In 2021 the team from THIS WAY UP, which is part of the Clinical Research Unit for Anxiety and Depression (CRUfAD), were involved in 16 research projects aimed at improving mental health outcomes in our communities. Several of the studies indicated the increased demand for our online mental health services during the COVID-19 pandemic, while others looked at effective treatments for unique challenges such as needle phobia and pain related distress. 

The team at CRUfAD, which is a joint initiative of the University of New South Wales and St Vincent‘s Hospital in Sydney Australia, has contributed over 35 years of research into the epidemiology and treatment of anxiety and depression, two highly prevalent conditions.

In 2021 we were proud to say that almost all of the research demonstrated the scalability of digital mental health programs and their value when integrated into Australia’s healthcare system. 

Here are the 16 research studies members of the THIS WAY UP team were involved with in 2021.  

Pilot studies investigating novel interventions  

Internet-delivered exposure therapy versus internet-delivered cognitive behavioural therapy for panic disorder: A pilot randomized controlled trial: Exposure therapy is one component of Cognitive Behavioural Therapy (CBT), a psychological treatment for people with panic disorder (who experience recurring panic attacks). Exposure therapy involves graded and repeated exposure to panic related sensations and situations, to increase tolerance and reduce fear. This study compared the effectiveness of an online CBT program for panic disorder versus an online program involving exposure therapy only. The study found that the exposure therapy program appeared to be equally effective as the CBT program in reducing symptoms of panic disorder. Read the journal article here.

Managing rumination and worry: A pilot study of an internet intervention targeting repetitive negative thinking in Australian adults: This study was the first to examine the effectiveness of a brief online intervention for rumination and worry, which are two styles of thinking linked to anxiety and depression. The 26 participants who undertook a 3-lesson online program saw a significant reduction in their levels of rumination and worry, as well as their levels of depression and anxiety. Read the journal article here.

A pilot study of intensive 7-day internet-based cognitive-behavioural therapy for social anxiety disorder: “Intensive” cognitive behavioural therapy (CBT) involves delivering CBT over a short timeframe, reducing the time and cost of treatment. In this study, 16 participants completed an intensive 7-day online CBT treatment for social anxiety. Participants reported a large and significant reduction in their social anxiety symptoms, comparable to treatment delivered over longer time periods (e.g. 8-12 weeks). Participants also saw significant reductions in symptoms of depression and impairment in daily life. Read the journal article here.

The effectiveness of iCBT programs during the COVID-19 pandemic 

The uptake and outcomes of Internet-based cognitive behavioural therapy for health anxiety symptoms during the COVID-19 pandemic: This study evaluated internet-based CBT for health anxiety during the COVID-19 pandemic. There was unprecedented demand for this program, with a 941% increase in the number of users registering for the THIS WAY UP Health Anxiety program during the COVID-19 pandemic in Australia, compared to pre-pandemic time frames (September 2019 to March 2020, compared to March 2020 to June 2020)..Users of the program experienced large reductions in levels of health anxiety and psychological distress. Read the journal article here.

COVID-19 related differences in the uptake and effects of internet-based cognitive behavioural therapy for symptoms of obsessive-compulsive disorder: This study investigated the uptake and effectiveness of iCBT for OCD (both self- and clinician-guided programs) during the first 8 months of the pandemic in Australia (March to October 2020) and compared outcomes with the previous year. There was a 522% increase in the number of users registering for the THIS WAY UP OCD program during the COVID-19 pandemic in Australia. Users of the program experienced significant reductions in OCD symptom severity, depression and psychological distress. Read the journal article here.

Internet-based cognitive behaviour therapy for insomnia before and during the COVID-19 pandemic: This study investigated the uptake and potential effectiveness of iCBT-I during the first 10 months of the pandemic in Australia (March- December 2020) and compared outcomes  to the year prior. There was a 140% increase in the number of users registering for the THIS WAY UP Insomnia program during the COVID-19 pandemic in Australia. The study showed that users of the program experienced significant reductions in insomnia symptom severity, depression and psychological distress. Read the journal article here.

A tale of two countries: Increased uptake of digital mental health services during the COVID-19 pandemic in Australia and New Zealand: Healthcare systems around the world have needed to respond to the challenge of adapting health care delivery during COVID-19. Digital mental health services provide highly accessible online psychological support that can supplement existing in-person mental health services. Two digital mental health services (THIS WAY UP in Australia, and Just a Thought in New Zealand) saw significant increases in both the number of users and also the number of registered clinicians in the first few months of the COVID-19 pandemic in 2020. Findings demonstrate that digital mental health services can be scalable and responsive during challenging times to provide effective psychological support to large numbers of individuals. Read the journal article here.

The uptake and effectiveness of online cognitive behaviour therapy for symptoms of anxiety and depression during COVID-19: There was a 504% increase in the number of users registering for the THIS WAY UP Mixed Depression and Anxiety program during the COVID-19 pandemic in Australia. Users of the program experienced significant reductions in levels of anxiety, depression and psychological distress. Read the journal article here.

Guidelines for clinicians for integrating iCBT, the reliability of the K10 and iCBT components for depression 

Integrating internet CBT into clinical practice: a practical guide for clinicians: This paper offers  guidance for clinicians on how they can safely and effectively incorporate online Cognitive Behaviour Therapy (iCBT) programs, such as THIS WAY UP, into their routine practice. The paper identifies three main ways iCBT can be used: as a stand-alone intervention, as an adjunct to face-to-face therapy, and as a relapse prevention tool. Read the journal article here.

Dismantling, optimising, and personalising internet cognitive behavioural therapy for depression: a systematic review and component network meta-analysis using individual participant data: This large study reviewed data from previous papers on THIS WAY UP’s Depression Program to analyse which components of internet delivered cognitive behavioural therapy were most helpful in reducing patients’ symptoms of depression. They found that behavioural activation, which includes strategies such as activity scheduling and engaging in pleasant activities, provided the most benefit. Additionally, having program staff provide encouragement and reminders to proceed with the program, alongside automated reminders, increased the likelihood of patients completing treatment. Read the journal article here.

The temporal stability of the Kessler Psychological Distress Scale (K10): Temporal stability refers to whether a questionnaire or test produces reliable measurements over time. This study showed that the Kessler-10, a questionnaire used by THIS WAY UP to measure levels of psychological distress, is a reliable measure over time periods of up to 13 weeks. Read the journal article here.

Treatments for blood-injection-injury phobia, young adults with comorbid social anxiety and alcohol use and people with personality disorders  

Re-Train Your Brain: Protocol for a randomized controlled pilot trial of a web-based cognitive bias modification intervention for emerging adults with comorbid social anxiety and hazardous alcohol use: This (ongoing) study looks at the link between alcohol use and anxiety disorders. The study involves adults (18-30 years) with co-occurring hazardous alcohol use and social anxiety and looks at the effectiveness of the web-based Re-train Your Brain program. Recruitment is expected to be completed by mid-2022 to late 2022, with follow-ups completed by early 2023. Read the journal article here.

A comprehensive group-based cognitive behavioural treatment for blood-injection-injury phobia: Disgust is a key factor in maintaining blood-injection-injury phobia (a fear of blood, injuries, and receiving an injection). Forty individuals undertook a novel group therapy that combined Cognitive Behavioural Therapy (CBT) with strategies to reduce disgust. The group therapy resulted in large reductions in blood-injection-injury related fear, fainting and disgust.  Read the journal article here.

Comorbid personality difficulties are not associated with poorer outcomes for online cognitive behaviour therapy for symptoms of anxiety and depression: Personality difficulties may often be present in individuals seeking internet-based Cognitive Behaviour Therapy (iCBT) for anxiety and depression. This study found that although a significant proportion of individuals who registered for a THIS WAY UP program reported experiencing personality difficulties, this did not affect their likelihood of completing treatment, nor their outcomes. This indicates that a broad range of people, including those with personality difficulties, can be encouraged to consider iCBT programs for anxiety and depression. Read the journal article here.

Investigating helpful treatments for chronic pain and motor vehicle rehabilitation 

Evaluating Real-World Adherence and Effectiveness of the “Reboot Online” Program for the Management of Chronic Pain in Routine Care: This study was the first to investigate the real-world effectiveness of an online multidisciplinary program for managing chronic pain, the THIS WAY UP Chronic Pain Program. The study found that for in the sample of 867 participants who undertook the program, they experienced significant improvements in symptoms of pain, pain-related disability and pain-related distress. Read the journal article here. 

Assessing unmet rehabilitation needs and the feasibility of a telehealth rehabilitation consultation service for road trauma survivors recently discharged from hospital: This study found that 86.5% of road accident survivors who did not receive rehabilitation during their hospital stay experienced ongoing impairments and limitations in their daily life after discharge from hospital. This study also examined the outcomes of 38 road accident survivors who engaged in a novel multidisciplinary rehabilitation program, delivered via telehealth. Participants in the program reported improvements in functional ability and quality of life, and evaluated the program as helpful, convenient and accessible. Read the journal article here.