The timing and magnitude of symptom improvements during an Internet-delivered transdiagnostic treatment program for anxiety and depression.

Bisby, Madelyne A.; Scott, Allan; Fisher, Alana; Gandy, Milena; Hathway, Taylor; Heriseanu, Andreea I.; Karin, Eyal; Cross, Shane; Staples, Lauren G.; Titov, Nickolai; Dear, Blake F.

doi:10.1037/ccp0000761

Cited by 13 publications

(4 citation statements)

References 64 publications

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“…The rationale behind ultra-brief treatments is that clinically meaningful change can happen in a very short period of time for some people. Supporting this, some studies have observed large improvements in mental health symptoms after just one session, and in some cases, over three-quarters of the treatment effect occurs by halfway through an 8-week treatment (Bisby et al, 2022b;Robinson, Delgadillo, & Kellett, 2020).…”

Section: Introductionmentioning

confidence: 79%

An online therapist-guided ultra-brief treatment for depression and anxiety: a randomized controlled trial

Bisby,

Balakumar,

Scott

et al. 2023

Psychol. Med.

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Background There are many barriers to engaging in current psychological treatments, including time, cost, and availability. Ultra-brief treatments overcome some of these barriers by delivering therapeutic information and skills using significantly less time than standard-length treatments. We developed a therapist-guided online ultra-brief treatment for depression and anxiety and compared it to an existing 8-week, 5-lesson therapist-guided standard-length treatment and a waitlist control. Methods In a randomized controlled trial, adults with self-reported depression or anxiety were randomized (1:1:1) to the ultra-brief treatment, standard-length treatment, or waitlist control. The primary outcomes were depression symptoms and anxiety symptoms assessed at baseline, 5-weeks later, 9-weeks later (primary timepoint), and 3-months later. The trial was prospectively registered. Results Between 7 February 2022, and 16 August 2022, 242 participants were enrolled in the ultra-brief treatment (n = 85), standard-length treatment (n = 80), and waitlist control (n = 77). Participants were mostly women with an average age of 48.56 years. At 9-weeks post-baseline, participants in the ultra-brief treatment group reported significantly lower depression (between groups d = 0.41) and anxiety (d = 0.53) than the waitlist control. The ultra-brief treatment was non-inferior for anxiety at both 9-weeks and 3-months follow-up. Non-inferiority for depression was observed at 9-weeks. Conclusions The online ultra-brief treatment resulted in significant reductions in depression and anxiety that were non-inferior to a longer treatment course after 9-weeks. Remotely delivered ultra-brief treatments have the potential to provide accessible and effective care for those who cannot, or would prefer not to, access longer psychological interventions.

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Section: Introductionmentioning

confidence: 79%

An online therapist-guided ultra-brief treatment for depression and anxiety: a randomized controlled trial

Bisby,

Balakumar,

Scott

et al. 2023

Psychol. Med.

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“…This is important given the literature demonstrating the relationship between engagement and positive symptom outcomes in DMH intervention research [ 56 , 57 ]. Other researchers have evaluated the cumulative findings of 4 randomized controlled trial studies to assess the timing and magnitude of symptom improvement in internet-delivered transdiagnostic treatment for anxiety and depression [ 58 ]. The authors concluded that the first month of treatment is the most important for determining symptom improvement and overall participant outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…This contact with research personnel may have been therapeutic for participants. Previous research evaluating the timing and magnitude of symptom improvement found participants to improve following an initial assessment call, with authors concluding that even brief therapeutic contact can influence symptom outcomes in clinical trials [ 58 ]. All participants also received automated emails throughout the trial to encourage progress and maintain engagement, with the same duration of access to the Life Flex program provided to all participants.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of a Digital Mental Health Biopsychosocial Transdiagnostic Intervention With or Without Therapist Assistance for Adults With Anxiety and Depression: Adaptive Randomized Controlled Trial

Andrews¹,

Klein²,

Huy³

et al. 2023

J Med Internet Res

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Background Digital mental health (DMH) interventions incorporating elements that adapt to the evolving needs of consumers have the potential to further our understanding of the optimal intensity of therapist assistance and inform stepped-care models. Objective The primary objective was to compare the efficacy of a transdiagnostic biopsychosocial DMH program, with or without therapist assistance for adults with subthreshold symptoms or a diagnosis of anxiety or depression. Methods In a randomized adaptive clinical trial design, all participants had access to the DMH program, with eligibility to have their program augmented with therapist assistance determined by program engagement or symptom severity. Participants who met stepped-care criteria were randomized to have their treatment program augmented with either low-intensity (10 min/week of video chat support for 7 weeks) or high-intensity (50 min/week of video chat support for 7 weeks) therapist assistance. A total of 103 participants (mean age 34.17, SD 10.50 years) were assessed before (week 0), during (weeks 3 and 6), and after the intervention (week 9) and at the 3-month follow-up (week 21). The effects of 3 treatment conditions (DMH program only, DMH program+low-intensity therapist assistance, and DMH program+high-intensity therapist assistance) on changes in the 2 primary outcomes of anxiety (7-item Generalized Anxiety Disorder Scale [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were assessed using the Cohen d, reliable change index, and mixed-effects linear regression analyses. Results There were no substantial differences in the outcome measures among intervention conditions. However, there were significant time effect changes in most outcomes over time. All 3 intervention conditions demonstrated strong and significant treatment effect changes in GAD-7 and PHQ-9 scores, with absolute Cohen d values ranging from 0.82 to 1.79 (all P<.05). The mixed-effects models revealed that, in the Life Flex program–only condition at week 3, mean GAD-7 and PHQ-9 scores significantly decreased from baseline by 3.54 and 4.38 (all P<.001), respectively. At weeks 6, 9, and 21, GAD-7 and PHQ-9 scores significantly decreased from baseline by at least 6 and 7 points (all P<.001), respectively. Nonresponders at week 3 who were stepped up to therapist assistance increased program engagement and treatment response. At the postintervention time point and 3-month follow-up, 67% (44/65) and 69% (34/49) of the participants, respectively, no longer met diagnostic criteria for anxiety or depression. Conclusions The findings highlight that early detection of low engagement and non–treatment response presents an opportunity to effectively intervene by incorporating an adaptive design. Although the study findings indicate that therapist assistance was no more effective than the DMH intervention program alone for reducing symptoms of anxiety or depression, the data highlight the potential influence of participant selection bias and participant preferences within stepped-care treatment models. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12620000422921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378317&isReview=true International Registered Report Identifier (IRRID) RR2-10.2196/45040

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“…All content and exercises were identical in both versions. This i-CBT intervention is considered transdiagnostic because it focuses on targeting both anxiety and depression, either with or without several other comorbid disorders (such as eating disorders, insomnia, and substance use disorders; Bisby et al, 2023;Norton & Roberge, 2017). Specific details of the i-CBT content are accessible by contacting the developers (https://www.silvercloud health.com/).…”

Section: Interventions I-cbtmentioning

confidence: 99%

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

Benjet,

Albor,

Alvis-Barranco

et al. 2023

Journal of Consulting and Clinical Psychology

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The timing and magnitude of symptom improvements during an Internet-delivered transdiagnostic treatment program for anxiety and depression.

Cited by 13 publications

References 64 publications

An online therapist-guided ultra-brief treatment for depression and anxiety: a randomized controlled trial

An online therapist-guided ultra-brief treatment for depression and anxiety: a randomized controlled trial

Efficacy of a Digital Mental Health Biopsychosocial Transdiagnostic Intervention With or Without Therapist Assistance for Adults With Anxiety and Depression: Adaptive Randomized Controlled Trial

Internet-delivered cognitive behavior therapy versus treatment as usual for anxiety and depression among Latin American university students: A randomized clinical trial.

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