The Depression and Anxiety Program is a web-based cognitive behavioral therapy (CBT) intervention that targets both depressive and anxiety symptoms.
Over the course of six lessons, the Depression and Anxiety Program presents the illustrated story of two fictional patients whose depression and anxiety improve through CBT. Lesson content teaches users controlled breathing techniques, thought monitoring, thought challenging, and includes some graded exposure exercises. Users are assigned homework after each lesson. The program also offers access to recovery stories from other users, resources on sleep and activity planning, problem solving techniques, and imaginal worry exposure. Users also have regular email or phone contact with a clinician prior to completion of the second lesson. After this point in treatment, the clinician monitors the users’ psychological distress and will contact them if it increases.
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Cognitive Behavioral Therapy (CBT)
Major Depressive Disorder
Generalized Anxiety Disorder (GAD)
Young Adults (18-30)
Internet cognitive behavioural therapy for mixed anxiety and depression: A randomized controlled trial and evidence of effectiveness in primary care.
Summary: This article reports on the results of two studies examining the efficacy of the Depression and Anxiety Program. The first study was a randomized controlled trial comparing the Depression and Anxiety Program to a waitlist control group. Individuals awaiting access to online cognitive behavioral therapy were eligible for participation. In addition, online advertisements were used to recruit new participants. Individuals meeting diagnostic criteria for generalized anxiety disorder (GAD) and/or depression were randomized (n=135). Depression, GAD, and psychological distress were assessed pre-treatment, post-treatment, and at a 3-month follow-up. Overall, 89% of the Depression and Anxiety Program group completed all 6 lessons. At the post-treatment assessment, participants getting the Depression and Anxiety Program had significantly larger decreases in depressive symptoms, GAD symptoms, and psychological distress compare to the waitlist control group. These reductions were sustained at the 3-month follow-up.
The second study reported on the outcomes of the Depression and Anxiety Program in a primary care setting. Clinicians in Australia (n=1,800) were able to prescribe the Depression and Anxiety Program to their patients with depression and/or GAD. In total, 136 primary care patients were referred to the program. Psychiatric symptoms were measured pre- and post-treatment. Although only 41% of participants completed all six sessions, there were still significant reductions in anxiety, depression, and psychological distress from pre- to post-treatment.
Take Away: The Depression and Anxiety Program is more effective than no treatment for depression and/or GAD. Additionally, this program is acceptable and potentially efficacious for primary care patients with mixed depression and anxiety.
Reductions in negative repetitive thinking and metacognitive beliefs during transdiagnostic internet cognitive behavioural therapy (iCBT) for mixed anxiety and depression.
Summary: This secondary analysis of the Newby et al. (2013) randomized controlled trial investigated the impact of changes in negative repetitive thinking (NRT) on anxiety and depressive symptoms. Data from the 135 participants were collected pre-, mid-, and post-treatment, then at a 3-month follow-up. Results showed that participants in the Depression and Anxiety Program had significantly larger reductions in RNT post-treatment. Only seven percent of the waitlist control group had reliable changes in their NRT post-treatment, compared to 55% of the group getting the Depression and Anxiety Program. These improvements were maintained at 3 months. Mid-treatment reductions in the frequency and positive beliefs about NRT mediated the impact of the treatment for depressive symptoms. For anxiety symptoms, mid-treatment decreases in NRTs mediated reductions in anxiety symptoms post-treatment.
Take Away: The Depression and Anxiety Program reduces negative repetitive thoughts, which contributes to reductions in depression and anxiety.
Effectiveness of transdiagnostic internet cognitive behavioural treatment for mixed anxiety and depression in primary care.
Summary: In this study, the authors further examined the effectiveness of the Depression and Anxiety Program for primary care patients in Australia. 707 patients with major depression and/or generalized anxiety disorder (GAD) were referred to the Depression and Anxiety program by their primary care providers. All participants had access to the program – the study had no control group. Pre- and post-treatment questionnaires were given to each participant to assess their depression, anxiety, social phobia symptoms, psychiatric distress, and disability. Overall, 47% of participants completed all six lessons in the Depression and Anxiety Program. From pre- to post-treatment, participants had significant decreases in depressive, anxiety, and social phobia symptoms. Additionally, disability and psychiatric distress decreased significantly. While 45% of participants reported suicidal ideation pre-treatment, only 26% reported suicidal ideation post-treatment.
Take Away: Results indicate preliminary efficacy of the program, but in the absence of a control condition results are difficult to interpret. Future research should examine strategies to increase treatment completion rates.