Evaluations

• Transdiagnostic internet treatment for anxiety and depression: A randomized controlled trial.

  Titov N, Dear BF, Schwencke G, Andrews G, Johnston L, Craske MG, McEvoy P. Behaviour Research and Therapy. 2011. 49(8): 441-452. doi: 10.1016/j.brat.2011.03.007

  Summary: This study describes the results of a randomized controlled trial of an earlier version of the Wellbeing Course, previously entitled the Wellbeing Program. Adults in Australia were recruited online and screened for depression and anxiety disorders. Those meeting criteria (n=78) for either depression, panic disorder, generalized anxiety disorder (GAD), and/or social phobia were randomized to a waitlist control, or the Wellbeing Program. Depressive and anxiety symptoms were assessed pre-, mid-, and post-treatment. Participants getting the Wellbeing Program also completed a 3-month follow-up. At baseline, all participants met criteria for at least one depressive or anxiety disorder, while 81% met criteria for two or more diagnoses. Results at post-treatment showed that participants getting the Wellbeing Program had significantly lower scores on depression, GAD, and panic disorder measures than those in the control group. A greater proportion of participants in the Wellbeing Program group were in remission post-treatment (43-51%), while only 16-19% of controls were in remission. This improvement was sustained at the 3-month follow-up.

  Take Away: The Wellbeing Program is effective at reducing depression and anxiety symptoms in adults.

• An open trial of a brief transdiagnostic internet treatment for anxiety and depression.

  Dear BF, Titov N, Schwencke G, Andrews G, Johnston L, Craske MG, McEvoy P. Behavior Research and Therapy. 2011. 49(12): 830-837. doi: 10.1016/j.brat.2011.09.007

  Summary: The authors modified the original Wellness Program to create a shorter, five-module version. This single group open trial study tested the efficacy of that brief version of the Wellness Program. Participants in the control group of the original randomized controlled trial of the Wellness Program (Titov et al, 2011) were asked to participate. After 4 declined, 36 participants were enrolled. All met criteria for depression, generalized anxiety disorder (GAD), panic disorder, and/or social phobia. As there was no control group, all participants received the brief Wellness Program. Participants completed assessments pre-treatment, post-treatment, and 3-months post-treatment. Depression and anxiety symptoms were significantly decreased at the post-treatment and 3-month follow-ups. At 3 months, 78% of participants no longer met criteria for their primary diagnosis. In addition, the percent of participants with comorbid diagnoses decreased from 78% pre-treatment to 12% at 3 months.

  Take Away: A brief version of the Wellness Program appears to decrease depression and anxiety in adults.

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

  Titov N, Dear BF, Johnston L, Lorian C, Zou J, Wootton B, Spence J, McEvoy PM, Rapee RM. PLOS One. 2013. 8(7): e62873. doi: 10.1371/journal.pone.0062873

  Summary: This study presents the results of the first randomized controlled trial of the Wellness Course, which was adapted from the Wellbeing Program tested by Titov et al (2011). Australian adults with depression, generalized anxiety disorder (GAD), social phobia, and/or panic disorder were enrolled in this study. Participants (n=257) were randomly assigned to: 1) the treatment (Wellness Course) plus automated email group (TEG); 2) the treatment (Wellness Course) only (TG) group; or 3) the control group. The TEG group received weekly emails with reminders, reinforcement, and skills promotion messages. The control group participants accessed the Wellness Course after completing the post-treatment assessment. All participants completed pre-treatment, post-treatment, and 3-month follow-up assessments. At the post-treatment assessments, participants getting the Wellness Course had lower depression and anxiety symptoms than participants in the control group. Among the entire sample, no significant differences in depression and anxiety were detected between participants in the TEG and TG groups. Among participants with comorbid disorders, the TEG group had lower anxiety and depression than the TG group at the post-treatment and 3-month assessments. The automated emails also improved program completion rates. While 57% of the TEG group completed the Wellness Course, only 30% of the TG group completed.

  Take Away: The Wellness Course is effective in reducing anxiety and depressive symptoms in adults. For users with comorbid disorders, adding weekly automated emails improved outcomes.

• Improving adherence and clinical outcomes in self-guided internet treatment for anxiety and depression: A 12-month follow-up of a randomized controlled trial.

  Titov N, Dear BF, Johnston L, McEvoy PM, Wootton B, Terides MD, Gandy M, Fogliati V, Kayrouz R, Rapee RM. PLoS One. 2014. 9(2): e89591. PMCID: PMC3934918.

  Summary: This study presents results from the final follow-up of participants from the Titov et al (2013) randomized controlled trial. A final assessment was conducted with all participants 12 months post-treatment. Results showed depressive and anxiety symptoms were comparable in the treatment only (TG) group and the treatment plus automated email group (TEG) at 12 months. Although the groups did not show further improvement from the 3-month follow-up, reductions in anxiety and depression were maintained. Unlike the 3-month follow-up, depression and anxiety symptoms were not different for participants with comorbid diagnoses in the TEG and TG groups.

  Take Away: Improvements in depression and anxiety from the Wellness Course are maintained at one year post-treatment.

• A feasibility open trial of internet-delivered cognitive behavioural therapy (iCBT) among consumers of a non-governmental mental health organization with anxiety.

  Kirkpatrick T, Manoukian L, Dear BF, Johnston L, Titov N. PeerJ. 2013. 1: e210. doi: 10.7717/peerj.210

  Summary: Using a single group, open trial design, this study assessed the feasibility of using the Wellness Course for consumers receiving care from a mental health agency. The mental health agency typically provided telephone, email, and face-to-face services to consumers. Ten consumers with anxiety were enrolled and referred to the Wellness Course. Anxiety symptoms were assessed pre-treatment, post-treatment, and 2-months post-treatment. All 10 participants completed the Wellness Course, 100% reported being “very satisfied” with the course, and none reported adverse events. Statistically significant improvement in anxiety was seen from pre- to post-treatment. Those improvements were maintained 2-months post-treatment.

  Take Away: The Wellness Course is an acceptable and potentially feasible treatment for consumers with anxiety seeking treatment at mental health agencies.

• A feasibility open trial of guided internet-delivered cognitive behavioural therapy for anxiety and depression amongst Arab Australians.

  Kayrouz R, Dear BF, Johnston L, Gandy M, Fogliati VJ, Sheehan J, Titov N. Internet Interventions. 2015. 2(1): 32-38. doi: 10.1016/j.invent.2014.12.001

  Summary: The authors modified the Wellness Course for Arab Australians and tested its feasibility in this single group, open trial. The Wellness Course was altered by translating key words and phrases into Arabic, changing names and demographics to be culturally relevant, and editing case examples to reflect the experiences of Arab Australians. The updated program was called the Arab Wellbeing Course. Eleven Arab Australians with depression and anxiety were enrolled to test the feasibility and efficacy of the program. Depressive and anxiety symptoms were measured at pre-, post-, and 3-month follow-up assessments. Ultimately, 91% of participants completed the program. Most were satisfied and 100% reported that the program was worth completing. Additionally, 89% would recommend the program to friends and family with depression. Large pre- and post-treatment effects were found for depressive and anxiety symptoms. From the pre- to post-treatment assessments, depression and anxiety decreased significantly. These changes were maintained at the 3-month follow-up.

  Take Away: The Arab Wellness Course is acceptable and feasible for Arab Australians with depression and anxiety. Further research is needed to test the program’s efficacy.

• Related Articles

  Transdiagnostic internet treatment for anxiety and depression. Titov N, Dear B, Johnston L, Terides M. Revista de Psicopatologia y Psicologia Clinica. 2012. 17(3): 237-260. doi: 10.1016/j.brat.2011.03.007