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.