Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: randomised controlled trial

Nickolai Titov, Blake F Dear, Luke Johnston, Carolyn Lorian, Judy Zou, Bethany Wootton, Jay Spence, Peter M McEvoy, Ronald M Rapee, Nickolai Titov, Blake F Dear, Luke Johnston, Carolyn Lorian, Judy Zou, Bethany Wootton, Jay Spence, Peter M McEvoy, Ronald M Rapee

Abstract

Background: Depression and anxiety are common, disabling and chronic. Self-guided internet-delivered treatments are popular, but few people complete them. New strategies are required to realise their potential.

Aims: To evaluate the effect of automated emails on the effectiveness, safety, and acceptability of a new automated transdiagnostic self-guided internet-delivered treatment, the Wellbeing Course, for people with depression and anxiety.

Method: A randomised controlled trial was conducted through the website: www.ecentreclinic.org. Two hundred and fifty seven people with elevated symptoms were randomly allocated to the 8 week course either with or without automated emails, or to a waitlist control group. Primary outcome measures were the Patient Health Questionnaire 9-Item (PHQ-9) and the Generalized Anxiety Disorder 7-Item (GAD-7).

Results: Participants in the treatment groups had lower PHQ-9 and GAD-7 scores at post-treatment than controls. Automated emails increased rates of course completion (58% vs. 35%), and improved outcomes in a subsample with elevated symptoms.

Conclusions: The new self-guided course was beneficial, and automated emails facilitated outcomes. Further attention to strategies that facilitate adherence, learning, and safety will help realise the potential of self-guided interventions.

Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12610001058066.

Conflict of interest statement

Competing Interests: NT and BFD are authors and developers of the Wellbeing Course, but derive no personal or financial benefit from it. NT, BFD, and RR have developed and operate a national telephone and online treatment service, the MindSpot Clinic (www.mindspot.org.au), for people with anxiety and depression, funded by the Australian Government. This service uses a version of the Wellbeing treatment course.

Figures

Figure 1. Wellbeing study flow chart.
Figure 1. Wellbeing study flow chart.
PHQ-9, Patient Health Questionnaire –9 Item. TEG: Treatment Plus Automated Email Group. TG: Treatment Group.
Figure 2. Means for the PHQ-9 and…
Figure 2. Means for the PHQ-9 and GAD-7 for the Overall and Comorbid Samples.
Note: TEG: Treatment plus automated email group. TG: Treatment group. PHQ-9: Patient Health Questionnaire-9 Item. GAD-7: Generalised Anxiety Disorder-7 Item.

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Source: PubMed

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