Issue 30 / 10 August 2015

AUSTRALIA is at the forefront of using multimodal cognitive behavioural therapies to treat mental health disorders, but experts say there is not a “one size fits all” solution. 
Dr Jennifer Randles, member of the section of psychotherapy for the Royal Australian and New Zealand College of Psychiatrists, said while web- and app-delivered cognitive behaviour therapy (CBT) had great potential in managing a range of conditions, it was unrealistic to think the therapy would be able to help everyone. 
“It takes a certain type of patient for CBT to work”, she said, saying it was usually not suited to patients with more severe problems. 
Dr Randles was commenting on a randomised controlled trial published in JAMA Psychiatry that found telephone-delivered CBT was effective in reducing worry, generalised anxiety disorder (GAD) symptoms and depressive symptoms among older adults living in rural areas. (1)
The authors found that at 4-month follow-up, there was greater decline in worry severity among participants who received telephone CBT compared with those receiving telephone non-directive supportive therapy, but no significant differences in general anxiety symptoms. There was also a greater decline in self-reported GAD symptoms and depressive symptoms in the CBT group.
An accompanying editorial said the evolution of mobile technology represented an unprecedented change in geriatric mental health. (2)
The editorial author said society was in the midst of two unprecedented trends — the ageing of the population and the transformation of people’s lives by mobile technology. “These 2 trends are inextricably linked in the area of geriatric mental health and our search for better, more effective treatments with greater reach”, the author wrote. 
“It has been argued that mobile technology will allow our field to accelerate behavioral treatment development by improving the quality of data collected and allowing for rapid transitions through intervention development stages (from mechanism to dissemination).
“Most in our field will welcome such a disruptive change after a relatively stagnant period of mental health clinical trials research”, the author wrote. 
Professor Gavin Andrews, professor of psychiatry at the University of NSW, said that the US study was outdated by Australian standards, because “America has been slower to pick up on CBT”. He said Australia had five competent centres providing CBT. 
“This year we expect 100 000 people to register for CBT”, he told MJA InSight.
He said Australia had also moved beyond the older method of phone-delivered CBT and onto web-based models, which had proven effective across different age groups. 
“Older patients are actually more compliant than young people in adhering [to web-delivered CBT].”
Dr Cate Howell, a GP and mental health practitioner in Adelaide, said the potential of CBT now extended beyond anxiety and depression, and could also be an effective approach to treating eating disorders and psychosis. 
However, she emphasised that results would vary across different age groups and that CBT would always need to be “modified and adapted to the patient’s needs and day-to-day routine”.
Professor Andrews was confident most GPs were aware of the availability of CBT, and that it was becoming more cost-effective, particularly using web-based delivery methods.
“Face-to-fact CBT from a clinical psychologist would be, on average, $40 above [the Medicare rebate] per visit. Across 10 sessions, that is a lot of money.”
However, he said web-based CBT could be provided for just $60 for a 6-month course, making it a cheaper option for patients.
Dr Randles said that with CBT becoming available through new modes of delivery, the demand for the therapy would increase.
However, it was impractical to expect all GPs to be able to pursue CBT as a treatment option for their patients, given their time constraints. 
This meant the responsibility would fall on psychiatrists, but a shortage of graduate psychiatrists qualified to provide CBT would need to be addressed first, Dr Randles said. 
(Photo: CLS Design / shutterstock)

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