Acceptability and Effectiveness of NHS-Recommended e-Therapies for Depression, Anxiety, and Stress: Meta-Analysis: Simmonds-Buckley 2020

[Sly Saint]

ABSTRACT
Background: There is a disconnect between the ability to swiftly develop e-therapies for the treatment of depression, anxiety, and stress, and the scrupulous evaluation of their clinical utility. This creates a risk that the e-therapies routinely provided within publicly funded psychological health care have evaded appropriate rigorous evaluation in their development.

Objective: This study aims to conduct a meta-analytic review of the gold standard evidence of the acceptability and clinical effectiveness of e-therapies recommended for use in the National Health Service (NHS) in the United Kingdom.

Methods: Systematic searches identified appropriate randomized controlled trials (RCTs). Depression, anxiety, and stress outcomes at the end of treatment and follow-up were synthesized using a random-effects meta-analysis. The grading of recommendations assessment, development, and evaluation approach was used to assess the quality of each meta-analytic comparison. Moderators of treatment effect were examined using subgroup and meta-regression analysis. Dropout rates for e-therapies (as a proxy for acceptability) were compared against controls.

Results: A total of 24 studies evaluating 7 of 48 NHS-recommended e-therapies were qualitatively and quantitatively synthesized. Depression, anxiety, and stress outcomes for e-therapies were superior to controls (depression: standardized mean difference [SMD] 0.38, 95% CI 0.24 to 0.52, N=7075; anxiety and stress: SMD 0.43, 95% CI 0.24 to 0.63, n=4863), and these small effects were maintained at follow-up. Average dropout rates for e-therapies (31%, SD 17.35) were significantly higher than those of controls (17%, SD 13.31). Limited moderators of the treatment effect were found.

Conclusions: Many NHS-recommended e-therapies have not been through an RCT-style evaluation. The e-therapies that have been appropriately evaluated generate small but significant, durable, beneficial treatment effects.

https://www.jmir.org/2020/10/e17049/

 

[Sly Saint]

eta:
hmm, says the person who has shares in said delivery system which avoids the need for RCTs, or produced on the back of mis-represented RCT results.....
see Mahana Therapeutics.

 

[rvallee]

The in-person therapies have no evidence of efficacy and are often found to be impertinent to the needs. The online versions carry this flaw with them, it's nothing to do with their delivery system. It's not a style problem, it's a substance problem, a complete lack thereof to be precise.

Billions have been wasted on this and the very best that's ever been achieved is small trivial and superficial "benefits" that always fail to have objective benefits. This is not an engagement failure, it's a technical and ethical failure. None of them are "durable", they literally all fail on follow-up. All of them. The complete lack of integrity needed to say otherwise is very much part of the reason for this disastrous failure.

 

[Invisible Woman]

Is psychology the only field where failure is rewarded with additional funds so you can fail all over again? And again. Ad nauseum.

 

[Sly Saint]

problem is not only with digital therapies:

Mental Health Sufferers Vote With Their Feet and Government Does Nothing At All

of those who undergo an initial assessment with the Improving Access to Psychological Therapies (IAPT) Service 40% do not go on to have treatment, and about the same proportion (42%) attend only one treatment session, according to a just published study by Davis A, Smith T, Talbot J, et al. Evid Based Ment Health 2020;23:8–14. doi:10.1136/ebmental-2019-300133.

These findings echo a study published last year by Moller et al (2019) https://doi.org/10.1186/s12888-019-2235-z, on a smaller sample, which suggested that 29% were non-starters and that the same proportion attended only one treatment session. Further scrutiny of the data reveals that about 3 out of 4 people drop out of treatment once begun.

from comments:

the Governments response is to fund it further for long term conditions – a pandemic of IAPTitis!

http://www.cbtwatch.com/mental-heal...-and-government-does-nothing-at-all/#comments

 

[rvallee]

Is psychology the only field where failure is rewarded with additional funds so you can fail all over again? And again. Ad nauseum.

Business. Politics.

That's it. Hardly coincidental that clinical psychology is heavily politicized and biased by ideology.

 

[Hutan]

problem is not only with digital therapies:

There's a thread for the first paper mentioned, with the astonishing statistics about patient dropout prior to and during the first two IAPT sessions, here:
Predicting patient engagement in IAPT services: a statistical analysis of electronic health records, 2019, Davis et al

And a thread for the second paper mentioned here:
The 2018 UK NHS Digital annual report on the Improving Access to Psychological Therapies programme: a brief commentary, 2019, Moller et al
This reported that most people referred to IAPT services were either not starting or dropping out before completing two sessions, and that there was no impact on employment rates.