials (RCTs). The system has 7 criteria, represented by the acronym "BIS FOES." The BIS FOES system directs readers to assess RCTs based on the following 7 criteria: the RCT's use (or not) of effective (1) Blinding; the RCT's use (or not) of (2) Intent-to-Treat Analysis; the RCT's (3) Size and other information reflecting the effectiveness of randomization; the amount of sample lost during (4) Follow-up; the (5) Outcomes examined by the RCT (specifically, the outcome measures used by the RCT), the (6) Effects reported (ie, the statistical and clinical significance of the RCT's primary, secondary, and safety findings), and any (7) Special Considerations (ie, additional strengths, limitations, or notable features of the RCT). The first 6 criteria are of basic importance to the assessment of every RCT, whereas the Special Considerations criteria allows the system to be expanded to include virtually any other important aspect of the RCT. This tutorial explains the importance of these criteria and how to assess them. This tutorial also describes how many BIS FOES criteria can be initially assessed from the RCT Abstract while also directing readers to specific locations in the RCT article where additional important information can be found. We hope that the BIS FOES system will help healthcare trainees, but also potentially clinicians, researchers, and the general public, rapidly and thoroughly assess RCTs.
Collapse
|
12
|
Hornstein S, Zantvoort K, Lueken U, Funk B, Hilbert K. Personalization strategies in digital mental health interventions: a systematic review and conceptual framework for depressive symptoms. Front Digit Health 2023; 5:1170002. [PMID: 37283721 PMCID: PMC10239832 DOI: 10.3389/fdgth.2023.1170002] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/05/2023] [Indexed: 06/08/2023] Open
Abstract
Introduction Personalization is a much-discussed approach to improve adherence and outcomes for Digital Mental Health interventions (DMHIs). Yet, major questions remain open, such as (1) what personalization is, (2) how prevalent it is in practice, and (3) what benefits it truly has. Methods We address this gap by performing a systematic literature review identifying all empirical studies on DMHIs targeting depressive symptoms in adults from 2015 to September 2022. The search in Pubmed, SCOPUS and Psycinfo led to the inclusion of 138 articles, describing 94 distinct DMHIs provided to an overall sample of approximately 24,300 individuals. Results Our investigation results in the conceptualization of personalization as purposefully designed variation between individuals in an intervention's therapeutic elements or its structure. We propose to further differentiate personalization by what is personalized (i.e., intervention content, content order, level of guidance or communication) and the underlying mechanism [i.e., user choice, provider choice, decision rules, and machine-learning (ML) based approaches]. Applying this concept, we identified personalization in 66% of the interventions for depressive symptoms, with personalized intervention content (32% of interventions) and communication with the user (30%) being particularly popular. Personalization via decision rules (48%) and user choice (36%) were the most used mechanisms, while the utilization of ML was rare (3%). Two-thirds of personalized interventions only tailored one dimension of the intervention. Discussion We conclude that future interventions could provide even more personalized experiences and especially benefit from using ML models. Finally, empirical evidence for personalization was scarce and inconclusive, making further evidence for the benefits of personalization highly needed. Systematic Review Registration Identifier: CRD42022357408.
Collapse
Affiliation(s)
- Silvan Hornstein
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kirsten Zantvoort
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Ulrike Lueken
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Burkhardt Funk
- Institute of Information Systems, Leuphana University, Lueneburg, Germany
| | - Kevin Hilbert
- Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
13
|
Schiller CE, Prim J, Bauer AE, Lux L, Lundegard LC, Kang M, Hellberg S, Thompson K, Webber T, Teklezghi A, Pettee N, Gaffney K, Hodgins G, Rahman F, Steinsiek JN, Modi A, Gaynes BN. Efficacy of Virtual Care for Depressive Disorders: Systematic Review and Meta-analysis. JMIR Ment Health 2023; 10:e38955. [PMID: 36622747 PMCID: PMC9871881 DOI: 10.2196/38955] [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: 04/25/2022] [Revised: 08/03/2022] [Accepted: 08/18/2022] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has created an epidemic of distress-related mental disorders such as depression, while simultaneously necessitating a shift to virtual domains of mental health care; yet, the evidence to support the use of virtual interventions is unclear. OBJECTIVE The purpose of this study was to evaluate the efficacy of virtual interventions for depressive disorders by addressing three key questions: (1) Does virtual intervention provide better outcomes than no treatment or other control conditions (ie, waitlist, treatment as usual [TAU], or attention control)? (2) Does in-person intervention provide better outcomes than virtual intervention? (3) Does one type of virtual intervention provide better outcomes than another? METHODS We searched the PubMed, EMBASE, and PsycINFO databases for trials published from January 1, 2010, to October 30, 2021. We included randomized controlled trials of adults with depressive disorders that tested a virtual intervention and used a validated depression measure. Primary outcomes were defined as remission (ie, no longer meeting the clinical cutoff for depression), response (ie, a clinically significant reduction in depressive symptoms), and depression severity at posttreatment. Two researchers independently selected studies and extracted data using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Risk of bias was evaluated based on Agency for Healthcare and Research Quality guidelines. We calculated odds ratios (ORs) for binary outcomes and standardized mean differences (SMDs) for continuous outcomes. RESULTS We identified 3797 references, 24 of which were eligible. Compared with waitlist, virtual intervention had higher odds of remission (OR 10.30, 95% CI 5.70-18.60; N=619 patients) and lower posttreatment symptom severity (SMD 0.81, 95% CI 0.52-1.10; N=1071). Compared with TAU and virtual attention control conditions, virtual intervention had higher odds of remission (OR 2.27, 95% CI 1.10-3.35; N=512) and lower posttreatment symptom severity (SMD 0.25, 95% CI 0.09-0.42; N=573). In-person intervention outcomes were not significantly different from virtual intervention outcomes (eg, remission OR 0.84, CI 0.51-1.37; N=789). No eligible studies directly compared one active virtual intervention to another. CONCLUSIONS Virtual interventions were efficacious compared with control conditions, including waitlist control, TAU, and attention control. Although the number of studies was relatively small, the strength of evidence was moderate that in-person interventions did not yield significantly better outcomes than virtual interventions for depressive disorders.
Collapse
Affiliation(s)
- Crystal Edler Schiller
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Julianna Prim
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anna E Bauer
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Linda Lux
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Laura Claire Lundegard
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michelle Kang
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Samantha Hellberg
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Katherine Thompson
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Theresa Webber
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Adonay Teklezghi
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Noah Pettee
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Katherine Gaffney
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Gabrielle Hodgins
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Fariha Rahman
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - J Nikki Steinsiek
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Anita Modi
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Bradley N Gaynes
- Department of Psychiatry, University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|
14
|
Alavi N, Moghimi E, Stephenson C, Gutierrez G, Jagayat J, Kumar A, Shao Y, Miller S, Yee CS, Stefatos A, Gholamzadehmir M, Abbaspour Z, Shirazi A, Gizzarelli T, Khan F, Patel C, Patel A, Yang M, Omrani M. Comparison of online and in-person cognitive behavioral therapy in individuals diagnosed with major depressive disorder: a non-randomized controlled trial. Front Psychiatry 2023; 14:1113956. [PMID: 37187863 PMCID: PMC10175610 DOI: 10.3389/fpsyt.2023.1113956] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023] Open
Abstract
Objective The increased prevalence of major depressive disorder (MDD) amid the COVID-19 pandemic has resulted in substantial growth in online mental health care delivery. Compared to its in-person counterpart, online cognitive behavioral therapy (e-CBT) is a time-flexible and cost-effective method of improving MDD symptoms. However, how its efficacy compares to in-person CBT is yet to be explored. Therefore, the current study compared the efficacy of a therapist-supported, electronically delivered e-CBT program to in-person therapy in individuals diagnosed with MDD. Methods Participants (n = 108) diagnosed with MDD selected either a 12 week in-person CBT or an asynchronous therapist-supported e-CBT program. E-CBT participants (n = 55) completed weekly interactive online modules delivered through a secure cloud-based online platform (Online Psychotherapy Tool; OPTT). These modules were followed by homework in which participants received personalized feedback from a trained therapist. Participants in the in-person CBT group (n = 53) discussed sessions and homework with their therapists during one-hour weekly meetings. Program efficacy was evaluated using clinically validated symptomatology and quality of life questionnaires. Results Both treatments yielded significant improvements in depressive symptoms and quality of life from baseline to post-treatment. Participants who opted for in-person therapy presented significantly higher baseline symptomatology scores than the e-CBT group. However, both treatments demonstrated comparable significant improvements in depressive symptoms and quality of life from baseline to post-treatment. e-CBT seems to afford higher participant compliance as dropouts in the e-CBT group completed more sessions on average than those in the in-person CBT group. Conclusion The findings support e-CBT with therapist guidance as a suitable option to treat MDD. Future studies should investigate how treatment accessibility is related to program completion rates in the e-CBT vs. in-person group. Clinical Trial Registration ClinicalTrials.Gov Protocol Registration and Results System (NCT04478058); clinicaltrials.gov/ct2/show/NCT04478058.
Collapse
Affiliation(s)
- Nazanin Alavi
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
- OPTT Inc., Toronto, ON, Canada
- *Correspondence: Nazanin Alavi,
| | - Elnaz Moghimi
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | | | - Gilmar Gutierrez
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Jasleen Jagayat
- Centre for Neuroscience Studies, Queen’s University, Kingston, ON, Canada
| | - Anchan Kumar
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Yijia Shao
- Department of Psychology, University of Toronto, Toronto, ON, Canada
| | - Shadé Miller
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Caitlin S. Yee
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Anthi Stefatos
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | | | - Zara Abbaspour
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | | | - Tessa Gizzarelli
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Ferwa Khan
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Charmy Patel
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Archana Patel
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Megan Yang
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
| | - Mohsen Omrani
- Department of Psychiatry, Queen’s University, Kingston, ON, Canada
- OPTT Inc., Toronto, ON, Canada
| |
Collapse
|
15
|
Atik E, Schückes M, Apolinário-Hagen J. Patient and Therapist Expectations for a Blended Cognitive Behavioral Therapy Program for Depression: Qualitative Exploratory Study. JMIR Ment Health 2022; 9:e36806. [PMID: 36583934 PMCID: PMC9840101 DOI: 10.2196/36806] [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: 01/26/2022] [Revised: 10/24/2022] [Accepted: 11/16/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Blended cognitive behavioral therapy (bCBT)-the combination of digital elements and face-to-face psychotherapy-has been proposed to alleviate challenges that patients and therapists face in conventional cognitive behavioral therapy. There is growing evidence that adding digital elements to face-to-face psychotherapy can contribute to better treatment outcomes. However, bCBT programs still show considerable shortcomings, and knowledge on how to improve digital apps using a bCBT protocol is limited. OBJECTIVE This study aimed to inductively identify functions and qualities that are expected from a bCBT treatment for depression in the eyes of patients and psychotherapists who were not currently receiving or practicing bCBT treatment. METHODS We used a qualitative exploratory study design and conducted 3 focus group interviews (n=6 in each) and 5 semistructured in-depth interviews with therapists as well as 11 individual interviews with patients with a primary diagnosis of depression and currently undergoing cognitive behavioral therapy treatment in Germany. Themes and categories were established inductively from transcribed interview records based on a rigorous coding method. RESULTS Both therapists and patients expected a digital app to provide patients with the opportunity to track their mood, work on therapeutic homework activities, easily access an intervention set for harder moments, and efficiently facilitate administrative tasks. The desire to be able to customize bCBT protocols to individual patient circumstances was evident in both patient and therapist interviews. Patients differed with respect to what content and the amount of material the app should focus on as well as the method of recording experiences. Therapists viewed digital apps as potentially aiding in their documentation work outside of sessions. Different attitudes surfaced on the topic of data security, with patients not as concerned as therapists. CONCLUSIONS Both patients and therapists had substantially positive attitudes toward the option of an integrated bCBT treatment. Our study presents novel findings on the expectations and attitudes of patients and therapists.
Collapse
Affiliation(s)
- Ece Atik
- Ruhr University Bochum, Bochum, Germany
| | - Magnus Schückes
- Institute for SME Research and Entrepreneurship, University of Mannheim, Mannheim, Germany
| | - Jennifer Apolinário-Hagen
- Institute of Occupational, Social and Environmental Medicine, Faculty of Medicine, Centre for Health and Society, Heinrich Heine University Dusseldorf, Dusseldorf, Germany
| |
Collapse
|
16
|
van Schaik DJF, Schotanus AY, Dozeman E, Huibers MJH, Cuijpers P, Donker T. Pilot Study of Blended-Format Interpersonal Psychotherapy for Major Depressive Disorder. Am J Psychother 2022:appipsychotherapy20210061. [DOI: 10.1176/appi.psychotherapy.20210061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Digna J. F. van Schaik
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Amrah Y. Schotanus
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Els Dozeman
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Marcus J. H. Huibers
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Pim Cuijpers
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| | - Tara Donker
- Mental Health Program, Amsterdam Public Health, Amsterdam (all authors); GGZ inGeest Mental Health Care, Amsterdam (van Schaik, Schotanus, Dozeman); Department of Clinical, Neuro-, and Developmental Psychology, Vrije Universiteit Amsterdam, Amsterdam (Huibers, Cuijpers, Donker)
| |
Collapse
|
17
|
Bielinski LL, Bur OT, Wälchli G, Suter JM, Walsh N, Kley MA, Krieger T, Berger T. Two sides of the same coin? Patient and therapist experiences with a transdiagnostic blended intervention focusing on emotion regulation. Internet Interv 2022; 30:100586. [PMID: 36386404 PMCID: PMC9663910 DOI: 10.1016/j.invent.2022.100586] [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: 03/06/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The combination of internet-based intervention and psychotherapy, commonly termed blended therapy (BT), has gained popularity in recent years. While advantages and disadvantages of BT have been identified from the patient and therapist perspective, the two perspectives have rarely been examined within the same treatment. Moreover, almost all available research on patient and therapist experiences with BT is disorder-specific. This study aimed to investigate patient and therapist experiences within the same transdiagnostic BT. METHODS A qualitative analysis of semi-structured interviews with eight patients and eight therapists taking part in a transdiagnostic blended intervention focusing on the topic of emotion regulation was conducted. A qualitative content analysis approach was used. Category frequencies were calculated and similarities and differences between the patient and therapist experience were explored. RESULTS Ten main themes and 59 subthemes were identified in the category system for patient interviews and ten main themes and 50 subthemes were identified in the category system for therapist interviews. Similarities and differences between the two perspectives were reported with regard to 1) expectations toward the intervention, 2) the internet-based intervention, 3) symptomatology and emotion regulation, 4) the therapeutic relationship and 5) the blended format. CONCLUSION This study provides first insights on the experiences with transdiagnostic BT focusing on emotion regulation. Based on the results, different recommendations for the improvement of transdiagnostic BT are made. Future research on patient and therapist experiences with transdiagnostic BT is necessary, in order to further improve the experience of those involved.
Collapse
Affiliation(s)
- Laura Luisa Bielinski
- Corresponding author at: Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Bern, Fabrikstrasse 8, 3012 Bern, Switzerland.
| | | | | | | | | | | | | | | |
Collapse
|
18
|
Dech M, Klawohn J, Romanczuk-Seiferth N. Das Beste aus zwei Welten: Eine systematische Übersicht zu Faktoren der Implementierung einer “Blended Therapy” (Gemischte Therapie) in der Psychotherapeutischen Routineversorgung. VERHALTENSTHERAPIE 2022. [DOI: 10.1159/000524332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
<b><i>Ziel:</i></b> Diese Arbeit gibt einen Überblick über bisherige wissenschaftliche Empfehlungen zur Implementierung der blended therapy, d.h. der Kombination von Therapien in Präsenz und via digitaler Medien. Die Empfehlungen umfassen die Themen: (1) wahrgenommene Barrieren von Psychotherapeut*innen, (2) Format der blended therapy und (3) Indikationen für Patient*innen. In diesem Rahmen werden Faktoren aufgezeigt, die Akteur*innen im Gesundheitssystem als Orientierung dienen können, welche Determinanten bei der Implementierung in die Routineversorgung zu berücksichtigen sind. <b><i>Methodik:</i></b> Die systematische Suche erfolgte in den Datenbanken PsycArticles, PsycInfo, PSYNDEX und PubMed. <b><i>Ergebnisse:</i></b> Die Publikationen umfassen vier quantitative, neun qualitative sowie drei Mixed-Methods-Studien. Die bisherigen Arbeiten kommen zu dem Ergebnis, dass Psychotherapeut*innen frühzeitig in den Implementierungsprozess einbezogen und langfristige supportive Maßnahmen für die Umstrukturierung der bisherigen Arbeitsroutine geschaffen werden sollten. Das Format der blended therapy sollte nicht standardisiert angewandt, sondern vielmehr individuell an die Patient*innen angepasst werden. Hinsichtlich möglicher Indikationen werden verschiedene Einflussfaktoren der Patient*innen diskutiert, die bisher jedoch nur unzureichend untersucht wurden. <b><i>Diskussion:</i></b> Bisherige Studien weisen größtenteils homogene Charakteristika und Ergebnisse auf. Forschungslücken bestehen hinsichtlich der Frage, inwieweit sich die Ergebnisse auf andere Therapieschulen, Berufsgruppen und Störungsbilder übertragen lassen. <b><i>Schlussfolgerung:</i></b> Das Review veranschaulicht, dass es wichtiger Vorarbeit hinsichtlich der Anwendungsunterstützung für Psychotherapeut*innen sowie weiterer Forschungsaktivität bedarf, um die Implementierung von blended therapy im Sinne einer möglichen Verbesserung der psychotherapeutischen Versorgung voranzutreiben.
Collapse
|
19
|
Charron CM, Gorey KM. Virtual versus Face-to-Face Cognitive Behavioral Treatment of Depression: Meta-Analytic Test of a Noninferiority Hypothesis and Men's Mental Health Inequities. DEPRESSION RESEARCH AND TREATMENT 2022; 2022:2972219. [PMID: 35663009 PMCID: PMC9161136 DOI: 10.1155/2022/2972219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/04/2022] [Indexed: 11/18/2022]
Abstract
Global rates of depression have increased significantly since the beginning of the COVID-19 pandemic. It is unclear how the recent shift of many mental health services to virtual platforms has impacted service users, especially for the male population which are significantly more likely to complete suicide than women. This paper presents the findings of a rapid meta-analytic research synthesis of 17 randomized controlled trials on the relative efficacy of virtual versus traditional face-to-face cognitive behavioral therapy (CBT) in mitigating symptoms of depression. Participants' aggregated depression scores were compared upon completion of the therapy (posttest) and longest follow-up measurement. The results supported the noninferiority hypothesis indicating that the two modes of CBT delivery are equally efficacious, but the results proved to be significantly heterogeneous indicating the presence of moderating effects. Indirect suggestive evidence was found to support moderation by gender; that is, depressed males may benefit more from virtual CBT. Perhaps, this field's most telling descriptive finding was that boys/men have been grossly underrepresented in its trials. Future trials ought to oversample those who have been at this field's margins to advance the next generation of knowledge, allowing us to best serve people of all genders, those who live in poverty, Indigenous, Black, and other Peoples of Colour, as well as any others at risk of being marginalized or oppressed in contemporary mental health care systems.
Collapse
Affiliation(s)
- Carly M. Charron
- University of Windsor, School of Social Work, 167 Ferry Street, Windsor, ON, Canada N9A 0C5
| | - Kevin M. Gorey
- University of Windsor, School of Social Work, 167 Ferry Street, Windsor, ON, Canada N9A 0C5
| |
Collapse
|
20
|
Blending Internet-based and tele group treatment: Acceptability, effects, and mechanisms of change of cognitive behavioral treatment for depression. Internet Interv 2022; 29:100551. [PMID: 35722084 PMCID: PMC9204733 DOI: 10.1016/j.invent.2022.100551] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/20/2022] Open
Abstract
The current COV-19 pandemic increases the need for remote treatment. Among several provision strategies, tele groups have been tested as an efficient option. Still, the number of studies is comparably low, with a clear lack of studies investigating supposed treatment mechanisms. Sixty-one mildly to moderately depressed participants from Salzburg, Bavaria, and Upper Austria were randomized to the intervention or a waiting list control group (RCT). The seven-week treatment comprised preparatory online modules, followed by personalized feedback and a subsequent tele group session. Large treatment effects were observed for depression (CES-D: d = 0.99, p < .001; PHQ-9: d = 0.87, p = .002), together with large effects for cognitive behavioral skills (cognitive style, and behavioral activation, d = 0.88-0.97). Changes in skills mediated treatment outcomes for CES-D and PHQ-9, suggesting comparable mechanisms as in face-to-face therapy. Two typical moderators, therapeutic alliance, and group cohesion, however, failed to predict outcome (p = .289), or only exhibited statistical tendencies (p = .049 to .071). Client satisfaction, system usability, and treatment adherence were high. Blending Internet-based and tele group interventions offers additional options for low-threshold care that is less dependent on population density, commuting distances, or constraints due to the current COV-19 crisis. Results indicate that the blended intervention is clinically effective by fostering core CBT skills. While findings suggest the notion that working alliance and group cohesion can be established online, their relevancy for outcomes of blended treatment needs to be further investigated.
Collapse
|
21
|
Rathnayaka P, Mills N, Burnett D, De Silva D, Alahakoon D, Gray R. A Mental Health Chatbot with Cognitive Skills for Personalised Behavioural Activation and Remote Health Monitoring. SENSORS (BASEL, SWITZERLAND) 2022; 22:s22103653. [PMID: 35632061 PMCID: PMC9148050 DOI: 10.3390/s22103653] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 05/08/2023]
Abstract
Mental health issues are at the forefront of healthcare challenges facing contemporary human society. These issues are most prevalent among working-age people, impacting negatively on the individual, his/her family, workplace, community, and the economy. Conventional mental healthcare services, although highly effective, cannot be scaled up to address the increasing demand from affected individuals, as evidenced in the first two years of the COVID-19 pandemic. Conversational agents, or chatbots, are a recent technological innovation that has been successfully adapted for mental healthcare as a scalable platform of cross-platform smartphone applications that provides first-level support for such individuals. Despite this disposition, mental health chatbots in the extant literature and practice are limited in terms of the therapy provided and the level of personalisation. For instance, most chatbots extend Cognitive Behavioural Therapy (CBT) into predefined conversational pathways that are generic and ineffective in recurrent use. In this paper, we postulate that Behavioural Activation (BA) therapy and Artificial Intelligence (AI) are more effectively materialised in a chatbot setting to provide recurrent emotional support, personalised assistance, and remote mental health monitoring. We present the design and development of our BA-based AI chatbot, followed by its participatory evaluation in a pilot study setting that confirmed its effectiveness in providing support for individuals with mental health issues.
Collapse
|
22
|
Lungu A, Wickham RE, Chen SY, Jun JJ, Leykin Y, Chen CEJ. Component analysis of a synchronous and asynchronous blended care CBT intervention for symptoms of depression and anxiety: Pragmatic retrospective study. Internet Interv 2022; 28:100536. [PMID: 35433277 PMCID: PMC9011163 DOI: 10.1016/j.invent.2022.100536] [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: 05/14/2021] [Revised: 11/04/2021] [Accepted: 04/04/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Depression and anxiety are leading causes of disability worldwide. Though effective treatments exist, depression and anxiety remain undertreated. Blended care psychotherapy, combining the scalability of online interventions with the personalization and engagement of a live therapist, is a promising approach for increasing access to evidence-based care. OBJECTIVES To evaluate the effectiveness and individual contribution of two components - i) digital tools and ii) video-based therapist-led sessions - in a blended care CBT-based intervention under real world conditions. METHODS A retrospective cohort design was used to analyze N = 1372 US-based individuals who enrolled in blended care psychotherapy. Of these, at baseline, 761 participants had depression symptoms in the clinical range (based on PHQ-9), and 1254 had anxiety symptoms in the clinical range (based on GAD-7). Participants had access to the program as a mental health benefit offered by their employer. The CBT-based blended care psychotherapy program consisted of regular video sessions with therapists, complemented by digital lessons and digital exercises assigned by the clinician and completed in between sessions. Depression and anxiety levels and clients' treatment engagement were tracked throughout treatment. A 3-level individual growth curve model incorporating time-varying covariates was utilized to examine symptom trajectories of PHQ-9 scores (for those with clinical range of depression at baseline) and GAD-7 scores (for those with clinical range of anxiety at baseline). RESULTS On average, individuals exhibited a significant decline in depression and anxiety symptoms during the initial weeks of treatment (P < .001), and a continued decline over subsequent weeks at a slower rate (P < .001). Engaging in a therapy session in a week was associated with lower GAD-7 (b = -0.81) and PHQ-9 (b = -1.01) scores in the same week, as well as lower GAD-7 (b = -0.58) and PHQ-9 (b = -0.58) scores the following week (all P < .01). Similarly, engaging with digital lessons was independently associated with lower GAD-7 (b = -0.19) and PHQ-9 (b = -0.18) scores during the same week, and lower GAD-7 (b = -0.25) and PHQ-9 (b = -0.27) the following week (all P < .01). CONCLUSIONS Therapist-led video sessions and digital lessons had separate contributions to improvements in symptoms of depression and anxiety over the course of treatment. Future research should investigate whether clients' characteristics are related to differential effects of therapist-led and digital components of care.
Collapse
Affiliation(s)
- Anita Lungu
- Lyra Health, 287 Lorton Ave, Burlingame, CA 94010, USA,Corresponding author.
| | - Robert E. Wickham
- Department of Psychological Sciences, Northern Arizona University, Flagstaff, AZ, 86011
| | - Shih-Yin Chen
- Lyra Health, 287 Lorton Ave, Burlingame, CA 94010, USA
| | - Janie J. Jun
- Lyra Health, 287 Lorton Ave, Burlingame, CA 94010, USA
| | - Yan Leykin
- Palo Alto University, Department of Psychology, Palo Alto, CA 94304, USA
| | | |
Collapse
|
23
|
Wright JH, Owen J, Eells TD, Antle B, Bishop LB, Girdler R, Harris LM, Wright RB, Wells MJ, Gopalraj R, Pendleton ME, Ali S. Effect of Computer-Assisted Cognitive Behavior Therapy vs Usual Care on Depression Among Adults in Primary Care: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2146716. [PMID: 35142833 PMCID: PMC8832170 DOI: 10.1001/jamanetworkopen.2021.46716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Depression is a common disorder that may go untreated or receive suboptimal care in primary care settings. Computer-assisted cognitive behavior therapy (CCBT) has been proposed as a method for improving access to effective psychotherapy, reducing cost, and increasing the convenience and efficiency of treatment for depression. OBJECTIVES To evaluate whether clinician-supported CCBT is more effective than treatment as usual (TAU) in primary care patients with depression and to examine the feasibility and implementation of CCBT in a primary care population with substantial numbers of patients with low income, limited internet access, and low levels of educational attainment. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial included adult primary care patients from clinical practices at the University of Louisville who scored 10 or greater on the Patient Health Questionnaire-9 (PHQ-9) and were randomly assigned to CCBT or TAU for 12 weeks of active treatment. Follow-up assessments were conducted 3 and 6 months after treatment completion. Enrollment occurred from June 24, 2016, to May 13, 2019. The last follow-up assessment was conducted on January 30, 2020. INTERVENTIONS CCBT included use of the 9-lesson computer program Good Days Ahead, along with as many as 12 weekly telephonic support sessions of approximately 20 minutes with a master's level therapist, in addition to TAU, which consisted of the standard clinical management procedures at the primary care sites. TAU was uncontrolled, but use of antidepressants and psychotherapy other than CCBT was recorded. MAIN OUTCOMES AND MEASURES The primary outcome measure (PHQ-9) and secondary outcome measures (Automatic Thoughts Questionnaire for negative cognitions, Generalized Anxiety Disorder-7, and the Satisfaction with Life Scale for quality of life) were administered at baseline, 12 weeks, and 3 and 6 months after treatment completion. Satisfaction with treatment was assessed with the Client Satisfaction Questionnaire-8. RESULTS The sample of 175 patients was predominately female (147 of 174 [84.5%]) and had a high proportion of individuals who identified as racial and ethnic minority groups (African American, 44 of 162 patients who reported [27.2%]; American Indian or Alaska Native, 2 [1.2%]; Hispanic, 4 [2.5%]; multiracial, 14 [8.6%]). An annual income of less than $30 000 was reported by 88 of 143 patients (61.5%). Overall, 95 patients (54.3%) were randomly assigned to CCBT and 80 (45.7%) to TAU. Dropout rates were 22.1% for CCBT (21 patients) and 30.0% for TAU (24 patients). An intent-to-treat analysis found that CCBT led to significantly greater improvement in PHQ-9 scores than TAU at posttreatment (mean difference, -2.5; 95% CI, -4.5 to -0.8; P = .005) and 3 month (mean difference, -2.3; 95% CI, -4.5 to -0.8; P = .006) and 6 month (mean difference, -3.2; 95% CI, -4.5 to -0.8; P = .007) follow-up points. Posttreatment response and remission rates were also significantly higher for CCBT (response, 58.4% [95% CI, 46.4-70.4%]; remission, 27.3% [95% CI, 16.4%-38.2%]) than TAU (response, 33.1% [95% CI, 20.7%-45.5%]; remission, 12.0% [95% CI, 3.3%- 20.7%]). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, CCBT was found to have significantly greater effects on depressive symptoms than TAU in primary care patients with depression. Because the study population included people with lower income and lack of internet access who typically have been underrepresented or not included in earlier investigations of CCBT, results suggest that this form of treatment can be acceptable and useful in diverse primary care settings. Additional studies with larger samples are needed to address implementation procedures that could enhance the effectiveness of CCBT and to examine potential factors associated with treatment outcome. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02700009.
Collapse
Affiliation(s)
- Jesse H. Wright
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Jesse Owen
- Department of Counseling Psychology, University of Denver, Denver, Colorado
| | - Tracy D. Eells
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky
| | - Becky Antle
- Kent School of Social Work, University of Louisville, Louisville, Kentucky
| | - Laura B. Bishop
- Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Renee Girdler
- Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- now with Norton Healthcare, Norton Community Medical Associates, Louisville, Kentucky
| | - Lesley M. Harris
- Kent School of Social Work, University of Louisville, Louisville, Kentucky
| | - R. Brent Wright
- Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky
| | - Michael J. Wells
- Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- now with Baptist Health, Baptist Health Medical Group Primary Care, Louisville, Kentucky
| | - Rangaraj Gopalraj
- Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- now with Norton Healthcare, Norton Community Medical Associates, Louisville, Kentucky
| | - Michael E. Pendleton
- Department of Family and Geriatric Medicine, University of Louisville School of Medicine, Louisville, Kentucky
- now with Baptist Health, Baptist Health Medical Group Primary Care, Louisville, Kentucky
| | - Shehzad Ali
- Mental Health and Addictions Research Group, Department of Health Sciences, University of York, Heslington, United Kingdom
- Department of Psychology, Macquarie University, Sydney, New South Wales, Australia
- Department of Epidemiology and Biostatistics, Schulich School of Medicine, Western University, London, Ontario, Canada
| |
Collapse
|
24
|
Milgrom J, Danaher BG, Seeley JR, Holt CJ, Holt C, Ericksen J, Tyler MS, Gau JM, Gemmill AW. Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster. J Med Internet Res 2021; 23:e17185. [PMID: 34889742 PMCID: PMC8701704 DOI: 10.2196/17185] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 03/10/2021] [Accepted: 09/28/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Previous research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND. OBJECTIVE This study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT). METHODS In this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up. RESULTS Of the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups. CONCLUSIONS In this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true.
Collapse
Affiliation(s)
- Jeannette Milgrom
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Australia
| | - Brian G Danaher
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - John R Seeley
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | | | - Charlene Holt
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
| | - Jennifer Ericksen
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
| | - Milagra S Tyler
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - Jeff M Gau
- University of Oregon, Eugene, OR, United States.,Influents Innovations, Eugene, OR, United States
| | - Alan W Gemmill
- Parent-Infant Research Institute, Heidelberg Repatriation Hospital, Heidelberg Heights, Australia
| |
Collapse
|
25
|
Netter AL, Beintner I, Brakemeier EL. Adding an app-based intervention to the Cognitive Behavioral Analysis System of Psychotherapy (CBASP): Proof-of-Concept in Routine Outpatient Psychotherapy Treatment (Preprint). JMIR Form Res 2021; 6:e35482. [PMID: 35943764 PMCID: PMC9399836 DOI: 10.2196/35482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 02/03/2022] [Accepted: 02/03/2022] [Indexed: 01/12/2023] Open
Abstract
Background The Cognitive Behavioral Analysis System of Psychotherapy (CBASP) is an empirically supported psychotherapeutic treatment developed specifically for persistent depressive disorder. However, given the high rates of nonresponse and relapse, there is a need for optimization. Studies suggest that outcomes can be improved by increasing the treatment dose via, for example, the continuous web-based application of therapy strategies between sessions. The strong emphasis in CBASP on the therapeutic relationship, combined with limited therapeutic availabilities, encourages the addition of web-based interventions to face-to-face therapy in terms of blended therapy. Objective The aim of this study was to test an app-based intervention called CBASPath, which was designed to be used as a blended therapy tool. CBASPath offers 8 sequential modules with app-based exercises to facilitate additional engagement with the therapy content and a separate exercise to conduct situational analyses within the app at any time. Methods CBASPath was tested in an open pilot study as part of routine outpatient CBASP treatment. Participating patients were asked to report their use patterns and blended use (integrated use of the app as part of therapy sessions) at 3 assessment points over the 6-month test period and rate the usability and quality of and their satisfaction with CBASPath. Results The results of the pilot trial showed that 93% (12/13) of participants used CBASPath as a blended tool during their therapy and maintained this throughout the study period. Overall, they reported good usability and quality ratings along with high user satisfaction. All participants showed favorable engagement with CBASPath; however, the frequency of use differed widely among the participants and assessment points. Situational analysis was used by all participants, and the number of completed modules ranged from 1 to 7. All participants reported blended use, although the frequency of integration in the face-to-face sessions varied widely. Conclusions Our findings suggest that the digital augmentation of complex and highly interactive CBASP therapy in the form of blended therapy with CBASPath is feasible in routine outpatient care. Therapeutic guidance might contribute to high adherence and increase patient self-management. A few adjustments, such as saving entries directly in the app, could facilitate higher user engagement. A randomized controlled trial is now needed to investigate the efficacy and added value of this blended approach. In the long term, CBASPath could help optimize persistent depressive disorder treatment and reduce relapse by intensifying therapy and providing long-term patient support through the app.
Collapse
Affiliation(s)
- Anna-Lena Netter
- Department of Clinical Psychology and Psychotherapy, Philipps University of Marburg, Marburg, Germany
| | | | - Eva-Lotta Brakemeier
- Department of Clinical Psychology and Psychotherapy, University of Greifswald, Greifswald, Germany
| |
Collapse
|
26
|
Liu Z, Liu R, Zhang Y, Zhang R, Liang L, Wang Y, Wei Y, Zhu R, Wang F. Latent class analysis of depression and anxiety among medical students during COVID-19 epidemic. BMC Psychiatry 2021; 21:498. [PMID: 34641795 PMCID: PMC8506472 DOI: 10.1186/s12888-021-03459-w] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 09/01/2021] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE The novel coronavirus disease 2019 (COVID-19) is a global public health emergency that has caused worldwide concern. The mental health of medical students under the COVID-19 epidemic has attracted much attention. This study aims to identify subgroups of medical students based on depression and anxiety and explore the influencing factors during the COVID-19 epidemic in China. METHODS A total of 29,663 medical students were recruited during the epidemic of COVID-19 in China. Depression and anxiety symptoms were assessed using Patient Health Questionnaire 9 (PHQ9) and Generalized Anxiety Disorder 7 (GAD7) respectively. Latent class analysis was performed based on depression and anxiety symptoms in medical students. The latent class subtypes were compared using the chi-square test. Multinomial logistic regression was used to examine associations between identified classes and related factors. RESULTS In this study, three distinct subgroups were identified, namely, the poor mental health group, the mild mental health group and the low symptoms group. The number of medical students in each class is 4325, 9321 and 16,017 respectively. The multinomial logistic regression results showed that compared with the low symptoms group, the factors influencing depression and anxiety in the poor mental health group and mild mental health group were sex, educational level, drinking, individual psychiatric disorders, family psychiatric disorders, knowledge of COVID-19, fear of being infected, and participate in mental health education on COVID-19. CONCLUSIONS Our findings suggested that latent class analysis can be used to categorize different medical students according to their depression and anxiety symptoms during the outbreak of COVID-19. The main factors influencing the poor mental health group and the mild mental health group are basic demographic characteristics, disease history, COVID-19 related factors and behavioural lifestyle. School administrative departments can carry out targeted psychological counseling according to different subgroups to promote the physical and mental health of medical students.
Collapse
Affiliation(s)
- Zhuang Liu
- grid.412449.e0000 0000 9678 1884School of Public health, China Medical University, Shenyang, Liaoning China
| | - Rongxun Liu
- grid.89957.3a0000 0000 9255 8984Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu 210029 People’s Republic of China ,grid.412990.70000 0004 1808 322XSchool of Medical Engineering, Xinxiang Medical University, Xinxiang, Henan China
| | - Yue Zhang
- grid.412449.e0000 0000 9678 1884School of Public health, China Medical University, Shenyang, Liaoning China
| | - Ran Zhang
- grid.89957.3a0000 0000 9255 8984Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu 210029 People’s Republic of China
| | - Lijuan Liang
- grid.412636.4Department of Psychiatry, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning China ,grid.443397.e0000 0004 0368 7493Department of Psychology, The First Affiliated Hospital of Hainan Medical University, Haikou, Hainan China
| | - Yang Wang
- grid.411907.a0000 0001 0441 5842Psychology Institute, Inner Mongolia Normal University, Huhehaote, Inner Mongolia China
| | - Yange Wei
- grid.89957.3a0000 0000 9255 8984Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu 210029 People’s Republic of China
| | - Rongxin Zhu
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China.
| | - Fei Wang
- Early Intervention Unit, Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China. .,Department of Psychiatry and Radiology, The First Affiliated Hospital of China Medical University, 155 Nanjing North Street, Shenyang, 110001, Liaoning, People's Republic of China. .,Nanjing Functional Brain Imaging Institute of Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, People's Republic of China.
| |
Collapse
|
27
|
Lin A, Espay AJ. Remote delivery of cognitive behavioral therapy to patients with functional neurological disorders: Promise and challenges. Epilepsy Behav Rep 2021; 16:100469. [PMID: 34409282 PMCID: PMC8361291 DOI: 10.1016/j.ebr.2021.100469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/29/2021] [Accepted: 07/03/2021] [Indexed: 11/03/2022] Open
Abstract
CBT is a promising treatment for patients with FND. Remote delivery of CBT can potentially increase access to care for patients with FND. Remote CBT can be integrated into clinical practice using a stepwise approach. Remote CBT can be integrated into practice using patient predictive factors.
Functional neurological disorders (FND) are an important source of healthcare utilization and morbidity. While there are no formal guidelines for treating these disorders, cognitive behavioral therapy (CBT) is emerging as a safe and effective treatment. Currently, there is a global shortage of CBT providers, with only a small subset trained in and comfortable with treating patients with FND. We highlight four types of remote CBT delivery to patients with FND to alleviate the access obstacle: workbooks, internet-guided CBT, app-based CBT, and teletherapy. CBT workbooks and teletherapy have been studied in FND, with preliminary studies suggesting efficacy; internet-guided CBT and app-based CBT have not but have been effectively used in patients with psychiatric disorders, particularly depression, anxiety, and post-traumatic disorders. As these disorders are often comorbid and share overlapping neurobiology with FND, internet-guided CBT and app-based CBT represent promising delivery options of CBT for FND. Although remotely-delivered CBT is unlikely to replace in-person CBT and there are technical and logistical challenges to overcome prior to widespread deployment, it holds promise as an adjunct treatment when in-person CBT is inaccessible. We propose a rational approach to future allocation of remote CBT treatment options and highlight important research gaps to bridge beforehand.
Collapse
Affiliation(s)
- Amanda Lin
- The Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH 43210, United States
| | - Alberto J Espay
- James J. and Joan A. Gardner Family Center for Parkinson's Disease and Movement Disorders, Department of Neurology, University of Cincinnati, Cincinnati, OH, United States
| |
Collapse
|
28
|
Taylor CB, Graham AK, Flatt RE, Waldherr K, Fitzsimmons-Craft EE. Current state of scientific evidence on Internet-based interventions for the treatment of depression, anxiety, eating disorders and substance abuse: an overview of systematic reviews and meta-analyses. Eur J Public Health 2021; 31:i3-i10. [PMID: 32918448 PMCID: PMC8495688 DOI: 10.1093/eurpub/ckz208] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND ICare represents a consortium of European Investigators examining the effects of online mental health care for a variety of common mental health disorders provided in a variety of settings. This article provides an overview of the evidence of effectiveness for Internet-based treatment for four common mental health disorders that are the focus of much of this work: depression, anxiety, substance abuse and eating disorders. METHODS The overview focused primarily on systematic reviews and meta-analyses identified through PubMed (Ovid) and other databases and published in English. Given the large number of reviews specific to depression, anxiety, substance abuse and/or eating disorders, we did not focus on reviews that examined the effects of Internet-based interventions on mental health disorders in general. Each article was reviewed and summarized by one of the senior authors, and this review was then reviewed by the other senior authors. We did not address issues of prevention, cost-effectiveness, implementation or dissemination, as these are addressed in other reviews in this supplement. RESULTS Across Internet-based intervention studies addressing depression, anxiety, substance abuse and eating disorders primarily among adults, almost all reviews and meta-analyses found that these interventions successfully reduce symptoms and are efficacious treatments. Generally, effect sizes for Internet-based interventions treating eating disorders and substance abuse are lower compared with interventions for depression and anxiety. CONCLUSIONS Given the effectiveness of Internet-based interventions to reduce symptoms of these common mental health disorders, efforts are needed to examine issues of how they can be best disseminated and implemented in a variety of health care and other settings.
Collapse
Affiliation(s)
- C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Andrea K Graham
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Rachael E Flatt
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA.,Department of Psychiatry & Behavioral Sciences, Stanford University, Palo Alto, CA, USA
| | - Karin Waldherr
- FernFH Distance Learning University of Applied Sciences, Wiener Neustadt, Austria
| | | |
Collapse
|
29
|
Roth CB, Papassotiropoulos A, Brühl AB, Lang UE, Huber CG. Psychiatry in the Digital Age: A Blessing or a Curse? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8302. [PMID: 34444055 PMCID: PMC8391902 DOI: 10.3390/ijerph18168302] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022]
Abstract
Social distancing and the shortage of healthcare professionals during the COVID-19 pandemic, the impact of population aging on the healthcare system, as well as the rapid pace of digital innovation are catalyzing the development and implementation of new technologies and digital services in psychiatry. Is this transformation a blessing or a curse for psychiatry? To answer this question, we conducted a literature review covering a broad range of new technologies and eHealth services, including telepsychiatry; computer-, internet-, and app-based cognitive behavioral therapy; virtual reality; digital applied games; a digital medicine system; omics; neuroimaging; machine learning; precision psychiatry; clinical decision support; electronic health records; physician charting; digital language translators; and online mental health resources for patients. We found that eHealth services provide effective, scalable, and cost-efficient options for the treatment of people with limited or no access to mental health care. This review highlights innovative technologies spearheading the way to more effective and safer treatments. We identified artificially intelligent tools that relieve physicians from routine tasks, allowing them to focus on collaborative doctor-patient relationships. The transformation of traditional clinics into digital ones is outlined, and the challenges associated with the successful deployment of digitalization in psychiatry are highlighted.
Collapse
Affiliation(s)
- Carl B. Roth
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Andreas Papassotiropoulos
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
- Transfaculty Research Platform Molecular and Cognitive Neurosciences, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Division of Molecular Neuroscience, Department of Psychology, University of Basel, Birmannsgasse 8, CH-4055 Basel, Switzerland
- Biozentrum, Life Sciences Training Facility, University of Basel, Klingelbergstrasse 50/70, CH-4056 Basel, Switzerland
| | - Annette B. Brühl
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Undine E. Lang
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| | - Christian G. Huber
- University Psychiatric Clinics Basel, Clinic for Adults, University of Basel, Wilhelm Klein-Strasse 27, CH-4002 Basel, Switzerland; (A.P.); (A.B.B.); (U.E.L.); (C.G.H.)
| |
Collapse
|
30
|
Bielinski LL, Trimpop L, Berger T. [All in the mix? Blended psychotherapy as an example of digitalization in psychotherapy]. PSYCHOTHERAPEUT 2021; 66:447-454. [PMID: 34257478 PMCID: PMC8268619 DOI: 10.1007/s00278-021-00524-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 11/06/2022]
Abstract
Hintergrund Über die letzten Jahrzehnte wurden verschiedene Ansätze zur Digitalisierung der Psychotherapie (PT) entwickelt. Eine Behandlungsform stellt die Kombination von „Face-to-face“-PT und Online-Interventionen, die „Blended-PT“, dar. Während das Forschungsinteresse zu Blended-PT in den letzten Jahren zugenommen hat, wurde die praktische Anwendung von Blended-PT im deutschsprachigen Raum bisher weniger stark umgesetzt. Auch bedingt durch die globale, durch die „coronavirus disease 2019“ (COVID-19) ausgelöste Pandemie gewinnen Blended-PT und andere Online-Ansätze zunehmend an Bedeutung. Ziel der Arbeit Ein Überblick zum Thema und zu verschiedenen Formen von Blended-PT wird gegeben. Im Weiteren wird auf die Wirksamkeit, die Sicht der Patient:innen und Therapeut:innen sowie auf das Thema der Implementierung eingegangen. Material und Methoden Narrative Übersicht der Literatur zum Thema Blended-PT; auf Basis einer umfassenden Suche werden wichtige Überlegungen und Befunde eingeordnet und beschrieben. Ergebnisse Der Begriff der Blended-PT wird bisher uneinheitlich verwendet. In Anlehnung an Blended-Learning-Ansätze können „blends“ auf verschiedenen Ebenen stattfinden. Es kann zwischen ergänzenden und transformierenden Blends unterschieden werden. In transformierenden Blends verändert das Format die Face-to-face-PT grundlegend. Zu einigen Blended-PT-Formen gibt es bereits Wirksamkeitsbelege, zu anderen besteht dringender Forschungsbedarf. Im Vergleich zu Face-to-face-PT und reiner Online-Therapie könnte die Blended-PT verschiedene Vorteile bieten. Schlussfolgerung Das Interesse an Blended-PT wächst aufseiten von Patient:innen und Therapeut:innen. Um evidenzbasierte Blended-PT erfolgreich anbieten zu können, bedarf es der engen Zusammenarbeit zwischen Wissenschaft, Institutionen, Therapeut:innen und Kostenträgern im Gesundheitssystem.
Collapse
Affiliation(s)
- Laura Luisa Bielinski
- Abteilung Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Bern, Fabrikstr. 8, 3012 Bern, Schweiz
| | - Leonie Trimpop
- Lehrstuhl für Klinische Psychologie und Psychotherapie, Universität Witten/Herdecke, Witten, Deutschland
| | - Thomas Berger
- Abteilung Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Bern, Fabrikstr. 8, 3012 Bern, Schweiz
| |
Collapse
|
31
|
Juul S, Gluud C, Simonsen S, Frandsen FW, Kirsch I, Jakobsen JC. Blinding in randomised clinical trials of psychological interventions: a retrospective study of published trial reports. BMJ Evid Based Med 2021; 26:109. [PMID: 32998993 DOI: 10.1136/bmjebm-2020-111407] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To study the extent of blinding in randomised clinical trials of psychological interventions and the interpretative considerations if randomised clinical trials are not blinded. DESIGN Retrospective study of trial reports published in six high impact factor journals within the field of psychiatry in 2017 and 2018. SETTING Trial reports published in World Psychiatry, JAMA Psychiatry, Lancet Psychiatry, American Journal of Psychiatry, British Journal of Psychiatry, or Psychotherapy and Psychosomatics. MAIN OUTCOME MEASURES Blinding status of participants, treatment providers, outcome assessors, data managers, the data safety and monitoring committee, statisticians and conclusion makers, if trialists rejected the null hypothesis on the primary outcome measure, and if trialists discussed the potential bias risk from lack of blinding in the published trial report. RESULTS 63 randomised clinical trials of psychological interventions were identified. None (0%; 95% CI 0% to 5.75%) of the trials reported blinding of all possible key persons. 37 (58.7%; 95% CI 46.42% to 70.04%) trials reported blinding of outcome assessors. Two (3.2%; 95% CI 0.87% to 10.86%) trials reported blinding of participants. Two (3.2%; 95% CI 0.87% to 10.86%) trials reported blinding of data managers. Three (4.8%; 95% CI 1.63% to 13.09%) trials reported blinding of statisticians. None of the trials reported blinding of treatment providers, the data safety and monitoring committee, and conclusion makers. 45 (71.4%; 95% CI 59.30% to 81.10%) trials rejected the null hypothesis on the primary outcome(s). 13 (20.7%; 95% CI 12.48% to 32.17%) trials discussed the potential bias risk from lack of blinding in the published trial report. CONCLUSIONS Blinding of key persons involved in randomised clinical trials of psychological interventions is rarely sufficiently documented. The possible interpretative limitations are only rarely considered. There is a need of randomised clinical trials of psychological interventions with documented blinding attempts of all possible key persons.
Collapse
Affiliation(s)
- Sophie Juul
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
| | - Sebastian Simonsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
| | - Frederik Weischer Frandsen
- Stolpegaard Psychotherapy Centre, Mental Health Services in the Capital Region of Denmark, Gentofte, Denmark
| | - Irving Kirsch
- Program in Placebo Studies, Harvard Medical School, Boston, Massachusetts, USA
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Copenhagen University Hospital, Copenhagen Ø, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
32
|
Liu Z, Qiao D, Xu Y, Zhao W, Yang Y, Wen D, Li X, Nie X, Dong Y, Tang S, Jiang Y, Wang Y, Zhao J, Xu Y. The Efficacy of Computerized Cognitive Behavioral Therapy for Depressive and Anxiety Symptoms in Patients With COVID-19: Randomized Controlled Trial. J Med Internet Res 2021; 23:e26883. [PMID: 33900931 PMCID: PMC8128049 DOI: 10.2196/26883] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/14/2021] [Accepted: 04/24/2021] [Indexed: 12/20/2022] Open
Abstract
Background The prevalence of depressive and anxiety symptoms in patients with COVID-19 is higher than usual. Previous studies have shown that there are drug-to-drug interactions between antiretroviral drugs and antidepressants. Therefore, an effective and safe treatment method was needed. Cognitive behavioral therapy (CBT) is the first-line psychological therapy in clinical treatment. Computerized CBT (cCBT) was proven to be an effective alternative to CBT and does not require face-to-face therapy between a therapist and the patient, which suited the COVID-19 pandemic response. Objective This study aims to evaluate the efficacy of the cCBT program we developed in improving depressive and anxiety symptoms among patients with COVID-19. Methods We customized a cCBT program focused on improving depressive and anxiety symptoms among patients with COVID-19, and then, we assessed its effectiveness. Screening was based on symptoms of depression or anxiety for patients who scored ≥7 on the Hamilton Depression Rating Scale (HAMD17) or the Hamilton Anxiety Scale (HAMA). A total of 252 patients with COVID-19 at five sites were randomized into two groups: cCBT + treatment as usual (TAU; n=126) and TAU without cCBT (n=126). The cCBT + TAU group received the cCBT intervention program for 1 week. The primary efficacy measures were the HAMD17 and HAMA scores. The secondary outcome measures were the Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Athens Insomnia Scale (AIS). Assessments were carried out pre- and postintervention. The patients’ symptoms of anxiety and depression in one of the centers were assessed again within 1 month after the postintervention assessment. Results The cCBT + TAU group displayed a significantly decreased score on the HAMD17, HAMA, SDS, SAS, and AIS after the intervention compared to the TAU group (all P<.001). A mixed-effects repeated measures model revealed significant improvement in symptoms of depression (HAMD17 and SDS scores, both P<.001), anxiety (HAMA and SAS scores, both P<.001), and insomnia (AIS score, P=.002) during the postintervention and follow-up periods in the cCBT + TAU group. Additionally, the improvement of insomnia among females (P=.14) and those with middle school education (P=.48) in the cCBT + TAU group showed no significant differences when compared to the TAU group. Conclusions The findings of this study suggest that the cCBT program we developed was an effective nonpharmacological treatment for symptoms of anxiety, depression, and insomnia among patients with COVID-19. Further research is warranted to investigate the long-term effects of cCBT for symptoms of anxiety, depression, and insomnia in patients with COVID-19. Trial Registration Chinese Clinical Trial Registry ChiCTR2000030084; http://www.chictr.org.cn/showprojen.aspx?proj=49952
Collapse
Affiliation(s)
- Zhifen Liu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Dan Qiao
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yifan Xu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Wentao Zhao
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yang Yang
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Dan Wen
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinrong Li
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaoping Nie
- Department of Medical Service, Chongqing Public Health Medical Center, Chongqing, China
| | - Yongkang Dong
- The Fourth People's Hospital of Taiyuan, Taiyuan, China
| | - Shiyou Tang
- Department of Psychiatry, Chongqing University Three Gorges Hospital, Chongqing, China
| | - Yi Jiang
- Department of Respiratory and Critical Disease Medicine, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Ying Wang
- Department of Geriatrics, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Juan Zhao
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Yong Xu
- Department of Psychiatry, The First Hospital of Shanxi Medical University, Taiyuan, China
| |
Collapse
|
33
|
Blaney C, Hitchon CA, Marrie RA, Mackenzie C, Holens P, El-Gabalawy R. Support for a non-therapist assisted, Internet-based cognitive-behavioral therapy (iCBT) intervention for mental health in rheumatoid arthritis patients. Internet Interv 2021; 24:100385. [PMID: 33912401 PMCID: PMC8056225 DOI: 10.1016/j.invent.2021.100385] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/12/2021] [Accepted: 03/18/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Anxiety is common in patients with rheumatoid arthritis (RA) and associated with worse RA outcomes. This study assessed the feasibility and preliminary health impacts (mental and physical) of a non-therapist assisted, online mental health intervention targeting anxiety in this population. METHODS Participants with confirmed RA and elevated anxiety symptoms were enrolled into the Worry and Sadness program, an Internet-based cognitive-behavioral therapy (iCBT) intervention for anxiety and depression shown to be effective in the general population. Validated self-report measures of anxiety, depression, pain interference, fatigue, physical health-related quality of life, functional status, and patient-reported disease severity were collected at baseline, post-intervention, and at three-month follow-up. Emotional distress scores were tracked between lessons. Participants provided qualitative feedback in writing post-intervention. RESULTS We analyzed the responses of 34 participants; the majority was female (86%) and the mean age was 57 (SD = 13). Of these, 80% (n = 28) completed the study in its entirety. Among these completers, 94.1% described the program as worthwhile. We found statistically significant improvements in anxiety, depression and fatigue from baseline to three-month follow-up, with small to large effect sizes (d = 0.39-0.81). Post-hoc analyses revealed that statistically significant change occurred between baseline and post-intervention for anxiety and depression and was maintained at three-month follow-up, whereas statistically significant change occurred between baseline and three-month follow-up for fatigue. Statistically significant reductions in emotional distress occurred across the program, with a large effect size (d = 1.16) between the first and last lesson. CONCLUSION The Worry and Sadness program shows promise as a feasible resource for improving mental health in RA.
Collapse
Affiliation(s)
- Caitlin Blaney
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada
| | - Carol A. Hitchon
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ruth Ann Marrie
- Department of Internal Medicine, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Corey Mackenzie
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada
| | - Pamela Holens
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Renée El-Gabalawy
- Department of Psychology, University of Manitoba, 190 Dysart Road, Winnipeg, Manitoba R3T 2N2, Canada
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, 671 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Psychiatry, University of Manitoba, 771 Bannatyne Avenue, Winnipeg, Manitoba R3T 2N2, Canada
- Corresponding author at: AE-2, Harry Medovy House, 671 William Avenue, Winnipeg, Manitoba R3E 0Z2, Canada.
| |
Collapse
|
34
|
Köhnen M, Dreier M, Seeralan T, Kriston L, Härter M, Baumeister H, Liebherz S. Evidence on Technology-Based Psychological Interventions in Diagnosed Depression: Systematic Review. JMIR Ment Health 2021; 8:e21700. [PMID: 33565981 PMCID: PMC7904404 DOI: 10.2196/21700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/30/2020] [Accepted: 11/18/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Evidence on technology-based psychological interventions (TBIs) for the treatment of depression is rapidly growing and covers a broad scope of research. Despite extensive research in this field, guideline recommendations are still limited to the general effectiveness of TBIs. OBJECTIVE This study aims to structure evidence on TBIs by considering different application areas (eg, TBIs for acute treatment and their implementation in health care, such as stand-alone interventions) and treatment characteristics (eg, therapeutic rationale of TBIs) to provide a comprehensive evidence base and to identify research gaps in TBIs for diagnosed depression. Moreover, the reporting of negative events in the included studies is investigated in this review to enable subsequent safety assessment of the TBIs. METHODS Randomized controlled trials on adults diagnosed with unipolar depression receiving any kind of psychotherapeutic treatment, which was at least partly delivered by a technical medium, were eligible for inclusion in our preregistered systematic review. We searched for trials in CENTRAL (Cochrane Central Register of Controlled Trials; until August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL; until the end of January 2018), clinical trial registers, and sources of gray literature (until the end of January 2019). Study selection and data extraction were conducted by 2 review authors independently. RESULTS Database searches resulted in 15,546 records, of which 241 publications were included, representing 83 completed studies and 60 studies awaiting classification (ie, preregistered studies, study protocols). Almost all completed studies (78/83, 94%) addressed the acute treatment phase, being largely either implemented as stand-alone interventions (66/83, 80%) or blended treatment approaches (12/83, 14%). Studies on TBIs for aftercare (4/83, 5%) and for bridging waiting periods (1/83, 1%) were scarce. Most TBI study arms (n=107) were guided (59/107, 55.1%), delivered via the internet (80/107, 74.8%), and based on cognitive behavioral treatment approaches (88/107, 79.4%). Almost all studies (77/83, 93%) reported information on negative events, considering dropouts from treatment as a negative event. However, reports on negative events were heterogeneous and largely unsystematic. CONCLUSIONS Research has given little attention to studies evaluating TBIs for aftercare and for bridging waiting periods in people with depression, even though TBIs are seen as highly promising in these application areas; thus, high quality studies are urgently needed. In addition, the variety of therapeutic rationales on TBIs has barely been represented by identified studies hindering the consideration of patient preferences when planning treatment. Finally, future studies should use specific guidelines to systematically assess and report negative events. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1136/bmjopen-2018-028042.
Collapse
Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Mareike Dreier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tharanya Seeralan
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, Ulm University, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
35
|
Berger T, Bur O, Krieger T. [Internet-based psychotherapeutic interventions]. FORTSCHRITTE DER NEUROLOGIE-PSYCHIATRIE 2020; 88:677-689. [PMID: 33049789 DOI: 10.1055/a-1165-7496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Over the past few years, research and application of internet-based psychotherapeutic interventions has grown rapidly. This kind of new therapeutic format offers a variety of chances for treating patients with psychotherapeutic disorders, but also arouses skepticism and concerns. This overview focuses on different forms of internet-based psychotherapeutic interventions, reflects the current state of research, and points out new areas of development as well as its implementation in daily practice.
Collapse
|
36
|
Köhnen M, Kriston L, Härter M, Baumeister H, Liebherz S. Effectiveness and acceptance of technology-based psychological interventions for the acute treatment of unipolar depression: a systematic review and meta-analysis (Preprint). J Med Internet Res 2020; 23:e24584. [PMID: 36260395 PMCID: PMC8386371 DOI: 10.2196/24584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 02/08/2021] [Accepted: 04/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background Evidence on technology-based psychological interventions (TBIs) for the acute treatment of depression is rapidly growing. Despite extensive research in this field, there is a lack of research determining effectiveness and acceptance of TBIs considering different application formats in people with a formally diagnosed depressive disorder. Objective The goal of the review was to investigate the effectiveness and acceptance of TBIs in people with diagnosed depression with particular focus on application formats (stand-alone interventions, blended treatments, collaborative and/or stepped care interventions). Methods Studies investigating adults with diagnosed unipolar depressive disorders receiving any kind of psychotherapeutic treatment delivered (at least partly) by a technical medium and conducted as randomized controlled trials (RCTs) were eligible for inclusion. We searched CENTRAL (Cochrane Central Register of Controlled Trials; August 2020), MEDLINE, PsycINFO, PSYNDEX, CINAHL (January 2018), clinical trial registers, and sources of grey literature (January 2019). Two independent authors decided about study inclusion and extracted data. We performed random effects meta-analyses to synthesize the data. Results Database searches resulted in 15,546 records of which 78 completed studies were included. TBIs delivered as stand-alone interventions showed positive effects on posttreatment depression severity when compared to treatment as usual (SMD –0.44, 95% CI –0.73 to –0.15, k=10; I²=86%), attention placebo (SMD –0.51, 95% CI –0.73 to –0.30; k=12; I²=66%), and waitlist controls (SMD –1.01, 95% CI –1.23 to –0.79; k=19; I²=73%). Superior long-term effects on depression severity were shown when TBIs were compared to treatment as usual (SMD –0.24, 95% CI –0.41 to –0.07; k=6; I²=48%) attention placebo (SMD –0.23, 95% CI –0.40 to –0.07; k=7; I²=21%) and waitlist controls (SMD –0.74, 95% CI –1.31 to –0.18; k=3; I²=79%). TBIs delivered as blended treatments (providing a TBI as an add-on to face-to-face treatment) yielded beneficial effects on posttreatment depression severity (SMD –0.27, 95% CI –0.48 to –0.05; k=8; I²=53%) compared to face-to-face treatments only. Additionally, TBIs delivered within collaborative care trials were more effective in reducing posttreatment (SMD –0.20, 95% CI –0.36 to –0.04; k=2; I²=0%) and long-term (SMD –0.23, 95% CI –0.39 to –0.07; k=2; I²=0%) depression severity than usual care. Dropout rates did not differ between the intervention and control groups in any comparison (all P≥.09). Conclusions We found that TBIs are effective not only when delivered as stand-alone interventions but also when they are delivered as blended treatments or in collaborative care trials for people with diagnosed depression. Our results may be useful to inform routine care, since we focused specifically on different application formats, formally diagnosed patients, and the long-term effectiveness of TBIs. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42016050413; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42016050413 International Registered Report Identifier (IRRID) RR2-10.1136/bmjopen-2018-028042
Collapse
Affiliation(s)
- Moritz Köhnen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Baumeister
- Department for Clinical Psychology and Psychotherapy, University of Ulm, Ulm, Germany
| | - Sarah Liebherz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
37
|
Schuster R, Topooco N, Keller A, Radvogin E, Laireiter AR. Advantages and disadvantages of online and blended therapy: Replication and extension of findings on psychotherapists' appraisals. Internet Interv 2020; 21:100326. [PMID: 32477885 PMCID: PMC7251770 DOI: 10.1016/j.invent.2020.100326] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/26/2022] Open
Abstract
Therapists hold a key role for the uptake of digital mental health interventions (DMHI) within regular care services but have demonstrated cautious attitudes towards such interventions. It is relevant to explore in detail what factors may positively influence therapists' perception when considering DMHI implementation within routine care. We recently assessed therapist views towards Internet-based and blended treatment in Austria (low implementation level). The present study aims at testing the reliability of previous findings, and moreover, it compares therapists' appraisals to a country with advanced DMHI implementation (Sweden). An online survey was conducted February through June of 2019. Respondents were recruited via email and social media. The survey assessed first-hand experience with Internet-based treatment (IT) and blended treatment (BT). To start, the survey presented a short informational video to half of the respondents, then assessed therapists' views on 17 advantages and 13 disadvantages of IT and BT on 6-point Likert scales. In total N = 300 therapists responded to the invitation, of which N = 165 provided full survey data (Germany 114/220, 52%; Sweden 51/80, 64%). German therapists rated the advantages of IT and BT as neutral (IT, M = 3.6; BT, M = 3.8) and to some extent agreed with disadvantages of IT (IT, M = 4.5; BT, M = 3.5). In comparison, Swedish therapists rated significantly greater advantages (IT, M = 4.6; BT, M = 4.5) and less disadvantages (IT, M = 3.2; BT, M = 2.8). Effect sizes ranged from d = 0.89 to d = 1.83; all P's < .001. Those with first-hand experience with DMHI reported more positive appraisals in both countries. No significant effect was found for exposure to the short informational video. The German sample represented essential characteristics of current German therapists; in comparison Swedish respondents skewed towards younger less experienced therapists (P's < .001). Those confounders accounted for a small non-significant proportion of variance (0.1-4.7%). We found that therapists considered blended treatment to have less disadvantages than Internet treatment, and that first-hand experience with DMHI, but not exposure to an acceptance facilitating video clip, predicted greater acceptability on individual level. The responses among German therapists closely resembled findings from our preceding study in Austria, indicating that reliable results can be achieved in small survey studies if sample and population parameters correspond. Swedish therapists held significantly more favorable attitudes towards both interventions. The comparison between countries, however, is limited by a number of potential confounding variables.
Collapse
Affiliation(s)
- Raphael Schuster
- Outpatient Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
- Center for mHealth, Palo Alto, CA, USA
| | - Antonia Keller
- Department of Psychology, University of Salzburg, Salzburg, Austria
| | - Ella Radvogin
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Anton-Rupert Laireiter
- Outpatient Center for Clinical Psychology, Psychotherapy and Health Psychology, Department of Psychology, University of Salzburg, Salzburg, Austria
- Faculty of Psychology, University of Vienna, Vienna, Austria
- Department of Psychology, University of Salzburg, Salzburg, Austria
| |
Collapse
|
38
|
Immediate and long-term effectiveness of adding an Internet intervention for depression to routine outpatient psychotherapy: Subgroup analysis of the EVIDENT trial. J Affect Disord 2020; 274:643-651. [PMID: 32663998 DOI: 10.1016/j.jad.2020.05.122] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 04/27/2020] [Accepted: 05/17/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To examine immediate and long-term effectiveness of an adjunctive Internet intervention for depression in a large sample of patients undergoing routine psychotherapy. METHOD The current study evaluated a subgroup of patients from the Evident trial, a randomized investigation of a 12-week minimally guided Internet intervention (Deprexis) for the treatment of mild to moderate depression. 340 adults (mean age = 43.3 years; 71.7 % female) of the original sample received routine outpatient psychotherapy during the trial period, resulting in a standard psychotherapy group (n = 174) and an augmented therapy group (n = 166). Outcomes were assessed at baseline, post-treatment and 6-month follow-up. RESULTS Intention-to-treat analyses indicated that combined treatment led to a greater reduction in symptoms of depression (effect size d = 0.32; p = .002), improved therapeutic progress (d = 0.36; p = .003), and higher mental health-related quality of life (d = 0.34; p = .004). There was no intervention effect on physical health-related quality of life. The same pattern was found at 6-month follow-up, and adjunctive treatment also resulted in increased rates of clinical improvement. Treatment success was independent from therapeutic orientation of combined face-to-face therapy. CONCLUSION Results indicate that the adjunctive use of the investigated intervention can produce additional and lasting effects in routine outpatient psychotherapy for mild to moderate levels of depression. The study adds to the ongoing evidence on augmented effects of blended treatment. Future studies should investigate different types of blends in diverse populations by means of change-sensitive assessment strategies.
Collapse
|
39
|
Leung LB, Dyer KE, Yano EM, Young AS, Rubenstein LV, Hamilton AB. Collaborative care clinician perceptions of computerized cognitive behavioral therapy for depression in primary care. Transl Behav Med 2020; 10:565-572. [PMID: 32766864 PMCID: PMC8018828 DOI: 10.1093/tbm/ibz122] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In Veterans Health Administration's (VA) Primary Care-Mental Health Integration (PC-MHI) models, primary care providers, care managers, and mental health clinicians collaboratively provide depression care. Primary care patients, however, still lack timely, sufficient access to psychotherapy treatment. Adapting PC-MHI collaborative care to improve uptake of evidence-based computerized cognitive behavioral therapy (cCBT) may be a potential solution. Understanding primary care-based mental health clinician perspectives is crucial for facilitating adoption of cCBT as part of collaborative depression care. We examined PC-MHI mental health clinicians' perspectives on adapting collaborative care models to support cCBT for VA primary care patients. We conducted 16 semi-structured interviews with PC-MHI nurse care managers, licensed social workers, psychologists, and psychiatrists in one VA health-care system. Interviews were audio-recorded, transcribed, coded using the constant comparative method, and analyzed for overarching themes. Although cCBT awareness and knowledge were not widespread, participants were highly accepting of enhancing PC-MHI models with cCBT for depression treatment. Participants supported cCBT delivery by a PC-MHI care manager or clinician and saw it as an additional tool to engage patients, particularly younger Veterans, in mental health treatment. They commented that current VA PC-MHI models did not facilitate, and had barriers to, use of online and mobile treatments. If effectively implemented, however, respondents thought it had potential to increase the number of patients they could treat. There is widespread interest in modernizing health systems. VA PC-MHI mental health clinicians appear open to adapting collaborative care to increase uptake of cCBT to improve psychotherapy access.
Collapse
Affiliation(s)
- Lucinda B Leung
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Karen E Dyer
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Elizabeth M Yano
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA
| | - Alexander S Young
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- VA VISN 22 Mental Illness Research, Education, and Clinical Center, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Lisa V Rubenstein
- Division of General Internal Medicine and Health Services Research, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
- RAND Corporation, Santa Monica, CA, USA
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| |
Collapse
|
40
|
Dimensionality of the system usability scale among professionals using internet-based interventions for depression: a confirmatory factor analysis. BMC Psychiatry 2020; 20:218. [PMID: 32398111 PMCID: PMC7216472 DOI: 10.1186/s12888-020-02627-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 04/27/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The System Usability Scale (SUS) is used to measure usability of internet-based Cognitive Behavioural Therapy (iCBT). However, whether the SUS is a valid instrument to measure usability in this context is unclear. The aim of this study is to assess the factor structure of the SUS, measuring usability of iCBT for depression in a sample of professionals. In addition, the psychometric properties (reliability, convergent validity) of the SUS were tested. METHODS A sample of 242 professionals using iCBT for depression from 6 European countries completed the SUS. Confirmatory Factor Analysis (CFA) was conducted to test whether a one-factor, two-factor, tone-model or bi-direct model would fit the data best. Reliability was assessed using complementary statistical indices (e.g. omega). To assess convergent validity, the SUS total score was correlated with an adapted Client Satisfaction Questionnaire (CSQ-3). RESULTS CFA supported the one-factor, two-factor and tone-model, but the bi-factor model fitted the data best (Comparative Fit Index = 0.992, Tucker Lewis Index = 0.985, Root Mean Square Error of Approximation = 0.055, Standardized Root Mean Square Residual = 0.042 (respectively χ2diff (9) = 69.82, p < 0.001; χ2diff (8) = 33.04, p < 0.001). Reliability of the SUS was good (ω = 0.91). The total SUS score correlated moderately with the CSQ-3 (CSQ1 rs = .49, p < 0.001; CSQ2 rs = .46, p < 0.001; CSQ3 rs = .38, p < 0.001), indicating convergent validity. CONCLUSIONS Although the SUS seems to have a multidimensional structure, the best model showed that the total sumscore of the SUS appears to be a valid and interpretable measure to assess the usability of internet-based interventions when used by professionals in mental healthcare.
Collapse
|
41
|
Wright JH, Mishkind M. Computer-Assisted CBT and Mobile Apps for Depression: Assessment and Integration Into Clinical Care. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:162-168. [PMID: 33162853 DOI: 10.1176/appi.focus.20190044] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
A surge in the development of computer-assisted cognitive-behavioral therapy (CCBT) and mobile apps for depression has provided many tools with potential for enhancing treatment delivery. This article assesses progress in evaluation and implementation of CCBT and mobile apps for depression, with a focus on providing practical information on clinical applications. Advantage and disadvantages of these technologies are identified, outcome research is reviewed, and recommendations are made for clinical use. With increasing use of computer technology in everyday life, it is likely that clinicians and patients will pursue opportunities to employ computer tools in treatment for depression.
Collapse
Affiliation(s)
- Jesse H Wright
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky (Wright); Johnson Depression Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora (Mishkind)
| | - Matthew Mishkind
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, Kentucky (Wright); Johnson Depression Center, Department of Family Medicine, University of Colorado School of Medicine, Aurora (Mishkind)
| |
Collapse
|
42
|
Abstract
BACKGROUND Depression and post-traumatic stress disorder (PTSD) are leading causes of disability and loss of life by suicide. Currently, there are less than satisfactory medical solutions to treat these mental disorders. Here, we explore recent preclinical and clinical studies demonstrating the potential of using buprenorphine to treat major depressive disorder, treatment-resistant depression, and PTSD. METHOD Bibliographic databases were searched to include preclinical and clinical studies demonstrating the therapeutic potential of buprenorphine and the involvement of the kappa opioid receptor (KOR) in mediating these effects. RESULTS Original clinical studies examining the effectiveness of buprenorphine to treat depression were mixed. The majority of participants in the PTSD studies were males and suffer from chronic pain and/or substance use disorders. Nonetheless, these recent studies and analyses established proof of concept warranting farther investigations. Additionally, KOR likely mediates the antidepressant and some of the anxiolytic effects of buprenorphine. Still, it appears that the full spectrum of buprenorphine's beneficial effects might be due to activity at other opioid receptors as well. CONCLUSIONS Pharmaceuticals' abilities to treat medical conditions directly relates to their ability to act upon the endogenous biological systems related to the conditions. Thus, these recent findings are likely a reflection of the central role that the endogenous opioid system has in these mental illnesses. Further studies are necessary to study the involvement of endogenous opioid systems, and specifically KOR, in mediating buprenorphine's beneficial effects and the ability to treat these medical conditions while minimizing risks for misuse and diversion.
Collapse
Affiliation(s)
- Caitlin A Madison
- Behavioral and Cellular Neuroscience, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX77843, USA
| | - Shoshana Eitan
- Behavioral and Cellular Neuroscience, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX77843, USA
| |
Collapse
|
43
|
Challenges of Mood Disorders Care. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2020; 18:205-207. [PMID: 33162860 PMCID: PMC7587890 DOI: 10.1176/appi.focus.18202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
|
44
|
Friedl N, Krieger T, Chevreul K, Hazo JB, Holtzmann J, Hoogendoorn M, Kleiboer A, Mathiasen K, Urech A, Riper H, Berger T. Using the Personalized Advantage Index for Individual Treatment Allocation to Blended Treatment or Treatment as Usual for Depression in Secondary Care. J Clin Med 2020; 9:jcm9020490. [PMID: 32054084 PMCID: PMC7073663 DOI: 10.3390/jcm9020490] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/02/2023] Open
Abstract
A variety of effective psychotherapies for depression are available, but patients who suffer from depression vary in their treatment response. Combining face-to-face therapies with internet-based elements in the sense of blended treatment is a new approach to treatment for depression. The goal of this study was to answer the following research questions: (1) What are the most important predictors determining optimal treatment allocation to treatment as usual or blended treatment? and (2) Would model-determined treatment allocation using this predictive information and the personalized advantage index (PAI)-approach result in better treatment outcomes? Bayesian model averaging (BMA) was applied to the data of a randomized controlled trial (RCT) comparing the efficacy of treatment as usual and blended treatment in depressive outpatients. Pre-treatment symptomatology and treatment expectancy predicted outcomes irrespective of treatment condition, whereas different prescriptive predictors were found. A PAI of 2.33 PHQ-9 points was found, meaning that patients who would have received the treatment that is optimal for them would have had a post-treatment PHQ-9 score that is two points lower than if they had received the treatment that is suboptimal for them. For 29% of the sample, the PAI was five or greater, which means that a substantial difference between the two treatments was predicted. The use of the PAI approach for clinical practice must be further confirmed in prospective research; the current study supports the identification of specific interventions favorable for specific patients.
Collapse
Affiliation(s)
- Nadine Friedl
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
- Correspondence:
| | - Tobias Krieger
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
| | - Karine Chevreul
- URC Eco Ile-de-France (AP-HP), Hotel Dieu, 1, Place du Parvis Notre Dame, 75004 Paris, France
| | - Jean Baptiste Hazo
- Eceve, Unit 1123, Inserm, University of Paris, Health Economics Research Unit, Assistance Publique-Hôpitaux de Paris, 75004 Paris, France
| | - Jérôme Holtzmann
- University Hospital Grenoble Alpes, Mood Disorders and Emotional Pathologies Unit, Pôle de Psychiatrie, Neurologie et Rééducation Neurologique, 38043 Grenoble, France
| | - Mark Hoogendoorn
- Department of Computer Science, VU University Amsterdam Faculty of Sciences, De Boelelaan 1081m, 1081 HV Amsterdam, The Netherlands
| | - Annet Kleiboer
- Section Clinical Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam and EMGO+ Institute for Health Care and Research, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands
| | - Kim Mathiasen
- Department of Psychology, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense M, Denmark
- Center of Telepsychiatry, University of Southern Denmark, 5000 Odense, Denmark
| | - Antoine Urech
- INSELSPITAL, University Hospital Bern, University Clinic for Neurology, University Acute-Neurorehabilitation Center, 3010 Bern, Switzerland
| | - Heleen Riper
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
- Department of Clinical, Neuro-and Developmental Psychology and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Thomas Berger
- Department of Clinical Psychology, University of Bern, 3012 Bern, Switzerland
| |
Collapse
|
45
|
Kooistra L, Ruwaard J, Wiersma J, van Oppen P, Riper H. Working Alliance in Blended Versus Face-to-Face Cognitive Behavioral Treatment for Patients with Depression in Specialized Mental Health Care. J Clin Med 2020; 9:jcm9020347. [PMID: 32012722 PMCID: PMC7073833 DOI: 10.3390/jcm9020347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 12/24/2022] Open
Abstract
This study investigates working alliance in blended cognitive behavioral therapy (bCBT) for depressed adults in specialized mental health care. Patients were randomly allocated to bCBT (n = 47) or face-to-face CBT (n = 45). After 10 weeks of treatment, both patients and therapists in the two groups rated the therapeutic alliance on the Working Alliance Inventory Short-Form Revised (WAI-SR; Task, Bond, Goal, and composite scores). No between-group differences were found in relation to either patient or therapist alliance ratings, which were high in both groups. In the full sample, a moderate positive association was found between patient and therapist ratings on Task (ρ = 0.41, 95% CI 0.20; 0.59), but no significant associations emerged on other components or composite scores. At 30 weeks, within-and between-group associations between alliance and changes in depression severity (QIDS, Quick Inventory of Depressive Symptomatology) were analyzed with linear mixed models. The analyses revealed an association between depression over time, patient-rated alliance, and group (p < 0.001). In face-to-face CBT, but not in bCBT, lower depression scores were associated with higher alliance ratings. The online component in bCBT may have led patients to evaluate the working alliance differently from patients receiving face-to-face CBT only.
Collapse
Affiliation(s)
- Lisa Kooistra
- Department of Clinical, Neuro-and Developmental Psychology and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Correspondence:
| | - Jeroen Ruwaard
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Jenneke Wiersma
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
| | - Patricia van Oppen
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro-and Developmental Psychology and the Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- Department of Research and Innovation, GGZ inGeest Specialized Mental Health Care, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands; (J.W.); (P.v.O.)
- Department of Psychiatry and the Amsterdam Public Health Research Institute, GGZ inGeest/Amsterdam UMC, Vrije Universiteit, de Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
46
|
Thase ME, McCrone P, Barrett MS, Eells TD, Wisniewski SR, Balasubramani GK, Brown GK, Wright JH. Improving Cost-effectiveness and Access to Cognitive Behavior Therapy for Depression: Providing Remote-Ready, Computer-Assisted Psychotherapy in Times of Crisis and Beyond. PSYCHOTHERAPY AND PSYCHOSOMATICS 2020; 89:307-313. [PMID: 32396917 PMCID: PMC7483890 DOI: 10.1159/000508143] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 04/16/2020] [Indexed: 12/26/2022]
Abstract
INTRODUCTION There is growing evidence that computer-delivered or computer-assisted forms of cognitive behavior therapy (CCBT) are helpful, but cost-effectiveness versus standard therapies is not well established. OBJECTIVE To evaluate the cost-effectiveness of a therapist-supported method for CCBT in comparison to standard cognitive behavior therapy (CBT). METHODS A total of 154 drug-free major depressive disorder outpatients were randomly assigned to either 16 weeks of standard CBT (up to twenty 50-min sessions) or CCBT using the Good Days Ahead program (including up to 5.5 h of therapist contact). Outcomes were assessed at baseline, weeks 8 and 16, and at 3 and 6 months post-treatment. Economic analyses took into account the costs of services received and work/social role impairment. RESULTS In the context of almost identical efficacy, a form of CCBT that used only about one third the amount of therapist contact as conventional CBT was highly cost-effective compared to conventional therapy and reduced the adjusted cost of treatment by USD 945 per patient. CONCLUSIONS A method of CCBT that blended internet-delivered modules and abbreviated therapeutic contact reduced the cost of treatment substantially without adversely affecting outcomes. Results suggest that use of this approach can more than double the access to CBT. Because clinician support in CCBT can be provided by telephone, videoconference, and/or email, this highly efficient form of treatment could be a major advance in remote treatment delivery.
Collapse
Affiliation(s)
- Michael E. Thase
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA,Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | | | - Marna S. Barrett
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA
| | | | | | | | - Gregory K. Brown
- Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA,Corporal Michael J Crescenz Veterans Affairs Medical Center, Philadelphia, PA
| | | |
Collapse
|
47
|
Mol M, van Genugten C, Dozeman E, van Schaik DJF, Draisma S, Riper H, Smit JH. Why Uptake of Blended Internet-Based Interventions for Depression Is Challenging: A Qualitative Study on Therapists' Perspectives. J Clin Med 2019; 9:E91. [PMID: 31905834 PMCID: PMC7019532 DOI: 10.3390/jcm9010091] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 12/10/2019] [Accepted: 12/20/2019] [Indexed: 02/06/2023] Open
Abstract
(1) Background: Blended cognitive behavioral therapy (bCBT; online and face-to-face sessions) seems a promising alternative alongside regular face-to-face CBT depression treatment in specialized mental health care organizations. Therapists are key in the uptake of bCBT. This study focuses on therapists' perspectives on usability, satisfaction, and factors that promote or hinder the use of bCBT in routine practice; (2) Methods: Three focus groups (n = 8, n = 7, n = 6) and semi-structured in-depth interviews (n = 15) were held throughout the Netherlands. Beforehand, the participating therapists (n = 36) completed online questionnaires on usability and satisfaction. Interviews were analyzed by thematic analysis; (3) Results: Therapists found the usability sufficient and were generally satisfied with providing bCBT. The thematic analysis showed three main themes on promoting and hindering factors: (1) therapists' needs regarding bCBT uptake, (2) therapists' role in motivating patients for bCBT, and (3) therapists' experiences with bCBT; (4) Conclusions: Overall, therapists were positive; bCBT can be offered by all CBT-trained therapists and future higher uptake is expected. Especially the pre-set structure of bCBT was found beneficial for both therapists and patients. Nevertheless, therapists did not experience promised time-savings-rather, the opposite. Besides, there are still teething problems and therapeutic shortcomings that need improvement in order to motivate therapists to use bCBT.
Collapse
Affiliation(s)
- Mayke Mol
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Claire van Genugten
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Els Dozeman
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Digna J. F. van Schaik
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Stasja Draisma
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| | - Heleen Riper
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam and the Amsterdam Public Health Research Institute, 1081 Amsterdam, The Netherlands
- Telepsychiatry and E-Mental Health, Department of Clinical Research, University of Southern Denmark, 5000 Odense, Denmark
| | - Jan H. Smit
- Department of Research and Innovation, GGZ inGeest, Specialized Mental Health Care, 1081 Amsterdam, The Netherlands; (C.v.G.); (E.D.); (D.J.F.v.S.); (S.D.); (H.R.); (J.H.S.)
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, 1081 Amsterdam, The Netherlands
| |
Collapse
|
48
|
Moore JR, Caudill R. The Bot Will See You Now: A History and Review of Interactive Computerized Mental Health Programs. Psychiatr Clin North Am 2019; 42:627-634. [PMID: 31672212 DOI: 10.1016/j.psc.2019.08.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The goal of automating complex human activities dates to antiquity. The mental health field has also made use of advances in technology to assist patients in need. Artificial Intelligence (AI) is the study of agents that receive percepts from the environment and perform actions. AI is increasingly being incorporated into the development of chatbots that can be deployed in both clinical and nonclinical settings. Chatbots are a computer program that simulates human conversation through voice commands or text chats or both. The collaboration between AI therapists and more traditional providers of such care will only grow.
Collapse
Affiliation(s)
- Joshua R Moore
- Department of Psychiatry and Behavioral Sciences, University of Louisville, School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY 40202, USA
| | - Robert Caudill
- Department of Psychiatry and Behavioral Sciences, University of Louisville, School of Medicine, 401 East Chestnut Street, Suite 610, Louisville, KY 40202, USA.
| |
Collapse
|
49
|
Topooco N, Byléhn S, Dahlström Nysäter E, Holmlund J, Lindegaard J, Johansson S, Åberg L, Bergman Nordgren L, Zetterqvist M, Andersson G. Evaluating the Efficacy of Internet-Delivered Cognitive Behavioral Therapy Blended With Synchronous Chat Sessions to Treat Adolescent Depression: Randomized Controlled Trial. J Med Internet Res 2019; 21:e13393. [PMID: 31682572 PMCID: PMC6858617 DOI: 10.2196/13393] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/17/2019] [Accepted: 07/28/2019] [Indexed: 01/17/2023] Open
Abstract
Background Depression is a common and serious problem among adolescents, but few seek or have access to therapy. Internet-delivered cognitive behavioral therapies (ICBTs), developed to increase treatment access, show promise in reducing depression. The inclusion of coach support in treatment is desired and may be needed. Objective The aim of this study was to determine the efficacy of an ICBT protocol blended with weekly real-time therapist sessions via chat; blended treatment, for adolescent depression, including major depressive episode (MDE). The protocol has previously been evaluated in a controlled study. Methods In a two-arm randomized controlled trial, adolescents 15 to 19 years of age were recruited through a community setting at the national level in Sweden (n=70) and allocated to either 8 weeks of treatment or to minimal attention control. Depression was assessed at baseline, at posttreatment, and at 12 months following treatment (in the intervention group). The primary outcome was self-reported depression level as measured with the Beck Depression Inventory II at posttreatment. The intervention was offered without the need for parental consent. Results Over two weeks, 162 adolescents registered and completed the baseline screening. Eligible participants (n=70) were on average 17.5 years of age (SD 1.15), female (96%, 67/70), suffered from MDE (76%, 53/70), had no previous treatment experience (64%, 45/70), and reported guardian(s) to be aware about their depression state (71%, 50/70). The average intervention completion was 74% (11.8 of 16 modules and sessions). Following the treatment, ICBT participants demonstrated a significant decrease in depression symptoms compared with controls (P<.001), corresponding to a large between-group effect (intention-to-treat analysis: d=0.86, 95% CI 0.37-1.35; of completer analysis: d=0.99, 95% CI 0.48-1.51). A significant between-group effect was observed in the secondary depression outcome (P=.003); clinically significant improvement was found in 46% (16/35) of ICBT participants compared with 11% (4/35) in the control group (P=.001). Conclusions The results are in line with our previous study, further demonstrating that adolescents with depression can successfully be engaged in and experience significant improvement following ICBT blended with therapist chat sessions. Findings on participants’ age and baseline depression severity are of interest in relation to used study methods. Trial Registration ClinicalTrials.gov NCT02363205; https://clinicaltrials.gov/ct2/show/NCT02363205
Collapse
Affiliation(s)
- Naira Topooco
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Center for m2Health, Palo Alto, CA, United States
| | - Sandra Byléhn
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | | | - Jenny Holmlund
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Johanna Lindegaard
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Sanna Johansson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Linnea Åberg
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Lise Bergman Nordgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maria Zetterqvist
- Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.,Department of Child and Adolescent Psychiatry, Region Östergötland, Linköping, Sweden
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
50
|
Kooistra LC, Wiersma JE, Ruwaard J, Neijenhuijs K, Lokkerbol J, van Oppen P, Smit F, Riper H. Cost and Effectiveness of Blended Versus Standard Cognitive Behavioral Therapy for Outpatients With Depression in Routine Specialized Mental Health Care: Pilot Randomized Controlled Trial. J Med Internet Res 2019; 21:e14261. [PMID: 31663855 PMCID: PMC6914243 DOI: 10.2196/14261] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/25/2019] [Accepted: 08/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Cognitive behavioral therapy (CBT) is an effective treatment, but access is often restricted due to costs and limited availability of trained therapists. Blending online and face-to-face CBT for depression might improve cost-effectiveness and treatment availability. OBJECTIVE This pilot study aimed to examine the costs and effectiveness of blended CBT compared with standard CBT for depressed patients in specialized mental health care to guide further research and development of blended CBT. METHODS Patients were randomly allocated to blended CBT (n=53) or standard CBT (n=49). Blended CBT consisted of 10 weekly face-to-face sessions and 9 Web-based sessions. Standard CBT consisted of 15 to 20 weekly face-to-face sessions. At baseline and 10, 20, and 30 weeks after start of treatment, self-assessed depression severity, quality-adjusted life-years (QALYs), and costs were measured. Clinicians, blinded to treatment allocation, assessed psychopathology at all time points. Data were analyzed using linear mixed models. Uncertainty intervals around cost and effect estimates were estimated with 5000 Monte Carlo simulations. RESULTS Blended CBT treatment duration was mean 19.0 (SD 12.6) weeks versus mean 33.2 (SD 23.0) weeks in standard CBT (P<.001). No significant differences were found between groups for depressive episodes (risk difference [RD] 0.06, 95% CI -0.05 to 0.19), response to treatment (RD 0.03, 95% CI -0.10 to 0.15), and QALYs (mean difference 0.01, 95% CI -0.03 to 0.04). Mean societal costs for blended CBT were €1183 higher than standard CBT. This difference was not significant (95% CI -399 to 2765). Blended CBT had a probability of being cost-effective compared with standard CBT of 0.02 per extra QALY and 0.37 for an additional treatment response, at a ceiling ratio of €25,000. For health care providers, mean costs for blended CBT were €176 lower than standard CBT. This difference was not significant (95% CI -659 to 343). At €0 per additional unit of effect, the probability of blended CBT being cost-effective compared with standard CBT was 0.75. The probability increased to 0.88 at a ceiling ratio of €5000 for an added treatment response, and to 0.85 at €10,000 per QALY gained. For avoiding new depressive episodes, blended CBT was deemed not cost-effective compared with standard CBT because the increase in costs was associated with negative effects. CONCLUSIONS This pilot study shows that blended CBT might be a promising way to engage depressed patients in specialized mental health care. Compared with standard CBT, blended CBT was not considered cost-effective from a societal perspective but had an acceptable probability of being cost-effective from the health care provider perspective. Results should be carefully interpreted due to the small sample size. Further research in larger replication studies focused on optimizing the clinical effects of blended CBT and its budget impact is warranted. TRIAL REGISTRATION Netherlands Trial Register NTR4650; https://www.trialregister.nl/trial/4408. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s12888-014-0290-z.
Collapse
Affiliation(s)
- Lisa Catharine Kooistra
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Jenneke Elize Wiersma
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Jeroen Ruwaard
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Koen Neijenhuijs
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Cancer Center Amsterdam, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Joran Lokkerbol
- Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands
| | - Patricia van Oppen
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Department of Psychiatry, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Filip Smit
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Center of Economic Evaluation, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| | - Heleen Riper
- Department of Clinical, Neuro and Developmental Psychology, Clinical Psychology Section, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
- Department of Research and Innovation, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Amsterdam Public Health Research Institute, Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
- Department of Psychiatry, GGZ in Geest/Amsterdam University Medical Center, VU University Medical Center, Amsterdam, Netherlands
| |
Collapse
|