Internet-delivered interventions for people with depression and anxiety in IAPT services

INTERVENTION: Post diagnostic assessment participants will be randomised to either the immediate treatment (depression or anxiety) or a waiting list control group using random permuted blocks using block sizes of 9 and including stratification within a 2:1 ratio between treatment groups – depression and anxiety ‐ and the waiting list control group. Immediate treatment group: Participants will be assigned to either the Space from Deopression or the Space from Anxiety interventions and they will be encouraged to use the intervention over 8 weeks and they will receive up to 6 online reviews from their clinician supporter over that time. Data will be collected at baseline, continuously at each session, at 8 weeks and at 3, 6, 9 and 12 months follow‐up. Space from Depression The online intervention ‘Space from Depression’ is a seven‐module online CBT‐based intervention for depression, delivered on a Web 2.0 platform using media‐rich interactive content. Programme content is delivered in a non‐linear fashion. Each module takes roughly 1 hour to complete and it is recommended one module be completed per week. The structure and content of the programme modules follow evidence‐based CBT principles. The treatment is comprised of established cognitive and behavioural components including self‐monitoring, self‐control desensitization, gradual stimulus control, thought recording, behavioural activation, cognitive restructuring, relaxation training and challenging core beliefs. Each module is structured to incorporate introductory quizzes, videos, informational content, interactive activities, as well as homework suggestions and summaries. In addition, personal stories and accounts from other users are incorporated into the presentation of the material. The intervention follows NICE guidelines for the treatment of depression and the intervention has been tested and proved efficacious (National Institute for Clinical Excellence, 2009; National Institute for Health and Clinical Excellence, 20 CONDITION: Depression and anxiety disorders ; Mental and Behavioural Disorders ; Depression and anxiety disorders PRIMARY OUTCOME: 1. Depression is assessed using the Patient Health Questionnaire‐9 (PHQ‐9) at baseline, throughout treatment, at 8 weeks and at 3, 6, 9 and 12 months follow‐up; 2. Anxiety is assessed using the Generalized Anxiety Disorder‐7 (GAD‐7) at baseline, throughout treatment, at 8 weeks and at 3, 6, 9 and 12 months follow‐up INCLUSION CRITERIA: 1. A score of = 9 on PHQ‐9 and/ or a score of = 8 on GAD‐7 2. 18 years of age 3. Suitable for an internet‐delivered intervention (iCBT) 4. Users of the Berkshire NHS Trust IAPT Talking Therapies Step 2 services SECONDARY OUTCOME: 1. Diagnosis of depression or anxiety for research purposes will be established using the M.I.N.I. International Neuropsychiatric Interview 7.0 (MINI) at baseline and 3 months follow‐up; 2. Work and social adjustment is assessed using the Work and Social Adjustment (WASA)at baseline, throughout treatment, at 8 weeks and at 3, 6, 9 and 12 months follow‐up; 3. Social Anxiety is assessed using the Social Phobia Inventory (SPIN)at baseline, throughout treatment, at 8 weeks and at 3, 6, 9 and 12 months follow‐up; 4. Health Anxiety is assessed using the Short Health Anxiety Inventory (HAI) at baseline, throughout treatment, at 8 weeks and at 3, 6, 9 and 12 months follow‐up; 5. Panic is assessed using the Panic Disorder Severity Scale‐Self Report (PDSS‐SR)at baseline, throughout treatment, at 8 weeks and at 3, 6, 9 and 12 months follow‐up; 6. GAD symptoms are assessed using the Penn State Worry Questionnaire (PSWQ) at baseline, throughout treatment, at 8 weeks and at 3, 6, 9 and 12 months follow‐up; 7. Quality of life for users of mental health services is assessed using the Recovering Quality of Life scale (ReQoL)at baseline, throughout treatment, at 8 weeks and at 3, 6, 9 and 12 months follow‐up; 8. Client service usage is assessed using the Client Service Receipt Inventory (CSRI)at baseline, throughout treatment, at 8 weeks and at 6, 9 and 12 months follow‐up; 9. Emotion regulation is assessed using the Emotion Regulation Questionnaire (ERQ) at baseline and at 8 weeks; 10. Rumination is assessed using the Positive Beliefs about Depressive Rumination Scale – adapted (PBRS‐A) version at baseline and 8 weeks; 11. Therapeutic Expectancy is assessed using the Expectancy and Credibility Questionnaire (ECQ) for the treatment group at baseline, 4 and 8 weeks; 12. Therapeutic Alliance for patients is assessed using the Scale to Assess Therapeutic Relationships – Patient Version (STAR‐P) throughout treatment; 13. Therapeutic Alliance for clinicians is assessed using the Scale to Assess Therapeutic Relationships – Clinician Version (STAR‐C) each time they review a patient and using semi‐structured interview with clinicians.; 14. CBT Skills is assessed using the Frequency of Actions and Thoughts Scale (FATS) at 3, 6, 9 and 12 months follow‐up; 15. Therapist behaviours are assessed by clinicians using the therapist behaviours checklist throughout treatment