E-couch - Anxiety and Worry program

Description:

The e-couch website provides evidence-based information about emotional problems including their causes, treatments and ways to manage and prevent them. Some information can be reviewed before registering. When you register for the program you complete a number of quizzes, for example depression and anxiety questionnaires, which give feedback on how you are feeling. On return visits, you can complete the quizzes again and view graphs your progress over time. The program includes five separate programs relating to depression, anxiety and worry, social anxiety, divorce and separation, and bereavement and loss.  Each program includes an 'armchair' section with lots of information, a collection of self-help toolkits with practical advice and techniques based on CBT, IPT, physical activity and relaxation, and a workbook.  You can complete the various activities within each program in any order - and your progress is tracked and displayed.

Service URL:

https://ecouch.anu.edu.au

Agency Responsible:

eHub Health.

Details

Format:

Website.

Intervention Types:

Psychological – CBT and Psychological – IPT. Also relaxation and physical activity

Course Length:

Long (more than 5 modules).

Support Option:

Automated only.

Target Audience

Primary Category:

Generalised anxiety disorder. Also depression, social anxiety, coping with divorce and separation, and dealing with bereavement and loss

Target Audiences:

Adolescent and Adult.

Language:

English.

Access

Fee:

Free.

Access:

Open: With registration.

Contact Details:

ecouch@ehubhealth.com 

Research evidence

Research Trials:

3

Research RCTs:

3

Outcome Summary:

There have been three randomised controlled trials assessing e-couch in relation to generalised anxiety. The first randomised controlled trial (RCT) (1) examined whether e-couch was effective in preventing Generalised Anxiety Disorder (GAD) in young adults with self-reported mild anxiety (n=558). Participants were given either a 10 week intervention of e-couch (Anxiety and Worry modules) or a control website ("HealthWatch") with varying levels of experimenter contact. There were no differences in GAD symptoms for ecouch participants and control participants at any post-test measure (immediate post-test, 6 month and 12 month followup). Nor were there any differences in cases of GAD at 6 months followup. On secondary outcomes, e-couch participants in the email reminder group reported: lower depression scores; lower worry scores; and lower anxiety sensitivity relative to controls at post-test. Also, e-couch participants (in the email and telephone reminder groups) showed reduced anxiety sensitivity at 6 months. Although the primary aim of GAD prevention was not supported, e-couch, in particular with weekly email reminders, may have other benefits to users.

In the second RCT (2), the effectiveness of e-couch as a treatment for young adults with GAD was investigated. 21 young adults diagnosed with GAD were assigned to either e-couch (n = 8), an attention control (AC) website (n = 7), or Sertraline (antidepressant) (n = 6). The e-couch and AC participants were given access to one module per week for a total of ten weeks. All participants attended four psychology appointments and three GP appointments over the course of the trial. Compared to the AC group, e-couch participants showed significantly lower GAD scores at post-test, but not at 6 or 12 months. e-couch and AC groups did not differ on depression scores at any timepoint.

in a large scale (N=1767) cluster randomised trial (3) E-couch was delivered to schoolchildren aged 12 to 18 in order to test its effectiveness as a universal preventive intervention. No significant differences were observed post-intervention on anxiety scores compared to waitlist controls, whether the course was delivered by teachers alone or with assistance from a mental health education officer from Headspace.

Overall, there is some evidence to suggest that e-couch may be effective in the treatment of GAD for young adults in the short-term. As a prevention tool for GAD, e-couch has not been shown to be effective. However,  it may have other positive benefits to users such as decreasing sensitivity to anxiety. 

Recommended rating, reviewer 1:

Recommended rating, reviewer 2:

Read more about Beacon's Smiley Rating System.

Research paper citations

 Evidence Evaluation

1. Christensen, H., Batterham, P. J. et. al. (2014). The prevention of Generalised Anxiety Disorder using a web intervention: i-Chill, a Randomised Controlled Trial. Journal of Medical Internet Research, 16, e199.

2. Christensen, H., Mackinnon, A. J., Batterham, P. J. et al. (2014). The effectiveness of an online e-health application compared to attention placebo or Sertraline in the treatment of Generalised Anxiety Disorder. Internet Interventions, 1, 169 - 174.

3. Calear, A. L., Batterham, P. J., Poyser, C. T., Mackinnon, A. J., Griffiths, K. M., & Christensen, H. (2016). Cluster randomised controlled trial of the e-couch Anxiety and Worry program in schools. Journal of affective disorders, 196, 210-217.

Additional References

Calear, A. L., Christensen, H., Griffiths, K. M., & Mackinnon, A. (2013). The Y-Worri Project: a study protocol for a randomised controlled trial. Trials, 14, 76.

Christensen, H., Guastella, A. J., Mackinnon, A. J. et al (2010). Protocol for a randomised controlled trial investigating the effectiveness of an online e-health application compared to attention placebo or sertraline in the treatment of generalised anxiety disorder. Trials, 11, 48. 

Christensen, H., Griffiths, K. M., Mackinnon, A. J. et al (2010). Protocol for a randomised controlled trial investigatig the effectiveness of an online e health application for the prevention of Generalised Anxiety Disorder. BMC Psychiatry, 10, 25.