Internet therapy - how many people drop out?

The internet is used more and more to deliver treatment for mental-health problems and research has shown that internet-based treatment is effective for a number of different psychological conditions. However, there are worries about the number of people who drop out of internet-based treatment and researchers from Griffith University in Brisbane and Queensland University of Technology reviewed 19 studies into this issue carried out between 1990 and April 2009. The studies had dropout rates between two and 83% with the average rate being 31%. The researchers also found that there was little evidence to suggest which factors made it more likely that people would drop out of internet therapy.

Melville, Katherine M.; Casey, Leanne M.; Kavanagh, David J. - Dropout from Internet-based treatment for psychological disorders British Journal of Clinical Psychology 49 (4), November 2010, 455-471

Major review gives thumbs up to self-help

In guided self-help patients take home a standardized psychological treatment and work through it more or less independently. The treatment can be written down in a book or be available via a web site, television, video or audio and some support is given by a professional therapist or coach. P. Cuijpers from the VU University in Amsterdam reviewed 21 studies, including 810 participants, comparing face-to-face therapy with guided self-help. They concluded that guided self-help was just as effective as face-to-face therapy, that its effects lasted for a year and that people were just as likely to carry on with their treatment.

Cuijpers, P. ... [et al] - Is guided self-help as effective as face-to-face psychotherapy for depression and anxiety disorders? A systematic review and meta-analysis of comparative outcome studies Psychological Medicine (2010), 40, 1943–1957

Teletherapy for PTSD

Although teletherapy can seem impersonal it does have a number of advantages. It is cheaper and is more suitable for people who find it hard to get into hospital, either for psychological or geographical reasons. Stephane Guay, from the University of Montreal, studied people with PTSD (post-traumatic stress disorder) who had either between 16 and 25 sessions with a therapist via a teleconference, or face-to-face therapy. Both groups saw a significant decrease in their post-traumatic stress, depression and anxiety symptoms and 75-80% overcame their PTSD; there was no difference in effectiveness between the two groups. However, the telemedicine participants were still treated in hospital as their treatment involved exposure to stress and it was felt to be important that someone was with them in case they reacted badly to it.

http://psychcentral.com/news/2010/03/24/teletherapy-for-ptsd-found-effective/12351.html

Young people, mental health and the Internet

Young people often find it difficult to access mainstream mental-health services partly because of the stigma associated with mental-health problems. One way round this is to use the Internet and a team of researchers from University College Cork surveyed 922 college students, aged between 18 and 24 to find out what they thought about doing this. 72.4% of the participants used the Internet several times a day and 30.8% had previously searched for mental-health information online, mostly for depression. 68% said they would use the Internet for mental-health support if they needed to but 79.4% said they would still prefer face-to-face support.

Horgan, A. and Sweeney, J. - Young students' use of the Internet for mental health, information and support Journal of Psychiatric and Mental Health Nursing 2010. 513), 117-123

Telephone counselling helps depressed heart patients

People who have had a coronary artery bypass often develop depression; something which can have a negative impact on their health. Researchers at the University of Pittsburgh School of Medicine studied 302 people who had had a coronary-artery bypass. 150 of the participants received eight months of collaborative care by telephone while the rest made up a control group. The people who received the telephone counselling had improvements in their mental health, physical functioning, moods and levels of depression compared to the other group, with depressed men benefiting more than depressed women; however, a significant minority of patients did not benefit from the intervention.

You can find out more about this research at

http://www.mentalhelp.net/poc/view_doc.php?type=news&id=123747&cn=5

Online CBT for depression

Computerised CBT has shown promise as a way of offering treatment to people who are unable or unwilling to receive face-to-face treatment and for those in areas where it is difficult to travel to get treatment. It is also significantly cheaper than face-to-face therapy and could be a good way of delivering this service to more people. Researchers from the University of Bristol studied 297 people suffering from depression. Half of them used online CBT while the other half received 'care-as-usual' from their GP. After four months almost two-fifths of those who received the online CBT got better compared to one in four of those receiving treatment as usual. After eight months people were still feeling the benefits of the online CBT.

http://www.telegraph.co.uk/health/healthnews/6062089/Depressed-people-should-get-online-counselling-study-says.html

Internet CBT for insomnia

One third of people report symptoms of insomnia and around one in ten actually meet the clinical criteria for the condition. Cognitive behaviour therapy is one of the most effective treatments for the condition but its availability is limited by a shortage of clinicians, poor geographical distribution of knowledgeable professionals, expense and inaccessability to treatment and clinicians. One way round this could be by using Internet CBT. Researchers at the University of Virginia in the U.S. and the University of Laval in Quebec studied 45 people with sleep problems comparing 22 people using an Internet CBT programme with 23 on a waiting list who formed a control group. The Internet programme was based on face-to-face CBT approaches and used the techniques of sleep restriction, stimulus control, sleep hygiene, cognitive restructuring and relapse prevention. The participants who received the Internet intervention significantly improved their sleep leading the researchers to conclude that Internet CBT has 'considerable potential in delivering a structured behavioural programme for insomnia'

Ritterband, Lee M. ... [et al] - Efficacy of an Internet-based behavioural intervention for adults with insomnia Archives of General Psychiatry July 2009, 66(7), 692-698

Computerized CBT helps with insomnia

Computerized cognitive behaviour therapy (CBT) is effective in treating sleep problems. Researchers from the University of Manitoba in Canada studied 118 adults with chronic insomnia. Half of them used a computerized CBT programme and half were placed on a waiting list for treatment. The programme was made up of information about insomnia and sleep hygiene, stimulus control instruction, relaxation training, sleep restriction and cognitive therapy. The cognitive therapy part of the programme was designed to help individuals develop realistic expectations about sleep and the impact of sleep on their functioning the next day while teaching them a variety of strategies for coping with worries and an over-active mind. The results showed that 81% of the people using the programme showed at least mild improvement in their sleep and 35% rated themselves as much, or very much, improved. 30% of people who finished the programme managed to get an extra hour's worth of sleep. They also developed healthier attitudes about sleep and were less likely to have an over-active mind at bedtime. However, there was a 33% drop-out rate for the programme, compared to only 22% for 'in person' psychotherapy.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/06/090601091916.htm

Computerized therapy for problem drinking: log on and cut down

A relatively small number of people are alcoholics but many more people drink more than is good for them. However, only 10-20% of people with alcohol problems ever seek out or take part in treatment. Researchers in the Netherlands looked into the effectiveness of a web-based, self-help treatment called Drinking Less which is made up of motivational, cognitive and self-control information and exercises. It helps problem drinkers decide if they really want to change their consumption, helps them set realistic goals for acheiving change and provides tools and exercises to maintain change and prevent relapses. Researchers in Holland studied 378 people who had used the Drinking Less web site between May and November 2007. They found that after six months the participants decreased their average weekly drinking and that 18.8% changed their drinking patterns to 'low-risk' drinking. For 84% of the participants this was the first time they had sought help to deal with their problem drinking.

You can find out more about this research at

http://www.sciencedaily.com/releases/2009/05/090512192905.htm



http://www.sciencedaily.com/releases/2009/05/090512192905.htm

Internet therapy for anxiety

There is good evidence that cognitive behaviour therapy (CBT) can improve the symptoms of anxiety. However, many people avoid or delay seeking treatment either because of stigma, because their condition limits how far they can travel or because of a shortage of qualified clinicians. Internet and computer-based treatments have been used in an attempt to overcome some of these barriers and researchers from Tacoma, Washington in the U.S. reviewed 19 trials into the effectiveness of Internet therapy for anxiety. They found that Internet therapy was more effective than being on a waiting list and as effective as traditional therapy. However, the trials had small sample sizes and some methodological problems so the review gave a qualified thumbs up rather than a whole-hearted endorsement.

Reger, Mark A. and Gahm, Gregory A. - A meta-analysis of the effects of Internet- and computer-based cognitive-behavioural treatments for anxiety Journal of Clinical Psychology January 2009, 65(1), 53-75

New web site on online therapy

A new website about online therapy has been set up for mental-health professionals. The site contains articles, discussion boards and resources and will look into issues such as therapists' roles on 'virtual world' sites such as Second Life.

You can find the site at

www.onlinetherapyinstitute.com

Computerized CBT and patient satisfaction

Cognitive behaviour therapy (CBT) is used to treat a variety of mental-health problems including depression and anxiety. However, it is not always available to service users because of a shortage of therapists and long waiting times. Alternative methods of provision have been developed including group therapy, bibliotherapy and computerized CBT (CCBT). There is evidence about the clinical effectiveness of CCBT but little information about its acceptability to service users. A review of 16 studies on the use of CCBT for depression found that although drop-out rates from CCBT were comparable to other forms of treatment, take-up rates were much lower. Overall there was limited information on patient satisfaction with CCBT but when treatment was completed several studies reported positive expectancies and high satisfaction.

Kattenthaler, E. ... [et al] - The acceptability to patients of computerized cognitive behaviour therapy for depression: a systematic review Psychological Medicine November 2008, 38(11), 1521-1530

Computerised CBT - the evidence so far

Depression and anxiety are common mental disorders, usually treated by GPs. Recognition of both disorders by GPs is often poor and the proportion of people who actually receive treatment is low. Medication is usually the first, and often the only treatment, offered but it can have unwanted side effects. There is substantial evidence to support the use of psychological therapies, particularly cognitive behavioural therapy (CBT) but it is expensive and there is a shortage of therapists leading to long waiting lists. Alternative methods of providing CBT have been developed, including computerised CBT (CCBT). A study of CCBT in the British Journal of Psychiatry reviewed previous research on the technique and found that 'there is some evidence to support the effectiveness of CCBT for the treatment of depression.' However, the studies examined had considerable drop-out rates and little evidence was presented regarding participants' preferences and the acceptability of the therapy.

Kaltenthaler, Eva ... [et al] - Computerised cognitive behavioural therapy for depression: systematic review British Journal of Psychiatry September 2008, 193(3), 181-184

Telephone help for overweight and depressed women

A study of 401 overweight women in California looked at the effectiveness of a phone and Internet based behavioural intervention designed to improve behaviours such as diet and exercise. Previous studies have shown that psychotherapy for depression can be delivered successfully by telephone or via the Internet and other studies have shown that exercise and weight loss can help people to feel less depressed so as well as their weight and exercise levels the study also monitored the women's mood. After 12 months those receiving the intervention significantly decreased their depression scores compared to a control group and those with probable depression showed clinically important improvements. The participants who engaged more readily with the intervention were more likely to reduced their depression scores.

Kerr, Jacqueline ... [et al] - Randomized control trial of a behavioral intervention for overweight women: impact on depressive symptoms Depression and Anxiety 25(7), 555-558

CBT4CBT

Cognitive behaviour therapy (CBT) has a comparatively strong level of empirical support as a treatment for a range of psychiatric disorders, including substance abuse. However, due to a lack of staff and resources CBT remains rarely implemented in the range of settings where individuals with substance use disorders are treated. Computer-assisted therapy could provide a comparatively low-cost method of teaching CBT skills to more substance users and a U.S. trial of 77 patients compared those using computer-based training for cognitive behaviour therapy (CBT4CBT) with those receiving standard treatment. Participants using CBT4CBT submitted significantly more negative urine samples and tended to have longer continuous periods of abstinence during treatment. The programme was positively evaluated by participants and completion of CBT4CBT homework asssingments was significantly correlated with outcome.

Carroll, Kathleen M. ... [et al] - Computer-assisted delivery of cognitive-behavioral therapy for addiction: a randomized trial of CBT4CBT American Journal of Psychiatry July 2008, 165(7), 881-888

Agoraphobia and virtual reality

Agoraphobia has been described as the most complex phobia, the one most difficult to treat and the phobia that produces the highest level of incapacity. Phobias are often treated by a gradual exposure to the situation or thing that people are afraid of but this can sometimes be logistically, economically or psychologically impossible. There has been an increasing interest in virtual reality exposure, used in conjunction with cognitive behaviour therapy (CBT) but its results in agoraphobia are unclear or inconsistent. A team of Spanish researchers compared virtual reality exposure plus CBT with traditional CBT. Both groups showed a significant improvement which was maintained three months later. The virtual reality group showed a slight amelioration in symptoms relative to the CBT group.

Penate, Wenceslao ... [et al] - The effects of a treatment based on the use of virtual reality exposure and cognitive-behavioral therapy applied to patients with agoraphobia International Journal of Clinical and Health Psychology, 2008, 8(1), 5-22

Computerised CBT for drug users

Cognitive behavioural therapy (CBT) concentrates on teaching skills and strategies to help people change behaviour patterns and has proven to be effective in treating a wide variety of psychiatric disorders. However, there is often a shortage of trained CBT practitioners so attention has shifted to new ways of delivering CBT, including by computer. A U.S. study of 77 drug users compared the effectiveness of traditional counselling to that of psychotherapy, supplemented by computer-assisted CBT. The computer-assisted therapy programme consisted of text, audio and videotaped examples designed to help the user learn new ways of avoiding the use of drugs and changing other problem behaviours. The participants who received computer-assisted training had significantly fewer positive drug tests at the conclusion of the study.

You can read more about this research at

http://psychcentral.com/news/2008/05/02/counseling-plus-computer-behavioral-therapy-helps-addicts/2215.html

Internet CBT for depression

Internet-based CBT is a promising new approach in the treatment of depression. There have been studies which have proved its short-term effectiveness but little research into its long-term effects. A Dutch study of 301 people over the age of 50 divided them into three groups. One group received internet-based CBT, one group received group CBT and the third group was placed on a waiting list as a control group. After a year the internet-based therapy was found to be superior to the control group and as effective as group CBT.

Spek, V. ... [et al] - One-year follow-up of results of a randomized controlled clinical trial on internet-based cognitive behavioural therapy for subthreshold depression in people over 50 years Psychological Medicine May 2008, 38(5), 635-639