Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-help Internet-Based Therapy for COVID-19–Induced Anxiety and Depression: Open-label, Pragmatic, Randomized Controlled Trial (Preprint)

Abstract

BACKGROUND The coronavirus (COVID-19) pandemic has led to a notable increase in psychological distress, globally. Oman is no exception to this, with several studies indicating high levels of anxiety and depression among the Omani public. There is a need for adaptive and effective interventions aiming at improving the increased levels of psychological distress arising from the COVID-19 pandemic. OBJECTIVE This study aimed at assessing the efficacy of therapist guided Online-Therapy versus self-help, e-mail delivered, therapy focusing on COVID-19-induced symptoms of anxiety and depression among individuals living in Oman during the COVID-19 pandemic. METHODS This was a 6-week pragmatic randomized controlled trial involving 60 participants who were recruited from a study sample surveyed for symptoms of anxiety/depression among the public in Oman amid the COVID-19 pandemic. The participants in the intervention group were allocated to receive 1 online session per week for 6 weeks from certified psychotherapists in Oman in Arabic or English. The Psychotherapists utilized Cognitive Behavioral Therapy (CBT) and Acceptance and Commitment Therapy (ACT) interventions. The participants in the control group received an automatic weekly newsletter via e-mail containing self-help information and tips to cope with distress associated with COVID-19. The information mainly consisted of behavioral tips revolving around the principles of CBT and ACT. The primary outcome was measured by comparing the change in the mean Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scores from baseline to the end of the study (after six sessions) between the two arms. The secondary outcome was comparing the proportions of participants with depression and anxiety in the two groups. RESULTS Data from 46 participants were analyzed (22 in intervention arm and 24 in control arm). There was no statistical difference in baseline characteristics between both arms. Analysis of covariance indicated a significant reduction in the GAD scores (F(1,43) = 7.307; P = 0.010) between the two arms after adjusting for baseline scores. The intervention arm GAD scores reduced more than those of the control arm (B = -3.27; P = 0.010). The intervention arm had a greater reduction in PHQ-9 mean scores (F(1,43) = 8.298; P = 0.006) when compared to the control arm (B = -4.311; P = 0.006). While the levels of anxiety and depression reduced in both study arms, the reduction was higher in the intervention group (P values of <0.049 and <0.022, respectively). CONCLUSIONS This study provides preliminary evidence to support the efficacy of Online-Therapy for improving the symptoms of anxiety and depression during the COVID-19 crisis in Oman. Therapist guided Online-Therapy was noted to be superior to self-help Internet-based therapy, however, both therapies could be considered as viable options. CLINICALTRIAL ClinicalTrials.gov NCT04378257

Psychotherapies and Psychological Support for Individuals Facing Psychological Distress during the COVID-19 Pandemic: A Scoping Review

“…This indicates that COVID-19 was a global pandemic that transcended countries and regions. With regard to the types of psychotherapies and psychological support, a new generation of psychotherapy (i.e., ACT and mindfulness) [15,22,23,26,30,32] and the use of virtual reality were found [20,26].…”

“…After the second screening, if the two independent researchers disagreed on the results, the three experts discussed and reached a consensus. Consequently, 18 papers were included in this study [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31]. The paper's content was compiled by M.Y.…”

“…The subjects and participants in the articles we included in this study were categorized as follows: patients with COVID-19 (n = 4, 22%) [20,21,23,25], patients that had recovered from COVID-19 (n = 1, 6%) [16], citizens (n = 5, 28%) [15,17,20,24,29], caregivers (n = 4, 22%) [18,27,30,31], and healthcare workers (n = 4, 22%) [19,20,22,26]. Moreover, there were two cases falling under the category of "others": clients at a clinic (n = 1) [28] and refugees (n = 1) [14].…”

“…telephone support (n = 2, 11%) [25,27], mindfulness (n = 3, 17%) [22,23,26], ACT (n = 3, 17%) [15,30,32], CBT (n = 4, 22%) [15,24,28,32], and others (n = 4, 22%): Problem Management Plus (n = 1) [14], EMDR therapy (n = 1) [19], parenting intervention (n = 1) [31], and video-based psychotherapy (n = 1) [23] (see Figure 2).…”

“…The distribution of the types of intervention trials was as follows: validation of feasibility (n = 6, 33%) [20,[23][24][25][26]31], RCTs (n = 6, 33%) [14,15,20,22,27,30], established existing intervention (n = 7, 39%) [16, 18-21, 28, 29], and others (n = 1, exploratory-descriptive design, 6%) [17] (see Figure 2).…”