Online cognitive behavioral therapy among people with chronic health conditions Original paper

In this randomized controlled trial, an online cognitive behavioral therapy program that combined self-directed modules and therapist support sessions reduced anxiety and depression among participants with chronic physical health conditions.

The effects of online cognitive behavioral therapy CBT on depression and anxiety among adults with chronic physical health conditions.

The primary outcome was anxiety and depression, as measured using the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS).

The secondary outcomes included alternate measures of anxiety and depression (General Anxiety Disorder Scale and Patient Health Questionnaire-9), as well as functional impairment on the Work and Social Functioning Scale. Health-related quality of life was assessed using the European Quality of Life-5D questionnaire.

Distress related to COVID-19 was also assessed, as well as knowledge and confidence regarding health management (measured using the Illness Perception Questionnaire and Patient Activation Measure).

194 British adults (average age of 41; 153 women and 40 men) with chronic health conditions (inflammatory bowel disease, chronic kidney disease, multiple sclerosis, or psoriasis). The participants were recruited through charities related to their conditions in the United Kingdom.

During this 12-week randomized controlled trial, all participants received standard support through charities related to their conditions. Half of the participants received access to the online CBT platform COMPASS LTC.

The CBT program included a personalized welcome message, 5 support calls with psychologists (30-minute durations), and access to 11 treatment modules. The modules covered topics such as self-compassion, symptom management, and coping strategies.

Assessments were completed at baseline, 6 weeks, and 12 weeks.

Overall PHQ scores (combined anxiety and depression severity) were reduced with CBT after 6 and 12 months in comparison with the control group, with a moderate effect size. The alternate measures of anxiety and depression were also improved with CBT, as were overall functioning, health-related quality of life, and illness-related distress.

Scores of COVID-related distress were improved with CBT at 6 weeks but not at 12 weeks. Scores of confidence regarding self-management did not differ between groups.

The CBT group participants reported a reduction in symptom severity related to their health conditions at 6 weeks in comparison with the control group, but no differences were observed at 12 weeks.