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Demographic and clinical predictors of response to internet-enabled cognitive–behavioural therapy for depression and anxiety

  • Ana Catarino (a1), Sarah Bateup (a2), Valentin Tablan (a3), Katherine Innes (a4), Stephen Freer (a5), Andy Richards (a6), Richard Stott (a7), Steven D. Hollon (a8), Samuel Robin Chamberlain (a9), Ann Hayes (a10) and Andrew D. Blackwell (a11)...
Abstract
Background

Common mental health problems affect a quarter of the population. Online cognitive–behavioural therapy (CBT) is increasingly used, but the factors modulating response to this treatment modality remain unclear.

Aims

This study aims to explore the demographic and clinical predictors of response to one-to-one CBT delivered via the internet.

Method

Real-world clinical outcomes data were collected from 2211 NHS England patients completing a course of CBT delivered by a trained clinician via the internet. Logistic regression analyses were performed using patient and service variables to identify significant predictors of response to treatment.

Results

Multiple patient variables were significantly associated with positive response to treatment including older age, absence of long-term physical comorbidities and lower symptom severity at start of treatment. Service variables associated with positive response to treatment included shorter waiting times for initial assessment and longer treatment durations in terms of the number of sessions.

Conclusions

Knowledge of which patient and service variables are associated with good clinical outcomes can be used to develop personalised treatment programmes, as part of a quality improvement cycle aiming to drive up standards in mental healthcare. This study exemplifies translational research put into practice and deployed at scale in the National Health Service, demonstrating the value of technology-enabled treatment delivery not only in facilitating access to care, but in enabling accelerated data capture for clinical research purposes.

Declaration of interest

A.C., S.B., V.T., K.I., S.F., A.R., A.H. and A.D.B. are employees or board members of the sponsor. S.R.C. consults for Cambridge Cognition and Shire. Keywords: Anxiety disorders; cognitive behavioural therapies; depressive disorders; individual psychotherapy

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
Correspondence: Ana Catarino, Clinical Science Laboratory at Ieso, Ieso Digital Health, The Jeffreys Building, Cowley Road, Cambridge CB4 0DS, UK. Email: a.catarino@iesohealth.com
References
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1Ferrari, AJ, Charlson, FJ, Norman, RE, Patten, SB, Freedman, G, Murray, CJL, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study 2010. PLoS Med 2013; 10: e1001547.
2McManus, S, Bebbington, P, Jenkins, R, Brugha, T. Mental Health and Wellbeing in England. Health and Social Care Information Centre, 2016.
3McCrone, P, Dhanasiri, S, Patel, A, Knapp, M, Lawton-Smith, S. Paying the price: the cost of mental health care in England to 2026. Br J Psychiatry 2008; 184: 386–92.
4Clark, DM. Implementing NICE guidelines for the psychological treatment of depression and anxiety disorders: the IAPT experience. Int Rev Psychiatry 2011; 23: 318–27.
5Health and Social Care Information Centre. Psychological Therapies: Annual Report on the Use of IAPT Services. Health and Social Care Information Centre, 2016.
6Olthuis, JV, Watt, MC, Bailey, K, Hayden, JA. Therapist-supported Internet cognitive behavioural therapy for anxiety disorders in adults. Cochrane Database Syst Rev 2015; 3: CD011565.
7Saddichha, S, Al-Desouki, M, Lamia, A, Linden, IA, Krausz, M. Online interventions for depression and anxiety–a systematic review. Heal Psychol Behav Med 2014; 2: 841–81.
8Spek, V, Cuijpers, P, Nyklícek, I, Riper, H, Keyzer, J, Pop, V. Internet-based cognitive behaviour therapy for symptoms of depression and anxiety: a meta-analysis. Psychol Med 2007; 37: 319–28.
9Gega, L, Marks, I, Mataix-Cols, D. Computer-aided CBT self-help for anxiety and depressive disorders: experience of a London clinic and future directions. J Clin Psychol 2004; 60: 147–57.
10Beattie, A, Shaw, A, Kaur, S, Kessler, D. Primary-care patients’ expectations and experiences of online cognitive behavioural therapy for depression: a qualitative study. Health Expect 2009; 12: 4559.
11Andersson, G, Cuijpers, P. Pros and cons of online cognitive-behavioural therapy. Br J Psychiatry 2008; 193: 270–1.
12Dryman, MT, McTeague, LM, Olino, TM, Heimberg, RG. Evaluation of an open-access CBT-based Internet program for social anxiety: patterns of use, retention, and outcomes. J Consult Clin Psychol 2017; 85: 988–99.
13Kessler, D, Lewis, G, Kaur, S, Wiles, N, King, M, Weich, S, et al. Therapist-delivered internet psychotherapy for depression in primary care: a randomised controlled trial. Lancet 2009; 374: 628–34.
14National Institute for Health and Clinical Excellence. Common Mental Health Disorders: the NICE Guideline on Identification and Pathways to Care. The British Psychological Society and The Royal College of Psychiatrists, 2011.
15El, AS, Ljótsson, B, Hedman, E, Kaldo, V, Andersson, E, Rück, C, et al. Predictors of symptomatic change and adherence in internet-based cognitive behaviour therapy for social anxiety disorder in routine psychiatric care. PLoS One 2015; 10: e0124258.
16Alaoui S, E, Ljotsson, B, Hedman, E, Svanborg, C, Kaldo, V, Lindefors, N. Predicting outcome in internet-based cognitive behaviour therapy for major depression: a large cohort study of adult patients in routine psychiatric care. PLoS One 2016; 11: e0161191.
17Roth, AD, Pilling, S. Accelerated publication using an evidence-based methodology to identify the competences required to deliver effective cognitive and behavioural therapy for depression and anxiety disorders. Behav Cogn Psychother 2008; 36: 129–47.
18Health and Social Care Information Centre. IAPT Annual Report for 2015/2016. NHS Digital, 2017 (http://content.digital.nhs.uk/iaptreports).
19Gyani, A, Shafran, R, Layard, R, Clark, DM. Enhancing recovery rates: lessons from year one of IAPT. Behav Res Ther 2013; 51: 597606.
20Kroenke, K, Spitzer, RL, Williams, JB. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606–13.
21Spitzer, RL, Kroenke, K, Williams, JBW, Löwe, B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166: 1092–7.
22Kroenke, K, Spitzer, RL, Williams, JBW, Monahan, PO, Lowe, B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med 2007; 146: 317–25.
23R Development Core Team. R: A Language and Environment for Statistical Computing. R Foundation, 2016 (http://www.r-project.org/).
24Martino, L, Míguez, J. Generalized rejection sampling schemes and applications in signal processing. Signal Process 2010; 90: 2981–95.
25Myers, R. Classical and Modern Regression with Application (2nd edn). Duxbury/Thomson Learning, 1990.
26Hiller, W, Schindler, AC, Lambert, MJ. Defining response and remission in psychotherapy research: a comparison of the RCI and the method of percent improvement. Psychother Res 2012; 22: 111.
27Lin, M, Lucas, HC. Too big to fail: large samples and the p -value problem. Inf Syst Res 2013; 24: 938–9.
28Chen, H, Cohen, P, Chen, S. How big is a big odds ratio? Interpreting the magnitudes of odds ratios in epidemiological studies. Commun Stat Simul Comput 2010; 39: 860–4.
29Tryon, WW, Lewis, C. An inferential confidence interval method of establishing statistical equivalence that corrects Tryon's (2001) reduction factor. Psychol Methods 2008; 13: 272–7.
30Gould, RL, Coulson, MC, Howard, RJ. Efficacy of cognitive behavioral therapy for anxiety disorders in older people: a meta-analysis and meta-regression of randomized controlled trials. J Am Geriatr Soc 2012; 60: 218–29.
31Thorpe, K, Jain, S, Joski, P. Prevalence and spending associated with patients who have a behavioral health disorder and other conditions. Health Aff 2017; 36: 124–32.
32Fenton, WS, Stover, ES. Mood disorders: Cardiovascular and diabetes comorbidity. Curr Opin Psychiatry 2006; 19: 421–7.
33Clark, DM, Canvin, L, Green, J, Layard, R, Pilling, S, Janecka, M. Transparency about the outcomes of mental health services (IAPT approach): an analysis of public data. Lancet 2018; 391: 679–86.
34NHS England and NHS Improvement. Developing an Outcomes-Based Payment Approach for IAPT Services. NHS Improvement, 2017 (https://improvement.nhs.uk/documents/661/IAPT_Payment_Guidance.pdf).
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Demographic and clinical predictors of response to internet-enabled cognitive–behavioural therapy for depression and anxiety

  • Ana Catarino (a1), Sarah Bateup (a2), Valentin Tablan (a3), Katherine Innes (a4), Stephen Freer (a5), Andy Richards (a6), Richard Stott (a7), Steven D. Hollon (a8), Samuel Robin Chamberlain (a9), Ann Hayes (a10) and Andrew D. Blackwell (a11)...
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