SilverCloud provides internet-delivered interventions for depression and anxiety in NHS Mental Health Services. The interventions have proved successful in the management of depression and anxiety for clients presenting to mental health services, with recovery rates exceeding the national standard. Recently SilverCloud has embarked on tailoring the interventions for patients with long-term conditions including COPD, pain and diabetes. The purpose of the customisation is to make the interventions more meaningful and relevant to patients with LTCs, but all the while having the same goal of addressing depression and anxiety disorders. In doing so it would be expected that individuals might be in a better position to effectively self-manage their LTC. The current study, therefore, seeks to assess the possible effectiveness of implementing customised internet-delivered interventions for depression and anxiety for people with long-term conditions presenting to NHS mental health services.

Brief Title

iCBT for Long-term Conditions in IAPT

Official Title

Tailored Internet-delivered Cognitive Behavioural Therapy for Depression and Anxiety in Patients With a Long-term Condition (Chronic Pain, COPD and Diabetes).

Brief Summary

SilverCloud provides internet-delivered interventions for depression and anxiety in NHS<br /> Mental Health Services. The interventions have proved successful in the management of<br /> depression and anxiety for clients presenting to mental health services, with recovery rates<br /> exceeding the national standard. Recently SilverCloud has embarked on tailoring the<br /> interventions for patients with long-term conditions including COPD, pain and diabetes. The<br /> purpose of the customisation is to make the interventions more meaningful and relevant to<br /> patients with LTCs, but all the while having the same goal of addressing depression and<br /> anxiety disorders. In doing so it would be expected that individuals might be in a better<br /> position to effectively self-manage their LTC. The current study, therefore, seeks to assess<br /> the possible effectiveness of implementing customised internet-delivered interventions for<br /> depression and anxiety for people with long-term conditions presenting to NHS mental health<br /> services.

Detailed Description

iCBT is the delivery of a tailored structured cognitive and behaviour therapy based
programme, with support, to individuals with mild to moderate symptoms of depression and
anxiety. There is now a substantial body of research evidence that supports the efficacy and
effectiveness of internet-delivered cognitive behaviour therapy for depression and anxiety
(Richards & Richardson, 2012; Andersson and Cuijpers, 2009). Historically, a number of iCBT
interventions have been used in clinical practice in IAPT services. However, they have often
suffered from poor engagement and consequently poor clinical outcomes. More recent
developments in the field have produced more robust technological platforms, where content is
delivered through a variety of media that enhance productivity, increase engagement and
produce better clinical outcomes. The SilverCloud intervention has been demonstrated to be a
clinical effective evidence-based cognitive behavioural treatment option (Richards et al.,
2015).

Chronic illnesses can have profound effects on well-being, functional capacity and quality of
life. Psychological comorbidities with an LTC can further contribute to the distress that is
caused by these symptoms. Patients with comorbid depression and anxiety disorders and a
long-term condition are associated with significantly higher health care utilisation, poorer
outcomes from treatment and increased costs of care (Moussavi et al., 2007; Naylor et al.,
2012). The IAPT programme in the UK provides effective treatments for depression and anxiety
but these have been underutilized by people with LTCs and partially this is due to an
underrecognition; one reason for this has been the traditional precedence set on managing the
physical aspects of any LTC and effectively paying little attention to psychological
comorbidity (Coventry et al., 2011).

Several pathfinders sites are currently involved in providing psychological treatment for
long-term conditions, but to date, results have been limited due to several factors, such as
delays in commencing programmes and funding issues. To this extent, SilverCloud wishes to
implement their tailored "Space from…" series of programmes for long-term conditions -
chronic pain, COPD and Diabetes. The purpose of the tailoring is to make the interventions
more meaningful and relevant to patients with LTCs, but all the while having the same goal of
addressing depression and anxiety disorders. In doing so it would be expected that
individuals might be in a better position to effectively self-manage their LTC. The current
study, therefore, seeks to assess the clinical feasibility of implementing customised
internet-delivered interventions for depression and anxiety for people with LTCS presenting
to IAPT services.

Outcome Measures

Outcome measures are the tests that investigators perform to prove whether or not a treatment being tested in a clinical trial is having any effect.

Inclusion Criteria:

  -  18 years of age

  -  English language speakers

  -  Have capacity to consent

  -  Has a chronic condition (Diabetes, COPD, Chronic Pain) with comorbid depression and/or
     anxiety.

  -  Suitable for step 2 intervention in NHS IAPT Services.

Exclusion Criteria:

  -  Exceed cut-off score for risk in terms of self-harm on the screening questionnaires.

  -  Receiving an intervention (therapeutic or biological) that is not a part of treatment
     as usual, or another trial.