McKeown, A.; Potts, H.W.W.; (2009) Computerised cognitive-behavioural therapy for prevention and early intervention in anxiety and depression: a case study of Xanthis. In: Eysenbach, G., (ed.) Medicine 2.0 Proceedings: Volume 2. (pp. p. 22). Centre for Global eHealth Innovation: Toronto, Canada.

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Abstract

Introduction: Mental health issues such as anxiety and depression are a leading cause of morbidity and a huge public health cost. Prevention and early treatment are effective, but are difficult to deliver in traditional forms to large populations. Internet-delivered approaches, such as computerised CBT (cCBT), appear promising as a cost-effective way of reaching populations for what are sensitive and stigmatised conditions. However, there are challenges to achieving this within a viable financial model. Objective: Explore the use of cCBT in sub-clinical or preventative care, within a work-based delivery model. Method: A realist methodology was adopted for a programme of research as it provides a flexible and pluralistic approach to deconstructing complex interventions. This included: a systematic literature review on cCBT in a preventative context; and data collected around use of Xanthis, a commercial sub-clinical cCBT package. Xanthis was made available to all employees, accessible over the Internet, in three large, UK, public sector organisations: Dyfed-Powys Police, Cardiff University and Oxford University. Its use was tied into Occupational Health/Human Resources policies. User numbers were monitored. Interviews were conducted with purchasers of the package. At Dyfed-Powys Police, a before/after questionnaire was conducted on users. Results: The literature on cCBT in prevention and early treatment is heterogeneous. Five papers specifically considered cCBT in the prevention of depression and anxiety, showing mixed results. There were further papers on cCBT as a community-based, sub-clinical treatment rather than specifically as prevention. These vary in terms of method, cCBT package, population and conditions treated. Outcomes were generally positive. Research was mostly on high risk groups rather than the general population. Terminology and definitions varied between and within papers. Attrition rates remain high in internet-based spontaneous self help. Xanthis user numbers peaked after launch in all organisations before settling at 5-10% staff. Users find the tool a useful support and like that it is confidential, accessible, increases knowledge and understanding about problems, and links to sources of help. However, there were many problems associated with the implementation and launch of the tool. Different organisations sought to use Xanthis in different ways and in conjunction with other activity. How the tool was promoted internally was critical. Commercialisation was constrained by the resources typically devoted to Occupational Health. Conclusion: cCBT in prevention and early management of mental illness is a new but promising field. Technology offers a new delivery platform for reaching individuals at different illness stages, confidentially and accessibly. cCBT can reduce symptoms in sub-clinical populations, including spontaneous Internet users, but adherence and attrition rates are a challenge. The financing and implementation of sub-clinical cCBT packages must be researched, including determining which are suitable for use in different user populations and circumstances. Packages such as Xanthis have potential for use within sub-clinical care in a variety of contexts, but there are challenges in its commercialisation, delivery and use within a work-based delivery model which must be overcome.

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