Background
CBT for the treatment of depression and anxiety in cancer
Online CBT for emotional health problems comorbid with physical illness
ADAPT and development of iCanADAPT
Aims of ‘iCanADAPT Early’ study
Hypotheses
Methods/design
Study design
Study setting
Recruitment
Inclusion/exclusion criteria for participation in the trial
Trial design and blinding
Randomisation
Trial procedure
Measure | Pre-treatmenta
| Before each lessonb
| Mid –treatmentc
| Post-treatmentd
| 3-month follow-upb
|
---|---|---|---|---|---|
HADS-T | ♦ | ♦ | ♦ | ♦ | |
K-10 | ♦ | ♦ | ♦ | ♦ | ♦ |
PHQ9-Q9 | ♦ | ♦ | ♦ | ♦ | |
BDI-II Item 9 | ♦ | ♦ | ♦ | ♦ | |
FCRI | ♦ | ♦ | ♦ | ♦ | |
FACT-G | ♦ | ♦ | ♦ | ♦ | |
CEQ | ♦ | ♦ | |||
ADIS | ♦ | ♦ |
Description of the interventions
Internet delivered CBT (iCBT), the ‘iCanADAPT Early’ program group
Lesson 1 - Learning about Depression & Anxiety
Psycho-education about depression and anxiety, including their prevalence in cancer, psycho-education about the CBT cycle and the flight or fight response. Introduction to rumination and worry and good sleep hygiene. Skills of relaxation and progressive muscle relaxation. Lesson 2 - Identifying and Tackling Thoughts
Key cognitive therapy skills including cognitive monitoring, recognising distorted cognitive styles, and later cognitive restructuring. Examples of each skill in use. Lesson 3 - Tackling Unhelpful Behaviours
Key behavioural activation skills including tackling the low activity cycle, daily activity scheduling and the role of physical activity in improving general health. Additional skills relating to structured problem solving and assertive communication skills. Lesson 4 - Helpful Coping
Further cognitive skills including worry-Free Zones and challenging mega-cognitions. Expanded attention to CBT strategies to tackle sleep difficulties. An introduction to mindfulness and related extra resources. Lesson 5 - Adjusting to Change
Assessment of one’s personal values and goals. The need to pace physical activity. The use of CBT to tackle the impact of physical health (and/or treatment) symptoms on emotional wellbeing. Lesson 6 - Tackling Avoidance
Introduction to avoidance and the rationale for combatting avoidance using graded exposure and exposure stepladders. Numerous examples of confronting avoidance (both in cancer and non-cancer settings) are intertwined to allow generalisation. Lesson 7 - Mastering Your Skills
A guide to potential pitfalls that people encounter when trying to master CBT skills, in particular that of exposure work. An introduction to imaginal exposure. Lesson 8 - Staying Well in the Long Term and Getting Even Better
Relapse prevention planning and an overview of the skills learned. |