Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr 5:28:100536.
doi: 10.1016/j.invent.2022.100536. eCollection 2022 Apr.

Component analysis of a synchronous and asynchronous blended care CBT intervention for symptoms of depression and anxiety: Pragmatic retrospective study

Anita Lungu  1 , Robert E Wickham  2 , Shih-Yin Chen  1 , Janie J Jun  1 , Yan Leykin  3 , Connie E-J Chen  1
Affiliations

Component analysis of a synchronous and asynchronous blended care CBT intervention for symptoms of depression and anxiety: Pragmatic retrospective study

Anita Lungu et al. Internet Interv. .

Abstract

Background: Depression and anxiety are leading causes of disability worldwide. Though effective treatments exist, depression and anxiety remain undertreated. Blended care psychotherapy, combining the scalability of online interventions with the personalization and engagement of a live therapist, is a promising approach for increasing access to evidence-based care.

Objectives: To evaluate the effectiveness and individual contribution of two components - i) digital tools and ii) video-based therapist-led sessions - in a blended care CBT-based intervention under real world conditions.

Methods: A retrospective cohort design was used to analyze N = 1372 US-based individuals who enrolled in blended care psychotherapy. Of these, at baseline, 761 participants had depression symptoms in the clinical range (based on PHQ-9), and 1254 had anxiety symptoms in the clinical range (based on GAD-7). Participants had access to the program as a mental health benefit offered by their employer. The CBT-based blended care psychotherapy program consisted of regular video sessions with therapists, complemented by digital lessons and digital exercises assigned by the clinician and completed in between sessions. Depression and anxiety levels and clients' treatment engagement were tracked throughout treatment. A 3-level individual growth curve model incorporating time-varying covariates was utilized to examine symptom trajectories of PHQ-9 scores (for those with clinical range of depression at baseline) and GAD-7 scores (for those with clinical range of anxiety at baseline).

Results: On average, individuals exhibited a significant decline in depression and anxiety symptoms during the initial weeks of treatment (P < .001), and a continued decline over subsequent weeks at a slower rate (P < .001). Engaging in a therapy session in a week was associated with lower GAD-7 (b = -0.81) and PHQ-9 (b = -1.01) scores in the same week, as well as lower GAD-7 (b = -0.58) and PHQ-9 (b = -0.58) scores the following week (all P < .01). Similarly, engaging with digital lessons was independently associated with lower GAD-7 (b = -0.19) and PHQ-9 (b = -0.18) scores during the same week, and lower GAD-7 (b = -0.25) and PHQ-9 (b = -0.27) the following week (all P < .01).

Conclusions: Therapist-led video sessions and digital lessons had separate contributions to improvements in symptoms of depression and anxiety over the course of treatment. Future research should investigate whether clients' characteristics are related to differential effects of therapist-led and digital components of care.

Keywords: Anxiety; Blended care psychotherapy; CBT/cognitive behavior therapy; Component analysis; Depression; Video psychotherapy.

PubMed Disclaimer

Conflict of interest statement

AL and SYC are employed by Lyra Health, receive income from Lyra Health, and have been granted equity in Lyra Health. JJ and CC are employed by Lyra Health and Lyra Clinical Associates, receive income from Lyra Health and Lyra Clinical Associates, and have been granted equity in Lyra Health. RW is a paid consultant for Lyra Health. YL has nothing to disclose.

Figures

Fig. 1
Fig. 1
Participant flow.
Fig. 2
Fig. 2
Completion of therapy sessions, digital exercises and lessons during BC-CBT (depression symptoms analysis).
Fig. 3
Fig. 3
Completion of therapy sessions, digital exercises and lessons during BC-CBT (anxiety symptoms analysis).
See this image and copyright information in PMC

References

    1. Andersson G., Cuijpers P. Internet-based and other computerized psychological treatments for adult depression: a meta-analysis. Cogn. Behav. Ther. 2009;38:196–205. doi: 10.1080/16506070903318960. - DOI - PubMed
    1. Andrews G., Basu A., Cuijpers P., Craske M.G., McEvoy P., English C.L., Newby J.M. Computer therapy for the anxiety and depression disorders is effective, acceptable and practical health care: an updated meta-analysis. J. Anxiety Disord. 2018;55:70–78. doi: 10.1016/j.janxdis.2018.01.001. - DOI - PubMed
    1. Barlow D.H., Farchione T.J., Sauer-Zavala S., Latin H.M., Ellard K.K., Bullis J.R., Bentley K.H., Boettcher H.T., Cassiello-Robbins C. Oxford University Press; 2017. Unified Protocol for Transdiagnostic Treatment of Emotional Disorders: Therapist Guide.
    1. Bates D., Mächler M., Bolker B., Walker S. Fitting linear mixed-effects models using lme4. J. Stat. Softw. 2015;67:1–48. doi: 10.18637/jss.v067.i01. - DOI
    1. Baumeister H., Bauereiss N., Zarski A.-C., Braun L., Buntrock C., Hoherz C., Idrees A.R., Kraft R., Meyer P., Nguyen T.B.D., Pryss R., Reichert M., Sextl T., Steinhoff M., Stenzel L., Steubl L., Terhorst Y., Titzler I., Ebert D.D. Clinical and cost-effectiveness of PSYCHOnlineTHERAPY: study protocol of a multicenter blended outpatient psychotherapy cluster randomized controlled trial for patients with depressive and anxiety disorders. Front. Psychiatry. 2021;12:656. doi: 10.3389/fpsyt.2021.660534. - DOI - PMC - PubMed