Guided cCBT for treatment of depression
The aim of this intervention was to upscale access to computerised Cognitive Behavioural Therapy (cCBT) for depression patients. The cCBT interventions were up scaled in different settings in line with the health service provision for depression in 10 Member States. This allowed for employing cCBT in a range of care settings and to obtain knowledge about implementation of cCBT across different European countries.
The Member States included in MasterMind were at different developmental levels of eMental-health and started with different entry points of cCBT implementation. This provided the opportunity for the partners to learn from each other across national borders as well as levels of eMental-health development.
Applications of the cCBT service included computerised treatment at home or in community locations, preparation before inpatient treatment, long-term monitoring and/or monitoring after discharge. This way, the service was applied in several set-ups within the care for depression patients including self-administered guided cCBT at home (on PC or smartphone) and in community locations where computers are provided (libraries, GP practices, pharmacies, community education and other council run centres) and as part of a blended care process in connection with both out-patient and in-patient treatment.
Regardless of the setting, cCBT for depression had a number of advantages which included low threshold access and proven effectiveness for brief and more extensive treatments. In summary, cCBT and MasterMind made it possible for more patients to receive treatment due to easy access and dissemination, to receive better treatment, to receive treatment easier, and to receive less expensive/free of charge treatment.
As the cCBT program was wholly or partly self-administered, treatment could take place independently of time and place. This allowed for patients to receive treatment independently of their job situation and other aspects of their daily life. At the same time, this reduced inequality of access for those living in remote and rural areas.
Using MasterMind, Patients could access cCBT treatment by self-referral (e.g. online), GP referral or through the provision of their therapist in case of sequential or integrated blended treatment setting.
How it worked.
A citizen feeling depressed coud access the cCBT program from home or a community location. The citizen completed a depression test and was diagnosed and referred by a health professional. By completing minimum six modules (containing text, graphical and/or video based sessions by PC or smartphone), the patient received the same cCBT as he/she would have by attending face-to-face sessions or as an integral component of face to face therapy. The patient received support and guidance from a co-ordinator/health professional and could communicate with this person through a secure email function in the program and/or via video conference. This was either done at a predetermined frequency or on an ad hoc basis as needed.
On a regular basis, depression tests were carried out to determine the patient’s level of depression. Further, tests to determine the level of understanding, and whether the patient was suicidal, respectively, were carried out on a regular basis throughout the treatment process. After all modules had been finished, the treatment was considered completed and the coordinator/ health professional documents the cCBT treatment in the same way as it is done with regular treatment.
This intervention was aimed at all patients aged 18 or older diagnosed with depression.
Although the partners trialling this service were at different levels of eMental-health development and had different cultural, political, and organisational settings, the interventions carried out in the different pilot sites were functionally equivalent. This ensured the aggregation of data across the pilot sites.
Below you can see a video of psychologist Kim Mathiasen, head of the ‘Internet psychiatry project’ in the Region of Southern Denmark, explain the cCBT intervention which was part of the MasterMind project (6 minutes – click on the ‘cc’ button at the bottom of the video to enable English subtitles):