Computerized Cognitive Behavioral Therapy to Treat Emotional Distress After Stroke: A Feasibility Randomized Controlled Trial

Abstract

BackgroundDepression and anxiety are common complications following stroke. Symptoms could be treatable with psychological therapy, but there is little research on its efficacy.ObjectivesThe aim of this study was to investigate (1) the acceptability and feasibility of computerized cognitive behavioral therapy (cCBT) to treat symptoms of depression and anxiety and (2) a trial design for comparing the efficacy of cCBT compared with an active comparator.MethodsOf the total 134 people screened for symptoms of depression and anxiety following stroke, 28 were cluster randomized in blocks with an allocation ratio 2:1 to cCBT (n=19) or an active comparator of computerized cognitive remediation therapy (cCRT, n=9). Qualitative and quantitative feedback was sought on the acceptability and feasibility of both interventions, alongside measuring levels of depression, anxiety, and activities of daily living before, immediately after, and 3 months post treatment.ResultsBoth cCBT and cCRT groups were rated as near equally useful (mean = 6.4 vs 6.5, d=0.05), while cCBT was somewhat less relevant (mean = 5.5 vs 6.5, d=0.45) but somewhat easier to use (mean = 7.0 vs 6.3, d=0.31). Participants tolerated randomization and dropout rates were comparable with similar trials, with only 3 participants discontinuing due to potential adverse effects; however, dropout was higher from the cCBT arm (7/19, 37% vs 1/9, 11% for cCRT). The trial design required small alterations and highlighted that future-related studies should control for participants receiving antidepressant medication, which significantly differed between groups (P=.05). Descriptive statistics of the proposed outcome measures and qualitative feedback about the cCBT intervention are reported.ConclusionsA pragmatic approach is required to deliver computerized interventions to accommodate individual needs. We report a preliminary investigation to inform the development of a full randomized controlled trial for testing the efficacy of computerized interventions for people with long-term neurological conditions such as stroke and conclude that this is a potentially promising way of improving accessibility of psychological support.

A Review Article on Internet-based Psychological Interventions in Primary Care. What is the Global Experience? How Reliable are Results from RCTs? Lessons Learned from the European, US and Australian Case Studies

“…The results showed no clinically or statistically significant changes before treatment and immediately after treatment between treatment groups in all studies (Berger et al, 2017;Høifødt et al, 2013;Newby et al, 2013;Rollman et al, 2017;Simblett et al, 2017;Gilbody et al, 2017;de Graaf et al, 2009;Levin et al, 2011;de Graaf et al, 2011;Hickie et al, 2010;Kessler et al, 2009;Gilbody et al, 2015). Less than half of the patients recovered at post-treatment.…”

“…Even though the drop-out rate was related to improvement attributed to other concurrent treatments (Newby et al, 2013), a variety of adverse events was also reported during treatment. As a consequence of commencing iCBT, the patients experienced a negative impact on their general wellbeing and reported slightly worse mood and more anxiety (Salomonsson et al, 2017;Rollman et al, 2017;Simblett et al, 2017).…”

“…In the study by Rollman et al (2017), at the six-month follow-up, 36.7% (221 of 603) of participants completed all eight sessions of the programme. The mean of 6.3 sessions of the BtB programme (40%) in the iCBT group and the mean of 7.2 sessions (32%) in the computerized cognitive remediation therapy (cCRT) group were completed in the study by Simblett et al (2017). In the study by Hickie et al (2010), 41% (12 of 29) participants did not complete MoodGYM programme.…”

“…Results from studies demonstrated that participants in the iCBT group were more likely to receive antidepressants compared with patients in the usual care group or in the treatment plus usual care group. It is difficult to evaluate the size of effect and relation between medication, face-to-face treatment or iCBT as long as data about the use of pharmacotherapy pre-and post-treatment and during the follow-up period are not available, which is true for the studies by Gilbody et al (2017), Simblett et al (2017), Levin et al (2011), Newby et al (2013) and Berger et al (2017). Moreover, no study has yet analysed the outperformance of unsupported iCBT or guided iCBT as compared to pharmacological treatment.…”

Emerging Non-Pharmacological Therapies for Post-stroke Depression and its Future Aspects: A Review

“…45 'Beating the blues' is a computerized cognitive behavioural therapy package to treat the post stroke depression symptoms with best evidence within primary care. 46…”