Delivery of cognitive behavioural therapy to workers: a systematic review

Naidu, V; Giblin, Elizabeth C.; Burke, Katie; Madan, Ira

doi:10.1093/occmed/kqv141

Cited by 14 publications

(17 citation statements)

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“…To address this issue, some investigators have examined whether CBTI programs could be administered through the Internet as a means for disseminating insomnia treatment to a wider audience [ 12 , 13 ]. Internet-delivered therapies have been previously found to be effective in particular settings, such as in the workplace to reduce anxiety [ 14 ], and for disease management in patients with type 2 diabetes [ 15 ]. Internet-delivered therapy when guided by a therapist was found to be equivalent to face-to-face CBT for certain psychiatric and somatic disorders [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis

et al. 2016

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BackgroundInsomnia is of major public health importance. While cognitive behavioral therapy is beneficial, in-person treatment is often unavailable. We assessed the effectiveness of internet-delivered cognitive behavioral therapy for insomnia.ObjectivesThe primary objectives were to determine whether online cognitive behavioral therapy for insomnia could improve sleep efficiency and reduce the severity of insomnia in adults. Secondary outcomes included sleep quality, total sleep time, time in bed, sleep onset latency, wake time after sleep onset, and number of nocturnal awakenings.Data SourcesWe searched PubMed/MEDLINE, the Cumulative Index to Nursing and Allied Health Literature, PsycInfo, Cochrane Library, Embase, and the Web of Science for randomized trials.MethodsStudies were eligible if they were randomized controlled trials in adults that reported application of cognitive behavioral therapy for insomnia via internet delivery. Mean differences in improvement in sleep measures were calculated using the Hartung-Knapp-Sidik-Jonkman method for random effects meta-analysis.ResultsWe found 15 trials, all utilizing a pretest-posttest randomized control group design. Sleep efficiency was 72% at baseline and improved by 7.2% (95% CI: 5.1%, 9.3%; p<0.001) with internet-delivered cognitive behavioral therapy versus control. Internet-delivered cognitive behavioral therapy resulted in a decrease in the insomnia severity index by 4.3 points (95% CI: -7.1, -1.5; p = 0.017) compared to control. Total sleep time averaged 5.7 hours at baseline and increased by 20 minutes with internet-delivered therapy versus control (95% CI: 9, 31; p = 0.004). The severity of depression decreased by 2.3 points (95% CI: -2.9, -1.7; p = 0.013) in individuals who received internet-delivered cognitive behavioral therapy compared to control. Improvements in sleep efficiency, the insomnia severity index and depression scores with internet-delivered cognitive behavioral therapy were maintained from 4 to 48 weeks after post-treatment assessment. There were no statistically significant differences between sleep efficiency, total sleep time, and insomnia severity index for internet-delivered versus in-person therapy with a trained therapist.ConclusionIn conclusion, internet-delivered cognitive behavioral therapy is effective in improving sleep in adults with insomnia. Efforts should be made to educate the public and expand access to this therapy. Registration Number, Prospero: CRD42015017622

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Section: Introductionmentioning

confidence: 99%

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis

et al. 2016

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“…Firstly, there is a huge gap between the numbers suffering from anxiety and depression and the numbers seeking and receiving minimal adequate treatment, both in Norway [28] and globally [2,29,30]. Secondly, while there are substantial evidence that psychological treatments, such as cognitive behavioural therapy (CBT), have good effect on symptom reduction and wellbeing [31,32] the degree to which such interventions have effect on functional and work outcomes remain unsettled [33,34]. There is notably growing evidence that incorporating an explicit work-focus in CBT treatments has a better effect on work outcomes than CBT alone [32,35,36].…”

Section: Introductionmentioning

confidence: 99%

Prompt Mental Health Care (PMHC): work participation and functional status at 12 months post-treatment

Knapstad

Sæther

Hensing

et al. 2020

BMC Health Serv Res

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Background: Anxiety and depression are associated with substantial functional impairment. Prompt Mental Health Care (PMHC), the Norwegian adaptation of IAPT is currently piloted across Norway, as a means to improve access to evidence-based care for adults with anxiety disorders (including subthreshold cases) and minor to moderate depression. The aims of the current paper were to examine the change in work status and functional status from pre-to post-treatment and 12 months post-treatment among clients at the first 12 PMHC pilot sites, and whether degree of change differed across sociodemographic characteristics. Methods: A prospective cohort design was used, including working age clients receiving treatment between October 2014 and December 2016 (n = 1446, participation rate = 61%). Work status and functional status were selfreported, the latter by the Work and Social Adjustment Scale (WSAS). Changes in work status and WSAS score were examined through multilevel models based on maximum likelihood estimation. Likelihood ratio tests were performed to determine whether the interaction between time and the respective background variables were statistically significant. Results: A substantial increase in regular work participation was observed from pre-to post-treatment, which further had increased at 12 months post-treatment. The increase was driven by a corresponding reduction in proportion of clients working and receiving benefits (OR 0.38 [0.29-0.50] baseline to final treatment, OR = 0.19 [0.12-0.32] final treatment to 12-months post-treatment), while no statistically significant change was observed in proportion out of work. Large improvement (ES = − 0.89) in WSAS score was observed from pre-to post treatment. WSAS score at 12 months post-treatment remained at the post-treatment level. Conclusions: Previous research has shown substantial symptom improvement among clients receiving treatment in PMHC. The current findings indicate that PMHC might also be able to aid adults struggling with mild to moderate anxiety and depression in returning to usual level of functioning. The degree to which the observed improvements are attributable to the treatment need nonetheless to be confirmed in a trial including a control group and with more complete follow-up data from registries.

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“…Our findings support conclusions from previous reviews that the methods used to evaluate DIs are heterogeneous. 14,18,19,21 The majority of trial-based economic evaluations are limited for decision-making purposes because of their truncated time horizon and inability to include the full range of possible alternative interventions and to incorporate all available evidence into the analysis. 44 The majority of the studies were conducted in high-income countries, so the results may not be readily generalisable to low-and middle-income countries.…”

Section: Discussionmentioning

confidence: 99%

“…Previous reviews have focused on specific types of DIs (e.g. internet-delivered CBT 14,18,19,21 or guided internet interventions 123 ) or on DIs for specific conditions (e.g. depression 19,23,123 or anxiety disorders 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…internet CBT). [18][19][20][21] Some reviews 22,23 include a wider range of interventions, such as online problem-solving therapy and positive psychology interventions. Most reviews are of studies of the most common mental health problems, namely depression and anxiety, but, increasingly, more reviews of economic evidence relevant to psychological and behavioural interventions include addictive behaviours (e.g.…”

Section: Gaps and Limitationsmentioning

confidence: 99%

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Digital interventions in mental health: evidence syntheses and economic modelling

Gega

Janković

Gonçalves

et al. 2022

Health Technol Assess

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Background Economic evaluations provide evidence on whether or not digital interventions offer value for money, based on their costs and outcomes relative to the costs and outcomes of alternatives. Objectives (1) Evaluate and summarise published economic studies about digital interventions across different technologies, therapies, comparators and mental health conditions; (2) synthesise clinical evidence about digital interventions for an exemplar mental health condition; (3) construct an economic model for the same exemplar mental health condition using the previously synthesised clinical evidence; and (4) consult with stakeholders about how they understand and assess the value of digital interventions. Methods We completed four work packages: (1) a systematic review and quality assessment of economic studies about digital interventions; (2) a systematic review and network meta-analysis of randomised controlled trials on digital interventions for generalised anxiety disorder; (3) an economic model and value-of-information analysis on digital interventions for generalised anxiety disorder; and (4) a series of knowledge exchange face-to-face and digital seminars with stakeholders. Results In work package 1, we reviewed 76 economic evaluations: 11 economic models and 65 within-trial analyses. Although the results of the studies are not directly comparable because they used different methods, the overall picture suggests that digital interventions are likely to be cost-effective, compared with no intervention and non-therapeutic controls, whereas the value of digital interventions compared with face-to-face therapy or printed manuals is unclear. In work package 2, we carried out two network meta-analyses of 20 randomised controlled trials of digital interventions for generalised anxiety disorder with a total of 2350 participants. The results were used to inform our economic model, but when considered on their own they were inconclusive because of the very wide confidence intervals. In work package 3, our decision-analytic model found that digital interventions for generalised anxiety disorder were associated with lower net monetary benefit than medication and face-to-face therapy, but greater net monetary benefit than non-therapeutic controls and no intervention. Value for money was driven by clinical outcomes rather than by intervention costs, and a value-of-information analysis suggested that uncertainty in the treatment effect had the greatest value (£12.9B). In work package 4, stakeholders identified several areas of benefits and costs of digital interventions that are important to them, including safety, sustainability and reducing waiting times. Four factors may influence their decisions to use digital interventions, other than costs and outcomes: increasing patient choice, reaching underserved populations, enabling continuous care and accepting the ‘inevitability of going digital’. Limitations There was substantial uncertainty around effect estimates of digital interventions compared with alternatives. This uncertainty was driven by the small number of studies informing most comparisons, the small samples in some of these studies and the studies’ high risk of bias. Conclusions Digital interventions may offer good value for money as an alternative to ‘doing nothing’ or ‘doing something non-therapeutic’ (e.g. monitoring or having a general discussion), but their added value compared with medication, face-to-face therapy and printed manuals is uncertain. Clinical outcomes rather than intervention costs drive ‘value for money’. Future work There is a need to develop digital interventions that are more effective, rather than just cheaper, than their alternatives. Study registration This study is registered as PROSPERO CRD42018105837. Funding This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 1. See the NIHR Journals Library website for further project information.

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Delivery of cognitive behavioural therapy to workers: a systematic review

Abstract: Internet CBT should be made available in workplaces for workers with anxiety disorders as part of a stepped care plan.

Cited by 14 publications

References 11 publications

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis

Internet-Delivered Cognitive Behavioral Therapy to Treat Insomnia: A Systematic Review and Meta-Analysis

Prompt Mental Health Care (PMHC): work participation and functional status at 12 months post-treatment

Digital interventions in mental health: evidence syntheses and economic modelling

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