Five‐year observational study of Internet‐delivered cognitive behavioural pain management when offered as routine care by an online therapy clinic

Abstract

Background: Internet-delivered cognitive behavioural pain management programmes (PMPs) are effective, but less is known about their use outside of research trials. Five years of data from offering the Internet-delivered cognitive behavioural PMP in an online therapy clinic was examined to assess effectiveness, acceptability and predictors of outcomes.Methods: Patients (N = 293) were offered a previously validated 8-week Internet-delivered cognitive behavioural PMP and administered measures at pre-treatment, post-treatment and 3 months.Results: There was growth in demand for an Internet-delivered cognitive behavioural PMP over time (n = 64 first year to n = 133 fifth year). Moderate-tolarge improvements on depression (post-treatment 35% reduction; 3-month 41% reduction) and anxiety (post-treatment 37% reduction; 3-month 41% reduction), and small-to-moderate improvements on disability (post-treatment 19% reduction; 3-month 20% reduction) were found. Lesson completion and satisfaction were high. Lower pain acceptance, lower pain self-efficacy and higher pain intensity were associated with lower improvements on depression, anxiety and disability. Conclusions: This longitudinal observational study provides support forInternet-delivered cognitive behavioural PMPs when offered as routine care by an online therapy clinic. Significance:This 5-year observational study provides support for Internetdelivered cognitive behavioural pain management programs (PMPs) offered as routine care in an online therapy clinic. Interest in the service grew over 5 years.Outcomes, engagement and satisfaction were strong. Higher pain acceptance, pain self-efficacy and lower pain severity were associated with greater posttreatment improvements on depression, anxiety and disability.

Acceptability and effectiveness study of therapist-assisted internet-delivered cognitive behaviour therapy for agriculture producers

“…When reflecting on barriers or challenges experienced during the course, clients expressed a desire for alternative delivery options (e.g., podcasts or audio clips) and additional therapist contact options (e.g., telephone check-ins or more frequent contact). Nevertheless, it should be noted that previous studies of ICBT have found that offering telephone check-ins are associated with implementation challenges, including requiring clients to make time during their day to schedule a synchronous phone call ( Hadjistavropoulos et al, 2021 ) and that more frequent contact beyond once weekly contact (e.g., response within one business day; Hadjistavropoulos et al, 2020a ) does not result in better outcomes. Although, these options for therapist support have not been examined in a sample of agriculture producers.…”

“…Reliable improvement, recovery, and deterioration were examined to assess for clinically significant changes in symptom scores. Consistent with previous ICBT research ( Dear et al, 2015a , Dear et al, 2015b ; Titov et al, 2020 ; Hadjistavropoulos et al, 2021 ), reliable improvement was defined as scoring ≥ 10 on the PHQ-9 or ≥8 on the GAD-7 at pre-treatment and scoring at least 6 points on the PHQ-9 or 5 points on the GAD-7 lower at post-treatment. Reliable deterioration was defined as an increase from pre- to post-treatment of 6 points on the PHQ-9 or 5 points on the GAD-7.…”

A Canadian psychologist’s primer to telehealth practice.

“…Telecommunication technologies, especially video, have been judged as effective means of providing both assessments and interventions for individuals presenting with conditions including, but not limited to, anxiety, depression, obsessive–compulsive disorder, trauma, behaviour concerns, weight, and substance use (Bashshur et al, 2016; Berryhill, Culmer, et al, 2019; Berryhill, Halli-Tierney, et al, 2019; Cullum & Grosch, 2013; Hilty et al, 2017; Jensen et al, 2019) across ages, races, ethnicities, and countries (Gurney et al, 2021; Kassam-Adams et al, 2019; Whitley & Yahia, 2021). More importantly, when adapted in line with evidence-informed literature, services have been suggested to yield similar clinical outcomes as those achieved in in-person care (Hadjistavropoulos et al, 2022). Evolution of the technology and practices have also allowed for the establishment and maintenance of therapeutic alliance comparable to in-person methods (e.g., video; Goldstein & Glueck, 2016; McLean et al, 2021; Rees & Maclaine, 2015; Simpson et al, 2016; Turvey, 2018).…”

An Observational Study of Outcomes Associated with Virtual Pain Management Programmes Based on Acceptance and Commitment Therapy Implemented During the COVID-19 Pandemic

“…In addition, evidence from 1 noninferiority trial suggests that in-person and remotely-delivered ACT for pain produce comparable outcomes 23 . Before the pandemic, however, remotely-delivered PMPs were not widely implemented, with notable exceptions 24 . Research is therefore needed to understand the effectiveness of remotely-delivered PMPs implemented in real-world practice where patients present with greater complexity 24 .…”

“…Before the pandemic, however, remotely-delivered PMPs were not widely implemented, with notable exceptions 24 . Research is therefore needed to understand the effectiveness of remotely-delivered PMPs implemented in real-world practice where patients present with greater complexity 24 . Crucially, implementation must consider the local context, including permitted technological platforms, staff resources, and support to sustainably deliver and continuously improve remote treatment 25–27 …”