None listed
Conditions
Brief summary
Anxiety and depression affect > 3 million Australians, at a cost of over $12.8 billion/year. Without proactive treatment, these disorders can result in chronic disability, illness, low workforce participation, impaired relationships, self-harm, and suicide. Digital mental health interventions (e.g., online cognitive behavioural therapy [CBT]) are effective, and cost-effective treatments for depression and anxiety, achieving similar outcomes to face-to-face therapy and pharmacotherapy. Most importantly, they improve the accessibility, quality, and standardisation of mental health care. Despite this evidence, they have poor uptake and limited use in routine care settings (e.g., private practice). Evidence indicates that blended digital and in-person treatments are preferred by practitioners over digital-only treatments, and reduce treatment length, sessions, and costs compared to face-to-face only treatment. Based on this evidence, along with knowledge about barriers and facilitators of implementation gained via extensive consultation with health professionals and end-users with lived experience of depression and anxiety, we have developed a new blended model of mental health care that integrates leading evidence-based digital interventions with in-person (and/or telehealth) therapy for depression and anxiety. This blended model of care comprises a smartphone application that clients use throughout the course of therapy to enhance therapy skills and provide support between therapy sessions. Psychologists can monitor their clients’ symptoms via a purpose-built Health Professional Portal and tailor their treatment based on their clients’ progress. The aim of this study is to evaluate the acceptability, feasibility and preliminary effectiveness of this new blended model of care in the context of psychological therapy for adults with depression or anxiety. Implementation barriers and facilitators, as well as outcomes at the client, psychologist, and practice level will be evaluated. The findings from this study are expected to generate new knowledge that will help to improve the uptake, use and sustained implementation of digital interventions for depression and anxiety in routine psychological therapy. In doing so, we hope to increase the quality of care provided to patients, and ultimately improve patient outcomes.
Interventions
BLENDED MODEL OF CARE
The current study will evaluate a new model of blended care for depression and anxiety. Blended models of care combine traditional psychotherapy (either face-to-face or telehealth-delivered) with digital interventions. The blended model of care used in the current study will include two main digital components, which will be integrated into routine psychological therapy: (1) a client-facing smartphone-based mobile application (app), and (2) a practitioner-facing Health Prof
BLENDED MODEL OF CARE The current study will evaluate a new model of blended care for depression and anxiety. Blended models of care combine traditional psychotherapy (either face-to-face or telehealth-delivered) with digital interventions. The blended model of care used in the current study will include two main digital components, which will be integrated into routine psychological therapy: (1) a client-facing smartphone-based mobile application (app), and (2) a practitioner-facing Health Professional Portal. SMARTPHONE APP The mobile application provides therapeutic skills and management strategies for adults experiencing symptoms of depression and/or anxiety. The app content draws on a variety of therapeutic approaches (including Cognitive Behavioural Therapy, Mindfulness and Emotion Regulation techniques). The mobile app is a non-sequential intervention consisting of eight therapeutic ‘programs’. The therapeutic programs are presented in a manner that is designed to align with common therapy goals, and are: 1. Feel happier 2. Cope with anxiety 3. Feel more relaxed 4. Sleep better 5. Think positively 6. Build confidence 7. Increase focus 8. Manage emotions Each of the therapy programs include 10 brief psychotherapeutic activities that are designed to support the following evidence-based treatment components: psychoeducation, cognitive restructuring, emotion awareness and acceptance, goal setting, problem solving, behavioural activation, exposure, relaxation, mindfulness, and values labeling. The activities vary in length, taking between 5 to 10 minutes each to complete, meaning that each program of 10 activities takes, on average, between 60 and 90 minutes to complete. At the start of treatment, users can select therapy programs (up to 3 initially) that they would like to begin working through. This selection can occur with the input of their treating psychologist. Based on their program selection, each user is then recommended five activities to get them started. Client participants will be asked to spend 10 minutes a day completing activities within the app. All activities are delivered with short informative text, ability to select or provide free text responses and often with engaging illustrations, photos or audio exercises. App analytics will be collected (e.g., number and type of activities completed) and participants asked about their engagement with the intervention to monitor adherence. All psychologists participating in the study will hold provisional or full registration as a psychologist with AHPRA and will have received online training in how to use the mobile app with their clients. Psychologists will complete the training at least one week before commencement of the intervention. A member of the research team will provide a single one hour session delivered over Zoom. The blended model of care will be delivered in the context of individual therapy, and all clients participating in the study will have access to use the mobile app with their psychologist for a 3-month implementation period. HEALTH PROFESSIONAL PORTAL In addition to having access to the mobile app to use with their clients, psychologists will have access to a Health Professional Portal that is connected to the mobile app. While using the app, clients will complete questionnaires to assess aspects of their mental health (e.g., severity of symptoms of depression and anxiety). Client summary scores will then be sent to the Health Professional Portal, where psychologists will be able to view them to track their clients’ progress throughout treatment. Psychologists will have access to the Health Professional Portal during the entire study period and will only be able to view their clients’ scores and will not be able to see the scores of the clients of other participating psychologists.
Sponsors
University of New South Wales, Sydney
Study design
Allocation
Non-randomised trial
Intervention model
Single group
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Two types of participants will be recruited for this study: psychologists and their clients. The key inclusion criteria for each of these types of participants is as follows: Psychologists 1. Provisional psychologist or psychologist registered with AHPRA 2. Practicing in Australia 3. English speaking 4. Currently providing mental health care to adults with anxiety or depression Clients 1. Self-reported symptoms of anxiety or depression 2. 18 years of age or older 3. Currently residing in Australia 4. English speaking 5. Has a mobile phone number and email address 6. Owns a smartphone device using a supported operating system (Apple: iOS 13 released 1999 or newer; Android: 7.0 released 2016 or newer)
Exclusion criteria
Exclusion criteria for those who are not eligible to participate in the study are as follows: Psychologists 1. Those who are not currently practicing or who do not work with adults with anxiety or depression 2. Other mental health professionals (e.g., social workers) who work with adults with anxiety and depression (future studies may extend to other health professional groups beyond psychologists) Clients 1. Clients who are under the age of 18 (as this program is designed for adults) 2. Clients who are actively suicidal as determined by their psychologist (as these clients may benefit from more intensive psychological therapy) 3. Clients experiencing a psychotic disorder (as symptomatology may influence their ability to engage with the intervention and respond to evaluation measures)
Outcome results
None listed