Blended vs. face-to-face cognitive behavioural treatment for major depression in specialized mental health care (2014)

Kooistra, L. C., Wiersma, J. E., Ruwaard, J., van Oppen, P., Smit, F., Lokkerbol, J., Cuijpers, P. & Riper, H. (2014). Blended vs. face-to-face cognitive behavioural treatment for major depression in specialized mental health care: study protocol of a randomized controlled cost-effectiveness trial. BMC psychiatry, 14(1), 290. doi:10.1186/s12888-014-0290-z Full Text

ABSTRACT
Background
Depression is a prevalent disorder, associated with a high disease burden and substantial societal, economic and personal costs. Cognitive behavioural treatment has been shown to provide adequate treatment for depression. By offering this treatment in a blended format, in which online and face-to-face treatment are combined, it might be possible to reduce the number of costly face-to-face sessions required to deliver the treatment protocol. This could improve the cost-effectiveness of treatment, while maintaining clinical effects. This protocol describes the design of a pilot study for the evaluation of the feasibility, acceptability and cost-effectiveness of blended cognitive behavioural therapy for patients with major depressive disorder in specialized outpatient mental health care.

Methods/design
In a randomized controlled trial design, adult patients with major depressive disorder are allocated to either blended cognitive behavioural treatment or traditional face-to-face cognitive behavioural treatment (treatment as usual). We aim to recruit one hundred and fifty patients. Blended treatment will consist of ten face-to-face and nine online sessions provided alternately on a weekly basis. Traditional cognitive behavioural treatment will consist of twenty weekly sessions. Costs and effects are measured at baseline and after 10, 20 and 30 weeks. Evaluations are directed at cost-effectiveness (with depression severity and diagnostic status as outcomes), and cost-utility (with costs per quality adjusted life year, QALY, as outcome). Costs will encompass health care uptake costs and productivity losses due to absence from work and lower levels of efficiency while at work. Other measures of interest are mastery, working alliance, treatment preference at baseline, depressive cognitions, treatment satisfaction and system usability.

Discussion
The results of this pilot study will provide an initial insight into the feasibility and acceptability of blended cognitive behavioural treatment in terms of clinical and economic outcomes (proof of concept) in routine specialized mental health care settings, and an indication as to whether a well-powered clinical trial of blended cognitive behavioural treatment for depression in routine practice would be advisable. This will be determined based on the perspective of various stakeholders including patients, mental health service providers and health insurers. Strengths and limitations of the study are discussed.

Wild West in de E-health: Eerst invoeren, dan pas valideren (2014)

Ruwaard, J. (2014). Wild West in de e-health: eerst invoeren, dan pas valideren. Kind en Adolescent praktijk, 13, 1.
Full Text (pdf)

ABSTRACT Terwijl medicijnen pas in de handel komen na uitgebreid onderzoek naar veiligheid, werkzaamheid en doelmatigheid, introduceren GGz-instellingen ongevalideerde e-health op steeds grotere schaal. Shoot first, ask questions later, eerst invoeren en dan valideren, is de onbeschreven wet van de Wild West e-health-praktijk. Daar zijn wel argumenten voor, maar die kloppen niet. Wie de effecten van e-health niet onderzoekt, loopt het risico om een bezuiniging die verschralend werkt, aan te zien voor doelmatige zorg.

E-health in de jeugd-ggz (2013)

Ruwaard, J., Linse, H. & Hagenbeuk, H. (2013). E-health in de Jeugd-ggz. Baat het of Schaadt het? Amsterdam: Landelijk Kenniscentrum Kinder- en Jeugdpsychiatrie. ISBN: 978-90-820527-0-1 Free Full Text (ipad ebook)

ABSTRACT E-health biedt een schat aan mogelijkheden voor de jeugd-ggz. Maar een professionele benadering en vooral een betere samenwerking zijn strikt noodzakelijk om ook daadwerkelijk successen te kunnen boeken. E-health heeft in elk geval veel meer potentie dan alleen voorlichting en preventieve programma’s: digitale toepassingen zullen binnen afzienbare tijd ‘de behandelkamer’ ingrijpend veranderen. Dit zijn enkele conclusies uit dit overzichtswerk over e-health in de jeugd-ggz, ontwikkeld en uitgegeven door het Landelijk Kenniscentrum Kinder- en Jeugdpsychiatrie. Het gratis e-book met de titel ‘E-health in de jeugd-ggz – baat het, of schaadt het?’ is bedoeld als gids voor professionals in de jeugd-ggz die aan de slag willen met e-health. Alle aspecten van e-health, van beleid (bij overheid, verzekeraars en jeugd-ggz) tot aan de soms weerbarstige en experimentele praktijk komen aan bod.

voor de iPad Het boek is ontwikkeld voor de iPad en is rijk geïllustreerd met multimediale content; deze versie is gratis te downloaden in de boekwinkel van iTunes. Dit is de volledige, interactieve versie van het boek, geschikt voor de iPad van Apple met iOs 5.1 of nieuwer en voorzien van de iBooks app versie 3.0 of nieuwer. Een soberder versie van het e-book is beschikbaar in ePub– en Mobipocket-formaat voor e-readers, PC, Mac en Android;

KEYWORDS Kinder- en Jeugdpsychiatrie; Jeugd-ggz; e-Mental Health; e-Health; ebook

The Efficacy and Effectiveness of Online CBT (2013)

Ruwaard, J. (2013). The efficacy and effectiveness of online CBT. Amsterdam: Department of Clinical Psychology, University of Amsterdam. ISBN: 978-94-6191-588-7 Full Text

ABSTRACT In 1997, researchers at the University of Amsterdam developed one of the first psychotherapeutic applications of the World Wide Web. They implemented a standardized cognitive behavioural treatment (CBT) of post-traumatic stress symptoms in a website, and used this site to treat clients over the internet, without face-to-face contact. Over the years, the efficacy of this treatment was established in a series of controlled trials. This thesis explores the wider applicability of online CBT, in four randomized controlled trials and a practice study. In the controlled studies, we assess the efficacy of online CBT for work-related stress, mild to moderate depression, panic disorder and bulimia nervosa. In the fifth study, we examine the effectiveness of online CBT in routine clinical practice. The results suggest that online CBT provides a feasible alternative to existing treatment options for people who suffer from a variety of mental health disorders.

KEYWORDS Psychotherapy; Cognitive Behaviour Therapy; Internet; e-Mental Health; e-Health; Randomized Controlled Trial; Routine Practice Evaluation; Follow-up Studies; Adult; Depression; Burnout; Panic Disorder; Bulimia Nervosa

The Effectiveness of Online CBT in Routine Clinical Practice (2012)

Ruwaard, J., Lange, A., Schrieken, B., Dolan, C.V., & Emmelkamp, P. (2012). The effectiveness of online cognitive behavioral treatment in routine clinical practice. PLoS One, doi: 10.1002/cpp.1767

ABSTRACT CONTEXT: Randomized controlled trails have identified online cognitive behavioral therapy as an efficacious intervention in the management of common mental health disorders. OBJECTIVE: To assess the effectiveness of online CBT for different mental disorders in routine clinical practice. DESIGN: An uncontrolled before-after study, with measurements at baseline, posttest, 6-week follow-up, and 1-year follow-up. PARTICIPANTS & SETTING: 1500 adult patients (female: 67%; mean age: 40 years) with a GP referral for psychotherapy were treated at a Dutch online mental health clinic for symptoms of depression (n = 413), panic disorder (n = 139), posttraumatic stress (n = 478), or burnout (n = 470). INTERVENTIONS: Manualized, web-based, therapist-assisted CBT, of which the efficacy was previously demonstrated in a series of controlled trials. Standardized duration of treatment varied from 5 weeks (online CBT for Posttraumatic stress) to 16 weeks (online CBT for Depression). MAIN OUTCOME MEASURES: Validated self-report questionnaires of specific and general psychopathology, including the Beck Depression Inventory, the Impact of Event Scale, the Panic Disorder Severity Scale-Self Report, the Oldenburg Burnout Inventory, and the Depression Anxiety Stress Scales. RESULTS: Treatment adherence was 71% (n =1071). Study attrition was 21% at posttest, 33% at 6-week FU and 65% at 1-year FU. Mixed-model repeated measures regression identified large short-term reductions in all measures of primary symptoms (d = 1.9 ± 0.2 to d = 1.2 ± 0.2; P < .001), which sustained up to one year after treatment. At posttest, rates of reliable improvement and recovery were 71% and 52% in the completer sample (full sample: 55%/40%). Patient satisfaction was high. CONCLUSIONS: Results suggest that online therapist-assisted CBT may be as effective in routine practice as it is in clinical trials. Although pre-treatment withdrawal and long-term outcomes require further study, results warrant continued implementation of online CBT.

Keywords Cognitive Behavior Therapy/*methods; Internet; Computer assisted protocol directed therapy; Effectiveness Studies; Follow-Up Studies; Internet Intervention; Treatment Outcome;