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

Condition(s) studied

Investigational drug(s) / intervention(s)

Internet-delivered cognitive behavioural therapy (iCBT): Guided iCBT in Singapore for mild-to-moderate anxiety and/or depression

Study 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

Primary outcome measure(s)

• Change in the depression scores (PHQ-9) from baseline at: 5 weeks, 8 weeks, 3 months, 6 months — Baseline, 5 weeks, 8 weeks, 3 months, 6 months
  Depression severity is assessed using the Patient Health Questionnaire-9 (PHQ-9). Total scores range from 0 to 27, where 0 indicates no depressive symptoms and 27 indicates the most severe depressive symptoms.
• Change in the anxiety scores (GAD-7) from baseline at: 5 weeks, 8 weeks, 3 months, 6 months — Baseline, 5 weeks, 8 weeks, 3 months, 6 months
  Anxiety severity is assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale. Total scores range from 0 to 21, where 0 indicates no anxiety symptoms and 21 indicates the most severe anxiety symptoms.
• Change in the functional scores (WHODAS 2.0) from baseline at: 5 weeks, 8 weeks, 3 months, 6 months — Baseline, 5 weeks, 8 weeks, 3 months, 6 months
  Disability and functional impairment are assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0). Total scores range from 0 to 48, where 0 indicates no disability and 48 indicates full disability.

Trial sites (3)

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