Sarah Bateup analyses how technology-enabled mental health treatments could be used to help those with Type 2 diabetes
A growing number of studies have indicated that patients with diabetes are more likely to experience common mental health problems such as anxiety or depression. Grigsby et al., (2002) reported that patients with diabetes are three times more likely to be depressed than the general population. They also suggested that 40% of patients with diabetes had a diagnosable anxiety disorder. In addition, people with diabetes can also experience disease-specific psychological issues such as denial of the diagnosis, avoidance of treatment-seeking behaviours, fear relating to hypoglycaemia or future complications, eating disorders and adjustment disorder. It is recognised that patients with diabetes respond well to evidenced psychological therapies like cognitive behavioural therapy (CBT).
Ieso Digital Health delivers CBT, via online written communication, to NHS patients across the UK. The online Ieso Method has demonstrated equivalence to traditional face-to-face CBT and has become an accepted convenient and effective way to receive psychological therapy.
Ieso Digital Health, in collaboration with Roche Diabetes Care, is running a research trial to test the assumption that CBT delivered online by qualified therapists using the Ieso Method is equally as effective as face-to-face CBT at:
- Reducing the symptoms of anxiety and depression;
- Enabling people to manage their diabetes more effectively;
- Reducing the distress that can sometimes be associated with having a diagnosis of diabetes.
Who can participate?
Anyone over the age of 18 who has had a diagnosis of Type 2 diabetes for at least 12 months and feels that they may anxious or depressed can participate. Participants must have access to an internet-enabled device such as a tablet, laptop, desktop computer or smartphone. Participants must feel confident in their ability to read and write in English, although spelling and grammar are unimportant.
CBT will be delivered by British Association of Behavioural and Cognitive Psychotherapy (BABCP) accredited CBT therapists. The therapists will provide treatment online using synchronous written communication (typed). For further information relating to this method please see www.iesohealth.com . The therapy provided will be identical to traditional face-to-face CBT in that it will use evidenced-based disorder-specific treatment protocols with fidelity to the CBT model.
CBT will be delivered online using the web-based platform provided by Ieso Digital Health. This means that the participants can be located in place of their choosing whilst receiving therapy. Participants may also choose the day and time of day that they have their therapy appointments.
When and how much
Participants will receive a disorder-specific treatment protocol for patients with an anxiety disorder or depression and a diagnosis of Type 2 diabetes. Participants will receive all elements of the treatment although this may be moderated to meet their individual needs. For example, some patients may find working behaviourally more helpful than working with cognitions. These types of moderations are very normal when delivering CBT. Treatment will consist of weekly therapy appointments lasting 60 minutes. Participants will also be encouraged to participate in between session practice tasks. Between session practice tasks are a routine part of CBT. Average treatment durations are seven treatments sessions over a period of two months, although patients who require more sessions (in order to gain benefit) will be provided with more sessions.
The therapists’ ability to deliver the interventions with fidelity to the CBT model and adherence to an evidence-based protocol will be assessed by a team of clinical supervisors at Ieso Digital Health. This is assessment is possible because the intervention is delivered online using synchronous written communication and therefore each therapy appointment is recorded as a transcript. It is, therefore, possible to quality check the intervention provided to every participant. Fidelity to the treatment model will be assessed using the standardised and validated tool ‘Cognitive Therapy Scale-Revised’ (CTS-R). The CTS-R is routinely used in research settings to ensure that that the intervention provided is CBT and not another type of therapy. The CTS-R is also routinely used in higher education settings as a formative and summative assessment of trainees’ ability to deliver CBT. The CTS-R is a 12-item scale where each item is scored on 0-6 Likert scale where 0 is incompetent and 6 equates to expert skill. The final score is reported as a total percentage. A score of 40% is considered to be competent.
The primary outcome measures used at every session are; the Patient Health Questionnaire (PHQ-9). The PHQ-9 is a 9 item, self-administered questionnaire that measures the severity of depression and the Generalised Anxiety Disorder Questionnaire (GAD-7), the GAD-7 is a 7-item self-administered questionnaire that measures the severity of generalised anxiety disorder.
The secondary outcome measures are the Patient Activation Measure (PAM) and the Diabetes Distress Scale (DDS).
The diabetes distress scale (DDS) is a 17-item scale that captures four critical dimensions of distress: emotional burden, regimen distress, interpersonal distress and physical distress. First published in 2005, it has been used widely around the world as a clinical instrument for an opening conversation with one’s patients as well as a critical outcome measure in numerous studies. (See www.diabetesdistress.org).
The PAM is a tool that helps health care professionals assess a patient’s activation level and their level of knowledge, skill and confidence in managing their long-term health condition. Evidence has demonstrated that when patients are supported to become more activated they are better able to manage their long-term condition and they have better physical health. For further information click here.
This is the first study that investigates the efficacy of online, therapist-delivered CBT specifically for patients with diabetes and a co-morbid mental health condition. The research is timely and necessary now particularly if we are to begin to tackle the dual problem of lack of availability of CBT and an increase in the prevalence of diabetes and mental health disorders.
Get in touch
If you would like more information about this study, or you know someone who would like to take part please contact Sarah Bateup, Chief Clinical Officer at Ieso Digital Health at [email protected].
This piece by Sarah Bateup was first seen on ‘Open Access Government‘, 18 November 2018.