scholarly journals Demographic and clinical predictors of response to internet-enabled cognitive–behavioural therapy for depression and anxiety

BJPsych Open ◽  
2018 ◽  
Vol 4 (5) ◽  
pp. 411-418 ◽  
Author(s):  
Ana Catarino ◽  
Sarah Bateup ◽  
Valentin Tablan ◽  
Katherine Innes ◽  
Stephen Freer ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cognitive Behavioural Therapy ◽  
Mental Health Problems ◽  
Positive Response ◽  
Behavioural Therapy ◽  
Response To Treatment ◽  
The Internet ◽  
Clinical Predictors ◽  
Predictors Of Response ◽  
Cognitive Behavioural

BackgroundCommon mental health problems affect a quarter of the population. Online cognitive–behavioural therapy (CBT) is increasingly used, but the factors modulating response to this treatment modality remain unclear.AimsThis study aims to explore the demographic and clinical predictors of response to one-to-one CBT delivered via the internet.MethodReal-world clinical outcomes data were collected from 2211 NHS England patients completing a course of CBT delivered by a trained clinician via the internet. Logistic regression analyses were performed using patient and service variables to identify significant predictors of response to treatment.ResultsMultiple patient variables were significantly associated with positive response to treatment including older age, absence of long-term physical comorbidities and lower symptom severity at start of treatment. Service variables associated with positive response to treatment included shorter waiting times for initial assessment and longer treatment durations in terms of the number of sessions.ConclusionsKnowledge of which patient and service variables are associated with good clinical outcomes can be used to develop personalised treatment programmes, as part of a quality improvement cycle aiming to drive up standards in mental healthcare. This study exemplifies translational research put into practice and deployed at scale in the National Health Service, demonstrating the value of technology-enabled treatment delivery not only in facilitating access to care, but in enabling accelerated data capture for clinical research purposes.Declaration of interestA.C., S.B., V.T., K.I., S.F., A.R., A.H. and A.D.B. are employees or board members of the sponsor. S.R.C. consults for Cambridge Cognition and Shire. Keywords: Anxiety disorders; cognitive behavioural therapies; depressive disorders; individual psychotherapy

scholarly journals Protocol investigating the clinical outcomes and cost-effectiveness of cognitive–behavioural therapy delivered remotely for unscheduled care users with health anxiety: randomised controlled trial

BJPsych Open ◽  
2016 ◽  
Vol 2 (1) ◽  
pp. 81-87 ◽  
Author(s):  
Shireen Patel ◽  
Sam Malins ◽  
Boliang Guo ◽  
Marilyn James ◽  
Joe Kai ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Randomised Controlled Trial ◽  
Clinical Outcomes ◽  
Cognitive Behavioural Therapy ◽  
Controlled Trial ◽  
Health Anxiety ◽  
Behavioural Therapy ◽  
Unscheduled Care ◽  
Cognitive Behavioural ◽  
Randomised Controlled

BackgroundHealth anxiety and medically unexplained symptoms cost the National Health Service (NHS) an estimated £3 billion per year in unnecessary costs with little evidence of patient benefit. Effective treatment is rarely taken up due to issues such as stigma or previous negative experiences with mental health services. An approach to overcome this might be to offer remotely delivered psychological therapy, which can be just as effective as face-to-face therapy and may be more accessible and suitable.AimsTo investigate the clinical outcomes and cost-effectiveness of remotely delivered cognitive–behavioural therapy (CBT) to people with high health anxiety repeatedly accessing unscheduled care (trial registration: NCT02298036).MethodA multicentre randomised controlled trial (RCT) will be undertaken in primary and secondary care providers of unscheduled care across the East Midlands. One hundred and forty-four eligible participants will be equally randomised to receive either remote CBT (6–12 sessions) or treatment as usual (TAU). Two doctoral research studies will investigate the barriers and facilitators to delivering the intervention and the factors contributing to the optimisation of therapeutic outcome.ResultsThis trial will be the first to test the clinical outcomes and cost-effectiveness of remotely delivered CBT for the treatment of high health anxiety.ConclusionsThe findings will enable an understanding as to how this intervention might fit into a wider care pathway to enhance patient experience of care.

scholarly journals Effect of web-based depression literacy and cognitive–behavioural therapy interventions on stigmatising attitudes to depression

2004 ◽  
Vol 185 (4) ◽  
pp. 342-349 ◽  
Author(s):  
Kathleen M. Griffiths ◽  
Helen Christensen ◽  
Anthony F. Jorm ◽  
Kimberley Evans ◽  
Chloe Groves
Keyword(s):  
Cognitive Behavioural Therapy ◽  
Skills Training ◽  
Educational Interventions ◽  
Behavioural Therapy ◽  
The Internet ◽  
Perceived Stigma ◽  
Personal Stigma ◽  
Cognitive Behavioural ◽  
Before And After ◽  
Depression Literacy

BackgroundLittle is known about the efficacy of educational interventions for reducing the stigma associated with depression.AimsTo investigate the effects on stigma of two internet depression sites.MethodA sample of 525 individuals with elevated scores on a depression assessment scale were randomly allocated to a depression information website (BluePages), a cognitive–behavioural skills training website (MoodGYM) or an attention control condition. Personal stigma (personal stigmatising attitudes to depression) and perceived stigma (perception of what most other people believe) were assessed before and after the intervention.ResultsRelative to the control, the internet sites significantly reduced personal stigma, although the effects were small. BluePages had no effect on perceived stigma and MoodGYM was associated with an increase in perceived stigma relative to the control. Changes in stigma were not mediated by changes in depression, depression literacy or cognitive–behavioural therapy literacy.ConclusionsThe internet warrants further investigation as a means of delivering stigma reduction programmes for depression.

scholarly journals Refining our understanding of depressive states and state transitions in response to cognitive behavioural therapy using latent Markov modelling

2020 ◽  
pp. 1-10
Author(s):  
Ana Catarino ◽  
Jonathan M. Fawcett ◽  
Michael P. Ewbank ◽  
Sarah Bateup ◽  
Ronan Cummins ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cognitive Behavioural Therapy ◽  
Transition Probabilities ◽  
Behavioural Therapy ◽  
State Transitions ◽  
Affective States ◽  
Markov Modelling ◽  
Treatment Protocols ◽  
Cognitive Behavioural ◽  
Depressive States

Abstract Background It is increasingly recognized that existing diagnostic approaches do not capture the underlying heterogeneity and complexity of psychiatric disorders such as depression. This study uses a data-driven approach to define fluid depressive states and explore how patients transition between these states in response to cognitive behavioural therapy (CBT). Methods Item-level Patient Health Questionnaire (PHQ-9) data were collected from 9891 patients with a diagnosis of depression, at each CBT treatment session. Latent Markov modelling was used on these data to define depressive states and explore transition probabilities between states. Clinical outcomes and patient demographics were compared between patients starting at different depressive states. Results A model with seven depressive states emerged as the best compromise between optimal fit and interpretability. States loading preferentially on cognitive/affective v. somatic symptoms of depression were identified. Analysis of transition probabilities revealed that patients in cognitive/affective states do not typically transition towards somatic states and vice-versa. Post-hoc analyses also showed that patients who start in a somatic depressive state are less likely to engage with or improve with therapy. These patients are also more likely to be female, suffer from a comorbid long-term physical condition and be taking psychotropic medication. Conclusions This study presents a novel approach for depression sub-typing, defining fluid depressive states and exploring transitions between states in response to CBT. Understanding how different symptom profiles respond to therapy will inform the development and delivery of stratified treatment protocols, improving clinical outcomes and cost-effectiveness of psychological therapies for patients with depression.

In Conversation… Reducing mental health problems in schools

2018 ◽  
Keyword(s):  
Mental Health ◽  
Cognitive Behavioural Therapy ◽  
Mental Health Problems ◽  
Behavioural Therapy ◽  
Health Problems ◽  
Clinical Psychologist ◽  
Therapy Approach ◽  
Whole School ◽  
Cognitive Behavioural

Dr Sophie Browning is a Consultant Clinical Psychologist working on whole school approaches to mental health. In this podcast with psychology journalist Jo Carlowe, she discusses an innovative cognitive behavioural therapy approach for reducing anxiety and mental health problems in schools. You can listen to this podcast on SoundCloud or iTunes.

Efficacy of cognitive behavioural therapy delivered over the Internet for depressive symptoms: A systematic review and meta-analysis

2017 ◽  
Vol 24 (8) ◽  
pp. 527-539 ◽  
Author(s):  
Dina M Sztein ◽  
Charles E Koransky ◽  
Leah Fegan ◽  
Seth Himelhoch
Keyword(s):  
Depressive Symptoms ◽  
Confidence Interval ◽  
Cognitive Behavioural Therapy ◽  
Meta Analysis ◽  
Behavioural Therapy ◽  
Mean Difference ◽  
The Internet ◽  
Moderate Depression ◽  
Cognitive Behavioural ◽  
Standardized Mean Difference

Introduction Cognitive behavioural therapy has been shown to improve depressive symptoms in adults with mild to moderate depression. To overcome many of the barriers associated with delivering this treatment, attempts have been made to deliver cognitive behavioural therapy via the Internet. The objective of this meta-analysis is to assess whether Internet-based cognitive behavioural therapy delivered to adults with depressive symptoms leads to a reduction in these symptoms as compared to those who receive no therapy. Methods In September 2015, the Cochrane, PubMed and PsycInfo databases were searched; studies were also found through bibliography searches. Studies were included if they were randomized controlled trials published in English between 2005–2015 conducted with adults >18 years of age experiencing mild to moderate depression where study subjects received Internet-based cognitive behavioural therapy, and the control group was placed on a wait-list. The search yielded 257 articles; 14 of these were included in the meta-analysis. Results Internet delivered cognitive behavioural therapy had a medium effect on reducing depressive symptoms at the end of the study period (standardized mean difference: 0.74, confidence interval: 0.62–0.86, p < 0.001). Internet-delivered cognitive behavioural therapy also has a large sustained effect in maintaining reduction of depressive symptoms in follow-up measures done 3–6 months after the conclusion of the therapy (standardized mean difference: 0.83, confidence interval: 0.69–0.99, p < 0.001). There was no publication bias and low heterogeneity. Discussion Cognitive behavioural therapy delivered over the Internet leads to immediate and sustained reduction in depressive symptoms; thus, it may be a good treatment modality for individuals unable or unwilling to access traditional face-to-face therapy.

scholarly journals Combined treatment with cognitive–behavioural therapy in adolescent depression: meta-analysis

2010 ◽  
Vol 197 (6) ◽  
pp. 433-440 ◽  
Author(s):  
Bernadka Dubicka ◽  
Rachel Elvins ◽  
Chris Roberts ◽  
Greg Chick ◽  
Paul Wilkinson ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Cognitive Behavioural Therapy ◽  
Adolescent Depression ◽  
Antidepressant Treatment ◽  
Meta Analysis ◽  
Combined Treatment ◽  
Behavioural Therapy ◽  
Response To Treatment ◽  
Global Improvement ◽  
Cognitive Behavioural

BackgroundThe treatment of adolescent depression is controversial and studies of combined treatment (antidepressants and cognitive–behavioural therapy, CBT) have produced conflicting findings.AimsTo address the question of whether CBT confers additional benefit to antidepressant treatment in adolescents with unipolar depression for depressive symptoms, suicidality, impairment and global improvement.MethodMeta-analysis of randomised controlled trials (RCTs) of newer-generation antidepressants and CBT in adolescent depression.ResultsThere was no evidence of a statistically significant benefit of combined treatment over antidepressants for depressive symptoms, suicidality and global improvement after acute treatment or at follow-up. There was a statistically significant advantage of combined treatment for impairment in the short-term (at 12 weeks) only. There was some evidence of heterogeneity between studies.ConclusionsAdding CBT to antidepressants confers limited advantage for the treatment of an episode of depression in adolescents. The variation in sampling and methodology between studies, as well as the small number of trials, limits the generalisability of the findings and any conclusions that can be drawn. Future studies should examine predictors of response to treatment as well as clinical components that may affect outcome.

Transdiagnostic cognitive behavioural therapy (CBT): case reports from Saudi Arabia

2014 ◽  
Vol 7 ◽  
Author(s):  
Yousra Alatiq
Keyword(s):  
Saudi Arabia ◽  
Cognitive Behavioural Therapy ◽  
Mental Health Problems ◽  
Small Sample Size ◽  
Case Reports ◽  
Preliminary Finding ◽  
Behavioural Therapy ◽  
Small Sample ◽  
Cognitive Behavioural ◽  
Wide Range

AbstractTransdiagnostic cognitive behavioural therapy (CBT) focuses on the processes shared across disorders and can be applied to a wide range of mental health problems or comorbid conditions. The transdiagnostic approach provides the potential opportunity to improve access to CBT, particularly in countries such as Saudi Arabia, where the number of well-trained therapists is limited. This study aims to examine the feasibility and potential benefit of transdiagnostic CBT for Saudi patients. Case reports describe the outcome of transdiagnostic CBT for four female patients who presented a wide range of symptoms and conditions without conducting any specific diagnostic assessments. The results support the positive effect of this treatment method on depression, anxiety symptoms, and general functioning. Patient feedback and observable improvements also supported these outcomes. However, the results are limited by the small sample size and simple study design. Transdiagnostic CBT is a feasible treatment approach for patients in Saudi Arabia. However, to confirm this preliminary finding, more studies are required.

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