A pilot study of self-guided internet-delivered cognitive behavioural therapy for anxiety and depression among Arabs

Abstract

This pilot study examined the efficacy and acceptability of a self-guided and culturally modified internet-delivered Cognitive Behaviour Therapy (iCBT) treatment for Arab people, aged 18 and over, with symptoms of depression and anxiety. Thirty-six participants from seven countries, with at least mild symptoms of depression (Patient Health Questionnaire 9-item; PHQ-9; total scores ≥ 5) or anxiety (Generalised Anxiety Disorder 7-item; GAD-7; total scores ≥ 5) accessed the online Arabic Wellbeing Course, which consisted of five online lessons delivered over eight weeks and presented in the English language. Standard measures of depression, anxiety, distress and disability were administered at pre-treatment, post-treatment and 3-month follow-up. Thirty-six percent of participants completed the five lessons over eight weeks, with 61% and 36% providing post-treatment and 3-month follow-up data respectively. Participants reported significant improvements (within-group Cohen's d; avg. reduction) in depression (ds ≥ 1.20; avg. reduction ≥ 46%), anxiety (ds ≥ 1.15; avg. reduction ≥ 45%), disability (ds ≥ 0.81; avg. reduction ≥ 35%) and psychological distress (ds ≥ 0.91; avg. reduction ≥ 24%) immediately post-treatment, which were sustained at or further improved to 3-month follow-up. Participants rated the Arabic Wellbeing Course as acceptable. Notwithstanding the absence of a control group, low follow-up questionnaire completion rates and the Course not being translated in Arabic, these results are encouraging and contribute to a growing body of literature indicating that, with minor modifications, internet-delivered interventions have the potential of increasing access to treatment for immigrant groups.

Facilitating access to iCBT: a randomized controlled trial assessing a translated version of an empirically validated program using a minimally monitored delivery model

“…Effect sizes on primary outcome measures were similar to the original minimally monitored version (Dear et al, 2015;Titov et al, 2013;Titov et al, 2015a). Recovery rates on the GAD-7 (56%) and PHQ-9 (40%) were significantly higher than in the control group (16% and 13%, respectively) and higher than in the minimally monitored Wellbeing Course with Arabic adaptations (36% and 31%, respectively) (Kayrouz et al, 2016a). Remission rates on the GAD-7 (50%) and the PHQ-9 (41%) were smaller than the ones obtained with the minimally monitored English version of the Wellbeing Course (58% and 56%, respectively) but comparable to the minimally monitored Arabic adaptation (43% and 46%, respectively) (Kayrouz et al, 2016a;Titov et al, 2013).…”

“…Recovery rates on the GAD-7 (56%) and PHQ-9 (40%) were significantly higher than in the control group (16% and 13%, respectively) and higher than in the minimally monitored Wellbeing Course with Arabic adaptations (36% and 31%, respectively) (Kayrouz et al, 2016a). Remission rates on the GAD-7 (50%) and the PHQ-9 (41%) were smaller than the ones obtained with the minimally monitored English version of the Wellbeing Course (58% and 56%, respectively) but comparable to the minimally monitored Arabic adaptation (43% and 46%, respectively) (Kayrouz et al, 2016a;Titov et al, 2013). The absence of deterioration among participants suggests that a minimally monitored delivery can be used safely with moderate symptomatology.…”

“…They have also been used in several iCBT studies (e.g. Kayrouz et al, 2016a;Titov et al, 2013) as well as in large dissemination trials assessing traditional face-to-face CBT and iCBT (e.g. Clark et al, 2009;Richards and Suckling, 2009).…”

“…Clark et al, 2009;Richards and Suckling, 2009). The recovery index was defined as the proportion of participants whose scores on the PHQ-9 or GAD-7 improved by 50% or greater at post-treatment (Kayrouz et al, 2016a). The index of remission was the percentage of participants whose pre-treatment scores were at or above the clinical cut-off scores (≥10 on the PHQ-9; ≥8 on the GAD-7; >45 on the PSWQ; >19 on the SPIN; >19 on the PAS) and below these cut-off scores at post-treatment or follow-up (Clark and Oates, 2014;Titov et al, 2011).…”

“…Its transportability using an English and clinician-guided version has been supported in routine care in Saskatchewan, Canada (Hadjistavropoulos et al, 2014;Hadjistavropoulos et al, 2016;Hadjistavropoulos et al, 2017). Translations in Arabic and Mandarin combined with cultural adaptations of the program have been made with encouraging results (Choi et al, 2012;Kayrouz et al, 2015;Kayrouz et al, 2016a;Kayrouz et al, 2016b), but no study has yet evaluated a translated version of the program with no cultural adaptations. It was hypothesized that compared with a waiting-list control group, the French Wellbeing Course (DaPonte et al, 2018), when provided using a minimally monitored delivery, would produce significantly higher improvements from pre-to post-treatment on primary outcome measures of anxiety and depression and secondary outcome measures of quality of life and life satisfaction.…”