Internet-delivered Treatments for Depression and Anxiety in Primary Care (SUMMA)
| Status: | Terminated |
|---|---|
| Conditions: | Anxiety, Depression, Depression |
| Therapuetic Areas: | Psychiatry / Psychology |
| Healthy: | No |
| Age Range: | 18 - 100 |
| Updated: | 9/12/2018 |
| Start Date: | February 8, 2017 |
| End Date: | February 9, 2018 |
A Pilot Study Investigating the Feasibility of Implementing Internet-delivered Treatments for Depression and Anxiety in Primary Care
The current study is an open feasibility trial with the aim of providing a description of the
factors associated with the implementation of an iCBT platform into an existing treatment
framework in a primary care setting. The trial will examine the factors surrounding
implementation, such as the experience of primary care practitioners and the online
supporters, the recruitment process, and attitudes towards the overall implementation of the
interventions. Patients presenting to the primary care setting will be screened using
standard depression and anxiety measures, and where appropriate, will be referred to an iCBT
intervention for either depression or anxiety, with support from trained staff. Analyses will
be conducted on outcome measures to examine changes in symptom severity as patients progress
through the intervention. Patient satisfaction data will also be collected to establish
patient acceptability of the intervention. [Note: Recruitment is ONLY open to patients at
Ohio Family Practice Center]
factors associated with the implementation of an iCBT platform into an existing treatment
framework in a primary care setting. The trial will examine the factors surrounding
implementation, such as the experience of primary care practitioners and the online
supporters, the recruitment process, and attitudes towards the overall implementation of the
interventions. Patients presenting to the primary care setting will be screened using
standard depression and anxiety measures, and where appropriate, will be referred to an iCBT
intervention for either depression or anxiety, with support from trained staff. Analyses will
be conducted on outcome measures to examine changes in symptom severity as patients progress
through the intervention. Patient satisfaction data will also be collected to establish
patient acceptability of the intervention. [Note: Recruitment is ONLY open to patients at
Ohio Family Practice Center]
iCBT is the delivery of a tailored structured cognitive and behaviour therapy based
programme, with support, to individuals with mild to moderate symptoms of depression and
anxiety. There is now a substantial body of research evidence that supports the efficacy and
effectiveness of internet-delivered cognitive behaviour therapy for depression and anxiety.
Historically, a number of iCBT interventions have been used in clinical practice in IAPT
services. However, they have often suffered with poor engagement and consequently poor
clinical outcomes. More recent developments in the field have produced more robust
technological platforms, where content is delivered through a variety of media that enhance
productivity, increase engagement and produce better clinical outcomes. The SilverCloud
intervention has been demonstrated to be a clinical effective evidence-based cognitive
behavioural treatment option.
Approximately 90% of primary care patients with depression have one or more visits to a
primary care physician (PCP) over a 12-month period, whereas less than one-third see a mental
health professional. It has been reported that individuals with an anxiety disorder are 3 to
5 times more likely to visit their primary care physician than those without, but their
symptoms are often associated with physical causes. PCPs often do not have training in
psychological therapies and therefore they do not feel competent to treat individuals
presenting with depression or anxiety. Often these individuals are prescribed antidepressant
or anti-anxiety medications.
The use of online programs to deliver CBT to people with mental health disorders is becoming
increasingly popular. Internet-delivered CBT (iCBT) consists of programs designed for the
treatment of specific disorders, such as depression and anxiety, which are delivered via the
internet. These programs can be clinician-guided and/or self-administered interventions.
Evidence suggests that iCBT can benefit individuals with anxiety and depression when offered
in a service context that offers brief support from trained staff. Such iCBT interventions
are widely-used in some European countries and the recommended length of treatment is
generally 6 - 8 online sessions. A robust evidence base supporting the use and effectiveness
of internet-delivered treatments for depression and anxiety has been established. Outcomes
have been greater for those programs offering the additional feature of human support.
The current study will examine the feasibility of implementing an iCBT platform within a
primary care setting. This objective can be further dismantled into several sub objectives:
1. Is the model of implementation (screening, recruitment, and adherence to the
internet-delivered intervention) feasible?
2. Will patients experience the iCBT intervention as satisfactory within their primary care
treatment?
3. What is the feedback of the Primary Care Practitioners about the implementation of the
internet-delivered intervention as part of primary care?
4. What is the experience of the trained supporters who assist patients within the iCBT
intervention?
5. Can an internet-delivered intervention achieve improvements in depressive and anxiety
symptoms for users?
6. Can patient attitudes toward internet-delivered interventions predict treatment outcome?
programme, with support, to individuals with mild to moderate symptoms of depression and
anxiety. There is now a substantial body of research evidence that supports the efficacy and
effectiveness of internet-delivered cognitive behaviour therapy for depression and anxiety.
Historically, a number of iCBT interventions have been used in clinical practice in IAPT
services. However, they have often suffered with poor engagement and consequently poor
clinical outcomes. More recent developments in the field have produced more robust
technological platforms, where content is delivered through a variety of media that enhance
productivity, increase engagement and produce better clinical outcomes. The SilverCloud
intervention has been demonstrated to be a clinical effective evidence-based cognitive
behavioural treatment option.
Approximately 90% of primary care patients with depression have one or more visits to a
primary care physician (PCP) over a 12-month period, whereas less than one-third see a mental
health professional. It has been reported that individuals with an anxiety disorder are 3 to
5 times more likely to visit their primary care physician than those without, but their
symptoms are often associated with physical causes. PCPs often do not have training in
psychological therapies and therefore they do not feel competent to treat individuals
presenting with depression or anxiety. Often these individuals are prescribed antidepressant
or anti-anxiety medications.
The use of online programs to deliver CBT to people with mental health disorders is becoming
increasingly popular. Internet-delivered CBT (iCBT) consists of programs designed for the
treatment of specific disorders, such as depression and anxiety, which are delivered via the
internet. These programs can be clinician-guided and/or self-administered interventions.
Evidence suggests that iCBT can benefit individuals with anxiety and depression when offered
in a service context that offers brief support from trained staff. Such iCBT interventions
are widely-used in some European countries and the recommended length of treatment is
generally 6 - 8 online sessions. A robust evidence base supporting the use and effectiveness
of internet-delivered treatments for depression and anxiety has been established. Outcomes
have been greater for those programs offering the additional feature of human support.
The current study will examine the feasibility of implementing an iCBT platform within a
primary care setting. This objective can be further dismantled into several sub objectives:
1. Is the model of implementation (screening, recruitment, and adherence to the
internet-delivered intervention) feasible?
2. Will patients experience the iCBT intervention as satisfactory within their primary care
treatment?
3. What is the feedback of the Primary Care Practitioners about the implementation of the
internet-delivered intervention as part of primary care?
4. What is the experience of the trained supporters who assist patients within the iCBT
intervention?
5. Can an internet-delivered intervention achieve improvements in depressive and anxiety
symptoms for users?
6. Can patient attitudes toward internet-delivered interventions predict treatment outcome?
Inclusion criteria:
At least 18 years of age, Speak English, Self-report symptoms of depression or anxiety
(using PHQ-9 and GAD-7 measures).
Specifically for the self-report symptoms,
participants will need to have a PHQ-9 score of 5 to 19 for the depression program or a
GAD-7 score of 5 to 15 for the anxiety program.
Participants currently attending face-to-face therapy/counseling will be excluded.
Exclusion criteria
Participants who flag as a risk on the self-harm item of the PHQ-9 during routine office
visit screening will not be referred to the study and will be provided treatment and/or
referral services as per the clinic's standard procedure.
We found this trial at
1
site
