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      Using the Online Psychotherapy Tool to Address Mental Health Problems in the Context of the COVID-19 Pandemic: Protocol for an Electronically Delivered Cognitive Behavioral Therapy Program

      , MD, FRCPC 1 , 2 , , , MD, FRCPC 1 , , BScH 1 , 2 , , MD 1 , , MD 1 , 3 , 4 , , BSc 1 , , MD, PhD 1 , 2 , 5 , , PhD 1 , , MD, PhD 5 , , BSc 6 , , MD, DABPN, FRCPC 1 , 2 , , MD, PhD 1 , 2 , , MD 1 , 2 , 7 , , MSc, MD, PhD 1 , 2 , , MD, PhD, FRCPC 1 , 2 , , MBA, MD, PhD, FRCPC 1 , 2
      (Reviewer), (Reviewer), (Reviewer)
      JMIR Research Protocols
      JMIR Publications
      mental health, COVID-19, depression, anxiety, psychotherapy, cognitive behavioural therapy, online, internet, electronic, mental health care

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          The considerable rise of mental health challenges during the COVID-19 pandemic has had detrimental effects on the public health sector and economy. To meet the overwhelming and growing demand for mental health care, innovative approaches must be employed to significantly expand mental health care delivery capacity. Although it is not feasible to increase the number of mental health care providers or hours they work in the short term, improving their time efficiency may be a viable solution. Virtually and digitally delivering psychotherapy, which has been shown to be efficient and clinically effective, might be a good method for addressing this growing demand.


          This research protocol aims to evaluate the feasibility and efficacy of using an online, digital, asynchronous care model to treat mental health issues that are started or aggravated by stressors associated with the COVID-19 pandemic.


          This nonrandomized controlled trial intervention will be delivered through the Online Psychotherapy Tool, a secure, cloud-based, digital mental health platform. Participants will be offered a 9-week electronically delivered cognitive behavioral therapy program that is tailored to address mental health problems in the context of the COVID-19 pandemic. This program will involve weekly self-guided educational material that provides an overview of behavioral skills and weekly homework. Participants (N=80) will receive personalized feedback from and weekly interaction with a therapist throughout the course of the program. The efficacy of the program will be evaluated using clinically validated symptomology questionnaires, which are to be completed by participants at baseline, week 5, and posttreatment. Inclusion criteria includes the capacity to consent; a primary diagnosis of generalized anxiety disorder or major depressive disorder, with symptoms that started or worsened during the COVID-19 pandemic; the ability to speak and read English; and consistent and reliable access to the internet. Exclusion criteria includes active psychosis, acute mania, severe alcohol or substance use disorder, and active suicidal or homicidal ideation.


          This study received funding in May 2020. Ethics approval was received in June 2020. The recruitment of participants began in June 2020. Participant recruitment is being conducted via social media, web-based communities, and physician referrals. To date, 58 participants have been recruited (intervention group: n=35; control group: n=23). Data collection is expected to conclude by the end of 2020. Analyses (ie, linear regression analysis for continuous outcomes and binomial regression analysis for categorical outcomes) are expected to be completed by February 2021.


          If proven feasible, this care delivery method could increase care capacity by up to fourfold. The findings from this study can potentially influence clinical practices and policies and increase accessibility to care during the COVID-19 pandemic, without sacrificing the quality of care.

          Trial Registration

          ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/ct2/show/NCT04476667

          International Registered Report Identifier (IRRID)


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          Most cited references25

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          Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide

          Without a complete published description of interventions, clinicians and patients cannot reliably implement interventions that are shown to be useful, and other researchers cannot replicate or build on research findings. The quality of description of interventions in publications, however, is remarkably poor. To improve the completeness of reporting, and ultimately the replicability, of interventions, an international group of experts and stakeholders developed the Template for Intervention Description and Replication (TIDieR) checklist and guide. The process involved a literature review for relevant checklists and research, a Delphi survey of an international panel of experts to guide item selection, and a face to face panel meeting. The resultant 12 item TIDieR checklist (brief name, why, what (materials), what (procedure), who provided, how, where, when and how much, tailoring, modifications, how well (planned), how well (actual)) is an extension of the CONSORT 2010 statement (item 5) and the SPIRIT 2013 statement (item 11). While the emphasis of the checklist is on trials, the guidance is intended to apply across all evaluative study designs. This paper presents the TIDieR checklist and guide, with an explanation and elaboration for each item, and examples of good reporting. The TIDieR checklist and guide should improve the reporting of interventions and make it easier for authors to structure accounts of their interventions, reviewers and editors to assess the descriptions, and readers to use the information.
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            Internet-based and other computerized psychological treatments for adult depression: a meta-analysis.

            Computerized and, more recently, Internet-based treatments for depression have been developed and tested in controlled trials. The aim of this meta-analysis was to summarize the effects of these treatments and investigate characteristics of studies that may be related to the effects. In particular, the authors were interested in the role of personal support when completing a computerized treatment. Following a literature search and coding, the authors included 12 studies, with a total of 2446 participants. Ten of the 12 studies were delivered via the Internet. The mean effect size of the 15 comparisons between Internet-based and other computerized psychological treatments vs. control groups at posttest was d = 0.41 (95% confidence interval [CI]: 0.29-0.54). However, this estimate was moderated by a significant difference between supported (d = 0.61; 95% CI: 0.45-0.77) and unsupported (d = 0.25; 95% CI: 0.14-0.35) treatments. The authors conclude that although more studies are needed, Internet and other computerized treatments hold promise as potentially evidence-based treatments of depression.
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              Is Open Access

              Guidance for reporting intervention development studies in health research (GUIDED): an evidence-based consensus study

              Objective To improve the quality and consistency of intervention development reporting in health research. Design This was a consensus exercise consisting of two simultaneous and identical three-round e-Delphi studies (one with experts in intervention development and one with wider stakeholders including funders, journal editors and public involvement members), followed by a consensus workshop. Delphi items were systematically derived from two preceding systematic reviews and a qualitative interview study. Participants Intervention developers (n=26) and wider stakeholders (n=18) from the UK, North America and Europe participated in separate e-Delphi studies. Intervention developers (n=13) and wider stakeholders (n=13) participated in a 1-day consensus workshop. Results e-Delphi participants achieved consensus on 15 reporting items. Following feedback from the consensus meeting, the final inclusion and wording of 14 items with description and explanations for each item were agreed. Items focus on context, purpose, target population, approaches, evidence, theory, guiding principles, stakeholder contribution, changes in content or format during the development process, required changes for subgroups, continuing uncertainties, and open access publication. They form the GUIDED (GUIDance for the rEporting of intervention Development) checklist, which contains a description and explanation of each item, alongside examples of good reporting. Conclusions Consensus-based reporting guidance for intervention development in health research is now available for publishers and researchers to use. GUIDED has the potential to lead to greater transparency, and enhance quality and improve learning about intervention development research and practice.

                Author and article information

                JMIR Res Protoc
                JMIR Res Protoc
                JMIR Research Protocols
                JMIR Publications (Toronto, Canada )
                December 2020
                18 December 2020
                18 December 2020
                : 9
                : 12
                : e24913
                [1 ] Department of Psychiatry Faculty of Health Sciences Queen's University Kingston, ON Canada
                [2 ] Centre for Neuroscience Studies Faculty of Health Sciences Queen's University Kingston, ON Canada
                [3 ] School of Rehabilitation Therapy Faculty of Health Sciences Queen's University Kingston, ON Canada
                [4 ] Centre for Behavioural Studies St. Lawrence College Kingston, ON Canada
                [5 ] OPTT Inc Digital Media Zone Ryerson University Toronto, ON Canada
                [6 ] Kingston Health Sciences Centre Kingston, ON Canada
                [7 ] Inpatient Psychiatry Unit Kingston General Hospital Kingston Health Science Centre Kingston, ON Canada
                Author notes
                Corresponding Author: Nazanin Alavi nazanin.alavitabari@ 123456kingstonhsc.ca
                Author information
                ©Nazanin Alavi, Megan Yang, Callum Stephenson, Niloofar Nikjoo, Niloufar Malakouti, Gina Layzell, Jasleen Jagayat, Amirhossein Shirazi, Dianne Groll, Mohsen Omrani, Anne O'Riordan, Sarosh Khalid-Khan, Rafael Freire, Elisa Brietzke, Fabiano Alves Gomes, Roumen Milev, Claudio N Soares. Originally published in JMIR Research Protocols (http://www.researchprotocols.org), 18.12.2020.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Research Protocols, is properly cited. The complete bibliographic information, a link to the original publication on http://www.researchprotocols.org, as well as this copyright and license information must be included.

                : 22 October 2020
                : 8 November 2020
                : 30 November 2020
                : 3 December 2020

                mental health,covid-19,depression,anxiety,psychotherapy,cognitive behavioural therapy,online,internet,electronic,mental health care


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