A Web- and Mobile-Based Intervention for Comorbid, Recurrent Depression in Patients With Chronic Back Pain on Sick Leave (Get.Back): Pilot Randomized Controlled Trial on Feasibility, User Satisfaction, and Effectiveness

Abstract

Background Chronic back pain (CBP) is linked to a higher prevalence and higher occurrence of major depressive disorder (MDD) and can lead to reduced quality of life. Unfortunately, individuals with both CBP and recurrent MDD are underidentified. Utilizing health care insurance data may provide a possibility to better identify this complex population. In addition, internet- and mobile-based interventions might enhance the availability of existing treatments and provide help to those highly burdened individuals. Objective This pilot randomized controlled trial investigated the feasibility of recruitment via the health records of a German health insurance company. The study also examined user satisfaction and effectiveness of a 9-week cognitive behavioral therapy and Web- and mobile-based guided self-help intervention Get.Back in CBP patients with recurrent MDD on sick leave compared with a waitlist control condition. Methods Health records from a German health insurance company were used to identify and recruit participants (N=76) via invitation letters. Study outcomes were measured using Web-based self-report assessments at baseline, posttreatment (9 weeks), and a 6-month follow-up. The primary outcome was depressive symptom severity (Center for Epidemiological Studies–Depression); secondary outcomes included anxiety (Hamilton Anxiety and Depression Scale), quality of life (Assessment of Quality of Life), pain-related variables (Oswestry Disability Index, Pain Self-Efficacy Questionnaire, and pain intensity), and negative effects (Inventory for the Assessment of Negative Effects of Psychotherapy). Results The total enrollment rate with the recruitment strategy used was 1.26% (76/6000). Participants completed 4.8 modules (SD 2.6, range 0-7) of Get.Back. The overall user satisfaction was favorable (mean Client Satisfaction Questionnaire score=24.5, SD 5.2). Covariance analyses showed a small but statistically significant reduction in depressive symptom severity in the intervention group (n=40) at posttreatment compared with the waitlist control group (n=36; F1,76=3.62, P=.03; d=0.28, 95% CI −0.17 to 0.74). Similar findings were noted for the reduction of anxiety symptoms (F1,76=10.45; P=.001; d=0.14, 95% CI −0.31 to 0.60) at posttreatment. Other secondary outcomes were nonsignificant (.06≤P≤.44). At the 6-month follow-up, the difference between the groups with regard to reduction in depressive symptom severity was no longer statistically significant (F1,76=1.50, P=.11; d=0.10, 95% CI −0.34 to 0.46). The between-group difference in anxiety at posttreatment was maintained to follow-up (F1,76=2.94, P=.04; d=0.38, 95% CI −0.07 to 0.83). There were no statistically significant differences across groups regarding other secondary outcomes at the 6-month follow-up (.08≤P≤.42). Conclusions These results suggest that participants with comorbid depression and CBP on sick leave may benefit from internet- and mobile-based interventions, as exemplified with the positive user satisfaction ratings. The recruitment strategy via health insurance letter invitations appeared feasible, but more research is needed to understand how response rates in untreated individuals with CBP and comorbid depression can be increased. Trial Registration German Clinical Trials Register DRKS00010820; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00010820.

Evidence of Human-Level Bonds Established With a Digital Conversational Agent: Cross-sectional, Retrospective Observational Study

“…These studies' results were collected later in the course of treatment (eg, bond subscore for face-to-face outpatient individual CBT: mean 4.0, SD 0.8 [11]; bond subscore for group CBT: mean 3.8, SD 0.80 [13]; data were collected after 2-8 weeks of therapy). Comparative study details are provided in Multimedia Appendix 1 [11,[13][14][15][17][18][19]. Participants reported higher bond levels when using Woebot than those in prior studies of internet-only CBT [13] (Figure 2).…”

“…Participants reported higher bond levels when using Woebot than those in prior studies of internet-only CBT [13] (Figure 2). [11,[13][14][15][17][18][19] are stratified by the week that the scores were recorded. Studies are colored based on the therapeutic modality.…”

“…The Kruskal-Wallis test was used to compare bond subscores across participants' reported age groups and genders. For comparison, relevant external studies were drawn from recent reviews of literature [11][12][13][14][15][16][17][18][19] that also reported unmodified WAI-SR subscores for other CBT modalities. Comparison data were presented descriptively without statistical testing, and raw subscores were scaled by dividing them by the number of items (eg, the bond subscale has 4 items).…”

“…Figure 2.Comparison of Working Alliance Inventory-Short Revised bond subscale scores across therapeutic modalities. Means and corresponding 95% CIs for working alliance bond scores from this study and from recent reviews of the literature[11,[13][14][15][17][18][19] are stratified by the week that the scores were recorded. Studies are colored based on the therapeutic modality.…”

A scoping review to ascertain the parameters for an evidence synthesis of psychological interventions to improve work and wellbeing outcomes among employees with chronic pain

“…The interventions tended to be complex, including multimodal elements for example physiological rehabilitation, exercise or medication management, in addition to psychological components. The psychological components of interventions often contained multiple components that drew explicitly upon approaches such as cognitive behavioural therapy (CBT) (30% of studies) (Angst et al, 2014 ; Asih, Neblett, Mayer, & Gatchel, 2018 ; Bergström, Jensen, Hagberg, Busch, & Bergstrom, 2012 ; Busch, Bodin, Bergstrom, & Jensen, 2011 ; Campello et al, 2012 ; Coole, Drummond, & Watson, 2013 ; Harris et al, 2017 ; Hartzell, Mayer, & Asih, 2014 ; Ibrahim, Weber, Courvoisier, & Genevay, 2019 ; Irvine et al, 2015 ; Johansen et al, 2019 ; Jorgensen et al, 2011 ; Lambeek et al, 2010 ; Linton et al, 2016 ; Luthi et al, 2018 ; Marchand et al, 2015 ; Mayer, Choi, Howard, & Gatchel, 2013 ; Mochari-Greenberger, Andreopoulos, Peters, & Pande, 2020 ; Myhre et al, 2014 ; Pato et al, 2010 ; Poulain et al, 2010 ; Rasmussen et al, 2016 ; Reme et al, 2016 ; Sander et al, 2020 ; Schlicker et al, 2020 ; Stein & Miclescu, 2013 ; Vindholmen, Hoigaard, & Haugen, 2016 ), counselling (8% of studies) (Calner et al, 2017 ; Ernsen & Lellefjell, 2014; Howard, Mayer, & Gatchel, 2012 ; Jensen et al, 2012b ; Knappe, Briest, & Bethge, 2015; Kold, Hansen, Vedsted-Hansen, & Forman, 2012 ; Sjöström, Asplund, & Alricsson, 2013 ), acceptance and commitment therapy (4% of studies) (Berglund et al, 2018 ; Gismervik et al, 2020 ; Hara, Bjørngaard, Brage et al, 2018 ; Hara, Bjørngaard, Jacobsen et al, 2018 ), motivational interviewing (2% of studies) (Gross et al, 2017 ; Park et al, 2018 ) or mindfulness-based stress reduction (1% of studies) (Soler-Font et al, 2019 ). Other interventions adopted explicit educational approaches (27.5% of studies) (Andersen et al, 2015...…”