- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04478058
Feasibility and Effectiveness of Delivering CBT Through OPTT for Depression
Feasibility and Effectiveness of Delivering Cognitive Behaviour Therapy Through Online Psychotherapy Tool (OPTT) for Depression
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Study Design For this study, a non-randomized, controlled trial study design will be employed. Qualitative focus groups will be conducted to gather personal demographic information as well as information regarding the feasibility of implementing an online psychotherapy clinic. Additionally, quantitative analyses of e-CBT treatment efficacy will be conducted using standardized and clinically validated symptomology questionnaires. All study procedures have been approved by the Queen's University Health Sciences and Affiliated Teaching Hospitals Research Ethics Board.
Participants Patients (n = 110; 55 e-CBT participants, 55 in-person CBT participants) aged 18-65 years will be recruited at Queen's University from outpatient psychiatry clinic at both Kingston Health Sciences Centre sites (Hotel Dieu Hospital and Kingston General Hospital) as well as Providence Care hospital, family doctors, physicians, clinicians, and self-referrals in Kingston, Ontario, Canada. Once informed consent is provided, participants will be evaluated by a psychiatrist on the research team through secure video appointment to make or confirm a diagnosis of Major Depressive Disorder (MDD) using the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
The inclusion criteria for the study include the following: at least 18 years of age at the start of the study, diagnosed with major depressive disorder according to DSM-5 by an attending psychiatrist on the research team, competence to consent to participate, ability to speak and read English, and consistent and reliable access to the internet. Exclusion criteria include active psychosis, acute mania, severe alcohol or substance use disorder, and/or active suicidal or homicidal ideation. If a participant is receiving another form of psychotherapy, they will also be excluded from the study, to avoid any confounding effect on the efficacy of this e-CBT program. If eligible for the study, participants will choose between the e-CBT program (n = 55) or the in-person CBT offered individually through this program at Hotel Dieu Hospital (n = 55).
During the informed consent process, it is explained to all participants that this program is not a crisis resource and that they will not have access to their therapist at all times. In the case of an emergency, participants are directed to the proper resources (e.g., emergency department, crisis lines, etc.) and this event will be reported to the principal investigator of the study.
Procedures The e-CBT care plan consists of 12 weekly sessions of approximately 30 slides and interactive content, delivered through OPTT. The e-CBT module content mirrors in-person group CBT content, including different weekly topics, general information, skill overviews, and homework. The efficacy of the therapeutic content has previously been tested through email administration and shown to significantly reduce depressive symptoms Participants are instructed to go through the content and complete homework at the end of the session which helps them practice skills they learned through that session. Homework is submitted through OPTT and reviewed by the therapist assigned to the participant, who will provide personalized feedback within three days of submission. Therapists have access to pre-designed session-specific feedback templates to use as a basic structure to write their feedback. By doing so, the time needed to respond to each patient is reduced and therefore the number of patients each therapist can handle increases. At the same time, by using a structured format in responding to patients, more standardized quality of care can be assured. The general structure of the feedback template is as follows: -validating the participant's time and effort, -reviewing the event they have used in their homework, -summarizing the previous module's content, and -discussing the participant's homework submission and how they could improve it. In addition to these points, the feedback will have an emphasis on specific content from the participant's submission, reassuring them that their therapist is reading and understanding their challenges. All feedback submissions are finished with a personalized signature from the therapist, helping to develop a rapport between the therapist and the participant. On average, developing this feedback takes a therapist 15-20 minutes per patient. In addition to the weekly feedback, participants have the option to message their therapist through the platform throughout the week regarding any questions or concerns they may have. All technical issues are handled directly through OPTT's technical support team.
Participants in the in-person CBT group will attend weekly sessions at Hotel Dieu Hospital (12 weeks) where they will receive standardized individual (one-on-one) CBT for MDD from a trained therapist. All content covered and skills taught will mirror the e-CBT program. Similar to the e-CBT group, participants will be assigned weekly homework assignments that they will complete during the week and hand-in at the start of their next session. At this time, participants will receive personalized feedback for their previous week's homework from their therapist.
At the end of the study, a few participants and healthcare providers (i.e., 8 participants, 2 providers) are recruited for focus groups. The focus group prompts will pertain to experience and expectations of service during the study and how they think the service could be improved.
Online Module Content Both e-CBT modules and in-person CBT sessions are designed to instill constructive and balanced coping strategies in participants. During the program, we focus on essential thinking and behavioural skills to help the patients become more engaged in day-to-day activities. The focus of the sessions is placed on the connection between thoughts, behaviours, emotions, physical reactions, and the environment. We work on evaluating negative beliefs and thought processes and their relationship with depression. Our goal is to adjust the negative thinking so that participants can think about and adapt to the things that are happening to them. This allows them to adjust the way they behave and think about their problems in a way that is not as negative and replaces those thoughts and behaviours with potentially more realistic and productive ones.
Training All therapists are research assistants hired by the principal investigator. They all undergo training in psychotherapy and additional training from a psychiatrist on the research team before any interaction with participants. During this training, therapists complete feedback on practice homework, which is reviewed by a psychiatrist on the research team to ensure adequate quality of work. All therapists are supervised by the lead psychiatrist, who is an expert in the area of electronically delivered psychotherapy. Feedback is always reviewed by the lead psychiatrist, before submission to the participants.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Ontario
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Kingston, Ontario, Canada, K7L 5G3
- Queen's University
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- At least 16 years old at the start of the study
- Diagnosed with major depressive disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-V) by a clinician
- Competence to consent to participate
- Ability to speak and read English
- Consistent and reliable access to the internet
Exclusion Criteria:
- High current suicide risk (score of over 17 points on section C, Suicidality, of MINI)
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Treatment
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: e-CBT
Weekly e-CBT sessions will occur through Online Psychotherapy Tool (OPTT) and consist of slides and interactive therapist videos.
Content and format mirrors live CBT.
Slides will highlight a different topic each week and include general information, overview of skills, and homework.
Homework will be submitted through OPTT and reviewed by administrators with personalized feedback within three days.
Weekly homework submission will be mandatory before beginning the next session.
DASS 21 and Q-LES-Q-SF questionnaires will be completed at the beginning and end of treatment.
After each cycle of e-CBT, patients and healthcare providers involved in e-CBT will be recruited for focus groups once they have completed their 12-week program.
Qualitative data will be gathered through 10 focus groups.
The focus group prompts will pertain to experience and expectations of service.
Patients will be contacted six months after treatment to complete DASS 21 and Q-LES-Q-SF questionnaires.
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Weekly online Cognitive Behavioural Therapy
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Active Comparator: Live CBT
The content and format of live CBT will be mirrored by the e-CBT group over the course of 12 weeks.
The sessions will highlight a different topic each week and include general information, an overview of skills, and homework on that topic.
Live CBT homework will be reviewed by the CBT group organizer and provided at the beginning of the next CBT session.
Weekly homework submission for feedback will be mandatory before being eligible for the next session.
DASS 21 and Q-LES-Q-SF questionnaires will be completed at the beginning and end of treatment for both live and e-CBT.
All live and e-CBT patients will be contacted six months after the completion of their CBT to complete final DASS 21 and Q-LES-Q-SF questionnaires.
This will allow for the examination of the longevity of e-CBT compared to live CBT.
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Weekly in-person Cognitive Behavioural Therapy
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Change in symptoms - Patient Health Questionnaire - 9 Item
Time Frame: Week 1, Week 6, Week 12, 6-Month Follow-Up
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Clinical standardized symptom questionnaire.
Scale of 0-3, 3 being the worst.
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Week 1, Week 6, Week 12, 6-Month Follow-Up
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Change in symptoms (Quick Inventory of Depressive Symptomatology)
Time Frame: Week 1, Week 6, Week 12, 6-Month Follow-Up
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Clinical standardized symptom questionnaire.
Scale of 0-3, 3 being the worst.
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Week 1, Week 6, Week 12, 6-Month Follow-Up
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Change in quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire)
Time Frame: Week 1, Week 6, Week 12, 6-Month Follow-Up
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Clinical standardized symptom questionnaire.
Scale of 1-5, 1 being the worst.
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Week 1, Week 6, Week 12, 6-Month Follow-Up
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Qualitative Analysis - Healthcare Provider Experience
Time Frame: Week 12 (Post-Treatment)
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Focus groups for healthcare providers who will be asked about feasibility of providing the e-psychotherapy program, how it compares to in-person psychotherapy.
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Week 12 (Post-Treatment)
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Qualitative Analysis - Participant Experience
Time Frame: Week 12 (Post-Treatment)
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Interviews with participants regarding personal, social, and cultural factors (gender, sexuality, background, supportive resources, structural/social barriers, etc.)
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Week 12 (Post-Treatment)
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Collaborators and Investigators
Sponsor
Collaborators
Investigators
- Principal Investigator: Nazanin Alavi, MD FRCPC, Queen's University
Publications and helpful links
Helpful Links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- PSIY-563-17
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
IPD Plan Description
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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