This Way Up - Mixed Depression and Anxiety Course

Description:

The course is designed to treat the symptoms of both anxiety and depression and is based on the principles of cognitive behavioural therapy (CBT). The course lasts 3 months and comprises of six online lessons, homework activities, participation in an online discussion forum and regular email/phone contact with either your own clinician or a This Way Up clinician. Each lesson takes about 20 minutes and you will need an additional 3-4 hours per week to complete suggested homework activities.  Part of each lesson is presented as an illustrated story about a woman who struggles with generalised anxiety and depression and a man who experiences panic attacks and social anxiety.  You will learn practical skills for tackling these difficulties and improving your emotional wellbeing.  As you progress through the lessons, automatic emails are sent to remind you to complete materials and to notify you of new resources. 

Service URL:

https://thiswayup.org.au/clinic/courses/courses-we-offer/mixed-depression-and-anxiety/

Agency Responsible:

This Way Up, Clinical Research Unit for Anxiety and Depression, St Vincent's Hospital, Sydney.

Details

Format:

Website.

Intervention Type:

Psychological – CBT.

Course Length:

Long (more than 5 modules). 6 lessons over 3 months

Support Option:

Clinical support. By your own clinician, self-directed course also available

Target Audience

Primary Category:

Generalised anxiety disorder. This course is designed to help with anxiety (including GAD, panic and social phobia) and depression

Target Audience:

Adult.

Language:

English.

Access

Fee:

Fee-based. The course costs $59

Access:

Closed: Fee required. You need to be referred by your clinician to register for the supervised course. A self-directed version is also available

Contact Details:

Through an online form at:
https://thiswayup.org.au/about/contact-us/

Research evidence

Research Trials:

6

Research RCTs:

2

Outcome Summary:

Two randomised control trials (RCTs) and four open-trials have been completed to test the efficacy of the Depression and Anxiety Course.  In one RCT, participants with a principal diagnosis of major depression, generalised anxiety disorder, panic disorder and/or social phobia were randomly assigned to either a treatment group or a waitlist control group (1). The treatment group reported significantly reduced symptoms of depression and anxiety compared to the control group on a generalised depression anxiety stress scale (d = 0.56), a measure of depression (d = 0 .58) and a measure of generalised anxiety disorder (d = 0.52).   Furthermore, a subsequent open trial in which participants from the original wait-list control group completed a shortened version of the course produced similar results on the same measures (2).

 A clinician-guided form of the course was also tested. It was administered to patients and compared against a wait-list control in an RCT (3). Depression, Generalized Anxiety Disorder (GAD), Repetitive Negative Thinking (RNT) and Positive beliefs about RNT were measured pre-,post- and mid-assessment. Those in the treatment group experienced significantly better improvements in generalised anxiety symptoms symptoms post-treatment compared to controls (g=0.85). The intervention group fared significantly better than controls on all other measures as well.

The effectiveness of the course in a primary care setting was also explored in a number of trials.  One compared its effectiveness in a research setting versus a primary care setting (4). In the primary care setting, although adherence was found to be lower than in research trials (41%), effect sizes remained large (>0.8) for depression and anxiety. Even among non-completers, 30% experienced benefit from taking the course. Another study was an open trial in a primary care setting (5) which found the course to be similarly effective. Adherence to the program was found to be moderate (47%) with a large within-subject effect size (d= 1.20) for generalised anxiety disorder symptoms.

In 2014 results of an open trial were published where patients undergoing routine-care were randomly assigned to one of five iCBT courses available through THisWayUp including the Mixed Depression and Anxiety course (with e-mail encouragements/clarification from their personal clinicians) (6). Results from this study also found significantly reduced symptoms of anxiety and depression post-treatment, though only four participants in the study completed the Mixed Depression and Anxiety Course. In 2017, findings of another open trial (7) compared the transdiagnostic approach of the ThisWayUp Mixed Depression and Anxiety course to disorder specific programs (the Depression course and the GAD course) in a primary care setting. The transdiagnostic program resulted in similar improvements (with large effect sizes) in anxiety and depression scores as the separate depression and anxiety programs. For participants with comorbid MDD and GAD, the transdiagnostic course and the depression course performed better than the GAD course on measures of disability/impairment and depression.

 Overall, these findings suggest that the program can offer effective treatment for both depression and anxiety.

Recommended rating, reviewer 1:

Recommended rating, reviewer 2:

Read more about Beacon's Smiley Rating System.

Research paper citations

Evidence evaluation studies:

(1)Titov, N., Dear, B.F., Schwencke. G., Andrews, G, Johnston, L., Craske, M.G., McEvoy, P. (2011)  Transdiagnostic internet treatment for anxiety and depression:  A randomised controlled trial.  Behaviour Research and Therapy, 49, 441-452.

(2)Dear, B.F., Titov, N., Schwencke. G., Andrews, G, Johnston, L., Craske, M.G., McEvoy, P. (2011)  An open trial of a brief transdianostic internet treatment for anxiety and depression.  Behaviour Research and Therapy, 49, 830-837.

(3)Newby, J.M., Williams, A.D., Andrews, G. (2014). Reductions in negative repetitive thinking and metacognitive beliefs during transdiagnostic internet cognitive behavioural therapy (iCBT) for mixed anxiety and depression. Behaviour Research and Therapy, 59, 52-60.

(4)Newby, J.M., Mackenzie, A., Williams, A., McIntyre, K., Watts, S., Wong, N., & Andrews, G. (2013). Internet cognitive behavioural therapy for mixed anxiety and depression: A randomized controlled trial and evidence of effectiveness in primary care. Psychological Medicine, 43(12), 2635-2648.

(5)Newby, J.M., Mewton, L., Williams, A.D., Andrews, G. (2014). Effectiveness of transdiagnostic internet cognitive behavioural treatment for mixed anxiety and depression in primary care. Journal of Affective Disorders, 165, 45-52.

(6)Mason,  E.C.,  Harvey, A.G. (2014). Insomnia before and after treatment for anxiety and depression. Journal of Affective Disorders, 168,  415-421.

Additional references:

Hilvert-Bruce, Z., Rossouw, P.J., Wong, N., Sunderland, M., Andrews, G. (2012)  Adherence as a determinant of effectiveness of internet cognitive behavioural therapy for anxiety and depressive disorders.  Behaviour Research and Therapy, 50, 463-468.

(7) Newby, J. M., Mewton, L., & Andrews, G. (2017). Transdiagnostic versus disorder-specific internet-delivered cognitive behaviour therapy for anxiety and depression in primary care. Journal of anxiety disorders, 46, 25-34.