Internet-Based Cognitive-Behavioral Therapy for Depression: A Feasibility Study for Homecare Older Adults

Abstract

This pilot study examined the feasibility of delivering internet-based cognitive behavioral therapy (iCBT) to homebound older adults with symptoms of depression who are recipients of non-medical home care. A feasibility open trial was conducted in the homes of homecare older adults (n=26). When possible, home care workers (HCWs) of older adults (n=13) were recruited to provide external support for iCBT usage. In cases where consistent assistance from the same HCW was not feasible, participants were given the choice of working on the program on their own (n=7) or receiving assistance from a research assistant (RA) (n=6). The mean therapy sessions completed was 4.7 out of 8 total sessions. The mean satisfaction rating was 7.7 (SD=2.9) and 86% would recommend the program to others with depressed mood. Significant reductions in depressive symptoms and anxiety symptoms and improvement on a quality of life measure were observed at post-test. The RA-supported group tended to have the best adherence, satisfaction, and reduction in depressive symptoms, followed closely by the HCW-supported group. The self-guided group had the lowest adherence, satisfaction, and symptom reduction. iCBT is a feasible and acceptable treatment modality for homebound older adults with depressive symptoms and potentially effective. Data from the participant exit interviews suggest a need for refining the existing treatment platform to better meet the needs and capabilities of homebound older adults. Future studies are warranted to examine treatment effectiveness as a function of HCW support.

Effectiveness of online cognitive behavioural therapy on quality of life in adults with depression: A systematic review

“…However, iCBT intervention groups with clinician guidance had the most remarkable improvement of QoL, when compared to selfguided iCBT sample groups, which had the lowest QoL improvements (Montero-Marín et al, 2016;Xiang et al, 2020).There was no statistically significant difference in QoL outcomes between groups with clinician guidance via scheduled telephone sessions compared to clinician guidance via e-mail correspondence (Farrer et al, 2012;Lindner et al, 2014). Additionally, synchronous clinician-guided iCBT improved the social functioning components of QoL scoring compared to asynchronous iCBT clinician-guided sessions (Dobkin et al, 2021;Johansson et al, 2012).…”

“…Nine studies compared iCBT with passive comparators such as treatment as usual or waitlist controls (Berger et al, 2011;Burton et al, Individual group sample sizes ranged from 14 (Burton et al, 2016) to 1843 (Donker et al, 2013). All studies recruited male and female participants, with mean ages ranging from 35 (Burton et al, 2016) to 76.4 (Xiang et al, 2020).…”

“…For example, the trials were unblinded, and participants receiving iCBT knew to which study group they belonged. Regarding weaknesses, attrition rates were higher than 20% for six of the studies (Berger et al, 2011;Donker et al, 2013;Farrer et al, 2012;Hadjistavropoulos et al, 2014;Montero-Marín et al, 2016;Xiang et al, 2020). However, data were analysed based on intention-to-treat to test whether the attrition rates impacted results.…”

“…Study post-treatment ranged from immediately post-intervention(Xiang et al, 2020) to 3 years follow-up(Andersson et al, 2013) post-intervention. Nine studies determined MDD by diagnosis(Andersson et al, 2013;Berger et al, 2011;CarolaPerez et al, 2021;Dobkin et al, 2021;Gilbody et al, 2015;Hadjistavropoulos et al, 2014;Johansson et al, 2012;Montero-Marín et al, 2016;Xiang et al, 2020). The QoL outcome for all studies were determined by self-report via valid instruments (Table1).ies recruited participants from various clinical care areas, including specialty clinics(Andersson et al, 2013;Burton et al, 2016;Chan et al, 2016;Dobkin et al, 2021;Farrer et al, 2012;Lindner et al, 2014;Lundgren et al, 2016;Montero-Marín et al, 2016: Xiang et al, 2020.…”

Understanding the Role of Support in Digital Mental Health Programs With Older Adults: Users’ Perspective and Mixed Methods Study

“…Mental health support refers to any type of support aimed at protecting or promoting psychosocial well-being [5], such as therapy, education, and health promotion programs. Recent reviews have demonstrated the effectiveness of digital health interventions in reducing social isolation and depression in older adults [6][7][8][9]. However, older adults may experience several barriers to accessing and using digital health resources, such as lack of knowledge and awareness of digital health resources, little exposure to and experience with technology in general, and lack of confidence in using a computer [10].…”