A randomized controlled trial of 'MUMentum Pregnancy': Internet-delivered cognitive behavioral therapy program for antenatal anxiety and depression
Background: Anxiety and depression are common during pregnancy and associated with adverse outcomes for the mother and infant if left untreated. Despite the need to improve treatment accessibility and uptake in this population, no studies have investigated internet-delivered cognitive behavioural therapy (iCBT) for antenatal anxiety and depression. In a randomised controlled trial, we examined the efficacy and acceptability of a brief, unguided iCBT intervention – the MUMentum Pregnancy program – in pregnant women with anxiety and/or depression. Methods: Participants meeting clinical threshold on validated self-report measures of generalised anxiety and/or depression were recruited online and randomised to iCBT (n=43) or a treatment as usual (TAU) control (n=44). Outcomes were assessed at baseline, post-treatment and four-week follow-up; and included anxiety, depression, psychological distress, antenatal bonding, quality of life, and treatment acceptability. Results: Of the 36 women who started iCBT, 26 completed all three lessons of treatment (76% adherence rate). iCBT produced moderate to large effect size reductions for anxiety on the GAD-7 (Hedges’ g=0.76) and psychological distress on the Kessler-10 (g=0.88) that were superior to TAU. Only small nonsignificant differences were found for depression outcomes (g=<0.35). Participants reported that iCBT was an acceptable treatment for antenatal anxiety and/or depression. Limitations: Lack of an active control condition and long-term postpartum follow-up. Conclusions: This is the first study to evaluate brief unguided iCBT for antenatal anxiety and depression. While our findings are promising, particularly for anxiety reduction, additional RCTs are required to establish treatment efficacy.
Internet-based cognitive behavioural therapy for treating symptoms of obsessive compulsive disorder in routine care
A growing evidence base supports the efficacy of Internet-based cognitive behaviour therapy (iCBT) for obsessive compulsive disorder (OCD). However, very few studies have evaluated the effectiveness of iCBT for OCD in routine care settings which service the bulk of a population's health needs. This study evaluated the treatment outcomes of 309 adults who enrolled in an online CBT course for their symptoms of OCD. Most patients (62.8%) enrolled in a self-help or unguided iCBT course, and the remainder were supported by a routine care, community clinician. The entire iCBT course was completed by 39.3% of participants, with 61.2% completing the majority of iCBT lessons. Higher baseline depression symptom severity predicted poorer adherence, while the presence of a supervising clinician was associated with greater adherence. Medium effect size reductions in OCD symptom severity (g= .61), depression symptom severity (g= .56), and psychological distress (g= .69) were observed from pre-to post-treatment. Pre-treatment OCD and depression symptom severity predicted post-treatment OCD symptom severity. Current results support the use of iCBT for OCD in routine care settings, and as health care resources are finite, iCBT for OCD may serve as a useful, low-intensity, and scalable addition to the existing healthcare infrastructure.
The effectiveness of internet-delivered cognitive behavioural therapy for health anxiety in routine care
Introduction: Randomised controlled trials have shown that internet-delivered cognitive behavioural treatment (iCBT) is an effective treatment for health anxiety, but the effectiveness of these programs in routine care has not been investigated. This study examined the effectiveness of iCBT for health anxiety symptoms in routine care settings in the community. Methods: Using an open-trial design, we investigated adherence to, and effectiveness of a 6-lesson iCBT program for health anxiety symptoms amongst individuals (n=391, mean age 41 years, 64% female) who enrolled in the program either self-guided (n=312) or under the supervision of community clinicians (general practitioners, psychologists and other allied health professionals) (n=79). Primary outcome was health anxiety severity on the Short Health Anxiety Inventory (SHAI), and secondary outcomes were depression severity on the Patient Health Questionnaire 9-item (PHQ-9) (depression) and distress (Kessler-10: K-10). Results: Adherence to the iCBT program was modest (45.6% in the clinician-supervised group, 33.0% in the unguided group), but within-subjects effect sizes were large (SHAI: g=1.66, 95%CI: 1.45–1.88; PHQ-9: g=1.12, 95%CI: 0.92–1.32; K-10: g=1.35, 95%CI: 1.15–1.56). Limitations: No control group, lack of follow-up data. Conclusions: iCBT is an effective treatment for health anxiety symptoms in routine care, but methods to increase adherence are needed to optimise benefits to participants. Randomised controlled effectiveness trials with long-term follow-up are needed.
A randomised controlled trial of 'MUMentum postnatal': Internet-delivered cognitive behavioural therapy for anxiety and depression in postpartum women
Maternal anxiety and depression is common during the first 12 months after childbirth (i.e., postpartum period), with 10–15% of mothers likely to meet diagnostic criteria for an anxiety disorder or Major Depressive Disorder (MDD; Dennis, Falah-Hassani, & Shiri, 2017; Woody, Ferrari, Siskind, Whiteford, & Harris, 2017). If left untreated, anxiety and depression adversely affect both the mother and infant (e.g., reduced maternal self-care, poor childhood emotional and behavioural development; Stein et al., 2014). Despite the deleterious effects of postpartum mental health problems, effective treatments exist.
COVID-19 related differences in the uptake and effects of internet-based cognitive behavioural therapy for symptoms of obsessive-compulsive disorder
Background: The impacts of COVID-19 for people with obsessive-compulsive disorder (OCD) may be considerable. Online cognitive behavioural therapy (iCBT) programmes provide scalable access to psychological interventions, although the effectiveness of iCBT for OCD during COVID-19 has not been evaluated.
Aim: This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinicianguided courses) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year.
Method: 1,343 adults (824/1343 (61.4%) female, mean age 33.54 years, SD = 12.00) commenced iCBT for OCD (1061 during the pandemic and 282 in the year before) and completed measures of OCD (Dimensional Obsessive-Compulsive Scale) and depression (Patient Health Questionaire-9) symptom severity, psychological distress (Kessler-10), and disability (WHO Disability Assessment Schedule) preand post-treatment.
Results: During COVID-19, there was a 522% increase in monthly course registrations compared with the previous year, with peak uptake observed between April and June 2020 (a 1191% increase compared with April to June 2019). OCD and depression symptom severity were similar for the COVID and pre-COVID groups, although COVID-19 participants were more likely to enrol in self-guided courses (versus clinicianguided). In both pre- and during-COVID groups, the OCD iCBT course was associated with medium effect size reductions in OCD (g = 0.65–0.68) and depression symptom severity (g = 0.56–0.65), medium to large reductions in psychological distress (g = 0.77–0.83) and small reductions in disability (g = 0.35–.50).
Conclusion: Results demonstrate the considerable uptake of online psychological services for those experiencing symptoms of OCD during COVID-19 and highlight the scalability of effective digital mental health services.