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Dear BF, Gilmore S, Campbell N, Titov N, Beeden A. Internet-Delivered Psychological Pain Management: A Prospective Cohort Study Examining Routine Care Delivery by a Specialist Regional Multidisciplinary Pain Service. THE JOURNAL OF PAIN 2024; 25:104601. [PMID: 38871146 DOI: 10.1016/j.jpain.2024.104601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
Several clinical trials have demonstrated the effectiveness of internet-delivered psychological-based pain management programs (PMPs). However, to date, no large studies have reported the outcomes of PMPs when delivered by specialist multidisciplinary pain services in routine care. The present study reports (n = 653) the outcomes of an internet-delivered PMP provided as routine care by a specialist Australian regional pain service over a 6-year period. High levels of treatment commencement (85%) and completion (72%) were observed, with more than 80% of patients reporting they were satisfied with the intervention. Clinical improvements were observed from pretreatment to post-treatment (% change, 95% confidence intervals (CI)) in pain-related disability (8.8%; 4.5, 12.8), depression (28.4%; 23.0, 33.4), anxiety (21.9%; 14.6, 28.5), and pain intensity (7%; 3.5, 10.5), which were maintained to 3-month follow-up. At 3-month follow-up, 27% (23, 31), 46% (41, 51), 44% (39, 49), and 22% (19, 26) reported clinically meaningful (defined as ≥ 30%) improvements in pain-related disability, depression, anxiety, and pain intensity, respectively. These results were obtained with relatively little therapist time per patient (M = 30.0, (standard deviation) SD = 18.8) to deliver the intervention. The current findings highlight the potential of internet-delivered PMPs as part of the services provided by specialist pain services, particularly those servicing large geographical regions and for patients unable to travel to clinics for face-to-face care. PERSPECTIVE: This study reports the outcomes of the routine delivery of an internet-delivered psychological PMP by a specialist pain service. The findings highlight the potential of this model of care when provided by specialist pain services, particularly for patients not unable to attend and not requiring intensive face-to-face care.
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Affiliation(s)
- Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia.
| | - Shereen Gilmore
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Nicole Campbell
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Alison Beeden
- North Queensland Persistent Pain Management Service, Townsville Hospital and Health Services, Townsville, Queensland, Australia
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Bisby M, Staples L, Dear B, Titov N. Changes in the Frequency of Actions Associated With Mental Health During Online Treatment: Analysis of Demographic and Clinical Factors. JMIR Form Res 2024; 8:e57938. [PMID: 39052998 PMCID: PMC11310636 DOI: 10.2196/57938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 04/17/2024] [Accepted: 05/04/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Specific daily actions (eg, goal setting, meaningful activities) are associated with mental health. Performing specific daily actions at a higher frequency is associated with significantly lower baseline symptoms of depression and anxiety, as well as better psychological treatment outcomes for depression and anxiety. OBJECTIVE This study explored how the frequency of specific daily actions associated with mental health may differ prior to, during, and following treatment according to demographic and clinical characteristics. METHODS Using a sample of 448 patients from an Australian national digital psychology service, we examined baseline differences in daily action frequency and changes in daily action frequency during a digital psychological treatment according to demographic and clinical subgroups. A total of 5 specific types of daily actions were measured using the Things You Do Questionnaire: healthy thinking, meaningful activities, goals and plans, healthy habits, and social connections. RESULTS The frequency of daily actions differed according to employment status (largest P=.005) and educational level (largest P=.004). Daily action frequency was lower in those participants with more severe or chronic depression or anxiety symptoms (largest P=.004). Participants reported larger increases in how often they did these daily actions from baseline to midtreatment compared to mid- to posttreatment. Depression duration (P=.01) and severity (P<.001) were associated with differences in how daily action frequency changed during treatment. CONCLUSIONS The findings of this study support continued research exploring the relationship between daily actions and mental health, how this relationship might differ between individuals, and the clinical potential of supporting individuals to increase the frequency of daily actions to improve mental health.
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Affiliation(s)
- Madelyne Bisby
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, Australia
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Lauren Staples
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, Australia
| | - Blake Dear
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, Australia
- School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, Australia
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Dudeney J, Scott AJ, Hathway T, Bisby MA, Harte N, Titov N, Dear BF. Internet-Delivered Psychological Pain-Management for Young Adults With Chronic Pain: An Investigation of Clinical Trial Data. THE JOURNAL OF PAIN 2024; 25:104447. [PMID: 38122876 DOI: 10.1016/j.jpain.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 11/28/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
Young adults report chronic pain at rates of around 12% but lack access to clinical services. There is interest in learning how this emerging adult population engages with and responds to treatment. Using data from young adults aged 18 to 30 years (Mage = 25.8, SD = 3.2), taken from 4 previous randomised controlled trials, the current study investigated the feasibility, acceptability, and efficacy of an internet-delivered psychological pain-management intervention for young adults with chronic pain. We compared young adults in a treatment group (n = 104) with 1) a young-adult wait-list control group (n = 48), and 2) a treatment group reflecting the average-aged participant from the previous trials (39-63 years, n = 561). Feasibility was determined through treatment engagement, adherence and completion, and acceptability through a treatment satisfaction measure. Clinical outcomes were disability, pain intensity, anxiety, and depression; assessed at pre-treatment, post-treatment, and 3-month follow-up. Generalised estimation equation analyses were undertaken, using multiple imputations to account for missing data. Young adults had high engagement and acceptability ratings, though 34% did not complete the intervention. The treatment group significant improved across all outcomes, compared with control, with improvements maintained at follow-up. Post-treatment improvements were equivalent for young-adult and average-aged adult treatment groups, with no significant differences in feasibility or acceptability outcomes. Findings indicate young adults can engage with and show improvements following a psychological pain-management intervention designed for all adults with chronic pain. Future research is encouraged to examine outcomes related to role functioning of young adults, and moderators of treatment acceptability and efficacy for this population. PERSPECTIVE: Secondary analysis of data from 4 RCTs found an Internet-delivered psychological pain-management intervention acceptable and clinically efficacious for improving disability, anxiety, depression and pain intensity in young adults (18-30) with chronic pain.
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Affiliation(s)
- Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Taylor Hathway
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
| | - Nicole Harte
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney NSW, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney NSW, Australia
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Hadjistavropoulos HD, McCall HC, Dear BF, Beahm JD, Carleton RN, Titov N. Outcomes of transdiagnostic internet-delivered cognitive behavioural therapy tailored to public safety personnel: A longitudinal observational study. J Anxiety Disord 2024; 104:102861. [PMID: 38640867 DOI: 10.1016/j.janxdis.2024.102861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 01/07/2024] [Accepted: 04/09/2024] [Indexed: 04/21/2024]
Abstract
First responders and other public safety personnel (PSP) experience high rates of mental health problems and face barriers to accessing mental healthcare. Internet-delivered cognitive behavioural therapy (ICBT) is an effective and accessible treatment for various mental health concerns. Canadian PSP report favorable attitudes toward ICBT, and preliminary outcomes demonstrate that they benefit from it. Expanding on this research, the current study consisted of a longitudinal observational study of 560 Canadian PSP who participated in ICBT. It was designed to assess the longer term effectiveness of ICBT and moderators of outcomes by gender, linguistic and occupational group, and years of occupational experience. We evaluated symptom change at 8, 26, and 52 weeks post-enrollment, and results among PSP who had elevated clinical scores, showed large reductions (Hedges' g) in symptoms of depression (g = 1.3), anxiety (g =1.48), posttraumatic stress (g =1.24), panic (g =1.19), and anger (g =1.07) and moderate reductions in symptoms of social anxiety (g =.48-.56). Moderator analyses revealed modest differences in pre-treatment symptoms among certain groups but no group differences in symptom change over time. Clients showed good completion of treatment materials and reported high treatment satisfaction. The results suggest further study of ICBT tailored to PSP is warranted, including evaluating ICBT tailored for PSP in other countries.
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Affiliation(s)
- Heather D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada.
| | - Hugh C McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia; eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - Janine D Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - R Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada; PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada; Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nickolai Titov
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia; eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
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Mak WWS, Tong ACY, Fu ACM, Leung IWY, Jung OHC, Watkins ER, Lui WWS. Efficacy of Internet-based rumination-focused cognitive behavioral therapy and mindfulness-based intervention with guided support in reducing risks of depression and anxiety: A randomized controlled trial. Appl Psychol Health Well Being 2024; 16:696-722. [PMID: 38073271 DOI: 10.1111/aphw.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/06/2023] [Indexed: 05/02/2024]
Abstract
Rumination and worry are common risk factors of depression and anxiety. Internet-based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three-arm randomized controlled trial compared the efficacy of Internet-based rumination-focused cognitive behavioral therapy (RFCBT), mindfulness-based intervention (MBI), and psychoeducation (EDU) control among 256 at-risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post-intervention (6 weeks), 3-month, and 9-month follow-ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3-month follow-up among participants in RFCBT, and no significant long-term effect among participants in MBI was noted at a 9-month follow-up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow-ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.
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Affiliation(s)
- Winnie W S Mak
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Alan C Y Tong
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Amanda C M Fu
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ivy W Y Leung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Olivia H C Jung
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Wacy W S Lui
- Center for Personal Growth and Crisis Intervention of the Corporate Clinical Psychology Services, Hospital Authority, Ma Tau Wai, Hong Kong
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Kötting L, Anand-Kumar V, Keller FM, Henschel NT, Lippke S. Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study. JMIR Hum Factors 2024; 11:e48218. [PMID: 38669073 PMCID: PMC11087862 DOI: 10.2196/48218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 01/31/2024] [Accepted: 02/20/2024] [Indexed: 04/30/2024] Open
Abstract
BACKGROUND In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. OBJECTIVE This study fills this research gap by applying a web-app aiming at improving pregnant women's communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. METHODS In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. RESULTS We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (β=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (β=.017; comparative fit index=0.994; Tucker-Lewis index=0.971; root mean square error of approximation=0.055). CONCLUSIONS Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735.
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Affiliation(s)
- Lukas Kötting
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | - Vinayak Anand-Kumar
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | | | - Nils Tobias Henschel
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
| | - Sonia Lippke
- Psychology and Methods, School of Business, Social & Decision Sciences, Constructor University Bremen gGmbH, Bremen, Germany
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Gandy M, Coleman H, Cutler H, Jones MP, Karin E, Kwan P, Nikpour A, Parratt K, Rayner G, Titov N, Todd L, Seil E, Winton‐Brown T, Wu W, Dear BF. Comparative effectiveness of digital mental healthcare models for adults with epilepsy: A study protocol of a randomized controlled trial. Epilepsia Open 2024; 9:808-818. [PMID: 38345357 PMCID: PMC10984311 DOI: 10.1002/epi4.12913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/25/2024] [Indexed: 04/04/2024] Open
Abstract
OBJECTIVE Mental health complaints are prevalent among people with epilepsy, yet there are major barriers that prevent access to psychological care, including high out-of-pocket costs and a lack of accessible specialized services. The purpose of the current study is to examine the comparative efficacy, acceptability, cost-effectiveness, and long-term outcomes of a digital psychological intervention when delivered under two models of care (i.e., guided vs. unguided) in supporting the mental health and functioning of adults with epilepsy. METHOD Approximately 375 participants across Australia will be enrolled. Eligible participants will have a confirmed diagnosis of epilepsy, experience difficulties with their emotional health, be at least 18 years of age, and live in Australia. Participants will be randomized (2:2:1) to receive the Wellbeing Neuro Course, a 10-week internet-delivered program, with (i.e., guided) or without guidance by a mental health clinician (i.e., unguided), or be allocated to a treatment-as-usual waiting-list control group. Participants will complete online questionnaires at pre-, post-treatment, and 3- and 12-month follow-up and consent to have their data linked to their medical records to capture healthcare system resource use and costs. ANALYSIS Primary outcome measures will be symptoms of depression and anxiety. A cost-utility analysis will be undertaken using the Australian healthcare system perspective and according to current economic evaluation guidelines. Resource use and costs to the healthcare system during the study period will be captured via data linkage to relevant administrative datasets in Australia. SIGNIFICANCE The results of this trial will provide important data concerning the relative outcomes of these different models of care and will inform the integration of digital psychological interventions translation into healthcare services. ETHICS AND DISSEMINATION The Human Research Ethics Committee of Macquarie University approved the proposed study (Reference No: 520231325151475). The results will be disseminated through peer-reviewed publication(s). ANZCTR TRIAL REGISTRATION NUMBER ACTRN12623001327673. PLAIN LANGUAGE SUMMARY This study seeks to find out if a 10-week online psychological treatment can improve the mental health and well-being of Australian adults with epilepsy. Around 375 participants will be randomly assigned to different groups: one will receive treatment with guidance from mental health clinician (guided group), one without guidance (unguided group), and one starting later (waiting control group). All participants will fill out the same outcome measures online. The main goal of this research is to compare these groups and assess how well the treatment works in improving mental health outcomes.
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Affiliation(s)
- Milena Gandy
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Honor Coleman
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
| | - Henry Cutler
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Michael P. Jones
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Eyal Karin
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Patrick Kwan
- Department of Neuroscience, Central Clinical SchoolMonash UniversityMelbourneVictoriaAustralia
| | - Armin Nikpour
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
| | - Kaitlyn Parratt
- Department of NeurologyRoyal Prince Alfred HospitalCamperdownNew South WalesAustralia
- The Epilepsy Society of AustraliaSouth AustraliaAustralia
| | - Genevieve Rayner
- Melbourne School of Psychological SciencesThe University of MelbourneMelbourneVictoriaAustralia
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Nickolai Titov
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
| | - Lisa Todd
- Epilepsy Action AustraliaSydneyNew South WalesAustralia
| | - Elizabeth Seil
- Australian Institute of Health InnovationMacquarie UniversitySydneyNew South WalesAustralia
- Macquarie University Centre for the Health EconomySydneyNew South WalesAustralia
- Macquarie University Business SchoolSydneyNew South WalesAustralia
| | - Toby Winton‐Brown
- Comprehensive Epilepsy ProgramAlfred HospitalMelbourneVictoriaAustralia
| | - Wendy Wu
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Blake F. Dear
- School of Psychological SciencesMacquarie UniversitySydneyNew South WalesAustralia
- MindSpotMQ Health, Macquarie UniversityNew South WalesAustralia
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Bucknell KJ, Kangas M, Karin E, Crane MF. A randomized controlled trial comparing the effects of self-reflective writing focused on successful and unsuccessful coping experiences on resilience. Stress Health 2024; 40:e3311. [PMID: 37671436 DOI: 10.1002/smi.3311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/12/2023] [Accepted: 08/24/2023] [Indexed: 09/07/2023]
Abstract
Evidence supports the effectiveness of self-reflective training approaches for the development of resilience. Building this work, the objective of this study was to investigate the impact of the focus of coping self-reflective activities on resilience by applying a self-reflection approach to a sample of 254 Australian ministry workers. This randomized controlled trial included three attention-matched conditions: (1) self-reflective writing focused on successful coping, (2) self-reflective writing focused on unsuccessful coping or (3) written descriptions of stressor events alone. Participants were assessed across four time points: prior to, immediately post, 3-months, and 6-months after the intervention. Results demonstrated that self-reflective writing was more effective in enhancing perceived resilience than descriptive writing. Analyses also showed greater maintenance of beneficial effects in the successful self-reflection condition, compared to the unsuccessful condition. These findings support the use of self-reflection training to strengthen individuals' psychological resilience, particularly when focused on successful coping situations for those who initially experience more ruminative thought.
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Affiliation(s)
- Kirsten J Bucknell
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Maria Kangas
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Eyal Karin
- School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Monique F Crane
- Centre for Elite Performance, Expertise and Training, School of Psychological Sciences, Macquarie University, North Ryde, New South Wales, Australia
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Wootton BM, McDonald S, Melkonian M, Karin E, Titov N, Dear BF. Efficacy and acceptability of a self-guided internet-delivered cognitive-behavioral educational program for obsessive-compulsive symptoms with international recruitment. Cogn Behav Ther 2024; 53:133-151. [PMID: 37941384 DOI: 10.1080/16506073.2023.2279492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 10/27/2023] [Indexed: 11/10/2023]
Abstract
Cognitive-behavioural therapy is an effective treatment for obsessive-compulsive disorder (OCD). However, there are many barriers in accessing this treatment, with stigma being a particularly prominent barrier for many patients. Self-guided internet-delivered cognitive-behavioural therapy (ICBT), which does not require any contact with a therapist, has the potential to overcome this barrier. However, there is limited research on the efficacy of self-guided ICBT for OCD. The aim of the current study was to examine the efficacy of self-guided ICBT for OCD in a large international sample. Two hundred and sixteen participants were included in the study (Mage = 34.00; SD = 12.57; 72.7% female). On the primary outcome measure, the Yale-Brown Obsessive-Compulsive Scale (YBOCS), a medium within-group effect size was found from pre-treatment to post-treatment (g = 0.63), and a large within-group effect size was found from pre-treatment to 3-month follow-up (g = 0.98). Approximately one-quarter to one-third of participants met criteria for clinically significant improvement at post-treatment and 3-month follow-up (11% and 17% met criteria for remission at post-treatment and 3-month follow-up, respectively). These results demonstrate that self-guided ICBT may be an efficacious treatment for individuals with OCD who cannot or do not wish to engage with a mental health professional, resulting in medium to large effect sizes.
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Affiliation(s)
- Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University Sydney, Macquarie Park, NSW, Australia
| | - Sarah McDonald
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Maral Melkonian
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Ultimo, NSW, Australia
| | - Eyal Karin
- eCentreClinic, School of Psychological Sciences, Macquarie University Sydney, Macquarie Park, NSW, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University Sydney, Macquarie Park, NSW, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University Sydney, Macquarie Park, NSW, Australia
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Dear BF, Walker J, Karin E, Asrianti L, England J, Feliciano I, Bisby MA, Nielssen O, Kayrouz R, Cross S, Staples LG, Hadjistavropoulos HD, Titov N. Evaluation of a therapist-guided virtual psychological pain management program when provided as routine care: a prospective pragmatic cohort study. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1372-1385. [PMID: 37540210 DOI: 10.1093/pm/pnad102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/15/2023] [Accepted: 07/25/2023] [Indexed: 08/05/2023]
Abstract
INTRODUCTION Numerous randomized controlled trials have evaluated the outcomes of internet-delivered psychological pain management programs (PMPs) as a way of increasing access to care for people with chronic pain. However, there are few reports of the effectiveness of these PMPs when provided as part of routine care. METHODS The present study sought to report the clinical and demographic characteristics of users (n = 1367) and examine the effectiveness of an established internet-delivered psychological PMP program in improving several pain-related outcomes, when offered at a national digital mental health service over a 5-year period. It also sought to comprehensively explore predictors of treatment commencement, treatment completion, and clinical improvement. RESULTS Evidence of clinical improvements (% improvement; Hedges g) were found for all outcomes, including pain interference (18.9%; 0.55), depression (26.1%; 0.50), anxiety (23.9%; 0.39), pain intensity (12.8%; 0.41), pain self-efficacy (-23.8%; -0.46) and pain-catastrophizing (26.3%; 0.56). A small proportion of users enrolled but did not commence treatment (13%), however high levels of treatment completion (whole treatment = 63%; majority of the treatment = 75%) and satisfaction (very satisfied = 45%; satisfied = 37%) were observed among those who commenced treatment. There were a number of demographic and clinical factors associated with commencement, completion and improvement, but no decisive or dominant predictors were observed. DISCUSSION These findings highlight the effectiveness and acceptability of internet-delivered psychological PMPs in routine care and point to the need to consider how best to integrate these interventions into the pathways of care for people with chronic pain.
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Affiliation(s)
- Blake F Dear
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Jennie Walker
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Eyal Karin
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Lia Asrianti
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Jonathan England
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Ivy Feliciano
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Madelyne A Bisby
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Olav Nielssen
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Rony Kayrouz
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Shane Cross
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
| | - Lauren G Staples
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | | | - Nickolai Titov
- MindSpot, MQ Health, Macquarie University, Sydney, NSW 2109, Australia
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW 2109, Australia
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11
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Scott AJ, Bisby MA, Heriseanu AI, Salameh Y, Karin E, Fogliati R, Dudeney J, Gandy M, McLellan LF, Wootton B, McDonald S, Correa A, Titov N, Dear BF. Cognitive behavioral therapies for depression and anxiety in people with chronic disease: A systematic review and meta-analysis. Clin Psychol Rev 2023; 106:102353. [PMID: 37865080 DOI: 10.1016/j.cpr.2023.102353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/12/2023] [Accepted: 10/12/2023] [Indexed: 10/23/2023]
Abstract
OBJECTIVE Anxiety and depression in chronic disease are common and burdensome co-morbidities. There has been growing interest in cognitive and behavioral therapies (CBTs) for anxiety and depression in chronic disease, however their efficacy has not been well-established. This study examined the efficacy of CBTs for depression and/or anxiety symptoms within chronic disease and explored the moderating role of clinical and methodological characteristics. METHODS Following prospective registration, electronic databases were searched up to 2023 for randomized controlled trials (RCTs) examining CBTs for depression and/or anxiety in any adult chronic disease population. RESULTS We included 56 RCTs. The overall effect of CBTs was g = 0.61 (95% CI, 0.49, 0.72) for depression and g = 0.56 (95% CI, 0.42, 0.70) for anxiety. A range of methodological features significantly moderated the effect sizes obtained, including type of control group and the outcome measure used. Risk of Bias ratings indicated some concerns regarding RCT conduct and reporting. CONCLUSIONS CBTs lead to moderate improvements in both depression and anxiety symptoms among people with chronic disease. However, the efficacy of CBT should be interpreted considering certain study and sample characteristics. It is recommended that future studies make improvements to study methodology and reporting.
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Affiliation(s)
- Amelia J Scott
- School of Psychological Sciences, Macquarie University, Australia.
| | - Madelyne A Bisby
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Yalda Salameh
- School of Psychological Sciences, Macquarie University, Australia
| | - Eyal Karin
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Joanne Dudeney
- School of Psychological Sciences, Macquarie University, Australia
| | - Milena Gandy
- School of Psychological Sciences, Macquarie University, Australia
| | | | - Bethany Wootton
- Discipline of Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Sarah McDonald
- Discipline of Psychology, Graduate School of Health, University of Technology, Sydney, Australia
| | - Ashleigh Correa
- School of Psychological Sciences, Macquarie University, Australia
| | - Nick Titov
- School of Psychological Sciences, Macquarie University, Australia; MindSpot Clinic, Macquarie University, Australia
| | - Blake F Dear
- School of Psychological Sciences, Macquarie University, Australia
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12
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Buhrman M, Tillfors M, Holländare F, Lekström E, Håkansson A, Boersma K. Psychological Treatment Targeting Acceptance and Compassion in Patients With Chronic Pain: A Randomized Controlled, Internet-delivered, Treatment Trial. Clin J Pain 2023; 39:672-685. [PMID: 37712248 DOI: 10.1097/ajp.0000000000001157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 08/16/2023] [Indexed: 09/16/2023]
Abstract
OBJECTIVES Chronic pain is often associated with lower function. Self-criticism is associated with depressive symptoms. The purpose of this study was to explore if fusing Acceptance and Commitment Therapy and compassion-focused therapy could improve psychological well-being and disability in individuals with chronic pain with high levels of self-criticism in comparison to a wait-list control group. METHODS Individuals with chronic pain (n=71) were randomly assigned to an 8-week internet-based intervention focused on acceptance and compassion or a wait-list condition. Primary treatment outcomes were the Chronic Pain Acceptance Questionnaire, Self-Compassion Scale, and Pain Disability Index. Secondary outcomes were the Montgomery Åsberg Depression Rating Scale, Anxiety Sensitivity Index, Quality of Life Inventory, Multidimensional Pain Inventory, and Perseverative Thinking Questionnaire. RESULTS Missing data at postintervention were 22.5%. Intention-to-treat analyses were conducted using linear mixed models. The results revealed greater levels of acceptance and self-compassion for the treatment group, which were primary outcomes, with effect sizes ranging from small to large, and these results were maintained at 6-month follow-up. The rates of clinically significant improvements were also greater for the treatment group in comparison to the wait-list control group on acceptance and compassion. The treatment group also improved in the third primary outcome, pain disability. Significant differences were found in several of the secondary outcomes, in favor of the treatment group. DISCUSSION Internet-based Acceptance and Commitment Therapy with compassion-focused therapy components shows promise as a viable treatment option in the management of chronic pain.
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Affiliation(s)
| | - Maria Tillfors
- Department of Social and Psychological Studies, Section of Psychology, Karlstad University, Karlstad
| | | | | | | | - Katja Boersma
- School of Medical Sciences
- Center for Health and Medical Psychology, School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
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Hurwitz C, Shiner CT, Sharrock MJ, Millard M, Mahoney A. Mindfulness-enhanced internet-based cognitive behavioural therapy for anxiety and depression: Outcomes in routine care. J Affect Disord 2023; 341:1-7. [PMID: 37625704 DOI: 10.1016/j.jad.2023.08.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/02/2023] [Accepted: 08/14/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND Clinical trials support the efficacy of mindfulness-enhanced, internet-based cognitive behavioural therapies (CBT) in reducing anxiety and depression symptom severity. However, it is unclear how effective these interventions are when delivered in routine clinical care settings. This study investigated the utilisation and treatment outcomes of an online mindfulness-enhanced CBT program in the general Australian community. METHODS Over a one-year study period, 2187 adults commenced the online mindfulness-enhanced CBT program. The program consisted of six sequential lessons to be completed within 90 days. Participants (mean age= 39 ± 14 years, 68 % female) completed measures of symptom severity for anxiety, depression, and psychological distress at pre-, mid- and post-treatment. Treatment effects were assessed via intention-to-treat linear mixed models with Hedges' g effect size calculations. RESULTS From pre- to post-treatment, the mindfulness-enhanced CBT program was associated with medium and large effect sized reductions in generalised anxiety symptom severity (g = 0.80, 95%CI: 0.74-0.86), depression symptom severity (g = 0.74, 95%CI: 0.68-0.80), and psychological distress (g = 0.97, 95%CI: 0.90-1.03). Program adherence was modest with approximately 30 % of participants completing all six lessons of the program. LIMITATIONS This study is limited by its lack of a comparator condition, longer-term follow-up, and assessment of the reasons for participant non-adherence. The relative acceptability and effectiveness of mindfulness versus CBT components was not examined. CONCLUSION This study supports the effectiveness of mindfulness-enhanced iCBT for symptoms of anxiety and depression when delivered in a routine care setting under the supervision of community health care practitioners.
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Affiliation(s)
- Claudia Hurwitz
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - Christine T Shiner
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Clinical Medicine, University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Maria J Sharrock
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia.
| | - Michael Millard
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia.
| | - Alison Mahoney
- Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia; School of Psychiatry, University of New South Wales, Sydney, New South Wales 2052, Australia.
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McCall H, Dear BF, Landry C, Beahm JD, Gregory J, Titov N, Carleton RN, Hadjistavropoulos HD. Internet-delivered cognitive behavioural therapy for symptoms of PTSD among public safety personnel: Initial outcomes of an open cohort preference trial of transdiagnostic and disorder-specific therapy. Internet Interv 2023; 33:100656. [PMID: 37609530 PMCID: PMC10440509 DOI: 10.1016/j.invent.2023.100656] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/27/2023] [Accepted: 08/07/2023] [Indexed: 08/24/2023] Open
Abstract
Public safety personnel (PSP) face high rates of mental health problems and many barriers to care. Initial outcomes of transdiagnostic internet-delivered cognitive behavioural therapy (ICBT) tailored for PSP are promising, but prior research has not evaluated outcomes of PTSD-specific ICBT among PSP or PSP's preferences for transdiagnostic or PTSD-specific ICBT. The current paper presents the initial outcomes (N = 150) of a mixed-methods observational study designed to (a) investigate preferences for transdiagnostic or PTSD-specific ICBT among PSP with elevated symptoms of PTSD and/or a primary concern with PTSD symptoms and (b) explore potential differences in client engagement, satisfaction, and symptom changes between the two forms of ICBT. PSP completed questionnaires before and after their preferred ICBT program. Mixed-methods analyses included generalized estimating equations, descriptive statistics, and inductive conventional qualitative content analysis. More clients (n = 85; 57 %) selected transdiagnostic ICBT than PTSD-specific ICBT (n = 65; 43 %), but the difference in the number of clients who selected each course was not statistically significant. Clients in both ICBT programs reported similar and favorable treatment satisfaction (e.g., 98 % would recommend the course to a friend), treatment engagement (i.e., 69 % accessed at least four of the five lessons), and pre-post improvement in symptoms (e.g., Hedges' g = 0.81 for reduction in PTSD symptom). Transdiagnostic ICBT resulted in greater reductions in symptoms of panic disorder than PTSD-specific ICBT. Qualitative analyses showed similarities across the ICBT programs in client feedback. The current study provides further evidence supporting the use and outcomes of ICBT for PSP in both transdiagnostic and disorder-specific formats. Implications for the literatures on PSP mental health and ICBT, as well as practical recommendations, are discussed.
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Affiliation(s)
- Hugh McCall
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Blake F. Dear
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
- eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - Caeleigh Landry
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Janine D. Beahm
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Julia Gregory
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Nickolai Titov
- School of Psychological Sciences, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
- eCentreClinic, Macquarie University, Balaclava Rd, Macquarie Park, NSW 2109, Australia
| | - R. Nicholas Carleton
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK S4S 0A2, Canada
- PSPNET, University of Regina, 2 Research Drive, Regina, SK S4T 2P7, Canada
- Canadian Institute for Public Safety Research and Treatment (CIPSRT), 2 Research Drive, Regina, SK S4T 2P7, Canada
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Heriseanu AI, Karin E, Walker J, Scott AJ, Bisby MA, Gandy M, Dudeney J, Fisher A, Titov N, Dear BF. The impact of obesity and overweight on response to internet-delivered cognitive behavioural therapy for adults with chronic health conditions. Int J Obes (Lond) 2023; 47:487-495. [PMID: 36869151 PMCID: PMC10212763 DOI: 10.1038/s41366-023-01285-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 02/16/2023] [Accepted: 02/17/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND There is growing evidence that internet-delivered cognitive behavioural therapy (iCBT) can improve functioning and reduce psychological distress in people with chronic health conditions. Obesity frequently co-occurs with chronic health conditions, yet its impact on response to psychological interventions in this population is not known. The current study examined associations between BMI and clinical outcomes (depression, anxiety, disability, and satisfaction with life) following a transdiagnostic iCBT program targeting adjustment to chronic illness. METHODS Participants from a large randomised controlled trial, who provided information on height and weight, were included (N = 234; mean age= 48.32, SD = 13.80; mean BMI = 30.43, SD = 8.30, range 16.18-67.52; 86.8% female). The influence of baseline BMI range on treatment outcomes at post-treatment and 3-month follow-up was examined using generalized estimating equations. We also examined changes in BMI and in participants' perceived impact of weight on their health. RESULTS Improvement in all outcomes occurred across BMI ranges; additionally, persons with obesity or overweight generally experienced greater symptom reductions than those within a healthy weight range. A greater proportion of participants with obesity achieved clinically significant change on key outcomes (e.g., depression: 32% [95% CI: 25%, 39%]) than participants with a healthy weight (21% [95% CI: 15%, 26%]) or overweight (24% [95% CI: 18%, 29%], p = 0.016). There were no significant changes in BMI from pre-treatment to 3-month follow-up, however there were significant reductions on the self-rated impact of weight on health. CONCLUSIONS Persons with chronic health conditions and with obesity or overweight benefit at least as much as those with a healthy BMI from iCBT programs targeting psychological adjustment to chronic illness, even without changes in BMI. iCBT programs may be an important component in the self-management of this population, and may address barriers implicated in health behaviour change.
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Affiliation(s)
- Andreea I Heriseanu
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia.
| | - Eyal Karin
- School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Jennie Walker
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, NSW, Australia
| | - Amelia J Scott
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Madelyne A Bisby
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Milena Gandy
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Joanne Dudeney
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Alana Fisher
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
| | - Nickolai Titov
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
- MindSpot Clinic, MQ Health, Macquarie University, Sydney, NSW, Australia
| | - Blake F Dear
- eCentreClinic, School of Psychological Sciences, Macquarie University, Sydney, NSW, Australia
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Kho MC, Karin E, Gucciardi DF, Crane MF. Testing a
supervisor‐led
extension of self‐reflection resilience training: A controlled trial randomized by platoon at the Royal Military College. JOURNAL OF OCCUPATIONAL AND ORGANIZATIONAL PSYCHOLOGY 2022. [DOI: 10.1111/joop.12420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Madison C. Kho
- School of Psychological Sciences Macquarie University North Ryde New South Wales Australia
| | - Eyal Karin
- eCentre Clinic, School of Psychological Sciences Macquarie University North Ryde New South Wales Australia
| | - Daniel F. Gucciardi
- Curtin School of Allied Health and Curtin Enable Institute Curtin University Bentley Western Australia Australia
| | - Monique F. Crane
- School of Psychological Sciences Macquarie University North Ryde New South Wales Australia
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Bisby MA, Titov N, Dear BF, Karin E, Wilhelms A, Nugent M, Hadjistavropoulos HD. Examining Change in the Frequency of Adaptive Actions as a Mediator of Treatment Outcomes in Internet-Delivered Therapy for Depression and Anxiety. J Clin Med 2022; 11:6001. [PMID: 36294322 PMCID: PMC9605214 DOI: 10.3390/jcm11206001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/07/2022] [Accepted: 10/10/2022] [Indexed: 11/17/2022] Open
Abstract
Adaptive actions, including healthy thinking and meaningful activities, have been associated with emotional wellbeing. The Things You Do Questionnaire-21 item (TYDQ-21) has recently been created to measure the frequency of such actions. A study using the TYDQ-21 found that adaptive actions increased across Internet-delivered therapy for symptoms of depression and anxiety, and higher TYDQ-21 scores were associated with lower psychological distress at post-treatment. The current study examined the relationships between adaptive actions and psychological distress among adults (n = 1114) receiving Internet-delivered therapy as part of routine care in Canada, and explored whether adaptive actions mediated reductions in depression and anxiety. As hypothesised, adaptive actions increased alongside reductions in depression and anxiety symptoms from baseline to post-treatment. Treatment effects were consistent when the intervention was provided with regular weekly therapist support or with optional weekly therapist support, and some (but not all) types of adaptive actions had a mediating effect on change in depressive symptoms. The present findings support further work examining adaptive actions as a mechanism of change in psychotherapy, as well as the utility and scalability of Internet-delivered treatments to target and increase adaptive actions with the aim of improving mental health.
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Affiliation(s)
- Madelyne A. Bisby
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney 2109, Australia
- MindSpot Clinic, MQ Health, Macquarie University, Sydney 2109, Australia
| | - Nickolai Titov
- MindSpot Clinic, MQ Health, Macquarie University, Sydney 2109, Australia
| | - Blake F. Dear
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney 2109, Australia
| | - Eyal Karin
- eCentreClinic, School of Psychological Sciences, Faculty of Medicine, Health, and Human Sciences, Macquarie University, Sydney 2109, Australia
| | - Andrew Wilhelms
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Marcie Nugent
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
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Peynenburg V, Hadjistavropoulos H, Thiessen D, Titov N, Dear B. A Randomized Factorial Trial of Internet-Delivered Cognitive Behaviour Therapy for Post-Secondary Students: Examining Motivational Interviewing and Booster Lessons (Preprint). J Med Internet Res 2022; 24:e40637. [PMID: 36069785 PMCID: PMC9494224 DOI: 10.2196/40637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/28/2022] [Accepted: 08/12/2022] [Indexed: 12/05/2022] Open
Abstract
Background Internet-delivered cognitive behavioral therapy (ICBT) can improve access to mental health care for students, although high attrition rates are concerning and little is known about long-term outcomes. Motivational interviewing (MI) exercises and booster lessons can improve engagement and outcomes in face-to-face cognitive behavioral therapy. Objective This study aimed to examine the use of pretreatment MI exercises and booster lessons in ICBT for postsecondary students. Methods In this factorial trial (factor 1: web-based MI before treatment; factor 2: self-guided booster lesson 1 month after treatment), 308 clients were randomized to 1 of 4 treatment conditions, with 277 (89.9%) clients starting treatment. All clients received a 5-week transdiagnostic ICBT course (the UniWellbeing course). Primary outcomes included changes in depression, anxiety, and perceived academic functioning from before treatment to after treatment and at the 1-month and 3-month follow-ups. Results Overall, 54% (150/277) of students completed treatment and reported large improvements in symptoms of depression and anxiety and small improvements in academic functioning after treatment, which were maintained at the 1-month and 3-month follow-ups. Pretreatment MI did not contribute to better treatment completion or engagement, although small between-group effects favored MI for reductions in depression (Cohen d=0.23) and anxiety (Cohen d=0.25) after treatment. Only 30.9% (43/139) of students randomized to one of the booster conditions accessed the booster. Overall, no main effects were found for the booster. Subanalyses revealed that clients who accessed the booster had larger decreases in depressive symptoms (Cohen d=0.31) at the 3-month follow-up. No interactions were found between MI and the booster. Conclusions Rather than offering MI before treatment, clients may experience more benefits from MI exercises later in ICBT when motivation wanes. The low uptake of the self-guided booster limited our conclusions regarding its effectiveness. Future research should examine offering a booster for a longer duration after treatment, with therapist support and a longer follow-up period. Trial Registration ClinicalTrials.gov NCT04264585; https://clinicaltrials.gov/ct2/show/NCT04264585
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Affiliation(s)
| | | | - David Thiessen
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Nickolai Titov
- eCentre Clinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake Dear
- eCentre Clinic, Department of Psychology, Macquarie University, Sydney, Australia
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Scott AJ, Bisby MA, Heriseanu AI, Hathway T, Karin E, Gandy M, Dudeney J, Staples LG, Titov N, Dear BF. Understanding the untreated course of anxiety disorders in treatment-seeking samples: A systematic review and meta-analysis. J Anxiety Disord 2022; 89:102590. [PMID: 35689850 DOI: 10.1016/j.janxdis.2022.102590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/31/2022] [Accepted: 06/02/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Very little is known about the course of anxiety disorders when they go untreated, despite the significant theoretical and practical value of this information, such as for treatment planning and benchmarking purposes. This meta-analysis aimed to examine the course of anxiety disorders in treatment-seeking samples using the control groups of treatment studies for anxiety disorders. METHODS Following pre-registration, we systematically searched the literature for RCTs of treatment for anxiety disorders. Studies were included if they randomised participants to a control arm, where treatment was not received (i.e. waitlist control or no-treatment control). Meta-analyses were conducted to determine the magnitude of symptom change over the control period (Hedges' g), and rate of response (pooled prevalence). Effects were compared between anxiety disorders, alongside other potential moderators. RESULTS Following search and screening, 173 RCTs met criteria (n = 15,250) for data extraction. Overall, untreated participants demonstrated significant, but small improvements to anxiety symptoms (g = 0.17, 95% CI 0.14, 0.21). Significant differences were observed between anxiety disorders, and according to other methodological features of the included trials. CONCLUSIONS Results suggest that anxiety disorders are unlikely to remit without treatment, with some disorders remitting to a lesser extent than others. While this review is limited to a treatment-seeking sample, results provide theoretical and practical value for researchers and treatment providers.
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Affiliation(s)
- Amelia J Scott
- Department of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Madelyne A Bisby
- Department of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Andreea I Heriseanu
- Department of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Taylor Hathway
- Department of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Eyal Karin
- Department of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Milena Gandy
- Department of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- Department of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Lauren G Staples
- Department of Psychological Sciences, Macquarie University, Sydney, Australia; MindSpot, MQ Health, Sydney, Australia
| | - Nickolai Titov
- Department of Psychological Sciences, Macquarie University, Sydney, Australia; MindSpot, MQ Health, Sydney, Australia
| | - Blake F Dear
- Department of Psychological Sciences, Macquarie University, Sydney, Australia
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20
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Lippke S, Gao L, Keller FM, Becker P, Dahmen A. Adherence With Online Therapy vs Face-to-Face Therapy and With Online Therapy vs Care as Usual: Secondary Analysis of Two Randomized Controlled Trials. J Med Internet Res 2021; 23:e31274. [PMID: 34730541 PMCID: PMC8600425 DOI: 10.2196/31274] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/26/2021] [Accepted: 09/13/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Adherence to internet-delivered interventions targeting mental health such as online psychotherapeutic aftercare is important for the intervention's impact. High dropout rates limit the impact and generalizability of findings. Baseline differences may be putting patients at risk for dropping out, making comparisons between online with face-to-face (F2F) therapy and care as usual (CAU) necessary to examine. OBJECTIVE This study investigated adherence to online, F2F, and CAU interventions as well as study dropout among these groups and the subjective evaluation of the therapeutic relationship. Sociodemographic, social-cognitive, and health-related variables were considered. METHODS In a randomized controlled trial, 6023 patients were recruited, and 300 completed the baseline measures (T1), 144 completed T2 (retention 44%-52%), and 95 completed T3 (retention 24%-36%). Sociodemographic variables (eg, age, gender, marital status, educational level), social-cognitive determinants (eg, self-efficacy, social support), health-related variables (eg, depressiveness), and expectation towards the treatment for patients assigned to online or F2F were measured at T1. RESULTS There were no significant differences between the groups regarding dropout rates (χ21=0.02-1.06, P≥.30). Regarding adherence to the treatment condition, the online group outperformed the F2F and CAU conditions (P≤.01), indicating that patients randomized into the F2F and CAU control groups were much more likely to show nonadherent behavior in comparison with the online therapy groups. Within study groups, gender differences were significant only in the CAU group at T2, with women being more likely to drop out. At T3, age and marital status were also only significant in the CAU group. Patients in the online therapy group were significantly more satisfied with their treatment than patients in the F2F group (P=.02; Eta²=.09). Relationship satisfaction and success satisfaction were equally high (P>.30; Eta²=.02). Combining all study groups, patients who reported lower depressiveness scores at T1 (T2: odds ratio [OR] 0.55, 95% CI 0.35-0.87; T3: OR 0.56, 95% CI 0.37-0.92) were more likely to be retained, and patients who had higher self-efficacy (T2: OR 0.57, 95% CI 0.37-0.89; T3: OR 0.52, 95% CI 0.32-0.85) were more likely to drop out at T2 and T3. Additionally, at T3, the lower social support that patients reported was related to a higher likelihood of remaining in the study (OR 0.68, 95% CI 0.48-0.96). Comparing the 3 intervention groups, positive expectation was significantly related with questionnaire completion at T2 and T3 after controlling for other variables (T2: OR 1.64, 95% CI 1.08-2.50; T3: OR 1.59, 95% CI 1.01-2.51). CONCLUSIONS While online interventions have many advantages over F2F variants such as saving time and effort to commute to F2F therapy, they also create difficulties for therapists and hinder their ability to adequately react to patients' challenges. Accordingly, patient characteristics that might put them at risk for dropping out or not adhering to the treatment plan should be considered in future research and practice. Online aftercare, as described in this research, should be provided more often to medical rehabilitation patients. TRIAL REGISTRATION ClinicalTrials.gov NCT04989842; https://clinicaltrials.gov/ct2/show/NCT04989842.
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Affiliation(s)
- Sonia Lippke
- Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany
| | - Lingling Gao
- Department of Psychology and Methods, Jacobs University Bremen, Bremen, Germany
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21
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The Pain Course: a randomised controlled trial and economic evaluation of an internet-delivered pain management program. Pain 2021; 163:1388-1401. [PMID: 34609359 DOI: 10.1097/j.pain.0000000000002507] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 09/24/2021] [Indexed: 11/26/2022]
Abstract
ABSTRACT There is interest in the potential of Internet-delivered programs to cost-effectively increase access to pain management for people with chronic pain. However, few large-scale clinical and economic evaluations have been undertaken. Using a randomised controlled trial design, the current study (n = 659) examined the clinical efficacy, cost-effectiveness, and cost utility of an Internet-delivered pain management program for people with mixed chronic pain conditions when delivered with optional clinician support. The treatment group reported significant improvements in disability, depression, anxiety, average pain intensity, and quality-adjusted life years (QALYs), compared with control, and exhibited relatively high levels of treatment engagement and satisfaction. Each additional clinical improvement (defined as ≥ 30% improvement) produced by the intervention, over control, was associated with a cost of $48, $27, $38, and $83 for disability, depression, anxiety, and average pain intensity, respectively. Gaining one QALY was associated with a cost of $152 or $11,910 per QALY when an 80% probability criterion for cost utility was applied. The program itself was associated a relatively small, fixed, cost per patient but was not cost saving over the brief intervention period. The findings support the clinical efficacy and cost-effectiveness of Internet-delivered programs with "on demand" clinician support as a way to increase access to pain management. Key limitations of the current study include the use of a waitlist-control group, a short follow-up period, and the focus on governmental healthcare costs. Further evaluation of these programs is necessary if they are scaled up and offered as routine care.
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22
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Hadjistavropoulos HD, Peynenburg V, Thiessen D, Schneider LH, Nugent M, Wilhelms A, Karin E, Titov N, Dear BF. Five-year observational study of Internet-delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic. Eur J Pain 2021; 26:390-404. [PMID: 34592026 PMCID: PMC9293405 DOI: 10.1002/ejp.1866] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/16/2021] [Accepted: 09/22/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Internet-delivered cognitive behavioural pain management programmes (PMPs) are effective, but less is known about their use outside of research trials. Five years of data from offering the Internet-delivered cognitive behavioural PMP in an online therapy clinic was examined to assess effectiveness, acceptability and predictors of outcomes. METHODS Patients (N = 293) were offered a previously validated 8-week Internet-delivered cognitive behavioural PMP and administered measures at pre-treatment, post-treatment and 3 months. RESULTS There was growth in demand for an Internet-delivered cognitive behavioural PMP over time (n = 64 first year to n = 133 fifth year). Moderate-to-large improvements on depression (post-treatment 35% reduction; 3-month 41% reduction) and anxiety (post-treatment 37% reduction; 3-month 41% reduction), and small-to-moderate improvements on disability (post-treatment 19% reduction; 3-month 20% reduction) were found. Lesson completion and satisfaction were high. Lower pain acceptance, lower pain self-efficacy and higher pain intensity were associated with lower improvements on depression, anxiety and disability. CONCLUSIONS This longitudinal observational study provides support for Internet-delivered cognitive behavioural PMPs when offered as routine care by an online therapy clinic. SIGNIFICANCE This 5-year observational study provides support for Internet-delivered cognitive behavioural pain management programs (PMPs) offered as routine care in an online therapy clinic. Interest in the service grew over 5 years. Outcomes, engagement and satisfaction were strong. Higher pain acceptance, pain self-efficacy and lower pain severity were associated with greater post-treatment improvements on depression, anxiety and disability.
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Affiliation(s)
| | - Vanessa Peynenburg
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - David Thiessen
- Department of Mathematics & Statistics, University of Regina, Saskatchewan, Canada
| | - Luke H Schneider
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Marcie Nugent
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Andrew Wilhelms
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada
| | - Eyal Karin
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
| | - Blake F Dear
- Department of Psychology, MindSpot Clinic and eCentreClinic, Macquarie University, Sydney, Australia
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Soucy JN, Hadjistavropoulos HD, Karin E, Dear BF, Titov N. Brief online motivational interviewing pre-treatment intervention for enhancing internet-delivered cognitive behaviour therapy: A randomized controlled trial. Internet Interv 2021; 25:100394. [PMID: 33996510 PMCID: PMC8099490 DOI: 10.1016/j.invent.2021.100394] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/12/2021] [Accepted: 04/14/2021] [Indexed: 11/16/2022] Open
Abstract
While the efficacy of therapist-guided internet-delivered cognitive behaviour therapy (iCBT) for anxiety and depression is well-established, a significant proportion of clients show little to no improvement with this approach. Given that motivational interviewing (MI) is found to enhance face-to-face treatment of anxiety, the current trial examined potential benefits of a brief online MI intervention prior to therapist-guided iCBT. Clients applying to transdiagnostic therapist-guided iCBT in routine care were randomly assigned to receive iCBT with (n = 231) or without (n = 249) the online MI pre-treatment. Clients rated motivation at screening and pre-iCBT and anxiety and depression at pre- and post-treatment and at 13- and 25-week follow-up after enrollment. Clients in the MI plus iCBT group made more motivational statements in their emails and were enrolled in the course for a greater number of days compared to clients who received iCBT only, but did not demonstrate higher motivation after completing the MI intervention or have higher course completion. Clients in both groups, at screening and pre-iCBT, reported high levels of motivation. No statistically significant group differences were found in the rate of primary symptom change over time, with both groups reporting large reductions in anxiety and depression pre- to post-treatment (Hedges' g range = 0.96-1.11). During follow-up, clients in the iCBT only group reported additional small reductions in anxiety, whereas clients in the MI plus iCBT group did not. The MI plus iCBT group also showed small increases in depression during follow-up, whereas improvement was sustained for the iCBT only group. It is concluded that online MI does not appear to enhance client outcomes when motivation at pre-treatment is high.
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Affiliation(s)
- Joelle N. Soucy
- Department of Psychology, University of Regina, Regina, Canada
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Canada,Corresponding author at: 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada.
| | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- MindSpot Clinic, Department of Psychology, Macquarie University, Sydney, Australia
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24
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Karin E, Crane MF, Dear BF, Nielssen O, Heller GZ, Kayrouz R, Titov N. Predictors, Outcomes, and Statistical Solutions of Missing Cases in Web-Based Psychotherapy: Methodological Replication and Elaboration Study. JMIR Ment Health 2021; 8:e22700. [PMID: 33544080 PMCID: PMC7895640 DOI: 10.2196/22700] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 12/09/2020] [Accepted: 12/13/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Missing cases present a challenge to our ability to evaluate the effects of web-based psychotherapy trials. As missing cases are often lost to follow-up, less is known about their characteristics, their likely clinical outcomes, or the likely effect of the treatment being trialed. OBJECTIVE The aim of this study is to explore the characteristics of missing cases, their likely treatment outcomes, and the ability of different statistical models to approximate missing posttreatment data. METHODS A sample of internet-delivered cognitive behavioral therapy participants in routine care (n=6701, with 36.26% missing cases at posttreatment) was used to identify predictors of dropping out of treatment and predictors that moderated clinical outcomes, such as symptoms of psychological distress, anxiety, and depression. These variables were then incorporated into a range of statistical models that approximated replacement outcomes for missing cases, and the results were compared using sensitivity and cross-validation analyses. RESULTS Treatment adherence, as measured by the rate of progress of an individual through the treatment modules, and higher pretreatment symptom scores were identified as the dominant predictors of missing cases probability (Nagelkerke R2=60.8%) and the rate of symptom change. Low treatment adherence, in particular, was associated with increased odds of presenting as missing cases during posttreatment assessment (eg, odds ratio 161.1:1) and, at the same time, attenuated the rate of symptom change across anxiety (up to 28% of the total symptom with 48% reduction effect), depression (up to 41% of the total with 48% symptom reduction effect), and psychological distress symptom outcomes (up to 52% of the total with 37% symptom reduction effect) at the end of the 8-week window. Reflecting this pattern of results, statistical replacement methods that overlooked the features of treatment adherence and baseline severity underestimated missing case symptom outcomes by as much as 39% at posttreatment. CONCLUSIONS The treatment outcomes of the cases that were missing at posttreatment were distinct from those of the remaining observed sample. Thus, overlooking the features of missing cases is likely to result in an inaccurate estimate of the effect of treatment.
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Affiliation(s)
- Eyal Karin
- Department of Psychology, Macquarie University, MindSpot Clinic, Macquarie Park, Australia
| | - Monique Frances Crane
- Department of Psychology, Macquarie University, MindSpot Clinic, Macquarie Park, Australia
| | - Blake Farran Dear
- Department of Psychology, Macquarie University, eCentreClinic, Sydney, Australia
| | - Olav Nielssen
- Department of Psychology, Macquarie University, MindSpot Clinic, Sydney, Australia
| | | | - Rony Kayrouz
- Department of Psychology, Macquarie University, MindSpot Clinic, Macquarie Park, Australia
| | - Nickolai Titov
- Department of Psychology, Macquarie University, MindSpot Clinic, Macquarie Park, Australia
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25
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Rickardsson J, Gentili C, Holmström L, Zetterqvist V, Andersson E, Persson J, Lekander M, Ljótsson B, Wicksell RK. Internet-delivered acceptance and commitment therapy as microlearning for chronic pain: A randomized controlled trial with 1-year follow-up. Eur J Pain 2021; 25:1012-1030. [PMID: 33460240 DOI: 10.1002/ejp.1723] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 12/08/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Studies of Internet-delivered acceptance and commitment therapy (ACT) for chronic pain have shown small to moderate positive effects for pain interference and pain acceptance. Effects on pain intensity, depression, anxiety and quality of life (QoL) have been less favourable, and improvements for values and sleep are lacking. In this randomized controlled trial iACT - a novel format of Internet-ACT using daily microlearning exercises - was examined for efficacy compared to a waitlist condition. METHODS Adult participants (mean age 49.5 years, pain duration 18.1 years) with diverse chronic pain conditions were recruited via self-referral, and randomized to iACT (n = 57) or waitlist (n = 56). The primary outcome was pain interference. The secondary outcomes were QoL, depression, anxiety, insomnia and pain intensity. The process variables included psychological inflexibility and values. Post-assessments were completed by 88% (n = 100) of participants. Twelve-month follow-up assessments were completed by 65% (iACT only, n = 37). Treatment efficacy was analysed using linear mixed models and an intention-to-treat-approach. RESULTS Significant improvements in favour of iACT were seen for pain interference, depression, anxiety, pain intensity and insomnia, as well as process variables psychological inflexibility and values. Between-group effect sizes were large for pain interference (d = 0.99) and pain intensity (d = 1.2), moderate for anxiety and depressive symptoms and small for QoL and insomnia. For the process variables, the between-group effect size was large for psychological inflexibility (d = 1.0) and moderate for values. All improvements were maintained at 1-year follow-up. CONCLUSIONS Internet-ACT as microlearning may improve a broad range of outcomes in chronic pain. SIGNIFICANCE The study evaluates a novel behavioral treatment with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. The innovative format of a digital ACT intervention delivered in short and experiential daily learnings may be a promising way forward.
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Affiliation(s)
- Jenny Rickardsson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Gentili
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Linda Holmström
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Women's and Children's Health Karolinska Institutet, Stockholm, Sweden
| | - Vendela Zetterqvist
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Jan Persson
- Functional Unit Behavioral Medicine, Karolinska University Hospital, Stockholm, Sweden.,Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Mats Lekander
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Rikard K Wicksell
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Hadjistavropoulos H, Peynenburg V, Nugent M, Karin E, Titov N, Dear B. Transdiagnostic Internet-delivered cognitive behaviour therapy with therapist support offered once-weekly or once-weekly supplemented with therapist support within one-business-day: Pragmatic randomized controlled trial. Internet Interv 2020; 22:100347. [PMID: 32995303 PMCID: PMC7508705 DOI: 10.1016/j.invent.2020.100347] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/23/2020] [Accepted: 08/28/2020] [Indexed: 11/30/2022] Open
Abstract
In routine care, internet-delivered cognitive behaviour therapy (iCBT) regularly includes therapist support delivered via secure email, but the optimal response time to emails is unknown. In this study, we compared the benefits of therapists providing support once-weekly versus therapists providing support once-weekly supplemented with a one-business-day response to all patient emails. This pragmatic randomized controlled trial included therapists employed by a specialized iCBT clinic or community mental health clinics, where providing iCBT is a secondary service. Patients with depression and/or anxiety who enrolled in transdiagnostic iCBT (5 core lessons over 8 weeks) were randomized to: 1) once-weekly support supplemented with a one-business-day response to patient emails by specialized therapists (n = 233); 2) once-weekly support also offered by specialized therapists (n = 216); or 3) once-weekly support offered by community clinic therapists (n = 226). Outcomes were measured at 8, 12, 24, and 52-weeks post-enrollment. Patient engagement and treatment experiences (e.g., treatment satisfaction, therapist alliance) were also assessed and a focus group was conducted with therapists. Supplementing once-weekly therapist support with a one-business-day response to patient emails resulted in therapists sending more emails to patients (M: 13 versus 9) and required more therapist time over treatment (M: 155 versus 109 min), but was not associated with improved outcomes, patient engagement or treatment experiences. All groups showed large improvements in symptoms of depression and anxiety maintained at 52-week follow-up, strong engagement and positive treatment experiences. Therapists viewed challenges of responding to patient emails within one-business-day to outweigh benefits. Contrary to expectations, supplementing once-weekly therapist support with a one-business-day response to all patient emails did not benefit patients and increased therapist time as well as therapist challenges when delivering iCBT in routine care.
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Affiliation(s)
- H.D. Hadjistavropoulos
- 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada
| | - V. Peynenburg
- 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada
| | - M. Nugent
- 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada
| | - E. Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Balaclava Road, North Ryde, NSW, Australia
| | - N. Titov
- MindSpot Clinic and eCentreClinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW, Australia
| | - B.F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Balaclava Road, North Ryde, NSW, Australia
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27
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Hadjistavropoulos H, Peynenburg V, Thiessen D, Nugent M, Adlam K, Owens K, Karin E, Dear B, Titov N. A pragmatic factorial randomized controlled trial of transdiagnostic internet-delivered cognitive behavioural therapy: Exploring benefits of homework reflection questionnaires and twice-weekly therapist support. Internet Interv 2020; 22:100357. [PMID: 33335846 PMCID: PMC7734229 DOI: 10.1016/j.invent.2020.100357] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 10/14/2020] [Accepted: 11/04/2020] [Indexed: 12/26/2022] Open
Abstract
With the growing demand for internet-delivered cognitive behavioural therapy (iCBT), this pragmatic factorial (2 × 2 × 2) randomized controlled trial evaluated strategies for facilitating iCBT engagement and outcomes in routine care. Specifically, the benefits to patients and therapists of using homework reflection questionnaires and offering patients twice-weekly therapist support were examined. Patients (n = 632) accepted into iCBT for depression and/or anxiety were randomly assigned to complete homework reflection questionnaires or not (factor 1), receive once- or twice-weekly support (factor 2), and to receive care from therapists employed in one of two settings (iCBT clinic or a community mental health clinic; factor 3). Outcomes were measured at pre-treatment, and 8, 12, and 24-weeks post-enrollment. Therapist time was tracked and a focus group was conducted to examine therapist experiences. No differences in patient outcomes were found between therapists employed in the two settings; as such, these two groups were combined for further analyses. In terms of engagement, homework reflection questionnaires were associated with fewer website log-ins and days accessing iCBT; twice-weekly support was associated with more patient emails sent to therapists. Despite engagement differences, homework reflection questionnaires and twice-weekly support did not significantly impact primary outcomes; all groups showed large improvements in depression and anxiety that were maintained at 24-week follow-up. Therapists perceived a number of benefits and challenges associated with responding to homework reflection questionnaires and offering twice-weekly support; most notably the strategies did not benefit all patients. Twice-weekly support was associated with increased therapist time and organizational challenges. It is concluded that neither completion of homework questionnaires nor offering twice-weekly support significantly improve iCBT in routine care.
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Affiliation(s)
- H.D. Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada,Corresponding author.
| | - V. Peynenburg
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - D.L. Thiessen
- Department of Mathematics & Statistics, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - M. Nugent
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - K. Adlam
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - K.M.B. Owens
- Adult Therapy Program, Regina Mental Health Clinic, Saskatchewan Health Authority, 2110 Hamilton St, Regina, SK S4P 2E3, Canada
| | - E. Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - B.F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW 2109, Australia
| | - N. Titov
- MindSpot Clinic, eCentreClinic, Department of Psychology, Macquarie University, Australian Hearing Hub Building, Sydney, NSW 2109, Australia
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28
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Dear BF, Karin E, Fogliati R, Dudeney J, Nielssen O, Scott AJ, Gandy M, Bisby MA, Heriseanu AI, Hathway T, Staples L, Titov N, Schroeder L. A Cost-effectiveness Analysis of an Internet-delivered Pain Management Program Delivered With Different Levels of Clinician Support: Results From a Randomised Controlled Trial. THE JOURNAL OF PAIN 2020; 22:344-358. [PMID: 33227510 DOI: 10.1016/j.jpain.2020.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/02/2020] [Indexed: 10/23/2022]
Abstract
There is growing interest in the potential of internet-delivered pain management programs (PMPs) to increase access to care for people with chronic pain. However, very few economic evaluations of these interventions have been reported. Using existing data, the current study examined the cost-effectiveness of an internet-delivered PMP for a mixed group chronic pain patients (n = 490) provided with different levels of clinician support. The findings indicated that each additional clinical outcome (defined as a ≥ 30% reduction in disability, depression, anxiety, and pain) was associated with cost-savings when the intervention was provided in a self-guided format (ICER range: -$404--$808 AUD) or an optional-guided format (ICER range: -$314--$541 AUD), and a relatively small fixed cost when provided in the clinician-guided format (ICER range: $88-$225 AUD). The results were driven by a reduction in service use costs among the treatment groups, which offset the costs of providing the internet-delivered PMP in the self-guided and optional-guided formats. The same general pattern of results was found when more stringent clinical outcomes (defined as a ≥ 50% reduction) were employed. These findings suggest that carefully developed and administered internet-delivered PMPs, provided with different levels of clinician support, can be highly cost effective for patients with a broad range of pain conditions. PERSPECTIVE: This study examines the cost-effectiveness of an internet-delivered PMP provided to adults with a broad range of chronic pain conditions. Evidence of cost-effectiveness was found across a broad range of clinical outcomes and with different levels of clinician support.
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Affiliation(s)
- Blake F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia.
| | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Rhiannon Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Olav Nielssen
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Amelia J Scott
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Milena Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Madelyne A Bisby
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andreea I Heriseanu
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Taylor Hathway
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Lauren Staples
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Liz Schroeder
- Centre for Health Economy, Macquarie University, Sydney, Australia
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Titov N, Dear BF, Nielssen O, Wootton B, Kayrouz R, Karin E, Genest B, Bennett-Levy J, Purtell C, Bezuidenhout G, Tan R, Minissale C, Thadhani P, Webb N, Willcock S, Andersson G, Hadjistavropoulos HD, Mohr DC, Kavanagh DJ, Cross S, Staples LG. User characteristics and outcomes from a national digital mental health service: an observational study of registrants of the Australian MindSpot Clinic. LANCET DIGITAL HEALTH 2020; 2:e582-e593. [PMID: 33103097 PMCID: PMC7571905 DOI: 10.1016/s2589-7500(20)30224-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background Interest is growing in digital and telehealth delivery of mental health services, but data are scarce on outcomes in routine care. The federally funded Australian MindSpot Clinic provides online and telephone psychological assessment and treatment services to Australian adults. We aimed to summarise demographic characteristics and treatment outcomes of patients registered with MindSpot over the first 7 years of clinic operation. Methods We used an observational design to review all patients who registered for assessment with the MindSpot Clinic between Jan 1, 2013, and Dec 31, 2019. We descriptively analysed the demographics, service preferences, and baseline symptoms of patients. Among patients enrolled in a digital treatment course, we evaluated scales of depression (Patient Health Questionnaire-9 [PHQ-9]) and anxiety (Generalized Anxiety Disorder 7-Item Scale [GAD-7]), as primary measures of treatment outcome, from the screening assessment to post-treatment and a 3 month follow-up. The Kessler Psychological Distress 10-Item Plus Scale was also used to assess changes in general distress and disability, and course satisfaction was measured post-treatment. Outcomes A total of 121 652 screening assessments were started, of which 96 018 (78·9%) were completed. The mean age of patients was 35·7 years (SD 13·8) and 88 702 (72·9%) were women. Based on available assessment data, 36 866 (34·5%) of 106 811 participants had never previously spoken to a health professional about their symptoms, and most people self-reported symptoms of anxiety (88 879 [81·9%] of 108 494) or depression (78 803 [72·6%] of 108 494), either alone or in combination, at baseline. 21 745 patients started treatment in a therapist-guided online course, of whom 14 503 (66·7%) completed treatment (≥four of five lessons). Key trends in service use included an increase in the proportion of people using MindSpot primarily for assessment and information, from 52·6% in 2013 to 66·7% in 2019, while the proportion primarily seeking online treatment decreased, from 42·6% in 2013 to 26·7% in 2019. Effect sizes and percentage changes were large for estimated mean scores on the PHQ-9 and GAD-7 from assessment to post-treatment (PHQ-9, Cohen's d effect size 1·40 [95% CI 1·37–1·43]; and GAD-7, 1·45 [1·42–1·47]) and the 3 month follow-up (PHQ-9, 1·36 [1·34–1·38]; and GAD-7, 1·42 [1·40–1·44]); proportions of patients with reliable symptom deterioration (score increase of ≥6 points [PHQ-9] or ≥5 points [GAD-7]) were low post-treatment (of 13 058 respondents, 184 [1·4%] had symptom deterioration on the PHQ-9 and 282 [2·2%] on the GAD-7); and patient satisfaction rates were high (12 452 [96·6%] of 12 895 respondents would recommend the course and 12 433 [96·7%] of 12 860 reported the course worthwhile). We also observed small improvements in disability following treatment as measured by days out of role. Interpretation Our findings indicate improvement in psychological symptoms and positive reception among patients receiving online mental health treatment. These results support the addition of digital services such as MindSpot as a component in contemporary national mental health systems. Funding None.
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Affiliation(s)
- Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Blake F Dear
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia.,Department of Psychology, Macquarie University, Sydney, NSW, Australia
| | - Olav Nielssen
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Bethany Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Rony Kayrouz
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Eyal Karin
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Ben Genest
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - James Bennett-Levy
- University Centre for Rural Health, The University of Sydney, NSW, Australia
| | - Carol Purtell
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | | | - Rheza Tan
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Casey Minissale
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Priti Thadhani
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Nick Webb
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
| | - Simon Willcock
- Macquarie University Health Sciences Centre, Macquarie University, Sydney, NSW, Australia
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
| | | | - David C Mohr
- Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - David J Kavanagh
- Centre for Children's Health Research and School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
| | - Shane Cross
- MindSpot Clinic, Macquarie University, Sydney, NSW, Australia
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A feasibility trial of an internet-delivered psychological intervention to manage mental health and functional outcomes in neurological disorders. J Psychosom Res 2020; 136:110173. [PMID: 32623193 DOI: 10.1016/j.jpsychores.2020.110173] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 05/15/2020] [Accepted: 06/08/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Mental health and cognitive difficulties are highly prevalent across neurological disorders and significantly contribute to poorer patient outcomes. Unfortunately, access to effective psychological services for these comorbidities are limited. To determine whether a novel transdiagnostic internet-delivered psychological intervention, the Wellbeing Neuro Course, was feasible, acceptable and efficacious a single-group feasibility open trial was employed. METHODS The Wellbeing Neuro Course, targets mental health and cognitive difficulties, across a variety of neurological disorders. It is comprised of six online lessons, based on Cognitive Behavioural Therapy and Compensatory Cognitive Rehabilitation, delivered over 10 weeks and provided with weekly support from a mental health professional via email and telephone. 105 adults with diagnoses of either epilepsy, multiple sclerosis, Parkinson's disease and/or acquired brain injury, underwent the intervention. RESULTS The intervention was found to be highly acceptable with high intervention completion and levels of satisfaction (>95%). There was evidence of clinically significant improvements in primary outcomes (within-group Cohen's d; average reductions) of depression (d = 0.93; avg. reduction ≥36%), anxiety (ds = 0.66, avg. reduction ≥36%), and disability (ds ≥ 0.49; avg. reduction ≥23%) at post-intervention, maintained at 3-month follow-up. For secondary outcomes there were significant improvements in fatigue severity and perceived cognitive difficulties of attention, planning and prospective memory. Findings were achieved with minimal clinician time, highlighting its public health potential. CONCLUSION This open trial provides preliminary evidence the Wellbeing Neuro Course is acceptable and reduces symptoms of depression, anxiety and disability in neurological disorders. Future controlled trials of the intervention are now needed. TRIAL REGISTRATION ACTRN12617000581369.
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Attridge MD, Morfitt RC, Roseborough DJ, Jones ER. Internet-Based Cognitive-Behavioral Therapy for College Students With Anxiety, Depression, Social Anxiety, or Insomnia: Four Single-Group Longitudinal Studies of Archival Commercial Data and Replication of Employee User Study. JMIR Form Res 2020; 4:e17712. [PMID: 32706662 PMCID: PMC7413280 DOI: 10.2196/17712] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 05/29/2020] [Accepted: 06/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background The growing behavioral health needs of college students have resulted in counseling centers reporting difficulties in meeting student demand. Objective This study aims to test the real-world voluntary use by college students of 4 digital, self-directed mental health modules based on a cognitive behavioral therapy clinical model. The findings were also compared with those of employee users. Methods Archival operational data from Learn to Live were extracted for student users at 4 colleges and universities in the Midwest region of the United States (N=951). The inclusion criteria were having clinical symptoms at established levels of moderate or higher severity and the use of 2 or more of the 8 lessons of a program within a 6-month period. Unique users in each program included 347 for depression; 325 for stress, anxiety, and worry; 203 for social anxiety; and 76 for insomnia. Paired t tests (two-tailed) compared the average level of change over time on a standardized measure of clinical symptoms appropriate to each program. Cohen d statistical effect sizes were calculated for each program. Potential moderator factors (age, gender, preliminary comprehensive assessment, number of lessons, duration, live coach support, and live teammate support) were tested together in repeated measures analysis of variance models with covariates in the full sample. Follow-up survey data (n=136) were also collected to explore user satisfaction and outcomes. Select data from another study of the same 4 programs by employee users meeting the same criteria (N=707) were examined for comparison. Results The percentage of users who improved to a clinical status of no longer being at risk after program use was as follows: stress, anxiety, and worry program (149/325, 45.8%); insomnia program (33/76, 43.4%), depression program (124/347, 35.7%); and social anxiety program (45/203, 22.2%). Significant improvements (all P<.001) over time were found in the mean scores for the clinical measures for each program: stress, anxiety, and worry (t324=16.21; d=1.25); insomnia (t75=6.85; d=1.10); depression (t346=12.71; d=0.91); and social anxiety (t202=8.33; d=0.80). Tests of the moderating factors across programs indicated that greater improvement was strongly associated with the use of more lessons and it also differed by program, by gender (males demonstrated more improvement than females), and by the use of live support (particularly coaching). Analyses of survey data found high satisfaction, improved academic outcomes, and successful integration into the university counseling ecosystem. The operational profile and outcomes of the college students were also similar to those of employee users of the same programs from our other study of employee users. Thus, this study provides a replication. Conclusions Self-directed internet-based cognitive behavioral therapy mental health modules are promising as a supplement to traditional in-person counseling services provided by college counseling centers.
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Crane MF, Kho M, Kangas M, Griffin B, Karin E, Earl JK, Harris CB. Strengthening resilience in over 50’s: a nested clustered-randomized controlled trial of adaptive systematic self-reflection. ANXIETY STRESS AND COPING 2020; 33:623-641. [DOI: 10.1080/10615806.2020.1768375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Monique F. Crane
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Madison Kho
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Maria Kangas
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Barbara Griffin
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Eyal Karin
- eCentre Clinic, Department of Psychology, Macquarie University, North Ryde, Australia
| | - Joanne K. Earl
- Department of Psychology, Macquarie University, North Ryde, Australia
| | - Celia B. Harris
- Department of Cognitive Science, Macquarie University, North Ryde, Australia
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Schneider L, Hadjistavropoulos H, Dear B, Titov N. Efficacy of internet-delivered cognitive behavioural therapy following an acute coronary event: A randomized controlled trial. Internet Interv 2020; 21:100324. [PMID: 32455120 PMCID: PMC7235608 DOI: 10.1016/j.invent.2020.100324] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 04/29/2020] [Accepted: 05/04/2020] [Indexed: 12/29/2022] Open
Abstract
Depression and anxiety are common among people who have experienced an acute coronary event (e.g., heart attack). Multidisciplinary cardiac rehabilitation programs often focus on reducing risk factors associated with future cardiac events, however, mental health interventions are not routinely available. Given known difficulties with access to mental health treatment, the present study sought to explore the efficacy and acceptability of an Internet-delivered cognitive behavioural therapy program (Cardiac Wellbeing Course) among participants who experienced an acute coronary event. The five-lesson course was delivered over eight weeks and was provided with brief weekly contact, via telephone and secure email with a guide. Participants were randomized to the Cardiac Wellbeing Course (n = 25) or waiting-list control group (n = 28). Symptoms were assessed at pre-treatment, post-treatment, and four-week follow-up. Completion rates (84%) and satisfaction ratings (95%) were high. Statistically significant between-group improvements were observed for the treatment group on primary measures of general anxiety (Cohen's d = 1.62; 67% reduction), depression (Cohen's d = 1.09; 61% reduction), and physical activity levels (Cohen's d = 0.27; 70% increase). Statistically significant improvements were also observed on secondary measures of distress (Cohen's d = 0.98; 51% reduction), cardiac anxiety (Cohen's d = 0.92; 34% reduction), and mental-health quality of life (Cohen's d = 0.23; 24% improvement). The changes were maintained at four-week follow-up. The current findings add to the existing literature and highlight the potential of Internet-delivered cognitive behavioural therapy programs among participants who have experienced an acute coronary event.
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Affiliation(s)
- L.H. Schneider
- 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada
| | - H.D. Hadjistavropoulos
- 3737 Wascana Parkway, Department of Psychology, University of Regina, Regina, SK S4S 0A2, Canada
- Corresponding author.
| | - B.F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
| | - N. Titov
- eCentreClinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
- MindSpot Clinic, Department of Psychology, Macquarie University, Balaclava Road, North Ryde, NSW 2109, Australia
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Kayrouz R, Karin E, Staples LG, Nielssen O, Dear BF, Titov N. A comparison of the characteristics and treatment outcomes of migrant and Australian-born users of a national digital mental health service. BMC Psychiatry 2020; 20:111. [PMID: 32160913 PMCID: PMC7065305 DOI: 10.1186/s12888-020-02486-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/07/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND To explore the characteristics and compare clinical outcomes of non-Australian born (migrant) and Australian-born users of an Australian national digital mental health service. METHODS The characteristics and treatment outcomes of patients who completed online treatment at the MindSpot Clinic between January 2014 and December 2016 and reported a country of birth other than Australia were compared to Australian-born users. Data about the main language spoken at home were used to create distinct groups. Changes in symptoms of depression and anxiety were measured using the Patient Health Questionnaire-9 Item (PHQ-9), and Generalized Anxiety Disorder Scale - 7 Item (GAD-7), respectively. RESULTS Of 52,020 people who started assessment at MindSpot between 1st January 2014 and 22nd December 2016, 45,082 reported a country of birth, of whom 78.6% (n = 35,240) were Australian-born, and 21.4% (n = 9842) were born overseas. Of 6782 people who completed the online treatment and reported country of birth and main language spoken at home, 1631 (24%) were migrants, 960 (59%) were from English-speaking countries, and 671 (41%) were from non-English speaking countries. Treatment-seeking migrant users reported higher rates of tertiary education than Australian-born users. The baseline symptom severity, and rates of symptom reduction and remission following online treatment were similar across groups. CONCLUSIONS Online treatment was associated with significant reductions in anxiety and depression in migrants of both English speaking and non-English speaking backgrounds, with outcomes similar to those obtained by Australian-born patients. DMHS have considerable potential to help reduce barriers to mental health care for migrants.
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Affiliation(s)
- Rony Kayrouz
- MindSpot Clinic, Macquarie University, Sydney, Australia. .,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia.
| | - Eyal Karin
- MindSpot Clinic, Macquarie University, Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia
| | - Lauren G Staples
- MindSpot Clinic, Macquarie University, Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia
| | - Olav Nielssen
- MindSpot Clinic, Macquarie University, Sydney, Australia
| | - Blake F Dear
- MindSpot Clinic, Macquarie University, Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia
| | - Nickolai Titov
- MindSpot Clinic, Macquarie University, Sydney, Australia.,eCentreClinic, Department of Psychology, Macquarie University, Sydney, New South Wales, 2109, Australia
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Dear BF, Johnson B, Singh A, Wilkes B, Brkic T, Gupta R, Jones MP, Bailey S, Dudeney J, Gandy M, Fogliati R, Titov N. Examining an internet-delivered intervention for anxiety and depression when delivered as a part of routine care for university students: A phase IV trial. J Affect Disord 2019; 256:567-577. [PMID: 31280082 DOI: 10.1016/j.jad.2019.06.044] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/17/2019] [Accepted: 06/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND There has been growing interest in the potential of emerging internet-delivered psychological treatments for supporting the mental health needs of university students. However, no large-scale prospective effectiveness trials examining their real-world potential have been reported. OBJECTIVE The aim of the current study was to evaluate the acceptability and effectiveness of a brief, 5-week, internet-delivered and therapist-guided intervention for anxiety and depression, when delivered as part of routine care by a university counselling service. DESIGN A large, prospective, single-group Phase-IV clinical trial. Students (n = 1326) engaging with the university counselling service were provided the opportunity to receive the intervention based on their preferences and identified needs. Students completed standardised measures of anxiety and depression at pre-treatment, each week of the intervention, post-treatment and 3-month follow-up. RESULTS Over a 4 year period, 1081 students (10% of those presenting to the counselling service) participated in the intervention. Large clinical reductions in symptoms of both anxiety (% reduction = 41%; Cohen's d = 0.94) and depression (% reduction = 36%; Cohen's d = 0.81) were observed alongside high levels of acceptability. The intervention required relatively little counsellor time (M = 36.28 mins; SD = 20.56) per student, and symptom deterioration was observed in less than 5% of students. CONCLUSION The findings of the current study are supportive of internet-delivered interventions provided as routine care to university students. Further research is needed to carefully explore whether these interventions could be used with a larger proportion of students presenting to counselling services, paying close attention to acceptability, engagement and clinical outcomes.
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Affiliation(s)
- Blake F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney, Australia.
| | - Bareena Johnson
- Macquarie University Counselling and Psychological Services, Sydney, Australia
| | - Ashwin Singh
- Macquarie University Counselling and Psychological Services, Sydney, Australia
| | - Benjamin Wilkes
- Macquarie University Counselling and Psychological Services, Sydney, Australia
| | - Tamara Brkic
- Macquarie University Counselling and Psychological Services, Sydney, Australia
| | - Richa Gupta
- Macquarie University Counselling and Psychological Services, Sydney, Australia
| | - Michael P Jones
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Steve Bailey
- Department of Psychology, Macquarie University, Sydney, Australia
| | - Joanne Dudeney
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Milena Gandy
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Rhiannon Fogliati
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia; MindSpot Clinic, MQ Health, Macquarie University, Sydney, Australia
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Facilitating access to iCBT: a randomized controlled trial assessing a translated version of an empirically validated program using a minimally monitored delivery model. Behav Cogn Psychother 2019; 48:185-202. [PMID: 31416489 DOI: 10.1017/s135246581900047x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite its established efficacy, access to internet-delivered CBT (iCBT) remains limited in a number of countries. Translating existing programs and using a minimally monitored model of delivery may facilitate its dissemination across countries. AIMS This randomized control trial aims to evaluate the efficacy of an iCBT transdiagnostic program translated from English to French and offered in Canada using a minimally monitored delivery model for the treatment of anxiety and depression. METHOD Sixty-three French speakers recruited in Canada were randomized to iCBT or a waiting-list. A French translation of an established program, the Wellbeing Course, was offered over 8 weeks using a minimally monitored delivery model. Primary outcome measures were the Generalized Anxiety Disorder-7 (GAD-7) and the Patient Health Questionnaire-9 (PHQ-9), which were obtained pre-treatment, post-treatment and at 3-month follow-up. RESULTS Mixed-effects models revealed that participants in the treatment group had significantly lower PHQ-9 and GAD-7 scores post-treatment than controls with small between-groups effect sizes (d = 0.34 and 0.37, respectively). Within-group effect sizes on primary outcome measures were larger in the treatment than control group. Clinical recovery rates on the PHQ-9 and GAD-7 were significantly higher among the treatment group (40 and 56%, respectively) than the controls (13 and 16%, respectively). CONCLUSIONS The provision of a translated iCBT program using a minimally monitored delivery model may improve patients' access to treatment of anxiety and depression across countries. This may be an optimal first step in improving access to iCBT before sufficient resources can be secured to implement a wider range of iCBT services.
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Wootton BM, Karin E, Titov N, Dear BF. Self-guided internet-delivered cognitive behavior therapy (ICBT) for obsessive-compulsive symptoms: A randomized controlled trial. J Anxiety Disord 2019; 66:102111. [PMID: 31301476 DOI: 10.1016/j.janxdis.2019.102111] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 06/23/2019] [Accepted: 06/26/2019] [Indexed: 11/27/2022]
Abstract
Internet-delivered cognitive behavior therapy (ICBT) for obsessive-compulsive disorder (OCD) has been demonstrated to be efficacious across multiple clinical trials. However, most of these interventions include clinician support, and many individuals with OCD prefer to manage their own symptoms. Self-guided ICBT overcomes this problem, but to date the efficacy of self-guided interventions has only been studied in uncontrolled trials. The present study aims to examine the efficacy and acceptability of ICBT for OCD symptoms when delivered in a self-guided format using a randomized controlled trial design. In the present study, 190 participants were randomized to either a self-guided ICBT condition or a waitlist control group. 140 participants completed the baseline assessment, initiated treatment, and were included in the analyses. The between-group effect size at post-treatment was large on the self-report version of the Yale-Brown Obsessive-Compulsive Scale (d = 1.05; 95% CI 0.89-1.21). Twenty-seven percent of the ICBT condition met conservative criteria for clinically significant change at post-treatment, which increased to thirty-eight percent at three-month follow-up. Participants rated the program as highly acceptable. The results indicate that self-guided ICBT may be a viable treatment option for some individuals with OCD symptoms.
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Affiliation(s)
- Bethany M Wootton
- University of Technology Sydney, NSW, Australia; Macquarie University, Sydney, NSW, Australia.
| | - Eyal Karin
- Macquarie University, Sydney, NSW, Australia
| | - Nick Titov
- Macquarie University, Sydney, NSW, Australia
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Hadjistavropoulos HD, Schneider LH, Mehta S, Karin E, Dear BF, Titov N. Preference trial of internet-delivered cognitive behaviour therapy comparing standard weekly versus optional weekly therapist support. J Anxiety Disord 2019; 63:51-60. [PMID: 30844613 DOI: 10.1016/j.janxdis.2019.02.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 01/13/2019] [Accepted: 02/20/2019] [Indexed: 12/17/2022]
Abstract
Emerging evidence from research trials suggests that Internet-delivered cognitive behaviour therapy (ICBT) produces similar symptom improvements whether patients receive weekly therapist support (standard support) or therapist support only when requested (optional support). It remains unknown, however, how many patients receiving ICBT as part of routine clinical care would prefer optional support compared to standard support and how outcomes compare when patients select their preferred treatment option. In this uncontrolled trial, we investigated patient preference and outcomes for standard versus optional support among patients with depression and or anxiety who were offered an 8-week transdiagnostic ICBT intervention in routine care. Of 401 patients accepted for ICBT, 22% selected optional support and 78% selected standard support. At assessment, patients who selected optional support had lower symptoms of anxiety and panic than patients who selected standard support. At post-treatment, both groups achieved similar large improvements in symptoms of anxiety and depression, with improvements sustained at 3-month follow-up. Patients receiving optional support sent and received fewer messages compared to patients receiving standard support. This study demonstrates the potential of optional therapist support to meet the needs and preferences of patients and to also reduce therapist costs in routine care.
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Affiliation(s)
- H D Hadjistavropoulos
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - L H Schneider
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - S Mehta
- Department of Psychology, University of Regina, 3737 Wascana Parkway, Regina, SK, S4S 0A2, Canada.
| | - E Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia.
| | - B F Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia.
| | - N Titov
- MindSpot Clinic, eCentreClinic, Department of Psychology, Macquarie University, Sydney, NSW, 2109, Australia.
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Owens VA, Hadjistavropoulos HD, Schneider LH, Gullickson KM, Karin E, Titov N, Dear BF. Transdiagnostic, internet-delivered cognitive behavior therapy for depression and anxiety: Exploring impact on health anxiety. Internet Interv 2019; 15:60-66. [PMID: 30723691 PMCID: PMC6350228 DOI: 10.1016/j.invent.2019.01.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 01/15/2019] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
Health anxiety is associated with significant personal distress and economic cost; as such, widely available and effective treatment options are crucial. Several studies suggest that Internet-delivered cognitive behavior therapy (ICBT) programs that specifically target health anxiety are efficacious for this condition. However, no known studies have examined the impact of transdiagnostic ICBT, which emphasizes the acquisition of broad coping skills applicable to a variety of mental health concerns, on symptoms of health anxiety. The current study sought to explore changes in health anxiety symptoms by utilizing data available from a previously published study of 8-week transdiagnostic ICBT. Specifically, changes in symptoms of health anxiety in response to a transdiagnostic ICBT program that targeted broad symptoms of depression and anxiety, were examined in a subsample of individuals who endorsed elevated symptom scores on the Short Health Anxiety Inventory at pre-treatment (n = 72). Following treatment, large reductions in health anxiety symptoms (Cohen's d = 0.91; 20% improvement), depression (Cohen's d = 0.85; reduction = 38%), generalized anxiety (Cohen's d = 1.21; reduction = 42%), and disability (Cohen's d = 0.90; reduction = 35%) were reported. Furthermore, results showed that transdiagnostic ICBT was rated as acceptable to people with high health anxiety symptoms. Despite elevated pre-treatment health anxiety scores, email correspondence between clients and their therapist revealed very few mentions of health anxiety. These findings provide preliminary evidence for transdiagnostic ICBT for symptoms of health anxiety and suggest further research is warranted.
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Affiliation(s)
| | - Heather D. Hadjistavropoulos
- Department of Psychology, University of Regina, Regina, Canada
- Corresponding author at: University of Regina, Department of Psychology, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada.
| | | | | | - Eyal Karin
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Nickolai Titov
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
| | - Blake F. Dear
- eCentreClinic, Department of Psychology, Macquarie University, Sydney, Australia
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The Pain Course: 12- and 24-Month Outcomes From a Randomized Controlled Trial of an Internet-Delivered Pain Management Program Provided With Different Levels of Clinician Support. THE JOURNAL OF PAIN 2018; 19:1491-1503. [PMID: 30099209 DOI: 10.1016/j.jpain.2018.07.005] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 01/26/2023]
Abstract
Little is known about the long-term outcomes of emerging Internet-delivered pain management programs. The current study reports the 12- and 24-month follow-up data from a randomized controlled trial (n = 490) of an Internet-delivered pain management program, the Pain Course. The initial results of the trial to the 3-month follow-up have been reported elsewhere. There were significant improvements in disability, depression, anxiety, and pain levels across 3 treatment groups receiving different levels of clinician support compared with a treatment as the usual control. No marked or significant differences were found between the treatment groups either after treatment or at the 3-month follow-up. The current study obtained long-term follow-up data from 78% and 79% of participants (n = 397) at the 12-month and 24-month follow-up marks, respectively. Clinically significant decreases (average percent reduction; Cohen's d effect sizes) were maintained at the 12- and 24-month follow-ups for disability (average reduction ≥27%; d ≥ .67), depression (average reduction ≥36%; d ≥ .80), anxiety (average reduction ≥38%; d ≥ .66), and average pain levels (average reduction ≥21%; d ≥ .67). No marked or consistent differences were found among the 3 treatment groups. These findings suggest that the outcomes of Internet-delivered programs may be maintained over the long term. PERSPECTIVE: This article presents the long-term outcome data of an established Internet-delivered pain management program for adults with chronic pain. The clinical improvements observed during the program were found to be maintained at the 12- and 24-month follow-up marks. This finding indicates that these programs can have lasting clinical effects.
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