Title
The effectiveness of internet-delivered interventions for depression and anxiety disorders in Ireland - a pilot service evaluation (Ireland)
Summary
The current pilot seeks to demonstrate the effectiveness of the SilverCloud suite of internet-delivered interventions addressing depression and anxiety disorders. SilverCloud interventions are used widely in mental health services and demonstrating the effectiveness of the interventions for depression and anxiety will mean that clinicians, patients, service managers, policy-makers and commissioners can act confidently in commissioning a gold standard service for digital service provision. Innovating service delivery with varying patient choice can only help to increase access to evidence-based psychological interventions, reducing the burden on waiting times and list management, and increase throughput. Healthcare is one of the largest spends in Ireland and innovative cost-effective solutions are required. SilverCloud has already demonstrated that it can increase access and maintain quality while also reducing costs. This pilot service evaluation will seek to recruit 200 participants across multiple sites to assess and offer an internet-delivered intervention for depression and anxiety.
Funding Agency
Health Service Executive
Date From
June 2019
Date To
December 2019
Title
The Effectiveness of Internet-Delivered Cognitive Behaviour Therapy as a Prequel to High-Intensity Therapy for Depression and Anxiety Disorders in Improving Access to Psychological Therapies. (Sussex)
Summary
The study followed an uncontrolled feasibility design with a mixed methods evaluation. On the one hand, it aimed at examining quantitatively clinical outcomes on depression and anxiety, functional outcomes in terms of work and social functioning, waiting time reduction and therapeutic alliance between client and clinician in regards to step-3 services. Qualitatively, clinicians' experiences about the acceptability of the online intervention as a prequel to high intensity therapy at step 3 of IAPT were assessed.
Funding Agency
SilverCloud Health
Date From
2013
Date To
2018
Title
Online treatments for depression: A randomised controlled trial on an adult student population
Summary
The proposed project is a randomised controlled trial investigating the online delivery of psychological interventions for the treatment of depression. The increasing incidence and prevalence of depression in adults, adolescents and children has been established (WHO, 2001; Gotlib, & Hammen, 2002). Depression is among the main reasons for referral to face-to-face and online counselling services (Richards & Tangney, in press). Depression is linked to suicidal ideation and completed suicides (Gotlib, & Hammen, 2002). Yet, despite its prevalence only a small percentage of people access the help they require (Marks et al, 2007). Psychotherapeutic interventions for the treatment of depression are established. Cognitive Behavioural Therapy is one of the most established treatments for depression (Nathan & Gorman, 1997). Cognitive behavioural therapy (CBT) is a therapeutic treatment that aims to help eliminate negative thoughts that maintain depression (Nathan & Gorman, 2002). However, due to demand, mental health services often have waiting lists and the shortage of therapists adds further complications (Proudfoot et al, 2003). Such a situation runs contrary to the beneficial impact of early intervention (Royal College of psychiatrists, 2003). In an attempt to increase access, reduce the stigma in receiving help and manage resources, significant progress has been made in developing and implementing online delivery of psychological interventions (Marks et al, 2007; Proudfoot et al, 2003). Especially CBT can be easily transferred into online formats. Online therapeutic interventions have the potential to reach an audience that do not ordinarily use traditional services (Richards & Tangney, 2007). They can increase access and expand resource capacity for clinical settings (Marks et al, 2007). However, further research is required to determine the best type of online intervention for a given population and the amount of therapist support required for success (Marks et al, 2007; NICE, 2007). The present study is a randomised controlled trial treating depression via the Internet using two conditions: Condition 1: Online asynchronous counselling following a CBT protocol for the treatment of depression [therapist-led] Condition 2: Self-directed Computerised Cognitive-Behavioural Therapy software for the treatment of depression [client-led] The two conditions include a comprehensive screening and a protocol-driven treatment for depression via the internet. The efficacy of the treatment conditions will be compared. A comparison of the differences among therapist-led and client-led online interventions will be made based on the key variable of the therapeutic relationship (Norcross, 2002). The study will assess the perception of working alliance (Horvath & Greenberg, 1989) within the stated conditions and examine which aspects of the interventions users find most significant (Timulak, 2007). Consideration will also be given to their cost effectiveness, including a comparison with face-to-face delivery.
Funding Agency
Health Service executive and ESB Electric Aid Grant
Date From
2008
Date To
2010
Title
An internet-based self-management program for Bipolar Disorder in mental health services in Ireland. Results and learnings from a feasibility trial (HSE)
Summary
Self-management strategies have been included in clinical guidelines for the treatment of patients with Bipolar Disorder (BD). Preliminary results investigating the effectiveness and feasibility of online-delivered self-management interventions for BD are promising, but studies have yet to be conducted in real-world settings. This trial aimed to examine the feasibility and preliminary effectiveness of implementing an online-delivered, clinician supported, self-management intervention for BD as an adjunct to treatment as usual at two mental health services in Ireland. This study used an uncontrolled, pre-post design with embedded mixed-methods evaluation. Fifteen (N=15) patients signed consent and used the programme over a period of 10 weeks. They were supported by clinicians from their care team. Feasibility and acceptability were assessed in terms of recruitment, use of the intervention and satisfaction from both clinicians and patients' perspectives. Measures of personal recovery, quality of life and severity of symptoms were administered at baseline and post-intervention. Recruitment to the intervention was found acceptable and usage of the platform was quite high with high frequency of tool usage. Significant differences in patients' sense of personal recoveryfrom pre- to post-intervention (z=2.38, p=.017) were found. Both, patients and clinicians, found the intervention acceptable, easy-to-use and convenient; however, some notable barriers to implementation of the intervention will need to be overcome for scaling. This is the first study that tests the feasibility of a digital intervention for patients with bipolar disorder in public mental health services in Ireland. More research is needed in order to increase the understanding of how to promote the integration and the uptake of digital interventions for individuals with BD.
Funding Agency
Health Service Executive
Date From
2017
Date To
2018
Title
Assessing the efficacy and acceptability of an internet-delivered intervention for resilience among college students
Summary
Background Exposure to new stressors places college students at increased risk for developing mental health problems. Preventive interventions aimed at enhancing resilience have the potential to improve mental health and well-being in college students and internet-delivery may improve access to these interventions. However, few studies have evaluated the efficacy of online interventions for resilience in college students. The present study seeks to assess the feasibility [initial efficacy and acceptability] of a newly developed internet-delivered intervention for resilience provided with human or automated support, in a sample of college students. Method A pilot randomised controlled trial including three groups: 1) an intervention group with human support; 2) an intervention group with automated support; and 3) a waiting list control group. The intervention, Space for Resilience, is based on positive psychology and consists of seven modules, delivered over a period of eight weeks. Primary outcomes measures will include the Connor-Davidson Resilience Scale (CD-RISC) and the Pemberton Happiness Index (PHI). Secondary outcomes measures will include the Brief Resilience Scale (BRS), the Patient Health Questionnaire - 4 items (PHQ-4), the Rosenberg Self-Esteem Scale (RSES), and the Perceived Stress Scale - 4 items (PSS-4). Acceptability will be examined using the Satisfaction with Treatment (SAT) questionnaire. Analysis will be conducted on an intention-to-treat basis. Discussion The study seeks to establish the initial efficacy and acceptability of an internet-delivered intervention for resilience with human support and automated support. Apart from determining the impact of the intervention on acceptability and effectiveness, this study will be a first to explore more clearly the relative benefits of different support modes.
Funding Agency
SilverCloud Health
Date From
2018
Date To
2019
Title
The efficacy of online delivered treatment for generalized anxiety disorder: A systematic review and meta-analysis
Summary
Generalized AnxietyDisorder(GAD)istypically considereda chronic condition characterizedbyexcessiveworry.Lifetime prevalence is 4.3-5.9%, yet only a small percentage seeks treatment. GAD is treatable and in recent yearsinternet-delivered treatment interventions have shown promise. This paper aims to systematically search for lit-erature on internet-delivered psychological interventions for the treatment of GAD and conduct a meta-analysisto examine their efficacy. The purpose of the paper is to inform the community of researchers, program devel-opers and practitioners in internet delivered interventions of the current state-of-the-art and research gapsthat require attention. A systematic search of the literature was conducted tofind all studies of internet-deliveredtreatments for GAD (N= 20). Using Review Manager 5 all Randomized Controlled Trials (RCTs;n= 11) that metour established eligibility criteria were included into a meta-analysis that calculated effect sizes via the standard-ized mean difference. Compared to the waiting-list controls, the results demonstrate positive outcomes for GADsymptoms (d=−0.91) and its central construct of pathological worry (d=−0.74). The meta-analysis supportsthe efficacy of internet-delivered treatments for GAD including the use of disorder-specific(4studies)andtransdiagnostic treatment protocols (7 studies). Caution is advised regarding the results as the data is limitedand highly heterogeneous, but revealing of what future research might be needed
Date From
2015
Date To
2015
Title
An internet-based approach to scalable, treatment prediction research in mental health. (Ireland, UK, USA)
Summary
Concept/Background. We need to develop tools that can improve the precision with which we allocate treatments in psychiatry. Current psychiatric disease classifications (DSM-5, ICD-10) ensure reliable diagnoses across clinicians, but their diagnostic categories do not allow for individual treatment predictions - for example, most patients with major depression do not recover after their first antidepressant treatment. This project aims to remedy this by using machine learning to develop an algorithm that can quantify how likely an individual is to respond to a range of antidepressant medications - we are now extending this protocol to include CBT treatment in collaboration with Silvercloud. Large samples are required to train a robust predictive model. To achieve this, all data collection will be web-based and subjects will be recruited worldwide. Predictors will include cognitive tests, which are linked to specific brain circuits and neurotransmitter systems that relate to psychiatric disease and treatment action, clinical symptoms and treatment variables, and demographics. The long-term goal of this work is to develop a tool that can be used by clinicians to achieve individualised treatment allocation. In the shorter term, we will establish a new methodology for carrying out agile treatment prediction research outside of the typical clinical trial route - which is slow, costly, and typically involves data that is limited in scope and not reflective of the state-of-the-art. It is of immense value to have a positive control treatment group like CBT in our study as this allows us to test if our algorithm is specific to SSRI treatment response, rather than being a generic marker of response to treatment. Adding CBT delivered via Silvercloud as a treatment arm also brings potential that we will be able to generate an algorithm that is specific to predicting CBT, but not antidepressant, response. The goal is to develop new methods that can help people get better, faster.
Funding Agency
MQ MENTAL HEALTH
Date From
2019
Date To
2021
Title
Online mental health community in Ireland (2004-2008 Completed)
Summary
Using constructivist principles and a model of informal learning a portal called the Trinity Online Mental Health Community was born. It allowed students to access psycho-educational materials, join in discussion with their peers on topics related to mental health and wellbeing, and also users could engage in online asynchronous counselling with a counsellor from the Colleges counselling service.
Funding Agency
Higher Education Authority
Date From
2004
Date To
2009
Title
Internet-delivered CBT intervention (Space for Sleep) for sleep disorder: study protocol for a pilot trial (SLEEP-UK-IAPT)
Summary
Background: The current study seeks to investigate the feasibility of an internet-delivered Cognitive Behavioural Therapy (CBT) based intervention for sleep disorder. CBT for Insomnia is evidence- based and recommended as a first line treatment in clinical guidelines outlined by the National Institute for Health and Care Excellence (NICE) in the UK for the management of sleep disorder. Method: Eligible patients (n = 35) will be invited to use the supported intervention over an 8-week period. Participants will indicate consent and complete screening measures online before beginning the programme. They will then be referred to a supporter from within Berkshire NHS Foundation Trust. Primary outcome measures will be the Insomnia Severity Index (ISI) and sleep efficiency (SE) as calculated by the programme's in-built sleep diary. Secondary outcome measures will be the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7) and the Work and Social Adjustment Scale (WSAS) as part of the minimum data set administered routinely by this IAPT site. All measures will be administered at baseline and weekly thereafter. Discussion: The findings will be used to understand the feasibility and preliminary efficacy of an internet-delivered intervention for insomnia disorder and to improve the programme in accordance with user needs. The findings will inform the design of a controlled evaluation of the clinical feasibility and effectiveness of Space for Sleep. This research will further contribute to the growing evidence base for web-based interventions designed to help those with sleep difficulties.
Funding Agency
SilverCloud Health
Date From
January 2019
Date To
December 2020
Title
Feasibility, Acceptability and Satisfaction with Internet-delivered Treatment for Depression, Anxiety and Stress in Students: An Open Feasibility Trial (Minnesota)
Summary
Background: In recent years University counseling and health services have reported an exponential increase in yearly visits, as well as an exponential increase in total yearly clients. This trend has been observed at many universities as behavioral and mental health issues pose significant problems for many college students. Aims/objectives: The aim of this study is to investigate the feasibility, acceptability and satisfaction of internet-delivered treatment for depression, anxiety and stress in university students. Methods/Design: The study is an open feasibility trial of the SilverCloud programs for depression (Space from depression), anxiety (Space from Anxiety), and stress (Space from Stress), each are 8-module internet-delivered CBT (iCBT) intervention programs. Participants are assigned a supporter who will provide weekly post-session feedback on progress and exercises. Participants will complete the PHQ-9, GAD-7 and stress sub-scale of DASS-21 as the primary outcome measures for the respective interventions (depression, anxiety and stress). Secondary outcomes include measures of acceptability and satisfaction of the intervention. Data will be collected at baseline and at posttreatment. Discussion: It is anticipated that the study will inform the researchers and service personnel of the study's efficacy as well as protocols and procedures to be employed in a future trial. In addition, it will provide insight into the students' engagement with the program, their user-experience and their satisfaction with the online delivery format while meeting the needs of services in demand.
Funding Agency
SilverCloud Health
Date From
2015
Date To
2016
Title
Computer-based psychological treatments for depression (2011-2012 Completed)
Summary
The study was a systematic review & meta-analysis of the literature on computer-based psychological treatments for depression. The review and meta-analysis support the efficacy and effectiveness of computer-based psychological treatments for depression, in diverse settings and with different populations. Further research is needed, in particular to investigate the influence of therapist factors in supported treatments, the reasons for dropout, and the maintenance of gains post-treatment.
Date From
2011
Date To
2012
Title
Internet-delivered cognitive behavioural therapy for the treatment of depression in axial spondyloarthritis: a pilot study.
Summary
AxSpA is characterised by inflammatory back pain, stiffness and functional impairment. Unlike other forms of arthritis, symptoms typically begin in early adulthood. Consequently, axSpA significant impacts quality of life and work productivity over the life course, at costs to both the individual and the economy (2). Biologic drugs that target tumour necrosis factor alpha (TNFi) have dramatically improved management of these patients. However TNFi are costly and can only be continued with demonstrable response. Depression is common in axSpA patients, with prevalence ranging from 15% to 52%; it is more common in younger patient groups (3). Depression is associated with worse disease and poorer quality of life. There has been very little dedicated research of depression in axSpA, but in rheumatoid arthritis it has been shown to adversely affect response to TNFi. AxSpA patients with depression therefore have worse disease and are likely to have poorer response to treatment. There is a real need for improvement of management of depression. The limitations of pharmacological interventions of depression are well recognised. Access to cognitive behavioural therapy (CBT), although an effective intervention, is severely limited in the NHS. Internet-delivered CBT (iCBT) has accumulated a growing body of evidence in treating depression and fibromyalgia (4-6). It is available on the NHS (although predominantly in primary care) and bypasses waiting times associated with traditional face-to-face CBT. The main limitation with these interventions is adherence. SilverCloud (SC) is iCBT package which has reported high levels of intervention adherence and clinical outcomes (7). Furthermore, it is has tailored programs for co-morbid depression and anxiety in chronic diseases including chronic pain. We plan to perform a pilot study of the "Space from Depression and Anxiety in Chronic Pain (7)" programme in axSpA patients to: 1) explore the feasibility of recruiting patients to this intervention, 2) test its acceptability and 3) assess whether it changes symptoms of depression, well-being and measures of axSpA disease severity.
Funding Agency
National Ankylosing Spondylitis Society (NASS)
Date From
2017
Date To
2020
Title
IAIM Study of online delpression anxiety and eating disorders in Students (USA)
Summary
SPECIFIC AIMS College mental health services are facing a nearly universal challenge: despite efforts to expand capacity, demand is swelling more rapidly. To date, a mobile mental health platform comprised of a suite of evidence-based, cognitive-behavioral therapy (CBT) interventions has not been tested at large scale. We propose to test the impact of such a platform in a trial across 20 diverse colleges. Students who screen positive or at high-risk for clinical anxiety, depression, or EDs, which account for a substantial proportion of the mental health burden on college campuses and who are not currently engaged in mental health services (N=7,884; of 146,000 initially screened) will be randomly assigned to: 1) intervention via the mobile mental health platform; or 2) referral to usual care (i.e., campus health or counseling center). Consistent with NIMH Strategic Plan20 Objectives 3 (Strive for Prevention and Cures) and 4 (Strengthen Public Health Impact of NIMH Research), our Aims are to: Aim 1 (uptake): Examine uptake (i.e., individuals beginning treatment) of the mobile mental health platform compared to referral to usual care. Hypothesis 1 (H1): The mobile mental health platform will yield substantially higher and earlier uptake of services compared to referral to usual care. Aim 2 (effectiveness): Evaluate the effectiveness of the mobile mental health platform, compared to usual care, in (2a) reducing the number of individuals with mental health disorders (primary outcome); (2b) reducing disorder-specific symptoms (secondary outcome); and (2c) improving quality of life and functioning (secondary outcome). H2: The mobile mental health platform will be superior to usual care in (H2a) reducing clinical cases; (H2b) reducing disorder-specific symptoms; and (H2c) improving quality of life and functioning. Aim 3 (targets, mediators, predictors, and moderators): (3a) Examine if the mobile intervention changes targets previously found to be associated with outcomes, both transdiagnostic (i.e., decreased dysfunctional cognitions, increased use of CBT skills) and disorder-specific (i.e., reduced avoidance for anxiety, increased behavioral activation for depression, reduced dietary restraint and weight/shape concerns for EDs); (3b) determine if changes in targets are associated with clinical benefit; and (3c; exploratory) identify other putative mediators of change (e.g., early engagement in help services, rapid response), (3d; exploratory) within-mobile program predictors of outcome (e.g., sessions completed), and (3e; exploratory) treatment moderators. H3a: The mobile treatment will result in significant change in both transdiagnostic and disorder-specific targets. H3b: Change in targets will be associated with clinical benefit (primary and secondary outcome variables). Other mediator, within-program predictor, and moderator analyses will be exploratory. Aim 4 (stakeholder outcomes, exploratory): Evaluate stakeholder-relevant outcomes: (4a) cost-effectiveness; (4b) students' academic performance; and (4c) attitudes. H4: Relative to usual care, the mobile mental health platform (H4a) will reduce downstream costs and have a higher net-benefit from a payer's perspective and (H4b) be superior in improving academic performance. (H4c) Stakeholder attitudes towards mobile platforms will significantly vary and will correlate with intention to adopt a mobile platform permanently. This population-level approach to service engagement has potential to improve mental health outcomes for millions of college students, which could in turn improve their educational and employment outcomes. The model could also be adapted, such as for employees and secondary school students, increasing reach and impact.
Funding Agency
National Institute for Mental Health (NIMH-US)
Date From
2019
Date To
2023
Title
Internet delivered treatment for generalised anxiety in routine care (TCD)
Summary
Generalized anxiety disorder is typically considered a chronic condition. In Europe the lifetime prevalence of GAD has been estimated at 4.3-5.9%, and a 12-month prevalence of 1.2-1.9%; yet only a very small percentage seek treatment. Several studies have reported elevated levels of anxiety and stress in university students. The current research is a naturalistic effectiveness study utilizing a randomized controlled trial design of a low-intensity internet intervention for the treatment of GAD. Research questions: First, can an online treatment for GAD be effective for an adult student population in a service-based setting? Second, what do participants find helpful and hindering in their online treatment for anxiety? Third, are participants satisfied with accessing and using an online treatment for anxiety? Fourth, what are the reasons for dropout from an online treatment?
Funding Agency
SilverCloud Health
Date From
2013
Date To
2015
Title
Development of an online platform to support self-management of symptoms and promote wellbeing of people with coronary heart disease and associated long-term conditions (LTCs) [with Kings College London]
Summary
CVD is responsible for premature death, impaired quality of life and disproportionate service usage and costs. Psychological distress in CVD is common and associated with poor outcome. Improved management within the community is needed. Current online psychological care packages do not address the CVD symptoms and risk factors that are related to poor outcome. We will develop an online cognitive, psychoeducational and psychotherapeutic CVD-specific package to support self-management and promote wellbeing. This will improve access to holistic care while reducing costs. Project Team: Barley, E., Clifton, A., Enright, A., Lee, G., Norman, I., Richards, D., Sturt, J.
Funding Agency
Papworth Hospital NHS Foundation Trust and Health Enterprise East Ltd
Date From
2014
Date To
2014
Title
Low-intensity internet-delivered treatment for adults with depressive symptoms in Colombia - South America
Summary
Prevalence rates for depression in Central and South America are not far removed from rates reported in high-income countries. Many barriers to accessing treatments exist, such as the underdevelopment of services, waiting lists, cost of the services, and personal stigma. Internet-delivered treatments for depression have demonstrated their efficacy. It is possible that such Internet-delivered treatments could overcome some of the barriers to accessing treatment in low-income countries countries. Project Team: Alicia Salamanca, Derek Richards, Ladislav Timulak
Funding Agency
Irish Research Council
Date From
2015
Date To
2018
Title
Prevalence and clinical course of depression
Summary
The study was a systematic review of the literature of the prevalence and clinical course of depression. The study considered literature from high-income countries. The review considered the literature on Major Depression beginning with a brief historical overview, its classification, and a synthesis of the current knowledge regarding prevalence and course.
Date From
2010
Date To
2011
Title
Internet-delivered treatment: Its potential as a low-intensity community intervention for adults with symptoms of depression [with Aware Charity]
Summary
The study is a randomized controlled trial of an online cognitive behavioural therapy (CBT) program for the treatment of adults with depressive symptoms compared to a waiting-list control group. The treatment consists of 8 modules of online delivered CBT, over 8 weeks, with supporters providing weekly feedback. The primary outcome is depressive symptoms, measured by the Beck Depression Inventory (BDI-II). Secondary outcomes included quality of life indicators. Data will be collected at baseline and at post-treatment. Project team: Richards, D., Timulak, L., Doherty, G., Sharry, J., & Hayes, C.
Funding Agency
SilverCloud Health & Aware Charity
Date From
2012
Date To
2015
Title
Prevalence of depression & associated risk factors in Colombia (2011-2012)
Summary
Since September 2011 I have been collaborating with the Faculty of Psychology, Universidad Antonio Nariño on a project involving research into the prevalence of depression in a sample of Colombian students.
Funding Agency
Universidad Antonio Narino
Date From
2011
Date To
2012
Title
Project Talia - AI for Improved Mental Health
Summary
One in four of us, at some point in our lives, will be affected by a mental health condition. Good mental health and well-being are fundamental to our general health and quality of life. It enables us to build resilience against everyday stresses, to work productively, to have fulfilling relationships, and to experience life as meaningful. Mental health presents one of the most challenging and under-investigated domains of machine learning research. In Project Talia we are exploring how we can best leverage AI to help improve the effectiveness of important mental health services. More Effective Digital Mental Healthcare with AI For improving mental health through AI, our research focuses on the following strategies: Stratify Understand patient sub-types which respond best to treatment + interventions Personalize Tailor content and delivery to achieve optimal therapy outcomes for individual patients Predict Identify which patients are more likely to drop-out for earlier intervention, or different programs Intervene Intervene timely to ensure earlier intervention and improved outcomes Improve Identify successful patterns in supporter behaviour in relation to patient sub-type to improve therapy effectiveness https://www.microsoft.com/en-us/research/?post_type=msr-project&p=609993&secret=X9sI1g
Funding Agency
SilverCloud Health
Date From
01/01/2019
Date To
30/12/2021
