The Effectiveness & Cost-Effectiveness of Internet-Delivered Interventions for Depression and Anxiety Disorders in the Improving Access to Psychological Therapies Programme D-IAPT.
For many years now, the UK IAPT services have been using SilverCloud to deliver low-intensity online delivered cognitive-behavioural therapy (CBT) to clients. Data reported nationally through this service demonstrates that SilverCloud interventions perform very well with 70% of clients showing reliable improvements in their symptoms after treatment. The current trial seeks to establish very robustly and independently the effectiveness of online CBT as a treatment for depression and anxiety. It also seeks to show that providing this service is cost-effective for the National Health Service.
Trial registration: ISRCTN91967124
A pilot randomised controlled trial including three groups: 1) an intervention group with human support; 2) an intervention group with automated support; and3) a waiting list control group. The intervention, Space for Resilience, is based on positive psychology and consists of seven modules, delivered over a period of eight weeks. Primary outcomes measures will include the Connor-Davidson Resilience Scale (CD-RISC) and the Pemberton Happiness Index (PHI). Secondary outcomes measures will include the Brief Resilience Scale (BRS), the Patient Health Questionnaire – 4 items (PHQ-4), the Rosenberg Self-Esteem Scale (RSES), and the Perceived Stress Scale – 4 items (PSS-4). Acceptability will be examined using the Satisfaction with Treatment (SAT) questionnaire. Analysis will be conducted on an intention-to-treat basis.
Trial registration: ISRCTN11866034
Online CBT has been mostly used with people in the mild-moderate symptom range. Although this is changing and the question that this study was interested in examining was whether we could use the Silvercloud interventions as part of a treatment package offered to clients who were assessed as severely depressed or anxious and waiting for face-to-face treatment. The study also facilitated us taking a look at the important construct of therapeutic alliance online and the perception of the clinical staff of the usability and acceptability of using a digital intervention as part of a package of care for their clients.
Main outcomes paper
Patients (n = 35) will be invited to use the supported intervention over an 8-week period. Participants will indicate consent and complete screening measures online before beginning the programme. They will then be referred to a supporter from within Berkshire NHS Foundation Trust. Primary outcome measures will be the Insomnia Severity Index (ISI) and sleep efficiency (SE) as calculated by the programme’s in-built sleep diary. Secondary outcome measures will be the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and the Work and Social Adjustment Scale (WSAS) as part of the minimum data set administered routinely by this IAPT site. All measures will be administered at baseline and weekly thereafter.
CULTURAL ADAPTATION AND EFFICACY OF ICBT IN COLOMBIA
This study aimed at evaluating the efficacy of a culturally adapted and internet-delivered cognitive behavioural therapy (iCBT) through a randomised controlled trial (RCT) and with 3-months follow-up. The programme consisted of 7-modules. Two hundred and fourteen Colombian college students with depressive symptoms were randomly assigned to either the treatment group (n= 107) or a waiting list control group (n=107). Participants received weekly support from a trained supporter. The primary outcome was symptoms of depression as measured by the Patient Health Questionnaire (PHQ-9) and the secondary outcomes were anxiety symptoms assessed by the Generalised Anxiety Disorder questionnaire (GAD-7).
Trial registration: NCT03062215
Paper on cultural adaptation methodology
Main outcomes from an efficacy trial
This trial implemented Silverclouds interventions for depression, anxiety and stress in a University student population. The aim of the study was to see how well it could be implemented and also assess outcomes. An interesting feature of this trial is the ability of the user to choose which programme they wish to use – a patient preference was included after participants learned their scores on the psychometric measures we used to assess their symptoms on depression, anxiety and stress levels.
Main outcomes paper