A randomized clinical trial evaluates whether online CCBT and internet support groups provide superior depression and anxiety disorder treatment.
The addition of non-physician care managers enforcing treatment protocols concurrent with primary care physicians has proven effective in treating mood and anxiety disorders. Challenges exist, however, in providing the care that one needs. This is where computerized cognitive behavioural therapy (CCBT) and internet support groups (ISG) can be utilized to maximize the treatment of these depressive disorders.
A randomized clinical trial in Pittsburgh, Pennsylvania was conducted with 704 patients aged 18-75 years old between August 2012 and September 2014. After screening the subjects, care managers guided them through eight CCBT sessions over the course of six months and relayed the patient progress to their primary care physician. Treatment durability from these sessions was assessed another six months later as a follow-up.
Another facet of the trial was patient registration to an internet support group with resources for answering questions, crisis hotline information, and instructional videos on insomnia, nutrition, and exercise. To further enhance patient interaction, the interface of the support group included aspects of social media including status indicators for users, notifications of internet support group activities, personalized profile and home page information, and gamification to encourage log-ins.
Patients could schedule a telephone call with care managers to review materials and establish a relationship. Care managers could use the internet support group platform to send positive feedback to patients and contact those that did not log in regularly or show improvement in the program.
Regarding intervention engagement, at the end the of the six-month window, 83.6% of patients with CCBT access finished at least one session, and 36.7% had completed all eight sessions. The CCBT+ISG arm of the trial showed that 75.5% of participants had logged into the internet support group platform at least once and 61.8% of those that did make at least one comment or post amongst the group interactions.
The results, published in JAMA Psychiatry, compared the different versions of the trial together and noted that different age groups reacted differently to trial variations. Patients aged 60-75 years positively responded to the CCBT+ISG trial while those aged 35-59 years showed no benefit to the ISG group. Both showed improvements over usual standard care which did nothing to promote interactivity. Overall, the study highlights the essential need for patient engagement and CCBT when dealing with anxiety disorders. The ease of use and follow-up care also means that care managers separate from physicians can take on more patient cases with little to no drop in quality of care and attention.
The limitations of this study were the singular type of CCBT and ISG used, which could be improved by a different system or interactive platform. Misleading symptom duration among patients also could have affected statistics, as short-term or mild anxiety disorders could be just as similarly improved as severe acute ones.
The burgeoning field of electronic mental health must be reinforced with the best systems possible to maintain a high level of care for those afflicted with mood disorders. This study showed that online CCBT provided more benefit to patients than the standard usual care, but that the internet support group conferred no additional benefits. In-depth studies like this one can help build the foundation of understanding and support that a growing number of people will require in the future.
Written by Cooper Powers, BSc
Reference: Rollman, BL, Belnap, BH, Hum, B, et al. (2017). Effectiveness of Online Collaborative Care for Treating Mood and Anxiety Disorders in Primary Care: A Randomized Clinical Trial. JAMA Psychiatry.