Guided Internet-Based Cognitive Behavioral Therapy for Adult Depression and Anxiety in Routine Secondary Care: Observational Study

Abstract

BackgroundInternet-based cognitive behavioral therapy (iCBT) is a promising new treatment method for depression and anxiety. However, it is important to determine whether its results can be replicated in routine care before its implementation on a large scale. Although many studies have demonstrated the efficacy of iCBT under controlled conditions, only a few studies have investigated its effectiveness in routine care. Furthermore, several effects of iCBT such as treatment effects in routine care are unclear.ObjectiveThis study aimed to evaluate the clinical effectiveness of iCBT for depression and anxiety in routine secondary care.Methodsn a retrospective cohort study, we analysed patients treated for depression or anxiety in a dedicated iCBT clinic in secondary care in Denmark. Patients were examined before treatment and weekly thereafter by using the Patient Health Questionnaire-9 and the Generalized Anxiety Disorder-7 scales for the diagnoses of depression and anxiety, respectively. Primary analyses were conducted using a linear mixed-effects model with random slope and intercept. Secondary analyses were conducted using baseline characteristics as predictors (gender, age, highest level of education, occupational status, marital status, psychotropic medication use, consumption of alcohol, and leisure drugs). Additionally, logistic regression analyses were used to predict noncompletion of treatment.ResultsA total of 203 (depression, N=60; anxiety, N=143) patients were included. Participants were mainly female (78.3% with depression and 65.7% with anxiety), with a mean age of 36.03 (SD 10.97) years (range, 19-67 years) for patients with depression and 36.80 (SD 13.55) years (range, 19-69 years) for patients with anxiety. The completion rates were 62% (37) and 40% (57) for depression and anxiety treatments, respectively. The primary analyses revealed large and significant reductions in the symptom levels of depression (beta=-6.27, SE 0.83, P<.001, d=1.0) and anxiety (beta=-3.78, SE 0.43, P<.001, d=1.1). High baseline severity of the primary disorder was associated with high treatment gains (r=-0.31 for depression; r=-0.41 for anxiety). In patients with anxiety, high baseline severity also predicted a high risk of noncompletion (odds ratio=1.08, CI=1.01-1.16, P=.03). An increase in the baseline severity of the comorbid disorder slightly increased the risk of noncompletion for both disorders (depression: odds ratio=1.03, CI=1.01-1.06, P=.02; anxiety: odds ratio=1.08, CI=1.01-1.16, P=.03).ConclusionsiCBT can be clinically effective in routine care. Since depression and anxiety are costly and debilitating disorders that are vastly undertreated, this finding is important. Additionally, iCBT may help bridge the gap between the need for treatment and its provision. Our results are comparable to the within-group results of efficacy and effectiveness studies. Our noncompletion rates are similar to those observed in psychotherapy but are higher than those reported in similar clinics. Multiple factors predicted outcome and n...

Effectiveness of guided Internet-delivered treatment for major depression in routine mental healthcare - An open study

“…These effects are also comparable to those obtained in recent effectiveness studies. In Denmark (Mathiasen et al, 2018) large effects ( d = 1.0) were reported for 60 patients with depression receiving guided ICBT with a completion rate of 62%. From a study conducted during routine care in Sweden (Hedman et al, 2014) in a sample of 1203 participants, large effects and a 75% completion rate were reported.…”

“…However, one limitation of this study was a large attrition rate at the six-month follow-up (63%). In a recently published study from Denmark (Mathiasen et al, 2018), guided ICBT for 60 adults with depression showed a large within-group effect size ( d = 1.10), with 62% completing the main parts (5 of 6 mandatory modules) of the treatment. In that study, higher education levels and more time spent in the program predicted improved outcomes.…”

Toward an Objective Assessment of Implementation Processes for Innovations in Health Care: Psychometric Evaluation of the Normalization Measure Development (NoMAD) Questionnaire Among Mental Health Care Professionals

“…More than 2 decades of research has shown that psychotherapy delivered through the internet, also referred to as eMental Health (eMH) interventions, can be an effective way to treat patients with common mental disorders such as depression and anxiety disorder [1]. Several examples of clinics routinely offering innovative and new eMH services exist, such as the Australian MindSpot clinic [2], GGZ InGeest Mindway [3] and Interapy in the Netherlands [4], Internetpsykiatr in Sweden [5], and Internetpsykatrien in Denmark [6,7]. Despite these examples, and although the technical infrastructure seems to be in place, large-scale use of eMH interventions in routine care is still lower than expected [8].…”

Internet-Delivered Cognitive Behavioral Therapy for Anxiety Disorders in Open Community Versus Clinical Service Recruitment: Meta-Analysis

“…On the other hand, uncontrolled effectiveness studies show large clinical effects [15-20], thereby suggesting that iCBT for anxiety disorders may be as effective in routine care settings as demonstrated in efficacy trials. One review investigated controlled research of iCBT in routine clinical practice [21].…”