net-step key-points net-step key-points net-step key-points Psychotherapy and Consultation via Internet today: a variety of options

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1 Internet Psychotherapy with Net-Step A Therapist-delivered IPT for Depression and Anxiety Disorders in Primary Care Patients SFT-17 Australia Successes and Failures in Telehealth Brisbane, Australia 30th October 2017 Prof. Dr. Dr. Ulrich Sprick Dr. Martin Köhne St. Alexius/ St. Josef - Clinic, Germany Psychotherapy and Consultation via Internet today: a variety of options Internet as a platform of information Selfhelp / minimal contacts / guided help / therapist delivered help Blended treatments ( IPT + face to face) Synchronous versus asynchronous settings (videoconference vs. written interventions) Group settings versus single client settings Therapist delivered internet with a low number of face to face contacts Diagnostic phase face to face with experts (psychological psychotherapist + psychiatrist) Modules of cognitive behavioral therapy Project in cooperation with AOK (health insurance) Term of the study: 24 months Depression, (ICD 10: F 32.0, F 32.1, F 33) Panic disorder (F 41.0), Social Phobia (F 40.1) In a randomised controlled trial 101 individuals with a confirmed diagnosis of depression, panic disorder or social phobia were recruited from practitioners, hospital ambulance or via the internet. Every participant was invited for a personal exploration and was tested face to face in the hospital ambulance. After confirmation of the diagnosis participants were randomly assigned to 12-weeks CBT online or to a face to face CBT for the same period of time. A waiting group (control) received online-cbt after a 12-week waiting period. Exclusion criteria for Internet with net-step acute suicidality psychotic thoughts and experiencing dissociative experience (comorbid drug or alcohol addiction) 1

2 additional cooperating partners Women s advice center e.v. Caritas RK e.v. Local public health department St. Alexius/ St. Josef-Hospital Heinrich-Heine- University of Düsseldorf Ev. Diakonie AKNamb. nursing service AOK Rheinland/Hamburg Virenze GmbH Netherlands Network of Net-step partners Cooperating partner Projectpartner Net-step modules 1. Psychoeducation Depression 2. List of positive activities / Happiness & satisfaction 3. Balanced and equated thinking (self test, diary of thoughts, reality check) 4. Aims and values 5. Self image and self perception (compass and positive diary) 6. Social competence (selfperception in social situations/surroundings) 7. Relapse prevention Depression net-step -Intervention (T0 and T1) BDI-Score DI-T0 DI-T1 DI n=20 T0 T1 MW 25,5 MW 10,5 STD 7,9 STD 9,0 SE 1,8 SE 2,0 Waiting group Depression (T0, Tw, T1) Comparison Internet and Face to Face (T0 and T1) 26,0 Waiting group (N = 9): 20,5 T0 TW T1 Face-to-Face Gruppe (N = 7): BDI-Score - Mean 15,0 9,5 MW: 23,11 22,22 8,11 STD: 4,99 8,90 8,01 SE: 1,66 2,97 2,67 T0 T1 MW: 20,00 MW: 9,43 STD: 5,23 STD: 6,80 SE: 1,98 SE: 2,57 4,0 DW(T0) DW-(TW) DW-(T1) 2

3 Panic disorder: net-step -Interventions Panic disorder: Waiting group (T0, TW, T1) 2,3 2,8 BSQ-Score 2,1 1,9 1,7 net-step -intervention (N = 10): T0: T1: MW: 2,18 MW: 1,66 STD: 0,36 STD: 0,26 SE: 0,11 SE: 0,08 BSQ-Score - 2,6 2,4 2,2 2,0 1,8 Waiting group (N = 5): T0: TW : T1: MW: 2,36 MW: 2,46 MW: 1,83 STD: 0,51 STD: 0,55 STD: 0,71 SE: 0,23 SE: 0,24 SE: 0,32 1,6 1,5 P-I-(T0) P-I-(T1) 1,4 P-W-(T0) P-W-(Tw) P-W-(T1) Social Phobia:,,net-step - Intervention SocialPhobia: Waiting group 42 net-step -Intervention Social Phobia (SPS) (N = 11): 39 SPS-Score T0: T1: MW: 41,09 MW: 30,45 STD: 14,41 STD: 17,88 SE: 4,34 SE: 5,39 SPS-Score Waiting group Social Phobia (SPS) (N = 13): T0 TW T1 MW: 37,15 MW: 37,8 MW: 29,23 STD: 11, 33 STD: 12,47 STD: 14,20 SE 3,14 SE: 3,94 SE: 3,94 24 SPS W T0 SPS W TW SPS W T1 Age and gender of patients using net-step age gender Status of education of net-step patients (n=101) 35,3% Remaining 4% 64,7% Mean age of patients is 36 years (median = 38 years). There are more female (nearly 2/3) than male patients (1/3). More than half of the patients (56 %) have finished highschool. 3

4 Social Relations of net-step Patients Partner status (n=101) Pre-Treatments 42% 41% several partners 1% living alone 41% 17% 51% fixed partnership other 7% YES NO Ambulant psychological/psychiatric pre-treatment in 59 % of the patients SEVERAL pre-treatments Specific life-situation of patients using net-step (n=101) 71% 10% no specific Mobility at Double Care for situation work function relative Only 19 percent of the patients were in a specific demanding life situation. 7% 12% Question: I would recommend this kind of therapy and would use net-step again if I should need in the future: % 8% 3% Trifft zu Trifft nicht zu keine Antwort Yes: (89%) No: (8%) No answer: (3%) Pros and Cons of internet Pros of internet - flexibility with regard to time of therapy flexibility with regard to location of therapy. no stigma of going to a psychotherapist early intervention and less waiting time less (??) costs of therapy less documentation and possibility of easy intervision/peer consulting 4

5 Cons of Internet - limited options for crisis intervention no additional (non)verbal or behavioral signals during session reduced emotionality in sessions difficulties in safe data protection using the internet Summary Internet (net-step) is a useful method for the treatment of depression and anxiety disorders. Net-step as a therapist delivered therapy is an attempt to combine advantages of solitary IPT with beneficial effects of F2F-therapy. In Germany IPT is not yet used as a regular treatment in primary care. u.sprick@ak-neuss.de It s only a click to do the next step! 5