Online Cognitive Behavioural Therapy (CBT) versus mindfulness for depression and anxiety: a randomised controlled trial

INTERVENTION: The internet‐delivered Cognitive Behavioural Therapy Program comprises 6 lessons completed over 10 weeks. It comprises psychoeducation about depression and anxeity as well as CBT techniques including thought challenging, behavioural activation, graded exposure and relapse prevention. One lesson will be released every 7 days (it will become available after the preceding lesson has been completed, with a minimum of 5 days between lessons), with each participant taking between one and two weeks to each lesson (10 weeks in total). Each lesson will take approximately 30‐40 minutes to complete. Participants will have access to summaries of each lesson, homework exercises, extra resources, for each lesson. Participants are advised to spend at least 3‐4 hours per week working through the lesson material, revisiting the content and homework tasks/ practicing the skills. Clinician guidance will be provided in the form of email or phone contact from the clinician (registered clinical psychologist) after completion of the first two lessons, then as required. The participant is able to email or phone the clinician at any point during the trial. The participant completes a measure of psychological distress before each lesson and if their scores increase by one or more standard deviations, the clinician is automatically alerted and initiates contact with the participant by phone or email. This mode of contact is dependent on what is clinically indicated in terms of the participant's distress score and or what the participant may have communicated (in the form of phone or email contact) to the clinician. The mode of contact (email or phone or both) therefore is dependent on the clinician's clinical judgement of the situation in hand. Strategies used to improved adherence to intervention protocols and procedures for monitoring adherence include: automated email reminders, monitoring the downloading of homework, collection of data on how long participants spent reading lessons and practicing skills. CONDITION: Agoraphobia Generalised anxiety disorder Major Depressive Disorder Obsessive Compulsive Disorder Panic disorder Social anxiety disorder PRIMARY OUTCOME: Changes in anxiety symptoms according to mean scores on the Generalised Anxiety Disorder 7‐item scale (GAD‐7). Changes in depression symptoms (according to mean scores on the Patient Health Questionnaire (PHQ‐9) SECONDARY OUTCOME: Adherence, according to the number of lessons completed, and the number who complete 100% of the complete 6‐lesson program within the 10‐week treatment period. Changes in in functional impairment and disability according to mean scores on the Work and Social Adjustment Scale (WSAS) Changes in mindfulness according to mean scores on the Five‐Factor Mindfulness Questionnaire (FFMQ) Changes in psychological distress according to mean scores on the Kessler‐10 (K10). Changes in self compassion according to the Self Compassion scale ‐ short form. Treatment Satisfaction according to the scores on the Treatment Satisfaction Questionnaire. INCLUSION CRITERIA: * Self‐identified as experiencing depression and/or anxiety. * Meet criteria for one or more of the following diagnoses: Major Depressive Disprder (MDD), Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), Panic Disorder (PD), Agoraphobia (AG), or Obsessive‐Compulsive Disorder (OCD) according to the ADIS‐5 for DSM‐5. * Australian resident status * At least 18 years of age * Access to a computer, printer, and the internet * If taking medication, must have been taking the same dose for at least 2 months and not intend to change that dose during the course of the program. * Prepared to provide name, phone number, and address, and to provide the name and phone number of a local general practitioner. * Willing to provide informed consent.