Internet-delivered treatments

Anxiety disorders are common mental health disorders that affect about 4 % of adults at any one time.1 In addition, anxiety disorders are the sixth leading cause of disability worldwide (depression is second on the list).2 The authors of these global studies on disease burden conclude:

”Anxiety disorders are chronic, highly prevalent, disabling conditions with onset usually in children and young people. Treatment rates are low despite the personal suffering and economic impact arising from these disorders (Kessler & Greenberg, 2002). Early access to cost-effective interventions will help to decrease the considerable global burden of anxiety disorders”

Since anxiety disorders are chronic if left untreated34, early access to effective treatment is crucial. This is why we need new innovations that help provide evidence-based treatments to patients. Internet-treatments are cost-effective5 and are easily scalable without loss of treatment integrity (the treatment content is identical for patient number one and 1000), which makes them suitable for implementation on a large scale.

”We know well enough what works. The problem is that we’re not doing it.” - Tom Insel, former head of NIMH.6

Internet-delivered CBT

Internet-delivered cognitive behavioral therapy (ICBT) is similar to regular cognitive behavioral therapy in content and treatment duration, it differs only in the mode of delivery. ICBT-treatments are usually divided into chapters that introduce exercises in a step-by-step manner. In addition, patients can plan and evaluate their exercises via specific work sheets. Therapists are available via a message system on the platform and patients receive answers within 24 hours. Online work sheets mirror their pen and paper counterparts and therapists use the same material in both ICBT and regular CBT.

There are several advantages of ICBT compared to regular CBT. Having contact with a therapist through an online platform increases access to therapy since patients do not have to wait for weekly appointments before they receive feedback and support. Another advantage is that patients can access the treatment content at any time, since the platform is always available. They are free to repeat material that they might have forgotten or to revise their weekly goals and plans as they go along. Taken together, the increased availability of ICBT makes it a compelling treatment alternative.

An entirely web-based psychiatric care

ICBT coupled with video-assessments with a psychiatrist before and after treatment opens up the possibility to reach and help anyone with an internet connection, regardless of where they happen to be. We are already using this technology in a research project where we treat body dysmorphic disorder over the internet7. The idea is to introduce similar technology in regular care. This has the potential to drastically increase accessibility to psychological treatments while preserving the quality of assessments and treatment.

Summary

Anxiety disorders are common and debilitating. Internet-delivered treatments can reduce the gap between supply and demand in the treatment of anxiety and other mental health conditions. It is likely that the assessment and treatment of common mental illnesses can be entirely web-based in the near future.

References


  1. Baxter, A. J., Scott, K. M., Ferrari, A. J., Norman, R. E., Vos, T., & Whiteford, H. A. (2014). CHALLENGING THE MYTH OF AN “EPIDEMIC” OF COMMON MENTAL DISORDERS: TRENDS IN THE GLOBAL PREVALENCE OF ANXIETY AND DEPRESSION BETWEEN 1990 AND 2010. Depression and Anxiety, 31(6), 506–516. http://doi.org/10.1002/da.22230 ^
  2. Baxter, A. J., Vos, T., Scott, K. M., Ferrari, A. J., & Whiteford, H. A. (2014). The global burden of anxiety disorders in 2010. Psychological Medicine, 44(11), 2363–2374. http://doi.org/10.1017/s0033291713003243 ^
  3. Eisen, J. L., Sibrava, N. J., Boisseau, C. L., Mancebo, M. C., Stout, R. L., Pinto, A., & Rasmussen, S. A. (2013). Five-Year Course of Obsessive-Compulsive Disorder. The Journal of Clinical Psychiatry, 74(03), 233–239. http://doi.org/10.4088/jcp.12m07657 ^
  4. Mataix-Cols, D., Rauch, S. L., Baer, L., Eisen, J. L., Shera, D. M., Goodman, W. K., et al. (2002). Symptom Stability in Adult Obsessive-Compulsive Disorder: Data From a Naturalistic Two-Year Follow-Up Study. American Journal of Psychiatry, 159(2), 263–268. http://doi.org/10.1176/appi.ajp.159.2.263 ^
  5. Hedman, E., Ljótsson, B., & Lindefors, N. (2012). Cognitive behavior therapy via the Internet: a systematic review of applications, clinical efficacy and cost–effectiveness. Expert Review of Pharmacoeconomics & Outcomes Research, 12(6), 745–764. http://doi.org/10.1586/erp.12.67 ^
  6. https://www.theatlantic.com/magazine/archive/2017/07/the-smartphone-psychiatrist/528726/ ^
  7. http://web.internetpsykiatri.se/behandling/bdd/ ^
Avatar
Oskar Flygare
PhD Student in psychology