A feasibility trial of an Internet‐delivered and transdiagnostic cognitive behavioral therapy treatment program for anxiety, depression, and disability among adults with epilepsy

Gandy, Milena; Karin, Eyal; Fogliati, Vincent J.; McDonald, Sarah; Titov, Nickolai; Dear, Blake F.

doi:10.1111/epi.13569

Cited by 35 publications

(23 citation statements)

References 38 publications

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“…14 This is an important area for future research to address, especially given that co-occurring anxiety and depression appear to be associated with poorer outcomes in PWE, 6 and emerging treatments that aim to treat both comorbidities simultaneously. 39 The literature examining psychiatric comorbidity in PWE has long accepted that epilepsy has a strong relationship with depression, and that PWE are at significantly increased risk of depression compared to the general population. However, anxiety has been relatively neglected.…”

Section: Discussionmentioning

confidence: 99%

Anxiety and depressive disorders in people with epilepsy: A meta‐analysis

et al. 2017

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Findings suggest the prevalence of anxiety and depressive disorders in PWE are equivalent, and variability in prevalence of anxiety disorders across studies can be attributed partly to the method of diagnosis. These findings also challenge widely held assumptions that psychiatric comorbidity is more common in people with drug-resistant epilepsy. Future research should aim to improve the detection and management of these comorbidities in PWE, particularly anxiety disorders, which have remained relatively neglected.

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Section: Discussionmentioning

confidence: 99%

Anxiety and depressive disorders in people with epilepsy: A meta‐analysis

et al. 2017

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“…The possibility to recruit patients without geographical barriers also presents opportunities for testing psychotherapy for people with conditions and problems (e.g., spinal cord injury, epilepsy) that can be highly disabling while also having a relatively low prevalence, making them very difficult to study feasibly in face‐to‐face trials.…”

Section: Innovationmentioning

confidence: 99%

Internet‐delivered psychological treatments: from innovation to implementation

et al. 2019

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Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

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“…This intervention was delivered by trained facilitators via telephone or a Web‐based platform and included regular guided discussions. In another single‐arm study, reductions in depressive symptoms and several secondary outcomes were observed in a sample of 27 PwE who used a clinician‐supported Internet intervention . However, this study did not include a control group, and both studies included clinician‐support.…”

Section: Introductionmentioning

confidence: 99%

Effects of an epilepsy‐specific Internet intervention (Emyna) on depression: Results of the ENCODE randomized controlled trial

et al. 2019

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Summary Objective Depression and anxiety are highly prevalent among people with epilepsy (PwE) but often remain unrecognized and treated inadequately. Effective psychosocial treatments such as cognitive behavioral therapy (CBT) are rarely available to most PwE, which is one reason electronically delivered CBT (eCBT) is regarded as promising. This study examined an eCBT intervention, termed Emyna, that was tailored to suit the needs of PwE. It includes CBT‐related content on depression, stress and anxiety, seizure triggers and auras, and lifestyle habits. The trial examined the efficacy of Emyna in reducing symptoms of depression (primary outcome) and anxiety as well as improving quality of life. Methods Participants (N = 200) with epilepsy, a diagnosis of a depressive disorder, and at least moderate depressive symptoms were randomized to Emyna or care as usual. At baseline and after 3, 6, and 9 months, participants were invited to complete online questionnaires. The primary outcome was improvement of depressive symptoms at 3 months. Results Relative to the control group, intervention group participants experienced significantly greater improvements in depression, anxiety, stress, social‐occupational impairment, and epilepsy‐related quality of life, in both intention‐to‐treat (ITT) and per‐protocol analyses. In ITT analyses, effects of medium magnitude were observed, as measured by the Patient Health Questionnaire–9 items (Cohen d = 0.54, 95% confidence interval [CI] = 0.25‐0.82, P < 0.001) and the Neurological Disorders Depression Inventory for Epilepsy (d = 0.51, 95% CI = 0.23‐0.79, P < 0.01). At 3 months, intervention group participants also reported fewer illness‐related days off work and fewer days hospitalized over the preceding months, compared to control group participants (P ≤ 0.05), whereas no such differences were present at baseline (P > 0.30). Significance These findings showed that Emyna, used adjunctively to usual care, could help improve mental health, social‐occupational functioning, and quality of life among PwE. The program provides an additional treatment option that could produce clinically relevant symptom reductions and reduce key cost drivers (ie, hospitalization rates and illness‐related inability to work).

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A feasibility trial of an Internet‐delivered and transdiagnostic cognitive behavioral therapy treatment program for anxiety, depression, and disability among adults with epilepsy

Abstract: The findings of the current study support the feasibility and potential of transdiagnostic Internet-delivered treatments for adults with epilepsy. Further large-scale controlled trials are warranted.

Cited by 35 publications

References 38 publications

Anxiety and depressive disorders in people with epilepsy: A meta‐analysis

Anxiety and depressive disorders in people with epilepsy: A meta‐analysis

Internet‐delivered psychological treatments: from innovation to implementation

Effects of an epilepsy‐specific Internet intervention (Emyna) on depression: Results of the ENCODE randomized controlled trial

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