310 likes | 486 Views
Treatment of anxiety and depression via the Internet Will computers replace clinicians?. Nickolai Titov CRUfAD School of Psychiatry UNSW/St Vincent’s Hospital Sydney, Australia APS, September 2009. Will computers replace clinicians?. NO! Internet CBT offers an important opportunity to:
E N D
Treatment of anxiety and depression via the Internet Will computers replace clinicians? Nickolai Titov CRUfAD School of Psychiatry UNSW/St Vincent’s Hospital Sydney, Australia APS, September 2009
NO! • Internet CBT offers an important opportunity to: • Reach people who don’t access treatment • Showcase the best of psychology/psychiatry
2007 NSMHWB: Service Utilization Who did the seek help from? • Any health professional 35% (41% vs 28%) • VisitedGP23% (30% vs 18%) • Visited Psychologist/Psychiatrist 15% • More likely to see a MHP if severe/comorbidity • Comparable treatment seeking for a physical disorder 80%
Barriers to Treatment • Costs • Direct: Costs of treatment • Indirect: Travel time, time off work/other responsibilities • Convenience • Location – tyranny of distance • Waiting lists • Anonymity • Stigma/Fear of therapy • Severity/Perceptions • Cost-benefit ratio • “Treatment doesn’t work”, “I would rather treat myself”
Converging Factors for I-CBT Marks and Cavanagh (2009) 1. Demand for therapy • Exceeds its affordable, convenient, and confidential supply by qualified therapists 2. Advances in IT • Increasing potential of IT platforms 3. Some therapy tasks are suited for computer programs • Psycho-education • Teaching 4. Funding increasing • England/Wales: NICE • Australia: MoodGym, Anxiety Online
Part 1: Context - Summary • 20% of Australians have a mental disorder • 35% of those seek treatment each year • 85% DO NOT see a Psychologist or Psychiatrist • Psychological treatment is effective • Significant barriers to treatment • Converging factors for I-CBT/low intensity interventions • 80% of Australians regularly access the Internet • Internet speed and reliability and software platforms are improving … Leading to a growth in I-CBT …
Part 2 I-CBT: Definitions and Examples
Definitions Internet Therapy • Treatment of common mental disorders where therapist has contact with patient via the Internet Internet-based Cognitive Behavioural Therapy (I-CBT) • Administration of CBT via the Internet • Highly structured, same materials and outcome measures as face to face treatment • Varying levels of therapist support and different types of communication
- Phobias/panic disorder - Depression - OCD/PTSD - General anxiety/stress - Eating disorders - Substance misuse - Bipolar disorder - Miscellaneous: pain, tinnitus, insomnia Used to Treat
Who Uses I-CBT? Severity of VirtualClinic patients same as Anxiety Disorders Clinic
About the VirtualClinic • Aim to develop and evaluate Internet-based programs for common mental disorders: • Social Phobia • Panic Disorder • Depression • Generalized Anxiety Disorder
Treatment Components • Topics Include: • Psycho-education • Behavioural activation • Graded exposure • Cognitive therapy • Problem solving • Communication skills • Relapse prevention
6 Lessons – Psycho-Education 6 Summaries/ Homework 6 Forums Additional Resources Stories from previous participants Messaging
Part 3 Does I-CBT Work? General Results
Does I-CBT Work? • Meta-analyses: • Spek et al (2006). Effective for anxiety and depression • Cuijpers et al. (2007). Criterion – 2 positive and independent RCTs: I-CBT supported in PTSD, panic, social anxiety, mild to moderate depression Clinician-Assisted > Self-Guided
Completed + Current Projects: Stage 1 = Proof of Concept – Does it work? Stage 2 = Parameters – Therapist vs. non therapist support Stage 3 = Effectiveness – vs. Face to Face, real world clinics 16 Studies: Total n = 1200+
Indicative Results Note: All Results ITT Results sustained at 3/6 months
Comorbid Conditions Improve Pre-post treatment scores from Titov et al (2009). SP Only meets DSM-IV criteria for social phobia; Dep, PHQ-9 score consistent with meeting criteria for Major Depressive Episode; GAD, GAD-7 score consistent with meeting criteria for GAD.
Part 4 Summary/ Conclusions
Summary • Depression and anxiety affect more than 2 million Australian adults each year • Less than 40% seek treatment in a 12 month period • Only 15% see a Psychologist and/or Psychiatrist • Psychological therapies are effective, butnot enough therapists + significant barriers to treatment seeking • Clinician-assisted Internet-based CBT (I-CBT) is effective • I-CBT provides an important opportunity for psychologists and psychiatrists to: • Educate people about symptoms and treatment • Encourage resilience and reduced vulnerability • Encourage more people to seek specialized treatment
References Australian code for the Responsible Conduct of Research. Joint NHMRC/AVCC Statement and Guidelines on Research Practice. 2007. Guidelines for providing psychological services and produces on the Internet. APS. 2004. Marks IM, Cavanagh K. Computer-aided psychological treatment: Evolving issues. Annual Review in Clinical Psychology 2009; 5:121-141. Quality Framework for Telephone Counselling and Internet-based Support Services. September 2008. Australian Government: Department of Health and Ageing. Titov N. Status of computerized cognitive behavioural therapy for adults. Australian and New Zealand Journal of Psychiatry 2007; 41:95-114.
Websites VirtualClinic: CRUfAD, St Vincent’s Hospital/UNSW www.virtualclinic.org.au Anxiety Online: Swinburne University of Technology www.anxietyonline.org.au MoodGYM: Australia National University www.moodgym.anu.edu.au Panic Centre: Evolution Health www.paniccenter.net beyondBlue www.beyondblue.org.au Black Dog Institute: UNSW www.blackdoginstitute.org.au
www.virtualclinic.org.au Thank you … nickt@unsw.edu.au