Randomized controlled trial of internet-delivered cognitive behaviour therapy comparing standard weekly versus optional weekly therapist support

H D Hadjistavropoulos; L H Schneider; M Edmonds; E Karin; M N Nugent; D Dirkse; B F Dear; N Titov

doi:10.1016/j.janxdis.2017.09.006

Randomized controlled trial of internet-delivered cognitive behaviour therapy comparing standard weekly versus optional weekly therapist support

J Anxiety Disord. 2017 Dec:52:15-24. doi: 10.1016/j.janxdis.2017.09.006. Epub 2017 Sep 23.

Authors

H D Hadjistavropoulos¹, L H Schneider², M Edmonds³, E Karin⁴, M N Nugent⁵, D Dirkse⁶, B F Dear⁷, N Titov⁸

Affiliations

¹ 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada. Electronic address: [email protected].
² 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada. Electronic address: [email protected].
³ 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada. Electronic address: [email protected].
⁴ eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia. Electronic address: [email protected].
⁵ 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada. Electronic address: [email protected].
⁶ 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK, S4S 0A2, Canada. Electronic address: [email protected].
⁷ eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia. Electronic address: [email protected].
⁸ MindSpot Clinic, Australian Hearing Hub Building, eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia. Electronic address: [email protected].

PMID: 28964994
DOI: 10.1016/j.janxdis.2017.09.006

Abstract

Internet-delivered cognitive behaviour therapy (ICBT) is effective for treating anxiety and depression. The relative benefits of offering standard weekly compared to optional weekly therapist support in conjunction with ICBT within routine care has not been examined. Patients seeking ICBT for depression and or anxiety in routine care were randomized to standard (n=92) or optional (n=88) weekly support. The optional approach resulted in therapists receiving half as many messages from (1.70 vs. 3.96) and sending half as many messages to patients (3.62 vs. 7.29). Optional Support was associated with lower completion rates (56.6% versus 82.4%), but, similar to Standard Support, resulted in large reductions on the GAD-7 (within Cohen's d≥1.08; avg. reduction ≥47%) and PHQ-9 (within Cohen's d≥0.82; avg. reduction ≥43%) at post-treatment and 3-month follow-up. Optional weekly support appears clinically effective and acceptable for many patients and may reduce costs, but safety requires monitoring given lower completion rates.

Keywords: Cognitive behaviour therapy; Depression; Generalized anxiety; Internet-delivered; Therapist-assisted; Transdiagnostic.

Publication types

Comparative Study
Equivalence Trial
Randomized Controlled Trial

MeSH terms

Adult
Anxiety Disorders / psychology
Anxiety Disorders / therapy*
Cognitive Behavioral Therapy / methods*
Depressive Disorder / psychology
Depressive Disorder / therapy*
Female
Humans
Internet*
Male
Patient Health Questionnaire
Remote Consultation / methods*
Social Support
Therapy, Computer-Assisted / methods
Treatment Outcome