scholarly journals Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study

10.2196/33452 ◽  
2021 ◽  
Vol 5 (12) ◽  
pp. e33452
Author(s):  
Monica S Wu ◽  
Robert E Wickham ◽  
Shih-Yin Chen ◽  
Connie Chen ◽  
Anita Lungu
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Early Phase ◽  
Retrospective Cohort ◽  
Digital Video ◽  
Behavioral Therapy ◽  
Anxiety Symptoms ◽  
Depression And Anxiety ◽  
Blended Care ◽  
Digital Components ◽  
Therapy Sessions

Background Depression and anxiety incur significant personal and societal costs. Effective psychotherapies exist, such as cognitive behavioral therapy (CBT); however, timely access to quality care is limited by myriad barriers. Blended care therapy models incorporate traditional face-to-face therapy with scalable, digital components of care, expanding the reach of evidence-based care. Objective The aim of this study is to determine the effectiveness of a blended care CBT program (BC-CBT) in real-world settings and examine the unique impacts of the (1) digital components of care (video lessons and digital exercises) and (2) phase of treatment (early versus late) in decreasing symptoms of anxiety and depression. Methods This retrospective cohort analysis included 3401 US-based individuals enrolled in a BC-CBT program, who presented with clinical levels of depression and/or anxiety. The treatment program consisted of regular therapy sessions augmented by clinician-assigned digital video lessons and exercises. A growth curve model incorporating time-varying covariates examined the relationship between engagement with BCT components (ie, therapy sessions, digital video lessons, and digital exercises) during the early (weeks 0-7) and late (weeks 8-15) phases of treatment, and weekly symptom reports on depression and anxiety measures. Results On average, a significant decline in depression and anxiety symptoms was observed during the initial weeks of treatment (P<.001), with a continued, though slower, decline over subsequent weeks (P<.001). Each session completed was associated with significant decreases in anxiety (b=–0.72) and depression (b=–0.83) in the early phase, as well as in the late phase (anxiety, b=–0.47; depression, b=–0.27). Significant decreases in anxiety (b=–0.15) and depression (b=–0.12) were observed for time spent on video lessons (measured in 10-minute intervals) in the early phase of treatment. Engaging with exercises was associated with statistically significant increases in anxiety symptoms (b=0.03) during the early phase of treatment. However, sensitivity analyses examining the effects of exercises in isolation revealed significant decreases in anxiety (b=–0.05) in the early phase, suggesting a potential suppression effect in the larger model. Conclusions Using a retrospective cohort design, therapy sessions and digital video lessons were uniquely predictive of improvements in depression and anxiety symptoms, and their effects were modulated based on the phase of treatment (early vs late). Future research should investigate whether other treatment variables, such as therapeutic alliance or familiarity with technology, are related to differential effects on various components of care.

scholarly journals Examining the Impact of Digital Components Across Different Phases of Treatment in a Blended Care Cognitive Behavioral Therapy Intervention for Depression and Anxiety: Pragmatic Retrospective Study (Preprint)

2021 ◽  
Author(s):  
Monica S Wu ◽  
Robert E Wickham ◽  
Shih-Yin Chen ◽  
Connie Chen ◽  
Anita Lungu
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Early Phase ◽  
Retrospective Cohort ◽  
Digital Video ◽  
Behavioral Therapy ◽  
Anxiety Symptoms ◽  
Depression And Anxiety ◽  
Blended Care ◽  
Digital Components ◽  
Therapy Sessions

BACKGROUND Depression and anxiety incur significant personal and societal costs. Effective psychotherapies exist, such as cognitive behavioral therapy (CBT); however, timely access to quality care is limited by myriad barriers. Blended care therapy models incorporate traditional face-to-face therapy with scalable, digital components of care, expanding the reach of evidence-based care. OBJECTIVE The aim of this study is to determine the effectiveness of a blended care CBT program (BC-CBT) in real-world settings and examine the unique impacts of the (1) digital components of care (video lessons and digital exercises) and (2) phase of treatment (early versus late) in decreasing symptoms of anxiety and depression. METHODS This retrospective cohort analysis included 3401 US-based individuals enrolled in a BC-CBT program, who presented with clinical levels of depression and/or anxiety. The treatment program consisted of regular therapy sessions augmented by clinician-assigned digital video lessons and exercises. A growth curve model incorporating time-varying covariates examined the relationship between engagement with BCT components (ie, therapy sessions, digital video lessons, and digital exercises) during the early (weeks 0-7) and late (weeks 8-15) phases of treatment, and weekly symptom reports on depression and anxiety measures. RESULTS On average, a significant decline in depression and anxiety symptoms was observed during the initial weeks of treatment (<i>P</i>&lt;.001), with a continued, though slower, decline over subsequent weeks (<i>P</i>&lt;.001). Each session completed was associated with significant decreases in anxiety (b=–0.72) and depression (b=–0.83) in the early phase, as well as in the late phase (anxiety, b=–0.47; depression, b=–0.27). Significant decreases in anxiety (b=–0.15) and depression (b=–0.12) were observed for time spent on video lessons (measured in 10-minute intervals) in the early phase of treatment. Engaging with exercises was associated with statistically significant increases in anxiety symptoms (b=0.03) during the early phase of treatment. However, sensitivity analyses examining the effects of exercises in isolation revealed significant decreases in anxiety (b=–0.05) in the early phase, suggesting a potential suppression effect in the larger model. CONCLUSIONS Using a retrospective cohort design, therapy sessions and digital video lessons were uniquely predictive of improvements in depression and anxiety symptoms, and their effects were modulated based on the phase of treatment (early vs late). Future research should investigate whether other treatment variables, such as therapeutic alliance or familiarity with technology, are related to differential effects on various components of care.

scholarly journals Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study (Preprint)

2020 ◽  
Author(s):  
Anita Lungu ◽  
Janie Jihee Jun ◽  
Okhtay Azarmanesh ◽  
Yan Leykin ◽  
Connie E-Jean Chen
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Real World ◽  
Behavioral Therapy ◽  
Anxiety Symptoms ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Symptoms Of Depression ◽  
Care Intervention ◽  
Blended Care ◽  
Over Time

BACKGROUND The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings. OBJECTIVE This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions. METHODS This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated. RESULTS The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, <i>P</i>&lt;.001 and β=–.64, <i>P</i>&lt;.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P&lt;.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33). CONCLUSIONS Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care.

scholarly journals Blended Care-Cognitive Behavioral Therapy for Depression and Anxiety in Real-World Settings: Pragmatic Retrospective Study

10.2196/18723 ◽  
2020 ◽  
Vol 22 (7) ◽  
pp. e18723
Author(s):  
Anita Lungu ◽  
Janie Jihee Jun ◽  
Okhtay Azarmanesh ◽  
Yan Leykin ◽  
Connie E-Jean Chen
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Real World ◽  
Behavioral Therapy ◽  
Anxiety Symptoms ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Symptoms Of Depression ◽  
Care Intervention ◽  
Blended Care ◽  
Over Time

Background The past few decades saw considerable advances in research and dissemination of evidence-based psychotherapies, yet available treatment resources are not able to meet the high need for care for individuals suffering from depression or anxiety. Blended care psychotherapy, which combines the strengths of therapist-led and internet interventions, can narrow this gap and be clinically effective and efficient, but has rarely been evaluated outside of controlled research settings. Objective This study evaluated the effectiveness of a blended care intervention (video-based cognitive behavior therapy and internet intervention) under real-world conditions. Methods This is a pragmatic retrospective cohort analysis of 385 participants with clinical range depression and/or anxiety symptoms at baseline, measured using Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), who enrolled in blended care psychotherapy treatment. Participants resided in the United States and had access to the blended care intervention as a mental health benefit offered through their employers. Levels of depression and anxiety were tracked throughout treatment. Hierarchical linear modeling was used to examine the change in symptoms over time. The effects of age, gender, and providers on participants’ symptom change trajectories were also evaluated. Paired sample t-tests were also conducted, and rates of positive clinical change and clinically significant improvement were calculated. Results The average depression and anxiety symptoms at 6 weeks after the start of treatment were 5.94 and 6.57, respectively. There were significant linear effects of time on both symptoms of depression and anxiety (β=–.49, P<.001 and β=–.64, P<.001). The quadratic effect was also significant for both symptoms of depression and anxiety (β=.04, P<.001 for both), suggesting a decelerated decrease in symptoms over time. Approximately 73% (n=283) of all 385 participants demonstrated reliable improvement, and 83% (n=319) recovered on either the PHQ-9 or GAD-7 measures. Large effect sizes were observed on both symptoms of depression (Cohen d=1.08) and of anxiety (d=1.33). Conclusions Video blended care cognitive behavioral therapy interventions can be effective and efficient in treating symptoms of depression and anxiety in real-world conditions. Future research should investigate the differential and interactive contribution of the therapist-led and digital components of care to patient outcomes to optimize care.

scholarly journals Possibilities of Using Cognitive Behavioral Therapy for the Treatment of Depression and Anxiety after Stroke

2018 ◽  
Vol 26 (1) ◽  
pp. 95-111 ◽  
Author(s):  
D.A. Zakharchenko ◽  
S.S. Petrikov
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Cognitive Behavioral ◽  
Depression And Anxiety ◽  
Flow Disturbance ◽  
Common Structure ◽  
Treatment Of Depression ◽  
Therapy Sessions

The paper presents the review of studies of cognitive behavioral therapy efficacy for patients with depression and anxiety after acute cerebral blood flow disturbance. The possibilities of adapting and modifying cognitive behavior methods of intervention to suit the needs and specific features of these patients are discussed. Organization of therapy sessions for patients with cognitive and emotional impairments during rehabilitation after acute cerebral blood flow disturbance is described. The common structure of the psychotherapeutic process and the peculiarities of behavioral and cognitive interventions are considered.

scholarly journals 0362 Video-conference Delivery Of Cognitive Behavioral Therapy For Insomnia: Effects On Insomnia, Depression And Anxiety Symptoms

SLEEP ◽  
2019 ◽  
Vol 42 (Supplement_1) ◽  
pp. A147-A148
Author(s):  
Philippe Stenstrom ◽  
Judith Davidson ◽  
Régine Denesle ◽  
Taís Araújo ◽  
Cherie La Rocque ◽  
...  
Keyword(s):  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Anxiety Symptoms ◽  
Cognitive Behavioral ◽  
Video Conference ◽  
Depression And Anxiety

scholarly journals Effects of Cognitive Behavioral Therapy for Depression and Anxiety, Response Rates and Adverse Events in Patients with Locoregional Advanced Nasopharyngeal Carcinoma

2021 ◽  
Vol 20 ◽  
pp. 153473542110061
Author(s):  
Feng Liu ◽  
Sheng-nan Fu ◽  
Yan-zhu Chen ◽  
Ou-ying Yan ◽  
Fei Tong ◽  
...  
Keyword(s):  
Nasopharyngeal Carcinoma ◽  
Adverse Events ◽  
Cognitive Behavioral Therapy ◽  
Behavioral Therapy ◽  
Response Rates ◽  
Cognitive Behavioral ◽  
Toxic Effects ◽  
Depression And Anxiety ◽  
Small Effect Size ◽  
Anxiety Response

Purpose: This retrospective study investigated the effects of cognitive behavioral therapy (CBT) on depression, anxiety, response rates, and adverse events in patients with locoregional advanced nasopharyngeal carcinoma (NPC). Methods: A total of 269 patients with diagnosis of stage III-IVA NPC received either CBT plus chemoradiotherapy (CBT group, n = 136) or treatment as usual (TAU) plus chemoradiotherapy (TAU group, n = 133). Patients in the CBT group received a series of 6 CBT sessions for 6 weeks during concurrent chemoradiotherapy. Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS) score at baseline, the completion of radiotherapy, and 6, 12, and 24 months after radiotherapy. Response rates and adverse events were also evaluated. Results: Patients in the CBT group showed significantly less depression and anxiety than patients in the TAU group after the completion of radiotherapy ( P < .05). Complete response rates were 99.3% (135/136) and 92.5% (123/133) in the CBT group and TAU group with a small effect size (Phi coefficient = .171), respectively ( P = .005). Compared with the TAU group, the CBT group showed a significantly lower incidence of acute adverse events and late toxic effects. Conclusions: The addition of CBT to chemoradiotherapy significantly reduced depressive and anxiety symptoms. CBT combined with chemoradiotherapy is associated with improved response rates, with reduced incidence of toxic effects in patients with locoregional advanced NPC. Based on this study, we registered a randomized controlled clinical trials to better define the role of CBT in patients with locoregional advanced NPC (Registration number: ChiCTR2000034701).

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