The Effectiveness & Cost-Effectiveness of Internet-Delivered Interventions for Depression and Anxiety Disorders in the Improving Access to Psychological Therapies Program D-IAPT.
For many years now, the UK IAPT services have been using SilverCloud to deliver low-intensity online delivered cognitive-behavioral 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.
Chronic illnesses can have profound effects on well being, functional capacity and quality of life. Psychological comorbidities with a LTC can further contribute to the distress that is caused by these symptoms.
The current study uses a mixed-methods, feasibility design to examine the outcomes for people with LTCs of the SilverCloud online CBT interventions on scores of depression, anxiety, functioning, health-related quality of life for people who are accessing the national IAPT services.
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 program 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.
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.
In the USA there is a growing recognition of the need to address the mental health of patients presenting at primary care clinics. Remember this is where most people will present with their symptoms, at least in the first instance. Therefore it is a unique opportunity to give access to evidence-based interventions. However, accessing mental health service is difficult due to reasons of costs and human resources. Introducing an online intervention as part of the repertoire of services available to primary care physicians for their patients could make a significant difference to the care provided.
The main aim of this study is to compare the effectiveness of a blended face-to-face and internet-delivered CBT intervention with treatment as usual, face-to-face CBT. A secondary aim is to examine patient and provider experience with iCBT.