Efficacy of a Six-Week-Long Therapist-Guided Online Therapy Versus Self-help Internet-Based Therapy for COVID-19–Induced Anxiety and Depression: Open-label, Pragmatic, Randomized Controlled Trial

Abstract

Background The COVID-19 pandemic has led to a notable increase in psychological distress, globally. Oman is no exception to this, with several studies indicating high levels of anxiety and depression among the Omani public. There is a need for adaptive and effective interventions that aim to improve the elevated levels of psychological distress due to the COVID-19 pandemic. Objective This study aimed to comparatively assess the efficacy of therapist-guided online therapy with that of self-help, internet-based therapy focusing on COVID-19–induced symptoms of anxiety and depression among individuals living in Oman during the COVID-19 pandemic. Methods This was a 6-week-long pragmatic randomized controlled trial involving 60 participants who were recruited from a study sample surveyed for symptoms of anxiety or depression among the Omani public amid the COVID-19 pandemic. Participants in the intervention group were allocated to receive 1 online session per week for 6 weeks from certified psychotherapists in Oman; these sessions were conducted in Arabic or English. The psychotherapists utilized cognitive behavioral therapy and acceptance and commitment therapy interventions. Participants in the control group received an automatic weekly newsletter via email containing self-help information and tips to cope with distress associated with COVID-19. The information mainly consisted of behavioral tips revolving around the principles of cognitive behavioral therapy and acceptance and commitment therapy. The primary outcome was measured by comparing the change in the mean scores of Patient Health Questionnaire-9 (PHQ-9) and General Anxiety Disorder-7 (GAD-7) scale from the baseline to the end of the study (ie, after 6 sessions) between the two groups. The secondary outcome was to compare the proportions of participants with depression and anxiety between the two groups. Results Data from 46 participants were analyzed (intervention group n=22, control group n=24). There was no statistical difference in the baseline characteristics between both groups. Analysis of covariance indicated a significant reduction in the GAD-7 scores (F1,43=7.307; P=.01) between the two groups after adjusting for baseline scores. GAD-7 scores of participants in the intervention group were considerably more reduced than those of participants in the control group (β=−3.27; P=.01). Moreover, a greater reduction in mean PHQ-9 scores was observed among participants in the intervention group (F1,43=8.298; P=.006) than those in the control group (β=−4.311; P=.006). Although the levels of anxiety and depression reduced in both study groups, the reduction was higher in the intervention group (P=.049) than in the control group (P=.02). Conclusions This study provides preliminary evidence to support the efficacy of online therapy for improving the symptoms of anxiety and depression during the COVID-19 crisis in Oman. Therapist-guided online therapy was found to be superior to self-help, internet-based therapy; however, both therapies could be considered as viable options. Trial Registration ClinicalTrials.gov NCT04378257; https://clinicaltrials.gov/ct2/show/NCT04378257

Effects of COVID-19 Mental Health Interventions among Community-based Children, Adolescents, and Adults: A Living Systematic Review of Randomised Controlled Trials

“…The 6 trials 25-30 that tested standard interventions minimally adapted for mental health during COVID-19 were conducted in Oman (N = 46), 25 Malaysia (N = 61), 26 Spain (N = 164), 27 Iran (N = 150), 28 Serbia (N = 104), 29 and China (N = 104). 30 Participants were recruited via social media, 26,29 an internet survey, 25 and a university email list; 27 in 2 trials, recruitment method was not reported.…”

“…The 6 trials 25-30 that tested standard interventions minimally adapted for mental health during COVID-19 were conducted in Oman (N = 46), 25 Malaysia (N = 61), 26 Spain (N = 164), 27 Iran (N = 150), 28 Serbia (N = 104), 29 and China (N = 104). 30 Participants were recruited via social media, 26,29 an internet survey, 25 and a university email list; 27 in 2 trials, recruitment method was not reported. 28,30 Two trials tested standard cognitive behavioural therapy delivered individually (6 sessions) 25 or in groups (10 sessions) 28 ; both reported targeting mental health symptoms from COVID-19, but neither described COVID-19-specific intervention adaptations.…”

“…30 Participants were recruited via social media, 26,29 an internet survey, 25 and a university email list; 27 in 2 trials, recruitment method was not reported. 28,30 Two trials tested standard cognitive behavioural therapy delivered individually (6 sessions) 25 or in groups (10 sessions) 28 ; both reported targeting mental health symptoms from COVID-19, but neither described COVID-19-specific intervention adaptations. Two interventions tested standard self-guided journaling (one session) 25 or expressive writing (5 sessions) 29 adapted by instructing participants to write about experiences during the pandemic.…”

“…28,30 Two trials tested standard cognitive behavioural therapy delivered individually (6 sessions) 25 or in groups (10 sessions) 28 ; both reported targeting mental health symptoms from COVID-19, but neither described COVID-19-specific intervention adaptations. Two interventions tested standard self-guided journaling (one session) 25 or expressive writing (5 sessions) 29 adapted by instructing participants to write about experiences during the pandemic. Two tested self-guided mindfulness apps (14 sessions) 27 or audio recordings (5 sessions) 30 that were described as targeting COVID-19 mental health symptoms but did not describe clear adaptations for COVID-19 challenges.…”

“…Among the 6 trials, 25-30 one trial25 had 3 high risk ratings, and the other 5 trials 26-30 had between 4 and 6 unclear or high ratings out of 7 risk of bias items. Most interventions were described sub-adequately; all had 3 to 6 no or partial TIDieR Checklist ratings.…”