Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial

Blake F. Dear; Judy B. Zou; Shehzad Ali; Carolyn N. Lorian; Luke Johnston; Joanne Sheehan; Lauren G. Staples; Milena Gandy; Vincent J. Fogliati; Britt Klein; Nickolai Titov

doi:10.1016/j.beth.2014.09.007

Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial

Blake F. Dear^*, Judy B. Zou, Shehzad Ali, Carolyn N. Lorian, Luke Johnston, Joanne Sheehan, Lauren G. Staples, Milena Gandy, Vincent J. Fogliati, Britt Klein, Nickolai Titov

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

87 Citations (Scopus)

Abstract

There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60. years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n= 35) or the waitlist control group (n= 37). The online treatment course was delivered over 8. weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8. weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=. 1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=. 1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs. =. 0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety.

Original language	English
Pages (from-to)	206-217
Number of pages	12
Journal	Behavior Therapy
Volume	46
Issue number	2
DOIs	https://doi.org/10.1016/j.beth.2014.09.007
Publication status	Published - 1 Mar 2015
Externally published	Yes

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Dear, B. F., Zou, J. B., Ali, S., Lorian, C. N., Johnston, L., Sheehan, J., Staples, L. G., Gandy, M., Fogliati, V. J., Klein, B., & Titov, N. (2015). Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial. Behavior Therapy, 46(2), 206-217. https://doi.org/10.1016/j.beth.2014.09.007

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title = "Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial",

abstract = "There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60. years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n= 35) or the waitlist control group (n= 37). The online treatment course was delivered over 8. weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8. weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=. 1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=. 1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs. =. 0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety.",

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author = "Dear, {Blake F.} and Zou, {Judy B.} and Shehzad Ali and Lorian, {Carolyn N.} and Luke Johnston and Joanne Sheehan and Staples, {Lauren G.} and Milena Gandy and Fogliati, {Vincent J.} and Britt Klein and Nickolai Titov",

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doi = "10.1016/j.beth.2014.09.007",

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Dear, BF, Zou, JB, Ali, S, Lorian, CN, Johnston, L, Sheehan, J, Staples, LG, Gandy, M, Fogliati, VJ, Klein, B & Titov, N 2015, 'Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial', Behavior Therapy, vol. 46, no. 2, pp. 206-217. https://doi.org/10.1016/j.beth.2014.09.007

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T1 - Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety

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AU - Zou, Judy B.

AU - Ali, Shehzad

AU - Lorian, Carolyn N.

AU - Johnston, Luke

AU - Sheehan, Joanne

AU - Staples, Lauren G.

AU - Gandy, Milena

AU - Fogliati, Vincent J.

AU - Klein, Britt

AU - Titov, Nickolai

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N2 - There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60. years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n= 35) or the waitlist control group (n= 37). The online treatment course was delivered over 8. weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8. weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=. 1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=. 1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs. =. 0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety.

AB - There is preliminary support for internet-delivered cognitive behaviour therapy (iCBT) as a way of improving access to treatment among older adults with anxiety. The aim of this randomized controlled trial (RCT) was to examine the efficacy, long-term outcomes, and cost-effectiveness of an iCBT program for adults over 60. years of age with anxiety. Successful applicants were randomly allocated to either the treatment group (n= 35) or the waitlist control group (n= 37). The online treatment course was delivered over 8. weeks and provided with brief weekly contact with a clinical psychologist via telephone or secure email. Eighty-four percent of participants completed the iCBT course within the 8. weeks and 90% provided data at posttreatment. Significantly lower scores on measures of anxiety (Cohen's d=. 1.43; 95% CI: 0.89 - 1.93) and depression (Cohen's d=. 1.79; 95% CI: 1.21 - 2.32) were found among the treatment group compared to the control group at posttreatment. These lower scores were maintained at 3-month and 12-month follow-up and the treatment group rated the iCBT treatment as acceptable. The treatment group had slightly higher costs ($92.2; 95% CI: $38.7 to $149.2) and Quality-Adjusted Life-Years (QALYs. =. 0.010; 95% CI: 0.003 to 0.018) than the control group at posttreatment and the intervention was found to have a greater than 95% probability of being cost-effective. The results support iCBT as an efficacious and cost-effective treatment option for older adults with symptoms of anxiety.

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KW - Internet

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IS - 2

ER -

Clinical and Cost-Effectiveness of Therapist-Guided Internet-Delivered Cognitive Behavior Therapy for Older Adults With Symptoms of Anxiety: A Randomized Controlled Trial

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