Friday, 18 September 2015

ClinicSpeak: online CBT to treat depression

Are you ready for the digital disruption of healthcare? Treating depression. #ClinicSpeak #MSBlog #MSResearch

"Are you ready for the digital disruption of healthcare? I am. The study below shows that an online CBT (cognitive behavioural therapy) programme was effect in treating MSers with depression. If this programme was widely available would you be up for an online screening questionnaire to see if you were depressed and if you were you would offered the option of enrolling on the online CBT programme? I am sure this is the future of healthcare in the digital age. Some of you may find an online consult more helpful than seeing your GP, neurologist or nurse specialist; surveys on this blog have shown how poorly we screen for and manage hidden symptoms in MS. What you also have to realise is that as online avatars get smarter, and more emotionally intelligent, they will start to compete with humans. Nobody's job is safe! Have seen the online footage of a robot giving elderly Japanese residents in a care home an exercise class? Quite amazing and more importantly the residents are engaged and seem to love their robotic aerobics teacher. I can only imagine how this is going to disrupt healthcare; the problem is that most healthcare professionals have their heads in the sand and are oblivious to the change that is coming."

Microsoft's Cortana - would you trust her to treat your depression?

"If you are interested in reading about the rise of artificial intelligence I would recommend the following article in the Economist: 'Artificial intelligence - Rise of the machines. May 9th 2015'."

Fischer et al. An online programme to reduce depression in patients with multiple sclerosis: a randomised controlled trial. Lancet Psychiatry. 2015 Mar;2(3):217-223.

BACKGROUND: With a lifetime risk for major depressive disorder of up to 50%, depression is a common comorbidity in multiple sclerosis but remains widely underdiagnosed and untreated. We investigated the potential of a fully automated, internet-based, cognitive behavioural therapy programme, Deprexis, to reduce depressive symptoms in patients with multiple sclerosis.


METHODS: For this randomised controlled trial, we recruited patients from an outpatient clinic in Hamburg, Germany. Patients aged 18-65 years were eligible for inclusion if they had multiple sclerosis and self-reported depressive symptoms. By use of a computer-generated randomisation sequence, we allocated 90 patients (1:1; no blocking or stratification) to either the intervention group or a waitlist control group for 9 weeks. The primary endpoint was the Beck Depression Inventory (BDI), as assessed by an intention-to-treat analysis. This trial is registered with ClinicalTrials.gov, number NCT01663649.

FINDINGS: 71 patients completed the trial: 35 patients in the intervention group and 36 patients in the control group. During the intervention, BDI scores decreased in the Deprexis group and increased in the control group, yielding a positive effect of Deprexis relative to the waitlist group (mean group difference -4·02 points [95% CI -7·26 to -0·79], p=0·015, effect size d=0·53). Worsening of depressive symptoms from below to above the clinical cutoff (BDI >13) occurred in three (7%) of 45 patients in the control group and no patients in the Deprexis group. We noted no adverse events with respect to new occurrence of suicidal ideation during the trial. 

INTERPRETATION: Psychological online-intervention programmes could be suitable for patients with multiple sclerosis who are unable to regularly attend therapeutic sessions because of mobility impairments

6 comments:

  1. Given some of the offhand, dismissive GPs that I have seen in the past, this seems like a pretty good idea: Better a robot than a stressed, grumpy doctor.

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  2. Analyzing coldly think a great idea yes, depression is such an invisible disease and MS, people who live with someone with depression often fail to understand the mechanism of disease, I think to be "fresh" ... It is a serious disease , silent and debilitating ... Coincidence or not the blog address this alternative treatment of depression by artificial intelligence when I received this morning the sad news that a little life my committed suicide because of severe depression which faced years ... :(((

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  3. "Psychological online-intervention programmes could be suitable for patients with multiple sclerosis who are unable to regularly attend therapeutic sessions because of mobility impairments"
    Given isolation is often a contributing factor for depression I have my doubts how effective this would be.
    That said in all my dealings with HP's the focus has followed a medical model.

    There doesn't seem time to explore the social / emotional impact of living with MS despite the potential for depression and anxiety to be more disabling than the disease itself. In my area the waiting list for NHS counselling / therapy is 12 months. In the end I forked out £80 per 50 minutes for counselling. MS is an expensive disease.

    I didn't need CBT, just simple human kindness / company and space to talk about my fears.

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  4. CBT and counselling are different. Counselling is more the therapist is listening and the service user is talking about their experience and feelings.

    There are different CBT types, low and high impact, CBT is more about being proactive and having strategies in place for now and the in the future.

    I've had all these over the years and high impact CBT has been the best. If the online intervention is high impact CBT and not counselling then I would use it.

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  5. This online therapy worked for people who engage with internet based solutions... Self selected group?

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  6. Talk to the electronic hand cos the human face ain't funded
    (btw, I like the irony of being asked if I'm a robot before posting this comment)

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