Internet Cognitive Behavioral Therapy Research Articles

Predictors for interest to participate in digital mental health therapy: a cross-sectional survey of individuals with anxiety and depression

BackgroundDue to a multitude of factors, the onset of the COVID-19 pandemic resulted in a significant increase in mental health issues within society, including depression and anxiety. Due to the increased trend of mental health disorders in society, digital mental health therapies are more useful than ever. With the emergence of programs utilizing Internet Cognitive Behavioral Therapy (iCBT), mental health resources are easily accessible and can be widely implemented to those in need.The aim of this study was to identify predictors for interest to participate in SilverCloud digital mental health therapy among individuals with mild to severe anxiety and/or depression based on preliminary findings from the COVIDsmart study.MethodsCOVIDSmart participants who had moderate to severe anxiety and/or depression based on the PHQ-9 and GAD-7 scores, and who consented to be contacted for future studies, were invited to complete a needs assessment survey via Research Electronic Data Capture (REDCap). This assessment used self-reported measures including medical diagnoses, mental health services received, reasons for anxiety and/or depression, the use of coping strategies, suicidal ideology using the Ask Suicide Questions tool, and whether they would be interested in receiving free digital mental therapy. Descriptive statistics were used to report participants’ demographics and a logistic regression was used to find predictors for interest in participation in SilverCloud. SAS 9.4 was used and p values < 0.05 were considered significant.ResultsOut of the original 782 COVIDsmart participants, 634 consented to be contacted for future studies, 280 were subsequently invited to complete the SilverCloud needs assessment, and 120 individuals completed it. The largest demographic among these participants were females (70.83%) who identified as White (80.83%). The mean age was 48.74 years (SD = 14.66). Results revealed that having a mental health comorbidity significantly predicted the likelihood of interest in participating in the SilverCloud digital mental health program (p = 0.027).ConclusionsIn this study, mental illness comorbidities predicted the interest to participate in digital mental therapy. Fragmented healthcare and perceptions of unmet care needs are likely contributor factors. Further research with a diverse sample of participants is necessary for generalizability. Findings may have important implications for healthcare best practices.

Clinical and cognitive insight in panic disorder: phenomenology and treatment effects in internet cognitive behavior therapy

Clinical observations suggest that individuals with panic disorder (PD) vary in their beliefs about the causes of their panic attacks. Some attribute these attacks to psychological factors, while others to physiological or medical factors. These beliefs also extend to whether individuals perceive panic attacks as dangerous. In other areas of psychiatric nosology, these phenomena are commonly called clinical insight (recognition of disorder and the need for treatment) and cognitive insight (the ability to reflect on one's beliefs). Despite its importance, limited research exists on insight in PD and its relation to symptoms and treatment outcomes. This study examines clinical and cognitive insight in 83 patients with PD who received internet-based cognitive behavioral therapy, investigating their relationship with symptoms, treatment outcomes, and changes in insight. We assessed patients using interview and self-report measures of insight and symptoms. Clinical and cognitive insight were correlated and both constructs improved significantly during treatment. Good clinical insight pretreatment was positively correlated with more severe pretreatment symptoms. Pretreatment clinical and cognitive insight were not correlated with symptom change or attrition. Greater change in clinical and cognitive insight was related to greater change in symptoms. The findings highlight the significance of clinical and cognitive insight in PD, and the importance of distinguishing between them. This suggests the need to develop interventions according to patients' level of insight, particularly focusing on those lacking insight. Further research is essential to advance our understanding of the relationship between insight and the phenomenology and treatment of PD.

A randomised controlled evaluation of an online perfectionism intervention for people with disordered eating – how perfect does it need to be?

ABSTRACT Less help-seeking for an eating disorder is predicted by higher levels of denial of, and failure to perceive, illness severity. This research evaluates a “backdoor” approach to early intervention by investigating whether internet cognitive behaviour therapy for perfectionism can significantly improve disordered eating. Additionally, we investigated whether a more interactive intervention impacted outcomes. Participants were recruited worldwide online; 368 were screened, 172 (46.7%) met inclusion criteria (endorsed high shape, weight, or eating concerns) and randomised to an interactive (Focused Minds Program; FMP) or static PDF intervention (Centre for Clinical Intervention; CCI-P) or waitlisted (control condition). Participants completed assessments on disordered eating, perfectionism, and a range of secondary variables at the end of treatment, and 1- and 3-month follow-up. Intent-to-treat analyses indicated that, compared to control, FMP resulted in significantly lower levels of disordered eating at each assessment and CCI-P at the 1- and 3-month follow-up (respective 3-month follow-up between group effect sizes of 0.78 and 0.54). There were no significant differences between the two active interventions on any measure except depression and hated self. Results suggest an alternative approach to directly tackling disordered eating that is low-cost is effective, with a more interactive intervention producing a more rapid effect. Trials Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) Trial Number: ACTRN12621001448831

A Review on the Relationship Between Internet Addiction, Life Satisfaction and Cognitive Behavioral Therapy

Teknolojinin gelişmesine paralel olarak hayatımıza giren internet bağımlılığı kavramı henüz DSM-5’te yer almasa da son zamanlarda yapılan çalışmalar incelendiğinde internet bağımlılığı ve internet bağımlılığı ile ilişkili olabilecek değişkenlere yönelik çalışmalara ağırlık verildiği görülmektedir. Bu çalışmanın amacı da internet bağımlılığı ve yaşam doyumu arasındaki ilişkiyi ele alan çalışmaları incelemek ve etkili bir terapi yöntemi olan bilişsel davranışçı terapinin söz konusu değişkenler üzerindeki etkisini inceleyen araştırmaları ortaya koymaktır. Bu amaçla literatür taraması yapılmış ve internet bağımlılığı ile yaşam doyumunun anlamlı ve negatif yönde ilişkili olduğunu ortaya koyan çalışmaların çoğunlukta olduğu tespit edilmiştir. Buna göre, internet bağımlılığı arttıkça yaşam doyumu düşmekte ya da yaşam doyumu arttıkça internet bağımlılığı azalmaktadır. Ayrıca bilişsel davranışçı terapinin internet bağımlılığını azaltma ve yaşam doyumunu artırma noktasında etkili bir tedavi yöntemi olduğu görülmektedir. Mevcut çalışmalar BDT’nin yaşam doyumunu artırmada etkili olduğunu gösterdiği için BDT’nin ruh sağlığı alanında internet bağımlılığını önleme ve tedavi etme de kullanılması önerilebilir. Ancak hem internet bağımlılığı ve yaşam doyumu ilişkisini ele alan çalışmalar hem de bilişsel davranışçı terapinin bu değişkenler üzerindeki etkisini ele alan çalışmalar henüz az sayıdadır. Söz konusu değişkenlerin ilişkisini daha farklı yöntemlerle ve örneklem gruplarıyla inceleyen daha fazla çalışmaya ihtiyaç vardır.

A pilot study of the perceptions and acceptability of guidance using artificial intelligence in internet cognitive behaviour therapy for perfectionism in young people

Perfectionism is a transdiagnostic process associated with a range of psychological disorders. Cognitive Behaviour Therapy for Perfectionism (CBT-P) has been demonstrated as efficacious across guided and unguided internet delivered interventions in reducing perfectionism and psychopathology. The aim of this pilot study was to understand perceptions and acceptability of an artificial intelligence supplemented CBT-P intervention (AI-CBT-P) in young people with lived experience of anxiety and depression (n = 8; age range 19–29 years, M = 24 years, SD = 3.77; 50 % female, 38 % male, 12 % non-binary). Young people reported that they were frequent users of artificial intelligence for study, work and general information, were positive about the intervention and using artificial intelligence for guidance in a self-help intervention, but also noted several concerns. Young people perceived numerous benefits to AI-CBT-P, including ease of access, low cost, lack of stigma and benefits for individuals with social anxiety. Overall, young people appear to be interested in, and have a positive view of, AI-CBT-P. Further research is now required to examine the feasibility and acceptability of the intervention.

Effect of modernized collaborative care for depression on brain-derived neurotrophic factor (BDNF) and depressive symptom clusters: Data from the eIMPACT trial

Brain-derived neurotrophic factor (BDNF) levels are lower in people with depression and are normalized following pharmacological treatment. However, it is unknown if psychological treatments for depression improve BDNF and if change in BDNF is a mediator of intervention effects on depressive symptoms. Therefore, using data from the eIMPACT trial, we sought to determine the effect of modernized collaborative care for depression on 12-month changes in BDNF and cognitive/affective and somatic depressive symptom clusters and to examine whether BDNF changes mediate intervention effects on depressive symptoms. 216 primary care patients with depression from a safety net healthcare system were randomized to 12 months of the eIMPACT intervention (internet cognitive-behavioral therapy [CBT], telephonic CBT, and select antidepressant medications) or usual primary care. Plasma BDNF was measured with commercially available kits, and depressive symptom clusters were assessed by the Patient Health Questionnaire-9. The intervention did not influence BDNF but did improve both the cognitive/affective and somatic clusters over 12 months. Changes in BDNF did not mediate the intervention effect on either cluster. Our findings suggest that modernized collaborative care is an effective treatment for both the cognitive/affective and somatic symptoms of depression and that the mechanism of action is not improvements in BDNF. Trial registrationClinicalTrials.gov Identifier: NCT02458690

Harnessing AI to Optimize Thought Records and Facilitate Cognitive Restructuring in Smartphone CBT: An Exploratory Study

BackgroundEffective cognitive restructuring (CR) requires identification of automatic thoughts that underlie experienced emotions. However, accurate recording of thoughts and emotions is challenging when CR is provided in internet cognitive-behavior therapy (iCBT). This study investigated the potential use of the artificial intelligence (AI) including the natural language processing (NLP) to facilitate CR offered in iCBT.MethodsWe applied the Japanese Text-to-Text Transfer Transformer (T5), one of the most advanced Large Language Models for the NLP,to records of thought-feeling pairs provided by participants in two randomized controlled trials of iCBT. We conducted threefold cross-validated prediction of self-reported feelings based on recorded thoughts. We examined the validity of the predictions by checking them against the human expert judgments and by the efficacy when the thought records were subjected to CR.Results1626 participants provided 4369 though-feeling records. The overall prediction accuracy was 73.5%. The self-reported feelings matched the human expert judgments more frequently when they were correctly predicted by the T5 than not (90% vs 37.5%, 95%CI of difference: 34.8 to 70.2%). When subjected to CR, the correctly predicted thought-feeling pairs led to greater reductions in negative feelings than the incorrectly predicted pairs (− 1.54 vs − 1.43 on a scale of 0 to 5, 95%CI of difference: 0.03 to 0.19).ConclusionsA new CR module of an iCBT application can incorporate this model and advise the users to revisit and revise their automatic thoughts to reflect their feelings more accurately. Whether such an iCBT application can ultimately lead to greater reductions in depression is to be examined in a future randomized trial.

Investigation of Active Ingredients Within Internet-Delivered Cognitive Behavioral Therapy for Depression

There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable. To test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients. This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire-9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023. Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training). The primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning. Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, -7.79 [90% CI, -8.21 to -7.37]; 6-month follow-up difference in PHQ-9 score, -8.63 [90% CI, -9.04 to -8.22]). A baseline score-adjusted analysis of covariance model using effect-coded intervention variables (-1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], -0.09 [90% CI, -0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], -0.18 [90% CI, -0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, -0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, -0.54, [90% CI, -0.97 to -0.11]). In this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers. isrctn.org Identifier: ISRCTN24117387.

INTERNET COGNITIVE BEHAVIOR THERAPY FOR POSTPARTUM DEPRESSION

Background: Postpartum depression (PPD) occurs in 25-50% of those affected with 10-15% of postpartum mothers each year having depressive symptoms that last more than 6 months. PPD is an important public health issue because of its chronic and long-term effects that have significant detrimental effects on mothers, their families, and their child's development. The primary treatments for PPD have included psychological interventions such as physical counseling, interpersonal psychotherapy (IPT), cognitive behavior training (CBT), and problem-focused counseling. However, there is no information about how efficient and suitable these approaches are for postpartum depression. Objective: This study aimed to examine the efficacy of internet cognitive behavior therapy for postpartum depression. Methods: A systematic review is a method of study. An extensive search was conducted in Google Scholar, ScienceDirect, Medline, and PubMed to locate detailed indexed articles. The search included articles published, in the last 5 years, from 2015 to 2020. Results: All 5 studies were Randomized Controlled Trials (RCT) studies, with a total of 481 participants. PPD measurements using self- evaluation scales for depression and structured clinical interviews. Three studies used application programs are MumMoodBooster and one study used Therapist and Be a Mom combined CBT program. Conclusion: The study looked at the impact of internet CBT on PPD reduction. When compared to the TAU (control group), the findings of this 5 study showed that internet CBT could lower the EPDS score of all mothers in the intervention group (iCBT). Keywords: cognitive behavior therapy, depression, postpartum.

Internet Cognitive Behavioural Therapy for Persons with Stroke: Developmental Phase

<h3>Research Objectives</h3> To identify gaps in the content of an existing ICBT program to meet the needs of those with stroke; to identify features of the online program and how it can be integrated into patient care; and to identify needs, potential facilitators and barriers that can influence implementation and use of the program. <h3>Design</h3> A Patient-Oriented Research Committee of 8 individuals, including clinicians, patients, and a caregiver was developed to adapt and tailor an existing internet-delivered cognitive behavior therapy (ICBT) course to meet the needs of individuals who have had a stroke. The panel members attended three 1-hour virtual meetings to identify gaps in the needs of stroke patients and provide feedback on the content. Meetings were transcribed verbatim and analyzed to generate a list of gaps in the current ICBT content for post-stroke patients. <h3>Setting</h3> General community. <h3>Participants</h3> Clinicians, patients, and a stroke caregiver. <h3>Interventions</h3> No intervention. <h3>Main Outcome Measures</h3> Feedback regarding an existing ICBT program to be updated tailored to target the specific needs of those post-stroke. <h3>Results</h3> The committee identified the following suggestions to tailor the program towards those post-stroke: 1) development of case vignettes aligned with experiences of those post-stroke; 2) incorporation of memory and planning aids; 3) avoid use of triggering language (e.g., "disability"; 4) visually adapting materials to aid readability and comprehension; 5) presenting materials in multiple formats (e.g., written, audio, visual); 6) normalizing lapses and lapse prevention plans. <h3>Conclusions</h3> Online programs tailored for those post-stroke may optimize management of psychosocial outcomes by overcoming barriers to treatment. Based on the feedback we received, new case vignettes have been added that have been tailored to align with experiences of those post-stroke and the new material has been sent to the committee for further feedback. Results from the current study will lead to the integration of ICBT programs into post-stroke treatment protocol. <h3>Author(s) Disclosures</h3> No author disclosures.

Exploring the psychosocial needs of persons with lower extremity amputation and feasibility of internet cognitive behavioural therapy: a qualitative study

Purpose Following major lower extremity amputation (LEA), patients experience significant emotional distress and are at risk for anxiety and depression. There is a lack of mental health supports for this population, and internet-based cognitive behavioural therapy (iCBT) may be a useful resource to meet this need. The purpose of this study was to use a qualitative approach to explore the mental health needs of LEA patients and to gauge their attitudes of the use of iCBT to help them cope with their amputation. Methods Semi-structured qualitative interviews were conducted with inpatients and outpatients with LEA recruited from a major urban rehabilitation hospital. Data were analysed using inductive codebook thematic analysis (TA). Results Ten interviews were completed with individuals with LEA. The main themes identified were: (1) Fixating on the past; (2) Worry about the future; (3) Unmet mental health needs; (4) Barriers to Mental Health Support; (5) Importance of peer support; and (6) Tailoring iCBT. Conclusions Our findings highlight that patients with LEA are open to learning more about iCBT to meet their mental health needs. Key iCBT implementation considerations include taking into account issues of stigma associated with mental health, timing of delivery, levels of digital literacy, online security, and interactive content. IMPLICATIONS FOR REHABILITATION Following lower extremity amputation (LEA), people experience significant emotional distress and are at risk for the development of anxiety and/or depression. Patients with LEA are receptive to an online mental health resource (i.e., internet-based cognitive behavioural therapy [iCBT]) but it needs to be tailored to meet the various mental health needs and digital literacy of the LEA population. The use of an implementation science approach can help identify factors related to the development and potential uptake of an iCBT for patients with LEA.

A protocol for unguided internet self-help cognitive behaviour therapy for perfectionism in adolescents at-risk of eating disorders

Perfectionism has a strong association with eating disorders, anxiety and depression. Unguided internet cognitive behaviour therapy for perfectionism has demonstrated efficacy in female adolescents without elevated eating disorder symptoms. No research to date has examined unguided internet cognitive behaviour therapy for perfectionism for adolescents with elevated eating disorder symptoms as an indicated prevention for eating disorders and co-occurring symptoms of anxiety and depression. The protocol outlines the plan for a randomised controlled trial of a co-designed, unguided internet cognitive behaviour therapy for perfectionism with female adolescents with elevated symptoms of eating disorders. The intervention will be a 4-week programme compared to a waitlist control. Outcomes on eating disorder symptoms, anxiety and depression will be measured pre and post intervention and follow-up. Trial registrationThis trial was registered on 23 September 2020 with the Australian New Zealand Clinical Trials Registry (ACTRN12620000951954P).

Mediators of symptom improvement in transdiagnostic internet cognitive behavioural therapy for mixed anxiety and depression

ABSTRACT Objectives Transdiagnostic internet cognitive behavioural therapy (iCBT) improves depression and anxiety symptoms, but the factors mediating these improvements are unknown. Design In a secondary analysis of a randomised controlled trial, we compared the impact of a transdiagnostic iCBT program (n = 39) on emotion regulation, repetitive negative thinking, and experiential avoidance relative to treatment-as-usual (TAU) control (n = 35). The extent to which changes in these processes mediated treatment gains in iCBT relative to TAU was also explored. Intention-to-treat mixed models were used to assess outcomes, and unmoderated simple mediation models were used to explore mediators of change of each outcome (depression/anxiety). Results Results showed iCBT outperformed TAU in reducing all three processes, with largebetween-group effect sizes for repetitive negative thinking (g = 1.04), and medium effect sizes for emotion regulation (g = 0.78), and experiential avoidance (g = 0.54). Changes in symptoms of depression and anxiety were partly mediated through pre-to-post changes in all three variables, but not pre-to-mid-treatment changes. Conclusion These findings provide evidence that transdiagnostic iCBT for depression and anxiety improves emotion regulation, reduces repetitive thinking and experiential avoidance, and provides preliminary evidence that symptom improvements are associated with improvements in these variables. KEY POINTS What is already known about this topic: (1) Transdiagnostic interventions aim to target the common symptoms and the functional emotional, cognitive, and behavioural processes shared across emotional disorders. (2) Transdiagnostic internet-delivered cognitive behavioural therapy (iCBT) improves depression and anxiety symptoms. (3) However, the factors mediating these symptom improvements are largely unknown. What this topic adds: (1) Transdiagnostic iCBT for depression and anxiety improves emotion regulation and reduces repetitive thinking and experiential avoidance in participants with an anxiety and/or depressive disorder. (2) Symptom improvements are associated with improvements in these transdiagnostic variables; emotion regulation, repetitive negative thinking, and experiential avoidance appear to be significant mediators of post-treatment improvements in symptoms of depression and anxiety. (3) Targeting these shared underlying processes is likely important to improve symptoms of depression and anxiety.

Real-World Evaluation of a Large-Scale Blended Care-Cognitive Behavioral Therapy Program for Symptoms of Anxiety and Depression.

Introduction:Prior studies have supported the effectiveness of blended interventions for anxiety and depression; however, outcomes research of large-scale blended interventions for these conditions is limited.Objective: To investigate the outcomes of scaled-up blended care (BC) cognitive behavioral therapy (CBT), a program that combined video-based psychotherapy with internet CBT, for symptoms of anxiety and depression.Materials and Methods: Participants were 6,738 U.S.-based adults with elevated symptoms of anxiety (Generalized Anxiety Disorder-7 [GAD-7] ≥ 8) and/or depression (Patient Health Questionnaire-9 [PHQ-9] ≥ 10) at baseline who received BC-CBT as an employer-offered mental health benefit. The primary outcomes, anxiety (GAD-7) and depression (PHQ-9) symptoms, were routinely measured in the program. Recovery and reliable improvement in outcomes were calculated, and growth curve models evaluated change in outcomes during treatment and the effects of engaging in psychotherapy sessions on outcomes.Results: On average, participants received treatment for 7.6 (standard deviation = 6.2) weeks. By the end of care, 5,491 (81.5%) participants had reliable improvement in either anxiety or depression symptoms; in addition, 5,535 (82.1%) fell below the clinical threshold for either anxiety or depression symptoms (i.e., recovered). Declines in anxiety and depression symptoms were statistically significant over the course of BC-CBT (both p's < 0.01), with the rate of decline significantly decreasing for each outcome as treatment progressed (both p's < 0.01). Each psychotherapy session completed was significantly associated with lower anxiety and depression symptoms during the week of the session and the subsequent week (all p's < 0.01).Conclusions: This real-world study provides evidence that scaled-up BC-CBT can be effective in the treatment of symptoms of anxiety and depression.

Internet delivered guided cognitive behavioral self-help for panic disorder: An open trial and benchmarking study

An open trial of a therapist-guided internet cognitive-behavioral therapy (ICBT) for panic disorder with and without agoraphobia (PD/A) was conducted. Ninety adults diagnosed with PD/A were treated using ICBT adapted from a face to face (FTF) protocol. Results were benchmarked against two FTF samples, one at the same research site using the same protocol and another from a large cognitive-behavioral therapy (CBT) study. In addition, effects were compared to mean aggregated estimates from four meta-analyses. Attrition rates and therapist time were also examined to facilitate cost-effectiveness analyses and inform policy makers. Both full intent-to-treat and completer samples were used when analyzing data. Overall, results suggest that within-group effects for ICBT (0.88 to 1.7) are similar to the effects found in the benchmarking samples and to effects across meta-analytic studies. Effects were larger for symptoms assessed by an independent evaluator compared to self-report measures. Treatment gains continued to increase 3 months after post treatment and were maintained at 6 month and 1 year follow-up. However, attrition rates in ICBT were twice as large (46%) compared to the FTF sample, possibly due to a more conservative definition of attrition used here compared to previous reports. Therapist time in ICBT was reduced by a factor of three (14 min/week) compared to FTF, suggesting that treatment effects can be maintained even when reducing therapist time. Taken together, these findings suggest good short and long-term efficacy and time efficiency along with greater attrition for ICBT, allowing for dissemination and enhancing accessibility to quality, evidence-based treatment in the community.

Feasibility of guided internet-based cognitive behavioral therapy for patients with anorexia nervosa

ObjectiveThe objective of the present study was to investigate the feasibility of guided internet cognitive behavioral therapy (ICBT) for anorexia nervosa. MethodsWe conducted a prospective single-arm study between January 2020 and March 2021. The intervention was built using videos, web programs, and chat tools. The intervention program was largely based on metacognitive training. Participants performed the self-help program once a week for 12 consecutive weeks. The primary outcome was the global Eating Disorder Examination Questionnaire (EDE-Q) score. Secondary outcomes included clinical symptoms of eating disorders, metacognitive function, body mass index, depression, and generalized anxiety. The main statistical analysis examined whether the EDE-Q score and other outcomes at the end of the intervention differed from the baseline. ResultsFourteen participants underwent the trial treatment, and 13 completed the intervention. There was a significant reduction in the global EDE-Q score from 3.48 (SD = 1.4) to 2.54 (SD = 1.5, p = 0.02, Cohen's d = 0.75) from baseline to post-intervention. Some EDE-Q subscales and body checking questionnaire scale demonstrated statistically significant improvements, with moderate to large effect sizes. Although there was no significant improvement in body mass index, metacognitive function, or depressive symptoms, there was a significant improvement in the severity of generalized anxiety (M = −4.0, p = 0.01, Cohen's d = 0.95). No adverse events were observed. DiscussionOur findings suggest that guided ICBT for anorexia nervosa is well accepted by female patients and practical as a telemedicine approach that improves symptoms. In the future, tightly controlled randomized controlled trials should be conducted for efficacy verification.

Internet and Face-to-face Cognitive Behavioral Therapy for Postnatal Depression Compared With Treatment as Usual: Randomized Controlled Trial of MumMoodBooster.

BackgroundPrevious research has confirmed that symptoms of postnatal depression (PND) can be ameliorated through internet-delivered psychological interventions. Advantages of internet-delivered treatment include anonymity, convenience, and catering to women who are unable to access face-to-face (FTF) treatments. To date, no research has examined the efficacy of such interventions compared directly with FTF treatments in women clinically diagnosed with PND.ObjectiveThis study aims to compare the efficacy of one of the first web-based cognitive behavioral therapy (CBT) interventions (internet CBT+coach calls) for PND (MumMoodBooster [MMB]) with FTF-CBT in a randomized controlled trial (RCT).MethodsIn this study, 116 postnatal women with a Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition (DSM-IV) diagnosis of major or minor depression were randomized to MMB (39/116, 33.6%), FTF-CBT (39/116, 33.6%), or a treatment-as-usual (TAU) control condition (38/116, 32.8%). Diagnostic status was determined at baseline and at 21-week follow-up using the Structured Clinical Interview for the DSM-IV. Severity of anxiety and depressive symptoms was evaluated using the Depression Anxiety Stress Scales and the revised Beck Depression Inventory at baseline, 12-week follow-up (after treatment), and 21-week follow-up.ResultsOf the 116 participants, 107 (92.2%) had a diagnosis of major depression at baseline. Rates of remission from a major or minor depressive episode at 21 weeks in both the FTF-CBT and MMB groups were superior to that of the TAU group (56.6% and 47.7% less likely to be depressed, respectively) and they were not significantly different from each other. Although remission rates differed between TAU and FTF-CBT, growth models showed that, in terms of symptom reduction across time, the FTF-CBT treatment was not significantly better than TAU. By comparison, MMB was statistically superior to both TAU and FTF-CBT in reducing symptoms of depression, anxiety, and stress from baseline to the 21-week follow-up (large and moderate effect sizes). Thus, after 21 weeks, the average symptom scores for depression and anxiety of women receiving MMB were approximately half those of women in both the TAU and FTF-CBT groups.ConclusionsIn this RCT, MMB was at least as effective as FTF-CBT in achieving remission from a diagnosed PND episode. MMB was superior to TAU and FTF-CBT in encouraging and maintaining reduction of symptom severity over the 21-week follow-up for depressed postnatal women. These findings replicate results of prior studies on MMB that showed clinically significant improvements in depressive symptoms, and they provide direct empirical support that internet-delivered treatment for depressed postnatal women is a viable alternative to FTF treatment. The generalizability of the results needs to be examined in future research, as RCTs of internet-based versus FTF treatments necessarily involve a subset of people who are willing to undertake either modality of treatment.Trial RegistrationAustralia and New Zealand Clinical Trials Registry (ANZCTR) ACTRN12613000881730; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364683&isReview=true

The Effectiveness of internet Cognitive Behaviour Therapy (iCBT) For Depression: A systematic review: Effectiveness of internet Cognitive Behaviour Therapy (iCBT) For Depression: A systematic review

Background. Lack of society in seeking treatment of depression still occurs in society. This is influenced by the limitations of psychological face-to-face treatment, stigma, limited medical expenses and limited therapists. Aims. The purpose of this study to determine the effectiveness of Internet Cognitive Behavior Therapy (iCBT) on reducing depression. Method. This study was systematic review of depressed patients with study selection criteria using Scopus, Science Direct, and Pubmed databases by Randomized Control Trial (RCT). Results. A total of 15 relevant articles were reviewed in this study. The findings showed that the iCBT has positive effect on decreasing the depression. It was due to iCBT therapy could control the mood of people. Conclusion. This systematic review is aimed to explore increasing the use of technology and information support in providing nursing care to clients to reduce depression

Effects of patient-driven iCBT for anxiety in routine primary care and the relation between increased experience of empowerment and outcome: A randomized controlled trial

BackgroundThe World Health Organization has declared that primary care should be organized to empower individuals, families, and communities to optimize health. Internet cognitive behavioral therapy (iCBT) tailored by psychologists' initial assessments to meet patients' specific needs have shown promising effects. However, few studies have evaluated patient involvement in decisions during iCBT. AimThis study aimed to explore the effect of patient-driven iCBT compared to standard iCBT on perceived control over treatment, adherence, and level of anxiety symptoms. A secondary aim was to assess the relationship between changes in empowerment and changes in anxiety symptoms. MethodParticipants were patients recruited form primary care and assessed as meeting the criterion for an anxiety disorder. Participants were randomized to patient-driven iCBT (n = 27) or standard iCBT (n = 28). Patient-driven iCBT was adapted to participants' preferences regarding for example focus of treatment program and order of modules. Participants randomized to the control condition received the standard iCBT program for anxiety disorders at the participating unit. The outcome measures were patients' perceived control over treatment, adherence to treatment, symptoms of anxiety, depression and general disability as well as the experience of empowerment. ResultsParticipants in patient-driven iCBT had statistically higher perceived control over treatment (t(43) = 2.13, p = .04). Symptoms were significantly reduced in both arms with regards to anxiety, depression, and general disability. A significant time per condition interaction effect for anxiety symptoms was observed (df = 45.0; F = 3.055; p = .038), where the patient-driven condition had a significantly larger reduction in anxiety. For both groups a significant correlation of r = −0.47 was found between changes in empowerment and changes in anxiety. ConclusionResults indicate that iCBT that is patient-driven, may have a greater effect on anxiety, than standard iCBT. The effect on perceived control over treatment might also be larger in patient-driven treatments than in standard iCBT. Internet-based therapies inherently promote as active agents of their own care and might be well suited for promoting perceived control and empowerment. Findings need to be replicated given the small sample size and the explorative nature of the study. Clinical trials registrationNCT04688567

Cost Effectiveness of Cognitive Behavioral Therapy for the Treatment of Subjective Tinnitus in Australia.

The aim of this study was to conduct an economic evaluation for the treatment of subjective tinnitus using different modalities of cognitive behavioral therapy (CBT) in Australia. A decision tree model was used to conduct a cost-utility analysis for CBT to determine the cost effectiveness for tinnitus treatments, in terms of cost per responder and cost per quality-adjusted life-year (QALY), from a health system perspective using a 2-year time horizon. Meta-analysis was used to differentiate the levels of effectiveness between three delivery methods for CBT: individual face-to-face care (fCBT), group sessions (gCBT), and a supported internet program (iCBT). One-way sensitivity analysis and probabilistic sensitivity analysis (PSA) explored the uncertainty surrounding model inputs and outcomes. Results were presented as incremental cost-effectiveness ratios compared with no treatment, and as net monetary benefit at a $50,000 willingness-to-pay threshold. Compared with no treatment, the incremental cost per responder was $700 for gCBT, $871 for iCBT, and $1380 for fCBT. The base case incremental cost-effectiveness ratio was $35,363 per QALY for fCBT, $17,935 per QALY for gCBT, and $22,321 per QALY for iCBT compared with no treatment, although there was substantial uncertainty around the QALY gain for responders. Net monetary benefit was $356 (fCBT), $555 (gCBT), and $487 (iCBT), indicating the treatments were cost effective compared with no treatment. One-way sensitivity analysis revealed the results were most sensitive to the probability of a positive response to treatment and treatment length. The PSA found the probability of being cost effective compared with no treatment for gCBT was 99.8%, iCBT 98.4%, and fCBT 71.5% at a willingness-to-pay of $50,000 per QALY, although QALY gain remained at a fixed value in the PSA. CBT for tinnitus was likely to be cost effective compared with no treatment regardless of treatment modality, assuming they are not mutually exclusive. Of the interventions, gCBT was the lowest cost per responder and lowest cost per QALY. Internet CBT obtained comparable economic outcomes due to similar treatment effectiveness and cost. Group CBT and iCBT warrant greater adoption in clinical practice for the treatment of subjective tinnitus. Further research on preference-based utility measures for varying levels of tinnitus severity and the durability of treatment effect is required to enhance the quality of economic evaluation in this field.