The Ostrich Community Internet-Cognitive Behavioural Therapy Program for Distress Related to Carrying Debt

Many individuals struggling with debt will experience associated psychological stress that negatively impacts both their physical and psychological health. People in debt may be too ashamed to participate in support groups or to seek face-to-face therapy but may welcome the more anonymous help that can be made available through an internet-based therapeutic intervention. The Ostrich community internet-cognitive behavioural therapy program was specifically designed to assist individuals with distress related to carrying debt, facilitating them to move out of denial of their financial problems to managing stress symptoms and mobilizing them to be able to cope more effectively with the financial problems. Preliminary outcome studies have demonstrated the feasibility of this approach and its effectiveness.

The uptake and outcomes of Internet cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic

Background: Internet cognitive behavioural therapy (iCBT) for health anxiety hasdemonstrated efficacy but has not been evaluated during the COVID-19 pandemic. Thisstudy presents the first evaluation of the uptake and outcomes of iCBT for health anxietyduring the COVID-19 pandemic.Methods: THIS WAY UP is an Australian digital mental health service which delivers iCBTinterventions to community members. We compared the uptake of THIS WAY UP’s iCBTcourse for health anxiety in an Australian adult sample who started the course before thepandemic (12th September 2019 to 11th March 2020) to during the pandemic (12th March to11th June 2020). The course was accessible to Australian adults over 18 years old, with noinclusion criteria. Outcomes included course registrations and commencements, lesson andcourse completion, and self-reported health anxiety (Short Health Anxiety Inventory),depression (Patient Health Questionnaire 9-item) and distress (Kessler-10).Results: From March to June 2020, we observed significant increases in course registrations(N=238 vs N=1057); and course commencements (N=126 vs. N= 778). Large, significantimprovements in health anxiety (g= 0.89), and distress (K10: g=0.91), and mediumimprovements in depression (g=0.55) were found. Course completion during COVID was30.5%.Conclusions: iCBT improved health anxiety during the COVID-19 pandemic, and providesscalable intervention that can address increased demands for mental health services in thecommunity.

Are claims of non-inferiority of Internet and computer-based cognitive-behavioural therapy compared with in-person cognitive-behavioural therapy for adults with anxiety disorders supported by the evidence from head-to-head randomised controlled trials? A systematic review

Objective: This review examines the evidence from head-to-head randomised controlled trials addressing whether the efficacy of cognitive-behavioural therapy for anxiety disorders, obsessive-compulsive disorder and post-traumatic stress disorders in adults delivered by computer or online (computer- and Internet-delivered cognitive-behavioural therapy) is not inferior to in-person cognitive-behavioural therapy for reducing levels of symptoms and producing clinically significant gains at post-treatment and at follow-up. A supplementary aim is to examine the evidence for severity as a moderator of the relative efficacy of computer- and Internet-delivered cognitive-behavioural therapy and in-person cognitive-behavioural therapy. Method: PubMed, PsycINFO, Embase and Cochrane database of randomised trials were searched for randomised controlled trials of cognitive-behavioural therapy for these disorders with at least an in-person cognitive-behavioural therapy and Internet or computer cognitive-behavioural therapy arm. Results: A total of 14 randomised controlled trials (9 Internet, 5 computer) of cognitive-behavioural therapy for social anxiety disorder, panic disorder and specific phobia and 3 reports of effect moderators were included. One study showed a low risk of bias when assessed against risk of bias criteria for non-inferiority trials. The remaining studies were assessed as high or unclear risk of bias. One study found that Internet-delivered cognitive-behavioural therapy was superior and non-inferior at post-treatment and follow-up to group in-person cognitive-behavioural therapy for social anxiety disorder. One study of Internet-delivered cognitive-behavioural therapy for panic disorder showed non-inferiority to individual in-person cognitive-behavioural therapy for responder status at post-treatment and one of Internet cognitive-behavioural therapy for panic disorder for symptom severity at follow-up. Other comparisons (22 Internet, 13 computer) and for estimates pooled for Internet cognitive-behavioural therapy for social anxiety disorder, Internet cognitive-behavioural therapy for panic disorder and computer-delivered cognitive-behavioural therapy studies did not support non-inferiority. Evidence of effect moderation by severity and co-morbidity was mixed. Conclusion: There is limited evidence from randomised controlled trials which supports claims that computer- or Internet-delivered cognitive-behavioural therapy for anxiety disorders is not inferior to in-person delivery. Randomised controlled trials properly designed to test non-inferiority are needed before conclusions about the relative benefits of in-person and Internet- and computer-delivered cognitive-behavioural therapy can be made. Prospero: CRD420180961655-6