The effective delivery of digital CBT: a service evaluation exploring the outcomes of young people who completed video conferencing therapy in 2020

Abstract

Despite its impressive evidence base, there is a widening access gap to receiving cognitive behavioural therapy (CBT). Video conferencing therapy (VCT) offers an effective solution for logistical barriers to treatment, which has been salient throughout the Coronavirus pandemic. However, research concerning the delivery of CBT via VCT for children and young people (CYP) is in its infancy, and clinical outcome data are limited. The aim of this service evaluation was to explore the effectiveness of a VCT CBT intervention for CYP referred from Child and Adolescent Mental Health Services (CAMHS) in the UK. A total of 989 records of CYP who had completed CBT via VCT in 2020 with Healios, a digital mental health company commissioned by the National Health Service (NHS), were examined to determine changes in anxiety, depression and progress towards personalised goals. Routine outcome measures (ROMs) were completed at baseline and endpoint, as well as session by session. Feedback was collected from CYP and their families at the end of treatment. There was a significant reduction in symptoms of anxiety and depression and significant progress towards goals, with pre- to post-effect sizes (Cohen’s d) demonstrating medium to large effects (d=.45 to d=−1.39). Reliable improvement ranged from 31 to 80%, clinical improvement ranged from 33 to 50%, and 25% clinically and reliably improved on at least one measure; 92% reported that they would recommend Healios. This service evaluation demonstrates that Healios’ CBT delivered via VCT is effective for CYP receiving it as part of routine mental health care. Key learning aims (1) To consider whether CBT can be effectively delivered in routine care via VCT. (2) To explore whether CBT delivered in routine care via VCT is acceptable to children, young people and their families. (3) To reflect on the benefits of VCT and the collection of a variety of ROMs via digital platforms.

Advances in digital CBT: where are we now, and where next?

“…The present articles also demonstrate advances in our knowledge of, and approaches to, user experiences of digital CBT. Many of the studies (Browne et al, 2022;Li et al, 2022;Patterson et al, 2022;Porter et al, 2022;Song and Foster, 2022) have incorporated at least an element of user feedback, which is perhaps a positive reflection of the value placed on this information as well as its importance in the development, refinement or delivery of interventions. Taking this one stage further, Li et al (2022) demonstrate in their study advances in how co-design principles are now being used to involve the 'end-users' of a digital product in its development from the outset.…”

“…These include an account of the co-design procedures used in the development of a CBT app for adolescents with depression and anxiety ( Li et al ., 2022 ), a review of apps that aim to complement clinical treatment by supporting assessment/diagnosis, treatment planning, treatment fidelity monitoring, or outcome tracking ( Pacheco and Scheeringa, 2022 ), and a review of apps implementing cognitive restructuring techniques ( Erhardt et al ., 2022 ). Three articles focus on remote treatment delivery, including an evaluation of the effectiveness of remote therapy in two Improving Access to Psychological Therapies (IAPT) services in London ( Nguyen et al ., 2022 ), an evaluation of the outcomes of CBT delivered via videoconferencing for young people treated in routine clinical practice ( Porter et al ., 2022 ), and a qualitative investigation of patient and therapist experiences of videoconferencing ( Song and Foster, 2022 ). Two articles examine digital adjuncts to treatment, one providing an evaluation of user experiences of a CBT-based online peer support platform ( Browne et al ., 2022 ), and the other examining the uptake and perceptions of a self-guided booster lesson among university students who had completed a course of internet-delivered CBT ( Patterson et al ., 2022 ).…”

“…One IAPT service showed a significant increase in their overall recovery rate after moving to remote treatment provision. Porter et al . (2022) also found promising clinical outcomes in their evaluation of videoconferencing based therapy for young people in routine clinical practice, which showed medium to large effect sizes in anxiety and depression symptoms reduction and in progress towards personalised goals.…”

“…Online administration of outcome questionnaires, surveys and focus groups are all demonstrated within this set of articles, which illustrate progress in how technology is being used to facilitate studies, and the collection of routine outcome data. It is promising to see that many of the present articles report on work conducted in routine clinical practice ( Browne et al ., 2022 ; Nguyen et al ., 2022 ; Porter et al ., 2022 ; Song and Foster, 2022 ), and it may well be the case that these studies have been made more achievable due to the technological advances that support data collection. Beyond advancing digital CBT, the studies serve as valuable examples of how to collect data in routine care and use this data collection to iteratively improve services.…”