Efficacy of an Electronic Cognitive Behavioral Therapy Program Delivered via the Online Psychotherapy Tool for Depression and Anxiety Related to the COVID-19 Pandemic: Pre-Post Pilot Study

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Abstract

Background

Lockdowns and social distancing resulting from the COVID-19 pandemic have worsened the population’s mental health and made it more difficult for individuals to receive care. Electronic cognitive behavioral therapy (e-CBT) is a cost-effective and evidence-based treatment for anxiety and depression and can be accessed remotely.

Objective

The objective of the study was to investigate the efficacy of online psychotherapy tailored to depression and anxiety symptoms during the pandemic.

Methods

The pilot study used a pre-post design to evaluate the efficacy of a 9-week e-CBT program designed for individuals with depression and anxiety affected by the pandemic. Participants were adults (N=59) diagnosed with major depressive disorder and generalized anxiety disorder, whose mental health symptoms initiated or worsened during the COVID-19 pandemic. The online psychotherapy program focused on teaching coping, mindfulness, and problem-solving skills. Symptoms of anxiety and depression, resilience, and quality of life were assessed.

Results

Participants demonstrated significant improvements in symptoms of anxiety ( P=.02) and depression ( P=.03) after the intervention. Similar trends were observed in the intention-to-treat analysis. No significant differences were observed in resilience and quality-of-life measures. The sample comprised mostly females, making it challenging to discern the benefits of the intervention in males. Although a pre-post design is less rigorous than a controlled trial, this design was selected to observe changes in scores during a critical period.

Conclusions

e-CBT for COVID-19 is an effective and accessible treatment option. Improvements in clinical symptoms of anxiety and depression can be observed in individuals whose mental health is affected by the COVID-19 pandemic.

Trial Registration

ClinicalTrials.gov NCT04476667; https://clinicaltrials.gov/study/NCT04476667

International Registered Report Identifier (IRRID)

RR2-10.2196/24913

Related collections

Most cited references 48

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Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis

Nader Salari, Amin Hosseinian-Far, Rostam Jalali … (2020)

Background The COVID-19 pandemic has had a significant impact on public mental health. Therefore, monitoring and oversight of the population mental health during crises such as a panedmic is an immediate priority. The aim of this study is to analyze the existing research works and findings in relation to the prevalence of stress, anxiety and depression in the general population during the COVID-19 pandemic. Method In this systematic review and meta-analysis, articles that have focused on stress and anxiety prevalence among the general population during the COVID-19 pandemic were searched in the Science Direct, Embase, Scopus, PubMed, Web of Science (ISI) and Google Scholar databases, without a lower time limit and until May 2020. In order to perform a meta-analysis of the collected studies, the random effects model was used, and the heterogeneity of studies was investigated using the I2 index. Moreover. data analysis was conducted using the Comprehensive Meta-Analysis (CMA) software. Results The prevalence of stress in 5 studies with a total sample size of 9074 is obtained as 29.6% (95% confidence limit: 24.3–35.4), the prevalence of anxiety in 17 studies with a sample size of 63,439 as 31.9% (95% confidence interval: 27.5–36.7), and the prevalence of depression in 14 studies with a sample size of 44,531 people as 33.7% (95% confidence interval: 27.5–40.6). Conclusion COVID-19 not only causes physical health concerns but also results in a number of psychological disorders. The spread of the new coronavirus can impact the mental health of people in different communities. Thus, it is essential to preserve the mental health of individuals and to develop psychological interventions that can improve the mental health of vulnerable groups during the COVID-19 pandemic.

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Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population.

Bernd Löwe, Oliver Decker, Stefanie H. Müller … (2008)

The 7-item Generalized Anxiety Disorder Scale (GAD-7) is a practical self-report anxiety questionnaire that proved valid in primary care. However, the GAD-7 was not yet validated in the general population and thus far, normative data are not available. To investigate reliability, construct validity, and factorial validity of the GAD-7 in the general population and to generate normative data. Nationally representative face-to-face household survey conducted in Germany between May 5 and June 8, 2006. Five thousand thirty subjects (53.6% female) with a mean age (SD) of 48.4 (18.0) years. The survey questionnaire included the GAD-7, the 2-item depression module from the Patient Health Questionnaire (PHQ-2), the Rosenberg Self-Esteem Scale, and demographic characteristics. Confirmatory factor analyses substantiated the 1-dimensional structure of the GAD-7 and its factorial invariance for gender and age. Internal consistency was identical across all subgroups (alpha = 0.89). Intercorrelations with the PHQ-2 and the Rosenberg Self-Esteem Scale were r = 0.64 (P < 0.001) and r = -0.43 (P < 0.001), respectively. As expected, women had significantly higher mean (SD) GAD-7 anxiety scores compared with men [3.2 (3.5) vs. 2.7 (3.2); P < 0.001]. Normative data for the GAD-7 were generated for both genders and different age levels. Approximately 5% of subjects had GAD-7 scores of 10 or greater, and 1% had GAD-7 scores of 15 or greater. Evidence supports reliability and validity of the GAD-7 as a measure of anxiety in the general population. The normative data provided in this study can be used to compare a subject's GAD-7 score with those determined from a general population reference group.

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Accuracy of Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression: individual participant data meta-analysis

Brooke Levis, Andrea Benedetti, Brett D. Thombs (2019)

Abstract Objective To determine the accuracy of the Patient Health Questionnaire-9 (PHQ-9) for screening to detect major depression. Design Individual participant data meta-analysis. Data sources Medline, Medline In-Process and Other Non-Indexed Citations, PsycINFO, and Web of Science (January 2000-February 2015). Inclusion criteria Eligible studies compared PHQ-9 scores with major depression diagnoses from validated diagnostic interviews. Primary study data and study level data extracted from primary reports were synthesized. For PHQ-9 cut-off scores 5-15, bivariate random effects meta-analysis was used to estimate pooled sensitivity and specificity, separately, among studies that used semistructured diagnostic interviews, which are designed for administration by clinicians; fully structured interviews, which are designed for lay administration; and the Mini International Neuropsychiatric (MINI) diagnostic interviews, a brief fully structured interview. Sensitivity and specificity were examined among participant subgroups and, separately, using meta-regression, considering all subgroup variables in a single model. Results Data were obtained for 58 of 72 eligible studies (total n=17 357; major depression cases n=2312). Combined sensitivity and specificity was maximized at a cut-off score of 10 or above among studies using a semistructured interview (29 studies, 6725 participants; sensitivity 0.88, 95% confidence interval 0.83 to 0.92; specificity 0.85, 0.82 to 0.88). Across cut-off scores 5-15, sensitivity with semistructured interviews was 5-22% higher than for fully structured interviews (MINI excluded; 14 studies, 7680 participants) and 2-15% higher than for the MINI (15 studies, 2952 participants). Specificity was similar across diagnostic interviews. The PHQ-9 seems to be similarly sensitive but may be less specific for younger patients than for older patients; a cut-off score of 10 or above can be used regardless of age.. Conclusions PHQ-9 sensitivity compared with semistructured diagnostic interviews was greater than in previous conventional meta-analyses that combined reference standards. A cut-off score of 10 or above maximized combined sensitivity and specificity overall and for subgroups. Registration PROSPERO CRD42014010673.

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Author and article information

Contributors

Nazanin Alavi:

ORCID: https://orcid.org/0000-0001-8710-6067

Department of PsychiatryFaculty of Health SciencesQueen's University166 Brock StreetKingston, ON, K7L 5G23Canada1 61354496661 6135443310nazanin.alavitabari@kingstonhsc.ca

Journal

Journal ID (nlm-ta): JMIR Ment Health

Journal ID (iso-abbrev): JMIR Ment Health

Journal ID (publisher-id): JMH

Title: JMIR Mental Health

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Electronic): 2368-7959

Publication date Collection: 2023

Publication date (Electronic): 25 December 2023

Volume: 10

Electronic Location Identifier: e51102

Affiliations

[1 ] Department of Psychiatry Faculty of Health Sciences Queen's University Kingston, ON Canada

[2 ] School of Rehabilitation Therapy Queen's University Kingston, ON Canada

[3 ] Centre for Neuroscience Studies Queen's University Kingston, ON Canada

[4 ] Patient and Family Centered Care Kingston Health Sciences Centre Kingston, ON Canada

[5 ] OPTT Inc Toronto, ON Canada

Author notes

Corresponding Author: Nazanin Alavi nazanin.alavitabari@ 123456kingstonhsc.ca

Author information

Elnaz Moghimi https://orcid.org/0000-0002-1010-284X

Callum Stephenson https://orcid.org/0000-0002-7929-1546

Anika Agarwal https://orcid.org/0000-0003-1350-9212

Niloofar Nikjoo https://orcid.org/0000-0002-2137-5878

Niloufar Malakouti https://orcid.org/0000-0001-9752-8597

Gina Layzell https://orcid.org/0000-0001-8102-5442

Anne O'Riordan https://orcid.org/0000-0002-1095-9683

Jasleen Jagayat https://orcid.org/0000-0002-1709-0773

Amirhossein Shirazi https://orcid.org/0000-0002-8586-3707

Gilmar Gutierrez https://orcid.org/0000-0003-0337-3737

Ferwa Khan https://orcid.org/0009-0007-4112-9803

Charmy Patel https://orcid.org/0009-0005-2915-303X

Megan Yang https://orcid.org/0000-0001-6365-2039

Mohsen Omrani https://orcid.org/0000-0002-0461-1947

Nazanin Alavi https://orcid.org/0000-0001-8710-6067

Article

Publisher ID: v10i1e51102

DOI: 10.2196/51102

PMC ID: 10760511

PubMed ID: 37993984

SO-VID: c715469d-c6cb-4ce2-b220-7246db39da74

Copyright © ©Elnaz Moghimi, Callum Stephenson, Anika Agarwal, Niloofar Nikjoo, Niloufar Malakouti, Gina Layzell, Anne O'Riordan, Jasleen Jagayat, Amirhossein Shirazi, Gilmar Gutierrez, Ferwa Khan, Charmy Patel, Megan Yang, Mohsen Omrani, Nazanin Alavi. Originally published in JMIR Mental Health (https://mental.jmir.org), 25.12.2023.

License:

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 Mental Health, is properly cited. The complete bibliographic information, a link to the original publication on https://mental.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 20 July 2023

Date revision requested : 17 November 2023

Date revision received : 17 November 2023

Date accepted : 21 November 2023

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