Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care

Lisa C Kooistra; Jeroen Ruwaard; Jenneke E Wiersma; Patricia van Oppen; Rosalie van der Vaart; Julia E W C van Gemert-Pijnen; Heleen Riper

doi:10.1016/j.invent.2016.01.003

Development and initial evaluation of blended cognitive behavioural treatment for major depression in routine specialized mental health care

Internet Interv. 2016 Jan 27:4:61-71. doi: 10.1016/j.invent.2016.01.003. eCollection 2016 May.

Authors

Lisa C Kooistra^{1

2}, Jeroen Ruwaard^{1

2}, Jenneke E Wiersma^{2

3}, Patricia van Oppen^{2

3}, Rosalie van der Vaart⁴, Julia E W C van Gemert-Pijnen⁵, Heleen Riper^{1

2

3

6}

Affiliations

¹ Faculty of Behavioural and Movement Sciences, Department of Clinical-, Neuro- and Developmental Psychology, VU University Amsterdam, Van der Boechorststraat 1, BT 1081 Amsterdam, The Netherlands.
² EMGO Institute for Health Care and Research, VU University Medical Centre, Van der Boechorststraat 1, BT 1081 Amsterdam, The Netherlands.
³ Department of Psychiatry, GGZ inGeest and VU University Medical Centre, P.O. Box 7057, Amsterdam MB 1007, the Netherlands.
⁴ Health, Medical and Neuropsychology Unit, Leiden University, Wassenaarseweg 52, AK 2333, Leiden, The Netherlands.
⁵ Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, NB 7522, Enschede, The Netherlands.
⁶ Faculty of Health Sciences, the Institute of Clinical Research /Telepsychiatric Centre, Mental Health Services in the Region of Southern Denmark, University of Southern Denmark, Winsløwparken 19, DK-5000 Odense, Denmark.

Abstract

Background: Blended care combines face-to-face treatment with web-based components in mental health care settings. Blended treatment could potentially improve active patient participation, by letting patients work though part of the protocol autonomously. Further, blended treatment might lower the costs of mental health care, by reducing treatment duration and/or therapist contact. However, knowledge on blended care for depression is still limited.

Objectives: To develop a blended cognitive behavioural treatment (bCBT) for depressed patients in an outpatient specialized mental health care centre and to conduct a preliminary evaluation of this bCBT protocol.

Method: A bCBT protocol was developed, taking recommendations into account from depressed patients (n = 3) and therapists and experts in the field of e-health (n = 18). Next, an initial evaluation of integrated high-intensive bCBT was conducted with depressed patients (n = 9) in specialized mental health care. Patients' clinical profiles were established based on pre-treatment diagnostic information and patient self-reports on clinical measures. Patient treatment adherence rates were explored, together with patient ratings of credibility and expectancy (CEQ) before treatment, and system usability (SUS) and treatment satisfaction after treatment (CSQ-8). During and after treatment, the blended treatment protocol was evaluated in supervision sessions with the participating therapists (n = 7).

Results: Seven out of nine patients started bCBT, of whom five completed ≥ 90% of treatment. System usability was evaluated as being above average (range 63 to 85), and patients were mostly to very satisfied with bCBT (range 16 to 32). Patients reported improvements in depression, health-related quality of life and anxiety. We observed that therapists evaluated the highly structured blended treatment as a helpful tool in providing evidence-based treatment to this complex patient group.

Discussion: Although no conclusions can be drawn based on the current study, our observations suggest that a blended CBT approach might shorten treatment duration and has the potential to be a valuable treatment option for patients with severe depression in specialized mental health care settings. Further exploration of the effectiveness of our bCBT protocol by means of a randomized controlled trial is warranted.

Keywords: Blended cognitive behavioural therapy; Depression; Face-to-face treatment; Online treatment; Outpatient specialized mental health care; Routine practise.