Tailored online cognitive behavioural therapy with or without therapist support calls to target psychological distress in adults receiving haemodialysis: A feasibility randomised controlled trial

Joanna L Hudson; Rona Moss-Morris; Sam Norton; Federica Picariello; David Game; Amy Carroll; Jonathan Spencer; Paul McCrone; Matthew Hotopf; Lucy Yardley; Joseph Chilcot

doi:10.1016/j.jpsychores.2017.09.009

Tailored online cognitive behavioural therapy with or without therapist support calls to target psychological distress in adults receiving haemodialysis: A feasibility randomised controlled trial

J Psychosom Res. 2017 Nov:102:61-70. doi: 10.1016/j.jpsychores.2017.09.009. Epub 2017 Sep 21.

Authors

Affiliations

¹ Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. Electronic address: Joanna.Hudson@kcl.ac.uk.
² Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. Electronic address: rona.moss-morris@kcl.ac.uk.
³ Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. Electronic address: sam.norton@kcl.ac.uk.
⁴ Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. Electronic address: Federica.Picariello@kcl.ac.uk.
⁵ Guy's and St Thomas' NHS Trust, UK. Electronic address: David.Game@gstt.nhs.uk.
⁶ Guy's and St Thomas' NHS Trust, UK. Electronic address: Amy.Caroll@gstt.nhs.uk.
⁷ King's Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK.
⁸ King's Health Economics, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK. Electronic address: Paul.Mccrone@kcl.ac.uk.
⁹ Department of Psychological Medicine, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK. Electronic address: Matthew.Hotopf@kcl.ac.uk.
¹⁰ Psychology Department, University of Southampton, UK; Nuffield Department of Primary Care and Health Sciences, University of Oxford, UK. Electronic address: L.Yardley@soton.ac.uk.
¹¹ Health Psychology Section, Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK. Electronic address: joseph.chilcot@kcl.ac.uk.

PMID: 28992899
DOI: 10.1016/j.jpsychores.2017.09.009

Abstract

Background: Psychological distress is prevalent in haemodialysis (HD) patients yet access to psychotherapy remains limited. This study assessed the feasibility and acceptability of online cognitive-behavioural therapy (CBT) tailored for HD patients, with or without therapist support, for managing psychological distress.

Methods: This feasibility randomised controlled trial recruited patients from a UK HD centre. Following psychological distress screens, patients with mild-moderate psychological distress (Patient Health Questionnaire PHQ-9; score: 5-19 and/or Generalised Anxiety Disorder; GAD-7 score: 5-14) who met remaining inclusion criteria were approached for consent. Consenters were individually randomised (1:1) to online-CBT or online-CBT plus three therapist support calls. Outcomes included recruitment, retention, and adherence rates. Exploratory change analyses were performed for: psychological distress, quality of life (QoL), illness perceptions, and costs. The statistician was blinded to allocation.

Results: 182 (44%) out of 410 patients approached completed psychological distress screens. 26% found screening unacceptable; a further 30% found it unfeasible. Psychological distress was detected in 101 (55%) patients, 60 of these met remaining inclusion criteria. The primary reason for ineligibility was poor computer literacy (N=17, 53%). Twenty-five patients were randomised to the supported (N=18) or unsupported arm (N=7); 92% were retained at follow-up. No differences in psychological distress or cost-effectiveness were observed. No trial adverse events occurred.

Conclusion: Online CBT appears feasible but only for computer literate patients who identify with the label psychological distress. A definitive trial using the current methods for psychological distress screening and online care delivery is unfeasible. ClinicalTrials.gov Identifier: NCT02352870.

Keywords: Anxiety; Cognitive behavioural therapy (CBT); Depression; Feasibility randomised controlled trial; Haemodialysis; Illness perceptions; Online cognitive behavioural therapy.

Publication types

Randomized Controlled Trial
Research Support, Non-U.S. Gov't

MeSH terms

Cognitive Behavioral Therapy / methods*
Feasibility Studies
Female
Humans
Male
Middle Aged
Quality of Life / psychology*
Renal Dialysis / methods
Renal Dialysis / psychology*
Stress, Psychological / therapy*
Surveys and Questionnaires

Associated data

ClinicalTrials.gov/NCT02352870