Tracing the missteps of stepped care: Improving the implementation of stepped care through contextual behavioral science

Efficacy of a Digital Mental Health Biopsychosocial Transdiagnostic Intervention With or Without Therapist Assistance for Adults With Anxiety and Depression: Adaptive Randomized Controlled Trial

“…Therefore, it would be beneficial to further investigate self-efficacy and motivation as predictors of engagement and attrition (as is planned in a subsequent paper by the authors) to better understand who is most suited for self-help and who may benefit from therapist assistance within DMH adaptive intervention designs. Research designed to improve the implementation of stepped care through contextual behavioral science recommends that the “match-mismatch” design be applied to stepped-care research to enhance understanding of treatment intensity and dose based on participant-specific characteristics [ 25 ]. Other studies are demonstrating the importance of increasing expectations among possible consumers of DMH treatments through education and marketing, which may increase mental health literacy among consumers regarding the various evidence-based treatment options available [ 70 ].…”

“…Research on DMH intervention programs incorporating adaptive treatment elements has the potential to further our understanding of the optimal intensity of therapist assistance. Adaptive intervention designs incorporate criteria that influence how and whether treatment is maintained or augmented based on participant responses, such as engagement levels or symptom severity [ 24 , 25 ]. An adaptive intervention design that has been studied is stepped-care models.…”

“…An adaptive intervention design that has been studied is stepped-care models. Stepped-care models enable participants with evolving needs to receive higher-intensity treatment if required [ 5 , 24 , 25 ]. Previous research, including systematic reviews and meta-analyses conducted on stepped care, indicates that stepped care is an effective delivery model with a moderate effect size for improving depressive symptoms and disorders [ 26 , 27 ] and a considerably better model than care as usual for reducing anxiety symptoms, as well as having significantly higher response rates for anxiety disorders [ 28 ].…”

“…If or when required (ie, a person’s needs change or symptoms rise), the intensity of treatment can be increased, for example, by adding a therapist to assist while using a web-based DMH intervention program. Adaptive intervention research designs provide the opportunity to evaluate the first 2 stages of a stepped-care model as the type or dosage of treatment can be adapted according to decision criteria [ 24 , 25 ].…”

A Novel and Integrated Digitally Supported System of Care for Depression and Anxiety: Findings From an Open Trial

“…Low-intensity treatments often include digital or online therapies, with or without support, as multiple trials targeting anxiety and depressive disorders have shown that these treatments can be as effective as face-to-face therapy [5][6][7][8]. While this "fail-first" approach more efficiently allocates resources than traditional approaches that strive to provide the highest level of clinician-delivered care to all patients, it results in delays to more intensive treatment for those who need it [9], and such delays may lead to symptom worsening and increased disability [10], discouragement for new treatments after initial options fail [11], or dropout before a second course of treatment [12]. An emerging body of literature indicates that stratified models, in which individuals are matched to level of care based on predetermined criteria (typically current symptom severity), produce superior outcomes and are more cost-effective in treating depression and anxiety compared with fail-first stepped care models [13][14][15][16].…”