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Published Online: 1 July 2015

MindSpot Clinic: An Accessible, Efficient, and Effective Online Treatment Service for Anxiety and Depression

Nickolai Titov, Ph.D., Blake F. Dear, Ph.D., Lauren G. Staples, Ph.D., James Bennett-Levy, Ph.D., Britt Klein, B.A., D.Psych. (Clinical), Ronald M. Rapee, Ph.D., Clare Shann, … Show All … , David Richards, Ph.D., Gerhard Andersson, Ph.D., Lee Ritterband, Ph.D., Carol Purtell, Greg Bezuidenhout, Luke Johnston, Ph.D., and Olav B. Nielssen, M.B.B.S., Ph.D.Authors Info & Affiliations
Publication: Psychiatric Services
Volume 66, Number 10
https://doi.org/10.1176/appi.ps.201400477
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Abstract

Objective:

The main objective of this study was to report the feasibility of delivering online cognitive-behavioral therapy (iCBT) treatments for anxiety and depression in a national public mental health service.

Methods:

A prospective noncontrolled cohort study was conducted of all patients who began assessment or treatment at the MindSpot Clinic from January through December 2013. Clinic services were used by a representative cross-section of the Australian population. Mean age at assessment was 36.4±13.0 years, and age range was 18–86 years. Patients completed one of four online courses over eight weeks, during which they received weekly support from a therapist via telephone or secure e-mail. Primary outcome measures were the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder scale (GAD-7) administered at posttreatment and three months posttreatment.

Results:

A total of 10,293 adults who self-identified as having problems with anxiety or depression commenced assessment, and 7,172 completed the assessment and were eligible for analysis. Of these, 2,049 enrolled in a course and 1,471 completed the course, for a course completion rate of 71.8%. Moderate to large noncontrolled effect sizes (Cohen's d=.67–1.66, 95% confidence interval=.08–2.07) were found from assessment to three-month follow-up. At posttreatment and follow-up, reliable recovery ranged from 46.7% to 51.1%, and deterioration ranged from 1.9% to 3.8%. Mean total therapist time per patient was 111.8±61.6 minutes.

Conclusions:

The MindSpot Clinic produced treatment outcomes that were comparable to results from published clinical trials of iCBT. This model of service delivery represents an innovative method of providing accessible, low-cost, effective, and acceptable mental health services to many people who currently are not receiving care.

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Information & Authors

Information

Published In

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Cover: Avenue of Oaks at Litchfield Plantation, by Elizabeth O'Neill Verner, circa 1940. Oil on board. The Morris Museum of Art, museum purchase; 1993.003. © Estate of Elizabeth O'Neill Verner/licensed by VAGA, New York City.

Psychiatric Services
Volume 66 • Number 10 • October 01, 2015
Pages: 1043 - 1050
PubMed: 26130001

History

Received: 15 October 2014
Revision received: 26 December 2014
Accepted: 13 February 2015
Published online: 1 July 2015
Published in print: October 01, 2015

Authors

Details

Nickolai Titov, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
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Blake F. Dear, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
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Lauren G. Staples, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
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James Bennett-Levy, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
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Britt Klein, B.A., D.Psych. (Clinical)
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
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Ronald M. Rapee, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
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Clare Shann
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
View all articles by this author
David Richards, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
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Gerhard Andersson, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
View all articles by this author
Lee Ritterband, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
View all articles by this author
Carol Purtell
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
View all articles by this author
Greg Bezuidenhout
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
View all articles by this author
Luke Johnston, Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
View all articles by this author
Olav B. Nielssen, M.B.B.S., Ph.D.
Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: [email protected]). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
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Funding Information

Dr. Titov and Dr. Dear are authors and developers of the treatment courses used at the MindSpot Clinic but derive no personal or financial benefit from them. Dr. Titov, Dr. Dear, Dr. Bennett-Levy, Dr. Rapee, and Dr. Klein are funded by the Australian Government to develop and provide a free national online and telephone-delivered treatment service. Dr. Ritterband has equity ownership in a company developing and making available e-health–related products (BeHealth Solutions, LLC). The terms of these arrangements have been reviewed and approved by the relevant universities in accordance with their conflict-of-interest policies. Dr. Nielssen is a member of a Lundbeck advisory board for an antipsychotic medication. The other authors report no financial relationships with commercial interests.

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