Internet-Based Cognitive Behavioural Therapy (iCBT) for Anxiety and Depression in Singapore

Summary

Cognitive-behavioural therapy (CBT) has a robust evidence base for treating anxiety disorders and depression, including transdiagnostic CBT. Internet-based CBT (iCBT) offers a new approach to delivering these therapies. iCBT is a digital adaptation of traditional CBT that leverages digital platforms to deliver similar therapeutic interventions. iCBT encompasses structured programmes that provide users with tools and techniques to manage mental health issues such as depression and anxiety. The digital format ensures timely access to CBT and typically includes interactive modules, videos, self-assessment tools, and virtual therapist support. This study aims to evaluate the effectiveness of iCBT in reducing symptoms of anxiety and depression, as well as its cost-effectiveness and acceptability in local context. The main questions it aims to answer are: 1. Do participants receiving iCBT show a reduction in symptoms of anxiety and/or depression, and does the effectiveness of iCBT vary based on individual user characteristics? 2. What are the factors that influence the acceptance, adoption, and engagement rates of iCBT among Singaporeans? 3. Is iCBT more cost-effective as compared to usual care? Researchers will compare guided iCBT to usual care (traditional CBT) to assess iCBT's clinical effectiveness, cost-effectiveness, and acceptability in Singapore's primary and community healthcare settings. Participants in the intervention group will: 1. Undergo guided iCBT intervention consisting of 8 weeks of online modules covering core CBT techniques 2. Counsellors will schedule 3 regular check-ins 3. Questionnaires will be administered at 5 timepoints 4. Selected participants will be invited for a semi-structured interview to assess their experiences with iCBT Participants in the control group will: 1. Continue usual care 2. Questionnaires will be administered at 5 timepoints A parallel qualitative study involving service providers is required to contextualise trial findings, identify implementation barriers and enablers and inform national scale-up and policy decisions. It aims to explore service providers' experiences, perceptions and contextual factors influencing the implementation of iCBT within routine primary-care and community mental-health services participating in this trial.

Eligibility

1. Quantitative Study - Patients

   Inclusion Criteria:
   * Age ≥21 years
   * Tier 2 - 3 depression and/or anxiety based on PHQ-9 and GAD-7 scores

     * PHQ-9 score of 5 to 19
     * GAD-7 score of 5 to 14
   * Able to provide informed consent

   Exclusion Criteria:
   * Unable to read or understand English (Primary 6 level)
   * Unable to use the internet (e.g. due to lack of internet access or insufficient digital literacy)
   * Does not possess a mobile device or is not able to access the iCBT application
   * Actively experiencing psychosis
   * Suspected with personality disorder
   * Primary concern is obsessive compulsive disorder (OCD)
   * Tier 4 patients with severe depression or anxiety

     * PHQ-9 score of 20 and above
     * GAD-7 score of 15 and above
   * Any suicidal risk or ideation

     * PHQ-9 Question 9 score of more than 2
2. Qualitative Study - Service Providers

Inclusion Criteria:

* Are currently or previously have been involved in the delivery, supervision, or implementation of the iCBT programme
* Have had direct experience supporting patients enrolled in the study
* Able to provide informed consent

Exclusion Criteria:

* Have no direct involvement in the iCBT programme; or
* Have had insufficient exposure to the programme, defined as managing fewer than one referred case or less than one month of involvement at the time of recruitment.
* Conflict of interest or Supervisory Hierarchy Concerns - Individuals whose participation may create perceived coercion or introduce bias
* Inability to provide informed consent

Conditions4

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