Developing and PilotingePACT: A Flexible Psychological Treatment for Depression in People Living With Chronic Spinal Cord Injury

Abstract

Accessibility, stigma and adverse effects of self-reliance can hinder the receipt of psychological treatments, especially in people living with chronic illness or disability. The aim of this study was to develop and pilot a flexible online psychological treatment using CBT and positive-psychology based techniques, for individuals with spinal cord injury (SCI) who also lived with depression or both depression and anxiety. A multiple case study approach provided in-principle evidence of the acceptability of the Electronic Personal Administration of Cognitive Therapy:ePACT. Three adults living with SCI completed pre- and post-intervention interviews and multiple modules ofePACT. The interviews used the Structural Clinical Interview for DSM Disorders (SCID/-N/P) for diagnosis and the standardised survey instruments: Depression Anxiety and Stress Scale — short version (DASS-21), Personal Wellbeing Index 4th edition (PWI) and the Spinal Cord Lesion Emotional Wellbeing Questionnaire (SCL EWQ v1 Australia). The results indicated that the online program was acceptable, and they all showed some improvement in symptoms. All participants indicated that they would not have sought face-to-face therapy for reasons of access and stigma. They all had a strong sense of independence and felt this would have been questioned if they sought therapy.

Development and evaluation of the positive psychology intervention for older adults

“…First, one-group pre-test/post-test design was used to evaluate the effectiveness of the intervention program. However, the use of this methodological approach is not uncommon in the literature, particularly for preliminary evaluation of positive psychology intervention programs at the initial stage of development (Bonhote et al, 1999;Carson et al, 2010;Lantz, Buchalter, & McBee, 1997;Migliorini, Tonge, & Sinclair, 2011). Future research should adopt RCT for assessing the outcomes of this intervention in order to minimize potential confounding effects.…”

A qualitative study on the use of personal information technology by persons with spinal cord injury

“…Preliminary findings using IT to support the health and well-being after SCI have been promising. For instance, using IT to deliver online psychological treatment can lead to improvements in symptoms of depression and anxiety following SCI [14]. Additional work has shown improvements in psychosocial adjustment [15][16][17][18], quality of life (QoL) [19], and physical symptoms [17,18] following counseling delivered via telephone or videoconference (see Dorstyn et al 2013 for review [20]).…”

Feasibility of an online well-being intervention for people with spinal cord injury: a pilot study

“…7,8,12 Still, the amount of participants not completing one module was considerable in this study, despite the intensive telephone support. Different factors may influence adherence to this type of treatment, such as disease severity 13 and the ability to reflect on one's thoughts and feelings that such programmes require.…”

“…Migliorini et al 7 also found improvement of mood after completion of their intervention, and this effect was neither universal nor significant. So far, the results of online positive psychological interventions do not compare positively with the results of traditional or telephone-based cognitive behavioural therapy of depression in persons with SCI.…”

“…6 We could only find one small study in which an online psychological program resulted in reduction in symptoms of depression, anxiety or stress in all three participants who had completed the program. 7 The 'ePACT' program evaluated in that study is a psychological therapy based on cognitive behaviour and positive psychology. It contains 10 sessions and 4 information pages and addresses problem-solving, altered thinking, goal setting and relaxation, among others.…”