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Camacho E, Chang SM, Currey D, Torous J. The impact of guided versus supportive coaching on mental health app engagement and clinical outcomes. Health Informatics J 2023; 29:14604582231215872. [PMID: 38112116 DOI: 10.1177/14604582231215872] [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] [Indexed: 12/20/2023]
Abstract
Although mobile mental health apps have the unique potential to increase access to care, evidence reveals engagement is low unless coupled with coaching. However, most coaching protocols are limited in their scalability. This study assesses how human support and guidance from a Digital Navigator (DN), a scalable coach, can impact mental health app engagement and effectiveness on anxiety and depressive symptoms. This study aims to detach components of coaching, specifically personalized recommendations versus general support, to inform scalability of coaching models for mental health apps. 156 participants were split into the DN Guide versus DN Support groups for the 6-week study. Both groups utilized the mindLAMP app for the duration of the study and had equal time with the DN, but the Guide group received personalized app recommendations. The Guide group completed significantly more activities than the Support group. 34% (49/139) of all participants saw a 25% decrease in PHQ-9 scores and 38% (53/141) saw a 25% decrease in GAD-7 scores. These findings show mental health apps, especially when supported by DNs, can reduce depression and anxiety symptoms when coupled with coaching, suggesting a feasible path for large-scale deployment.
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Affiliation(s)
- Erica Camacho
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sarah M Chang
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Danielle Currey
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - John Torous
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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2
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Duffy D, Richards D, Earley C, Timulak L. Implementing internet-delivered cognitive behavioral therapy in healthcare services: a qualitative exploration of stakeholder experience. Front Digit Health 2023; 5:1139125. [PMID: 37822855 PMCID: PMC10562631 DOI: 10.3389/fdgth.2023.1139125] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 09/11/2023] [Indexed: 10/13/2023] Open
Abstract
Background This study consisted of a qualitative exploration of stakeholder experience regarding the implementation of internet-delivered cognitive behavioral therapy (iCBT) as part of routine service provision within the UK's Improving Access to Psychological Therapies program. Methods Stakeholder groups included service providers (n = 6), commercial iCBT representatives (n = 6) and patients who received a course of iCBT as part of treatment at the service (n = 7). Participants took part in a semi-structured interview over the telephone, and subsequent data were qualitatively analyzed using the descriptive-interpretive approach. Results Service providers highlighted the importance of effective leadership and management, training initiatives, the provision of feedback to commercial iCBT representatives and creating work structures around iCBT to facilitate iCBT supporting staff in their use of it. Commercial iCBT representatives similarly reported the importance of training clinicians in iCBT use, identifying the appropriate individuals at all levels of the service to drive iCBT implementation, and the importance of being responsive to any problems or needs that arise from the service. Patients reported an overall positive experience of receiving iCBT but highlighted a need for more information from their supporter and the intervention to better structure their usage. Contextual factors, in terms of barriers and facilitators, were also highlighted by service provider and commercial participants; citing negative clinician attitudes and technological issues/bugs as barriers to implementation, and the exposure to iCBT created by COVID-19 and perseverance in using iCBT over time as facilitators. Discussion The findings contribute to a growing field of literature that seeks to understand the experience of relevant stakeholders who are involved with and contribute to iCBT implementation, including commercial iCBT representatives who, to our knowledge, have not been accounted for as part of published research to date.
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Affiliation(s)
- Daniel Duffy
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
- School of Psychology, Trinity College Dublin, Dublin, Ireland
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Bai P. Application and Mechanisms of Internet-Based Cognitive Behavioral Therapy (iCBT) in Improving Psychological State in Cancer Patients. J Cancer 2023; 14:1981-2000. [PMID: 37497400 PMCID: PMC10367931 DOI: 10.7150/jca.82632] [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: 01/13/2023] [Accepted: 04/18/2023] [Indexed: 07/28/2023] Open
Abstract
This review article is an overview of the effectiveness of internet-based cognitive behavioral therapy (iCBT) in Improving Psychological State in Cancer Patients. iCBT's effectiveness has been investigated in treating and managing conditions like depression, psychiatric disorders, generalized anxiety disorder (GAD), panic disorder, obsessive compulsive disorder (OCD), post-traumatic stress disorder (PTSD), adjustment disorder, bipolar disorder, chronic pain, and phobias. iCBT's role in the treatment of medical conditions such as diabetes mellitus with comorbid psychiatric illnesses was also explored. We conducted a thorough literature search using PubMed, Embase, Google Scholar, and Wanfang with no restrictions on the date. iCBT's role in treating and controlling psychiatric illnesses in cancer patients has been established in the literature. Development and popularization of iCBT, treament forms of iCBT, platforms for iCBT, application of iCBT, strategies and efficacy of iCBT for insomnia in cancer patients, current status of iCBT application, and genetic researches on iCBT for anxiety disorders were all reviewed and discussed in this review. From the data compiled, we conclude that iCBT is useful in treating or improving psychological state in cancer patients.
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Affiliation(s)
- Ping Bai
- Department of Operating Rooms, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, China
- Department of Operating Rooms, National Cancer Center/National Clinical Research Center for Cancer/Hebei Cancer Hospital, Chinese Academy of Medical Sciences, Langfang, 065001, China
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Schwarz J, Mauche N, Oehler C, Rummel-Kluge C, Hegerl U, Strauß M. ["iFightDepression" in inpatient treatment : Evaluation of a web-based, therapist-guided self-management program on a specialized ward for affective disorders]. DER NERVENARZT 2022; 93:459-467. [PMID: 34652484 PMCID: PMC9061691 DOI: 10.1007/s00115-021-01214-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/09/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND E‑mental health mainly plays a role in the outpatient treatment of patients with depressive disorders. The goal of this study was to implement and evaluate the web-based, therapist-guided self-management tool "iFightDepression" (iFD) to clarify if there is a benefit for inpatient use. MATERIAL AND METHODS In this study 78 inpatients with affective disorders (ICD-10 F32.0‑3, F33.0-3) or dysthymia (F34) were recruited. The intervention duration with the iFD tool went from admission until discharge, therapeutic support was granted by the ward staff. Symptom severity, intervention expectations and experience with therapy were processed in an online questionnaire before the intervention (T0) while intervention satisfaction was captured after the intervention shortly before discharge (T1) in a paper-pencil questionnaire. RESULTS Out of 78 participating inpatients 42 used the iFD tool at least once. Moderate to high levels of expectation regarding the iFD tool and mildly above-average level of satisfaction after the intervention were observed. Of the active users 67% indicated they would continue to use the iFD tool after discharge. The main reasons for not using the iFD tool were short duration of stay, severity of disease and lack of digital literacy. CONCLUSION An implementation of the iFD tool is feasible on principle. Active users gave positive feedback concerning the intervention and most participants claimed to continue using the iFD tool after discharge; however, low usage rates among study participants (42/78, 54%) showed barriers of implementation that have to be addressed and underline the importance of adaptations regarding the use of the intervention in a clinical setting.
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Affiliation(s)
- Julian Schwarz
- Department für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - Nicole Mauche
- Department für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | | | - Christine Rummel-Kluge
- Department für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Semmelweisstr. 10, 04103, Leipzig, Deutschland
| | - Ulrich Hegerl
- Senckenberg Professur, Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Goethe-Universität Frankfurt am Main, Frankfurt am Main, Deutschland
| | - Maria Strauß
- Department für Psychische Gesundheit, Klinik und Poliklinik für Psychiatrie und Psychotherapie, Universitätsklinikum Leipzig, AöR, Semmelweisstr. 10, 04103, Leipzig, Deutschland.
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5
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Zuelke AE, Luppa M, Löbner M, Pabst A, Schlapke C, Stein J, Riedel-Heller SG. Effectiveness and Feasibility of Internet-Based Interventions for Grief After Bereavement: Systematic Review and Meta-analysis. JMIR Ment Health 2021; 8:e29661. [PMID: 34889769 PMCID: PMC8701663 DOI: 10.2196/29661] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 08/23/2021] [Accepted: 08/23/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Although grief and its symptoms constitute a normal reaction to experiences of loss, some of those affected still report elevated levels of distress after an extended period, often termed complicated grief. Beneficial treatment effects of face-to-face therapies, for example, grief counseling or cognitive behavioral therapy against complicated grief, have been reported. Evaluations of internet- and mobile-based interventions targeting symptoms of grief in bereaved individuals with regard to objective quality criteria are currently lacking. OBJECTIVE We aim to conduct a systematic review and meta-analysis on the effectiveness and feasibility of internet- and mobile-based interventions against symptoms of grief after bereavement. METHODS We conducted systematic literature searches of randomized controlled trials or feasibility studies published before January 9, 2020, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, in PubMed, PsycINFO, Web of Science Core Collection, and the Cochrane Library. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations system. We further assessed aspects of feasibility and rated quality of interventions using criteria suggested by an expert panel on mental health care (German Association for Psychiatry, Psychotherapy, and Psychosomatics). A random-effects meta-analysis was conducted to assess between-group effect sizes. RESULTS In total, 9 trials (N=1349) were included. Of these, 7 studies were analyzed meta-analytically. Significant effects were found for symptoms of grief (g=0.54, 95% CI 0.32-0.77), depression (g=0.44, 95% CI 0.20-0.68), and posttraumatic stress (g=0.82, 95% CI 0.63-1.01). Heterogeneity was moderate for grief and depression (I2=48.75% and 55.19%, respectively) and low for posttraumatic stress symptoms (I2=0%). The overall quality of evidence was graded low (grief and depression) to moderate (posttraumatic stress). User satisfaction with the interventions was high, as was the quality of the interventions assessed using objective quality criteria. CONCLUSIONS Internet- or mobile-based interventions might constitute an effective treatment approach against symptoms of grief in bereaved adults. However, the small sample sizes and limited number of studies included in the review warrant further investigation. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42012002100; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=131428.
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Affiliation(s)
- Andrea E Zuelke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Christine Schlapke
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health (ISAP), Medical Faculty, University of Leipzig, Leipzig, Germany
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Rassy J, Bardon C, Dargis L, Côté LP, Corthésy-Blondin L, Mörch CM, Labelle R. Information and Communication Technology Use in Suicide Prevention: Scoping Review. J Med Internet Res 2021; 23:e25288. [PMID: 33820754 PMCID: PMC8132980 DOI: 10.2196/25288] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/10/2021] [Accepted: 03/16/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The use of information and communication technology (ICT) in suicide prevention has progressed rapidly over the past decade. ICT plays a major role in suicide prevention, but research on best and promising practices has been slow. OBJECTIVE This paper aims to explore the existing literature on ICT use in suicide prevention to answer the following question: what are the best and most promising ICT practices for suicide prevention? METHODS A scoping search was conducted using the following databases: PubMed, PsycINFO, Sociological Abstracts, and IEEE Xplore. These databases were searched for articles published between January 1, 2013, and December 31, 2018. The five stages of the scoping review process were as follows: identifying research questions; targeting relevant studies; selecting studies; charting data; and collating, summarizing, and reporting the results. The World Health Organization suicide prevention model was used according to the continuum of universal, selective, and indicated prevention. RESULTS Of the 3848 studies identified, 115 (2.99%) were selected. Of these, 10 regarded the use of ICT in universal suicide prevention, 53 referred to the use of ICT in selective suicide prevention, and 52 dealt with the use of ICT in indicated suicide prevention. CONCLUSIONS The use of ICT plays a major role in suicide prevention, and many promising programs were identified through this scoping review. However, large-scale evaluation studies are needed to further examine the effectiveness of these programs and strategies. In addition, safety and ethics protocols for ICT-based interventions are recommended.
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Affiliation(s)
- Jessica Rassy
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Research Center, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- School of Nursing, Université de Sherbrooke, Longueuil, QC, Canada
- Quebec Network on Nursing Intervention Research, Montréal, QC, Canada
| | - Cécile Bardon
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Luc Dargis
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
| | - Louis-Philippe Côté
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Laurent Corthésy-Blondin
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Carl-Maria Mörch
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Algora Lab, Université de Montréal, Montréal, QC, Canada
- Mila, Quebec Artificial Intelligence Institute, Montréal, QC, Canada
| | - Réal Labelle
- Center for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Montréal, QC, Canada
- Research Center, Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
- Department of Psychiatry, Université de Montréal, Montréal, QC, Canada
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Ezawa ID, Bartels GC, Strunk DR. Getting down to business: an examination of occupational outcomes in cognitive behavioral therapy for depression. Cogn Behav Ther 2021; 50:479-491. [PMID: 33544040 DOI: 10.1080/16506073.2021.1875039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Depression is associated with unemployment and poor occupational functioning. Although cognitive behavioral therapy (CBT) has been shown to reduce depressive symptoms, the degree to which it improves occupational outcomes has received little attention. We investigated change in job status and presenteeism (i.e., the inability to focus on and accomplish work) over the course of CBT. We assessed employment status, presenteeism, depressive symptoms, cognitive style, and CBT skills at intake and posttreatment in a sample of 126 participants enrolled in a 16-week course of CBT for depression. Employment status significantly improved from pre to posttreatment, with 11 of the 27 patients (41%) seeking to improve their employment status achieving this goal. Among the 59 consistently employed patients, presenteeism decreased significantly over the course of treatment (dz = 1.13). We also found, even after controlling for changes in symptoms, reductions in negative cognitive style (but not changes in CBT skills) were associated with reductions in presenteeism. Our findings suggest CBT patients experience positive changes in occupational outcomes, both in finding work and being more focused and productive at work. Changes in negative cognitive styles appeared to partly explain this latter change. We encourage future work examining CBT's impact on occupational outcomes.
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Affiliation(s)
- Iony D Ezawa
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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Rauen K, Vetter S, Eisele A, Biskup E, Delsignore A, Rufer M, Weidt S. Internet Cognitive Behavioral Therapy With or Without Face-to-Face Psychotherapy: A 12-Weeks Clinical Trial of Patients With Depression. Front Digit Health 2020; 2:4. [PMID: 34713017 PMCID: PMC8521970 DOI: 10.3389/fdgth.2020.00004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/30/2020] [Indexed: 12/15/2022] Open
Abstract
Depressive disorders are a curable, global health problem. However, most patients remain untreated, and more and more patients use internet-based interventions, but it is unclear whether it is beneficial for ongoing face-to-face psychotherapy. Thus, we compared the outcome of internet cognitive behavioral therapy (ICBT) with (ICBT+) or without (ICBT) additional face-to-face outpatient psychotherapy in adult patients with moderate to severe depressive disorder. For this longitudinal interventional clinical trial (NCT02112266), 168 of 252 online recruited adults with depressive symptoms received ICBT+ (n = 96) or ICBT (n = 72). Demographics (sex, age, age at first depressive episode, years of education, duration of depressive symptoms) were assessed and compared between groups. All patients underwent ICBT for 12 weeks. Quality of life (QoL) and severity of depressive symptoms were assessed within each group at three time points [baseline (T0), postinterventional after ICBT at 12 weeks (T1), and for follow-up at 6 months (T2)] using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) global score to assess QoL as primary and the Beck Depression Inventory (BDI-II) to assess self-rated depressive symptoms as secondary outcome variables, respectively. Differences were assessed between groups using t test and over time using repeated-measures analysis of variance. Data of intention-to-treat analysis are given as mean ± SD. Group differences were assumed at p < 0.05. Partial η2 is given as effect size. Demographic data, QoL, and depressive symptoms did not differ between groups (ICBT+/ICBT) at baseline (T0). Patients of both groups suffered from moderate to severe depressive disorders and gained improved QoL scores (WHOQOL-BREF-global: p < 0.001, η2 = 0.16), as well as experienced decreased depressive symptoms (BDI-II: p < 0.001, η2 = 0.2) after 12 weeks of ICBT compared to baseline. Patients without additional face-to-face outpatient psychotherapy lost QoL-albeit not significant-and had increased depressive symptoms (BDI: p = 0.02, η2 = 0.04) at 6 months' follow-up. Thus, ICBT is suitable for psychiatric treatment, although additional face-to-face outpatient psychotherapy helps stabilizing long-term outcome.
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Affiliation(s)
- Katrin Rauen
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Amanda Eisele
- Department of Geriatric Psychiatry, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland.,Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Ewelina Biskup
- Department of Advanced Biomedical Sciences, Frederico II University of Naples, Naples, Italy.,College of Fundamental Medicine, Shanghai University of Medicine and Health Sciences, Shanghai, China
| | - Aba Delsignore
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Steffi Weidt
- Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital Zurich, University of Zurich, Zurich, Switzerland
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Luppa M, Löbner M, Pabst A, Schlapke C, Stein J, Riedel-Heller SG. Effectiveness and feasibility of internet-based and mobile-based interventions for individuals experiencing bereavement: a systematic review protocol. BMJ Open 2020; 10:e036034. [PMID: 32327480 PMCID: PMC7204864 DOI: 10.1136/bmjopen-2019-036034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/28/2020] [Accepted: 03/20/2020] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Internet-based and mobile-based interventions (IMIs) provide an innovative and efficient self-management tool for mental health problems. This systematic review aims to summarise and critically evaluate studies addressing the effectiveness and feasibility of IMIs for normal and complicated grief in bereaved adults. METHODS AND ANALYSIS The databases MEDLINE, Cochrane Library, PsycINFO, Embase and Web of Science and Google Scholar (for 'grey' literature) will be systematically searched for feasibility studies or randomised controlled trials of IMIs for bereaved adults who were experiencing normal/complicated grief. Data will be extracted and evaluated independently by two reviewers from studies eligible for inclusion. Quality of evidence will be assessed, and results will be synthesised qualitatively and pooled meta-analytically, if sufficient outcome data are available. Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards and Grades of Recommendation, Assessment, Development and Evaluation methodology will be used. ETHICS AND DISSEMINATION No primary data will be collected; thus, ethical approval is not required. The results will be disseminated through a peer-reviewed publication and conference presentations. TRIAL REGISTRATION NUMBER CRD42019131428.
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Affiliation(s)
- Melanie Luppa
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Christine Schlapke
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
| | - Steffi G Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Faculty of Medicine, Leipzig, Sachsen, Germany
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Affiliation(s)
- Dean Ho
- The N.1 Institute for Health (N.1)National University of Singapore 117456 Singapore
- The Institute for Digital Medicine (WisDM)Yong Loo Lin School of MedicineNational University of Singapore 117597 Singapore
- Department of Biomedical EngineeringNUS EngineeringNational University of Singapore 117583 Singapore
- Department of PharmacologyYong Loo Lin School of MedicineNational University of Singapore 117600 Singapore
| | - Gavin Teo
- B Capital Group 94111 San Francisco
- Straits Venture Capital 169813 Singapore
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Thew GR. IAPT and the internet: the current and future role of therapist-guided internet interventions within routine care settings. COGNITIVE BEHAVIOUR THERAPIST 2020; 13:e4. [PMID: 34567240 PMCID: PMC8442601 DOI: 10.1017/s1754470x20000033] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/21/2019] [Accepted: 01/30/2020] [Indexed: 02/05/2023]
Abstract
Compared with the traditional face-to-face format, therapist-guided internet interventions offer a different approach to supporting clients in learning skills to manage and overcome mental health difficulties. Such interventions are already in use within IAPT (Improving Access to Psychological Therapies) and other routine care settings, but given their potential to deliver treatment more efficiently and therefore increase availability and access to evidence-based interventions, their use is likely to increase significantly over the coming years. This article outlines what is meant by therapist-guided internet interventions and why an online format is thought to be advantageous for clients, therapists, services, and communities more broadly. It reviews the current evidence in the context of common therapist beliefs about internet-based treatment. It aims to identify gaps where further research is required, particularly in relation to the broader implementation of these treatments in IAPT and other routine clinical services. Specifically, it emphasises the importance of choosing the right programmes, providing adequate therapist training in their use, and considering practical and organisational issues, all of which are likely to determine the success of implementation efforts. KEY LEARNING AIMS To understand what therapist-guided internet interventions are and their potential advantages.To understand the current evidence base for these interventions.To learn where further research is needed with regard to both the interventions themselves, and to their broader implementation in IAPT.
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Affiliation(s)
- Graham R. Thew
- Department of Experimental Psychology, University of Oxford, Oxford, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
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12
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Hadjistavropoulos HD, Peynenburg V, Mehta S, Adlam K, Nugent M, Gullickson KM, Titov N, Dear B. An Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Clients Referred and Funded by Insurance Companies Compared With Those Who Are Publicly Funded: Longitudinal Observational Study. JMIR Ment Health 2020; 7:e16005. [PMID: 32014840 PMCID: PMC7058169 DOI: 10.2196/16005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 11/25/2019] [Accepted: 12/15/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Anxiety and depression are leading causes of disability but are often undertreated. Internet-delivered cognitive behavioral therapy (ICBT) improves access to treatment by overcoming barriers to obtaining care. ICBT has been found to be efficacious in research trials and routine care, but there is limited research of ICBT when it is recommended and funded by insurance companies for clients on or recently in receipt of disability benefits or accommodations. OBJECTIVE The aim of this study was to examine ICBT engagement, treatment satisfaction, and effectiveness among individuals involved with 2 insurance companies. The 2 samples were benchmarked against published outcomes from a publicly funded (PF) ICBT clinic. METHODS Individuals who were on or recently in receipt of disability benefits and were either insurance company (IC) employees (n=21) or IC plan members (n=19) were referred to ICBT funded by the respective insurance companies. Outcomes were benchmarked against outcomes of ICBT obtained in a PF ICBT clinic, with clients in the clinic divided into those who reported no involvement with insurance companies (n=414) and those who were on short-term disability (n=44). All clients received the same 8-week, therapist-assisted, transdiagnostic ICBT course targeting anxiety and depression. Engagement was assessed using completion rates, log-ins, and emails exchanged. Treatment satisfaction was assessed posttreatment. Depression, anxiety, and disability measures were administered pretreatment, posttreatment, and at 3 months. RESULTS All samples showed high levels of ICBT engagement and treatment satisfaction. IC employees experienced significant improvement at posttreatment (depression d=0.77; anxiety d=1.13; and disability d=0.91) with outcomes maintained at 3 months. IC plan members, who notably had greater pretreatment disability than the other samples, experienced significant moderate effects at posttreatment (depression d=0.58; anxiety d=0.54; and disability d=0.60), but gains were not maintained at 3 months. Effect sizes at posttreatment in both IC samples were significantly smaller than in the PF sample who reported no insurance benefits (depression d=1.14 and anxiety d=1.30) and the PF sample who reported having short-term disability benefits (depression d=0.95 and anxiety d=1.07). No difference was seen in effect sizes among IC employees and the PF samples on disability. However, IC plan members experienced significantly smaller effects on disability d=0.60) compared with the PF sample with no disability benefits d=0.90) and those on short-term disability benefits d=0.94). CONCLUSIONS Many clients referred and funded by insurance companies were engaged with ICBT and found it acceptable and effective. Results, however, were not maintained among those with very high levels of pretreatment disability. Small sample sizes in the IC groups are a limitation. Directions for research related to ICBT funded by insurance companies have been described.
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Affiliation(s)
| | | | - Swati Mehta
- Department of Physical Medicine and Rehabilitation, Western University, London, ON, Canada
| | - Kelly Adlam
- Online Therapy Unit, University of Regina, Regina, SK, Canada
| | - Marcie Nugent
- Online Therapy Unit, University of Regina, Regina, SK, Canada
| | | | - Nickolai Titov
- MindSpot, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake Dear
- MindSpot, Department of Psychology, Macquarie University, Sydney, Australia
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Salamanca-Sanabria A, Richards D, Timulak L, Connell S, Mojica Perilla M, Parra-Villa Y, Castro-Camacho L. A Culturally Adapted Cognitive Behavioral Internet-Delivered Intervention for Depressive Symptoms: Randomized Controlled Trial. JMIR Ment Health 2020; 7:e13392. [PMID: 32003749 PMCID: PMC7055858 DOI: 10.2196/13392] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/24/2019] [Accepted: 08/07/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Internet-delivered treatments for depressive symptoms have proved to be successful in high-income Western countries. There may be potential for implementing such treatments in low- and middle-income countries such as Colombia, where access to mental health services is limited. OBJECTIVE The objective of this study was to assess the efficacy of a culturally adapted cognitive behavioral internet-delivered treatment for college students with depressive symptoms in Colombia. METHODS This was a randomized controlled trial with a 3-month follow-up. The program comprised seven modules. A total of 214 Colombian college students were recruited. They were assessed and randomly assigned to either the treatment group (n=107) or a waiting list (WL) control group (n=107). Participants received weekly support from a trained supporter. The primary outcome was symptoms of depression, as measured by the Patient Health Questionnaire - 9, and the secondary outcomes were anxiety symptoms assessed by the Generalized Anxiety Disorder questionnaire - 7. Other measures, including satisfaction with treatment, were evaluated after 7 weeks. RESULTS Research attrition and treatment dropouts were high in this study. On average, 7.6 sessions were completed per user. The mean time spent on the program was 3 hours and 18 min. The linear mixed model (LMM) showed significant effects after treatment (t197.54=-5.189; P<.001) for the treatment group, and these effects were maintained at the 3-month follow-up (t39.62=4.668; P<.001). Within-group results for the treatment group yielded a large effect size post treatment (d=1.44; P<.001), and this was maintained at the 3-month follow-up (d=1.81; P<.001). In addition, the LMM showed significant differences between the groups (t197.54=-5.189; P<.001). The results showed a large effect size between the groups (d=0.91; P<.001). In the treatment group, 76.0% (16/107) achieved a reliable change, compared with 32.0% (17/107) in the WL control group. The difference between groups was statistically significant (X22=10.5; P=.001). CONCLUSIONS This study was the first contribution to investigating the potential impact of a culturally adapted internet-delivered treatment on depressive symptoms for college students as compared with a WL control group in South America. Future research should focus on identifying variables associated both with premature dropout and treatment withdrawal at follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT03062215; https://clinicaltrials.gov/ct2/show/NCT03062215.
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Affiliation(s)
- Alicia Salamanca-Sanabria
- Trinity College Dublin, School of Psychology, E-mental Health Research Group, Dublin, Ireland.,SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | - Derek Richards
- Trinity College Dublin, School of Psychology, E-mental Health Research Group, Dublin, Ireland.,SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | - Ladislav Timulak
- Trinity College Dublin, School of Psychology, E-mental Health Research Group, Dublin, Ireland
| | - Sarah Connell
- SilverCloud Health, Clinical Research & Innovation, Dublin, Ireland
| | | | - Yamilena Parra-Villa
- Universidad Autonoma de Bucaramanga, School of Psychology, Bucaramanga, Colombia
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14
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Duffy D, Enrique A, Connell S, Connolly C, Richards D. Internet-Delivered Cognitive Behavior Therapy as a Prequel to Face-To-Face Therapy for Depression and Anxiety: A Naturalistic Observation. Front Psychiatry 2020; 10:902. [PMID: 31998149 PMCID: PMC6962244 DOI: 10.3389/fpsyt.2019.00902] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 11/14/2019] [Indexed: 01/16/2023] Open
Abstract
Background: The UK's Improving Access to Psychological Therapies (IAPT) program is a stepped-care model treating individuals with depression and anxiety disorders. Internet-delivered cognitive behavioral therapy (iCBT) is routinely offered to individuals with mild to moderate symptoms, but its applicability to individuals with severe clinical symptoms and requiring a high-intensity intervention is relatively unknown. The current study sought to investigate the potential impacts of using iCBT as a prequel for patients requiring high-intensity treatment (HIT; face-to-face) for depression and anxiety in IAPT. Methods: The study utilized an open study design. One hundred and twenty-four participants who were on a waiting list for high-intensity, face-to-face psychological treatment were offered iCBT. Psychometric data on symptoms of depression, anxiety, and functioning were collected from participants before starting and on finishing iCBT and at the point of service exit. Therapeutic alliance data were collected from patients and clinicians during treatment. Patient pathway data, such as number of treatment sessions and time in treatment, was also collected and incorporated into the analysis. Results: Significant reductions across primary outcome measures of depression and anxiety, as well as improved functioning, were observed from baseline to iCBT treatment exit, and from iCBT exit to service exit. Analysis of the therapeutic alliance data for patients and clinicians illustrated differences in outcome for those who dropped out and those who completed treatment. Discussion: This study illustrates the potential for using iCBT as a prequel to high-intensity therapy for depression and anxiety disorders and is the first of its kind to do so within IAPT stepped care. The results show that iCBT is a valuable option reducing waiting times and enhancing clinical efficiency. The study contributes to the well-established evidence on online psychological treatments worldwide, but further clinical and service development research is necessary to scale these treatments appropriately.
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Affiliation(s)
- Daniel Duffy
- Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
- E-Mental Health Research Group, School of Psychology, Trinity College, Dublin, Ireland
| | - Angel Enrique
- Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
- E-Mental Health Research Group, School of Psychology, Trinity College, Dublin, Ireland
| | - Sarah Connell
- Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Conor Connolly
- Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
| | - Derek Richards
- Clinical Research and Innovation, SilverCloud Health, Dublin, Ireland
- E-Mental Health Research Group, School of Psychology, Trinity College, Dublin, Ireland
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Kouvonen A, Mänty M, Harkko J, Sumanen H, Konttinen H, Lahti J, Pietilainen O, Blomgren J, Tuovinen E, Ketonen EL, Stenberg JH, Donnelly M, Sivertsen B, Mittendorfer-Rutz E, Pirkola S, Rahkonen O, Lallukka T. Effectiveness of internet-delivered cognitive behavioural therapy in reducing sickness absence among young employees with depressive symptoms: study protocol for a large-scale pragmatic randomised controlled trial. BMJ Open 2019; 9:e032119. [PMID: 31690647 PMCID: PMC6858165 DOI: 10.1136/bmjopen-2019-032119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Depression is a highly prevalent condition with typical onset in early adulthood. Internet-delivered cognitive behavioural therapy (iCBT) is a promising cost-effective and more widely available alternative to face-to-face CBT. However, it is not known whether it can reduce sickness absence in employees showing depressive symptoms. The randomised controlled trial component of the DAQI (Depression and sickness absence in young adults: a quasi-experimental trial and web-based treatment intervention) project aims to investigate if iCBT is effective in reducing sickness absence compared with care as usual (CAU) among young employees with depressive symptoms in primary care provided in an occupational health setting. METHODS AND ANALYSIS This study will use a randomised controlled single-centre service-based trial of an existing iCBT programme (Mental Hub iCBT for Depression) to evaluate whether or not this treatment can reduce the number of sickness absence days in public sector employees aged 18-34 years who present at the occupational health service with mild depressive symptoms (score ≥9 on the Beck Depression Inventory-IA). Control participants will be offered CAU, with no constraints regarding the range of treatments. The active condition will consist of seven weekly modules of iCBT, with support from a web therapist. Primary outcome will be participants' all-cause sickness absence as indicated in employer's and national administrative records up to 6 months from study entry. Secondary outcomes relating to long-term sickness absence (over 11 calendar days) for mental and musculoskeletal disorders and psychotropic medication use will be obtained from the Finnish Social Insurance Institution's administrative records; and short sickness absence spells (up to 11 calendar days) will be extracted from employer's records. Analyses will be conducted on an intention-to-treat basis. ETHICS AND DISSEMINATION The Coordinating Ethics Committee of the Hospital District of Helsinki and Uusimaa has approved the study (HUS/974/2019). The results will be published in peer-reviewed scientific journals and in publications for lay audience. TRIAL REGISTRATION NUMBER ISRCTN10877837.
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Affiliation(s)
- Anne Kouvonen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Research Institute of Psychology, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Minna Mänty
- Unit of Statistics and Research, City of Vantaa, Vantaa, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jaakko Harkko
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Hilla Sumanen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Unit of Health Care and Emergency Care, South-Eastern Finland University of Applied Sciences, Kotka, Finland
| | - Hanna Konttinen
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
| | - Jouni Lahti
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Olli Pietilainen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Jenni Blomgren
- Research Unit, The Social Insurance Institution of Finland, Helsinki, Finland
| | | | | | - Jan-Henry Stenberg
- Department of Psychiatry, Helsinki University Hospital, Helsinki, Finland
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Børge Sivertsen
- Department of Public Mental Health, Norwegian Institute of Public Health, Bergen, Norway
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway
| | - Ellenor Mittendorfer-Rutz
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sami Pirkola
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Ossi Rahkonen
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Tea Lallukka
- Department of Public Health, University of Helsinki, Helsinki, Finland
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