Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of depression: a randomized controlled trial.

UNLABELLED: Depression is a common and significant health problem among older adults. Unfortunately, while effective psychological treatments exist, few older adults access treatment. The aim of the present randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of a therapist-guided internet-delivered cognitive behavior therapy (iCBT) intervention for Australian adults over 60 years of age with symptoms of depression. Participants were randomly allocated to either a treatment group (n=29) or a delayed-treatment waitlist control group (n=25). Twenty-seven treatment group participants started the iCBT treatment and 70% completed the treatment within the 8-week course, with 85% of participants providing data at posttreatment. Treatment comprised an online 5-lesson iCBT course with brief weekly contact with a clinical psychologist, delivered over 8 weeks. The primary outcome measure was the Patient Health Questionnaire-9 Item (PHQ-9), a measure of symptoms and severity of depression. Significantly lower scores on the PHQ-9 (Cohen's d=2.08; 95% CI: 1.38 - 2.72) and on a measure of anxiety (Generalized Anxiety Disorder-7 Item) (Cohen's d=1.22; 95% CI: 0.61 - 1.79) were observed in the treatment group compared to the control group at posttreatment. The treatment group maintained these lower scores at the 3-month and 12-month follow-up time points and the iCBT treatment was rated as acceptable by participants. The treatment group had slightly higher Quality-Adjusted Life-Years (QALYs) than the control group at posttreatment (estimate: 0.012; 95% CI: 0.004 to 0.020) and, while being a higher cost (estimate $52.9l 95% CI: -23.8 to 128.2), the intervention was cost-effective according to commonly used willingness-to-pay thresholds in Australia. The results support the potential efficacy and cost-effectiveness of therapist-guided iCBT as a treatment for older adults with symptoms of depression. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12611000927921; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=343384.

Clinical and cost-effectiveness of therapist-guided internet-delivered cognitive behavior therapy for older adults with symptoms of anxiety: a randomized controlled trial.

UNLABELLED: There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60 years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n=35) or the waitlist control group (n=37). The online treatment course was delivered over 8 weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8 weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs=0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry: ACTRN12611000929909; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000929909.

Brief internet-delivered cognitive behavioral therapy for anxiety in older adults: a feasibility trial.

This study examined the efficacy of an Internet-delivered cognitive-behavior therapy program developed for older adults. Twenty-two participants with elevated scores (≥8) on the Generalized Anxiety Disorder 7-Item Scale (GAD-7) participated in the course, which consisted of five lessons, homework tasks, additional resources, a moderated discussion forum, and weekly telephone support from a Clinical Psychologist. Ninety-five percent of the sample met diagnostic criteria for an anxiety disorder at pre-treatment. All participants completed the five lessons within the allotted eight weeks. Three-month follow-up data was collected from 95% of participants. Reductions in symptoms of anxiety and stress, with large within-group effect sizes (Cohen's d) were found on the GAD-7 (d=1.03) and the Depression, Anxiety and Stress Scales - 21 Items (d=0.98) at follow-up. Participants reported high levels of satisfaction with the program. These encouraging results provide tentative support for the online treatment of older adults with anxiety.

Self-perception and rumination in social anxiety.

The present study examined the relationship between perceptions of performance and post-event processing (PEP) following task feedback in individuals with social phobia and matched control participants. Groups of high and low socially anxious participants engaged in a structured 5-min conversation in groups of four people. Following the conversation, false feedback (given in the form of either high scores or moderate scores) was given and self-appraisals of performance, levels of positive and negative mood, and levels of PEP were assessed. Results showed that participants' perceptions of their own performance and levels of positive affect significantly predicted the degree to which they engaged in negative rumination about the task. The moderate score condition was found to be detrimental for socially anxious individuals' self-appraisals and PEP, whereas controls showed no significant difference in self-appraisal and PEP, regardless of feedback. The results are discussed in relation to current cognitive models of social phobia and both treatment implications and directions for future research are explored.

The effect of attentional focus on social anxiety.

The aim of the present study was to examine the effect of attentional focus on social anxiety in a group of high and low blushing-anxious subjects. One hundred and fourteen psychology undergraduate students were screened using the Fear of Blushing subscale of the Blushing Questionnaire [Bögels, S. M., & Reith, W. (1999). Validity of two questionnaires to assess social fears: The Dutch social phobia and anxiety questionnaire and the blushing, trembling and sweating questionnaire. Journal of Psychopathology and Behavioral Assessment, 21, 51-66]. Those with the most extreme scores in the top and bottom 20% of the distribution were selected to form a high (n=22) and a low (n=22) blushing-anxious group. Subjects were randomly allocated to either a self-focused attention (SFA) condition or a task-focused attention (TFA) condition. They were asked to engage in a 5 min conversation with the first author, and were instructed to either self-focus (SFA condition) or task-focus (TFA condition). Levels of social anxiety and self-awareness were measured using visual analogue scales. Results suggest that the there was a significant condition by group interaction, with high blushing individuals showing considerably higher levels of social anxiety in the SFA condition compared to the TFA condition while low blushing individuals showed no significant difference across the two conditions.