Innovation summary

THIS WAY UP addresses the treatment gap for anxiety and depressive disorders (major depressive disorder, generalized anxiety disorder, panic disorder/agoraphobia, social phobia, obsessive compulsive disorder, mixed anxiety and depressive disorder). Consisting of internet-delivered cognitive behavior therapy (iCBT) anxiety and depression, THIS WAY UP reflects an illustrated story of a recovering person alongside offline ‘homework’. Clinicians prescribe illness-specific courses to individuals seeking treatment. The innovation consists of a stepped care model where mild and moderate cases are prescribed iCBT and severe cases receive face-to-face clinician time.

Impact summary

Evidence from 15 RCTs and 6 field studies has shown1-15

  • 3,000 clinicians have enrolled, registering 7,000 patients
  • 50% of completers recover, 30% improve
  • iCBT is 10 times more cost-effective than face-to- face therapy where tested

"I participated in a Virtual Clinic Course for worry and depression 3 years ago. I have not had a recurrence of depression, and only the anxiety over flying still remains, all else is very good."

– A THIS WAY UP service user

Innovation details

THIS WAY UP comprises of a virtual clinic featuring the following elements:

Courses Offered

Courses available for the following anxiety and depressive disorders:

  • major depressive disorder
  • generalized anxiety disorder
  • panic disorder/agoraphobia
  • social phobia
  • obsessive compulsive disorder
  • mixed anxiety and depressive disorder

Each course has 6 lessons prescribed by clinicians to individuals who meet the criteria for the target disorder

Automated Cognitive Behavior Therapy

  • Service users receive automated, internet delivered, cognitive behavior therapy (iCBT) using an illustrated story of a recovering individual, coupled with offline homework tasks
  • iCBT teaches the patient/client to recognize the symptoms of the disorder and to control of dysfunctional thoughts, emotions and behaviors typical of each disorder

Responsibilities of Clinician

  • System sends the treating clinician an email alert about people whose symptoms worsen to intervene with face-to-face therapy if needed
  • Delivered as part of a stepped care model leaving the clinician time to provide face-to-face therapy for those that do not recover following iCBT

Key drivers

Strong Research Base

THIS WAY UP has a strong research base with over 1,000 citations to date. Evidence-based research has aided the positive and successful reception of the program.

Challenges

Marketing to Clinicians

The key challenge for successfully implementing the innovation was marketing the program to clinicians.

Continuation

Receptiveness

THIS WAY UP is making gradual inroads in the US market, but the UK is currently less receptive.

Additional Components of the Innovation

There are also free, short self-help courses accessible for global service users, however are currently only available in English.

There is an internet-based learning system (THIS WAY UP Schools) that provides health and well-being courses for students to manage stress, anxiety and depression.

Potential for Scalability

THIS WAY UP has the potential for good scalability without loss of fidelity.

Evaluation methods

THIS WAY UP has been tested in 15 replicated randomized controlled trials in 6 field studies of effectiveness. 1-14

Cost of implementation

  • The cost to the patient to use the program is $51 USD 15-16
  • iCBT is 10 times more cost effective than face-to-face therapy in the countries where it has been released 15-16
  • The cost to the government for the maximum possible number of people using the program (1500 people) per year is $230 USD per patient without any additional resources 15-16

Impact details

The initial trial showed promising results:

  • 3 out of 4 individuals complete all the lessons
  • 3 out of 4 individuals who complete the course are no longer troubled by their emotional disorder
  • 9 out of 10 say they are satisfied with the services they received

As of December 2012, 2,400 clinicians and 7,000 patients have enrolled in the THIS WAY UP clinic. On average 50% of completers recover, 30% improve, and 10% show no change in their symptoms and 10% worsen. The number of lost work days is halved with iCBT.

References

  1. 1. Titov N et al. (2008) Distance treatment for social over the Internet. A randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 42(7): 585-594.
  2. Titov N et al. (2008) Shyness 3: RCT of guided vs unguided internet based CBT for social phobia. Australian and New Zealand Journal of Psychiatry, 42(12):1030-1040.
  3. Perini SJ et al. (2009) Clinician-assisted Internet-based treatment is effective for depression: A randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 43(6):571-578.
  4. Titov N et al. (2010) Internet treatment for depression: a randomized controlled trail comparing clinician vs. technician assistance. PLoS One, 5(6):e10939.
  5. Watts S et al. (2013) CBT for depression: A pilot RCT comparing mobile phone vs. computer. BMC Psychiatry, 13:49.
  6. Titov N et al. (2009) Clinician-assisted Internet-based treatment is effective for generalized anxiety disorder: A randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 43(10):905-912.
  7. Robinson E et al. (2010) Internet treatment for generalized anxiety disorder: a randomized controlled trail comparing clinician vs. technician assistance. PLoS One, 5(6):e10942.
  8. Wims E et al. (2010) Clinician-assisted internet-based treatment is effective for panic: a randomized controlled trial. Australian and New Zealand Journal of Psychiatry, 44(7):599-607.
  9. Titov N et al. (2011) Transdiagnostic internet treatment for anxiety and depression: A randomised controlled trial. Behaviour Research and Therapy, 49(8), 441-452.
  10. Newby J et al. (2013) Internet-based cognitive behavioural therapy for mixed anxiety and depression: Results from a RCT and effectiveness in primary care settings. Psychological Medicine, 43(12): 2635-2648.
  11. Watts S et al. (2012) A clinical audit of changes in suicide ideas with internet treatment for depression. BMJ Open, 2(5).
  12. Mewton L et al (2012) The effectiveness of internet cognitive behavioural therapy for generalised anxiety disorder in clinical practice. Depression and Anxiety, 29(10): 843-849.
  13. Hilvert-Bruce Z et al. (2012) Adherence as a determinant of effectiveness of internet coginitive behavioural therapy for anxiety and depressive disorders. Behaviour Research and Therapy, 50(7-8): 463-468.
  14. Williams AD et al. (2013) Effectiveness of internet cognitive behavioural therapy (iCBT) for depression in primary care: A quality assurance study. PLOS ONE, 8: e57447.
  15. Andrews G et al. (2010)

Research

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Country

Australia, United States of America

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