Evaluation of 100% Online Psychotherapy with App-Support Versus Therapy as Usual for Clients with Depression or Anxiety Disorder: A Retrospective Matched Cohort Study Investigating the Effectiveness, Efficiency, Client Satisfaction, and Costs

Abstract

Introduction: Depressive and anxiety disorders are common mental disorders ranking among the leading causes of global disease burden. Not all clients currently benefit from therapy and clients are looking for modern ways of therapy. Online psychotherapy is a promising option for better meeting clients’ needs. Recently, a new psychotherapy concept has emerged that combines videoconferencing sessions with app-support.

Material and methods: The study was a retrospective observational matched cohort study, comparing online therapy with Therapy As Usual (TAU) for clients with a depressive or anxiety disorder. The data was obtained via questionnaires, which are part of standard clinical care. Primary outcomes were general mental functioning, and depressive and anxiety symptoms. Secondary outcomes were efficiency, client satisfaction and therapy costs. The primary endpoints were analyzed using linear mixed models analysis, with an interaction term between time and group. Secondary outcomes were analyzed using linear regression. 

Results: On general mental functioning and depressive symptoms, larger improvements were observed in the online compared to the TAU group (i.e., General mental functioning: B = -8.50, 95 CI: -15.01 -  -1.97, p = .011; Depressive disorder: B = - 3.66, 95% CI: -5.79 – -1.54 p < .01). No significant differences in change over time between the two groups were observed for anxiety disorder (B = -3.64, 95% CI: (-13.10 – 5.82) p = .447). The total number of sessions was significantly higher in the online therapy group than in TAU (B= 3.71, p < .01) , although clients were matched on treatment time in weeks. Treatment session time in minutes was comparable across the two groups.

Discussion: Online psychotherapy with app-support showed to be a promising alternative to TAU for depressive and anxiety disorders. More research is needed to evaluate the effectiveness, cost-effectiveness and client satisfaction of online therapy compared to TAU, such as randomized controlled trials or studies multiple baseline series designs and in-dept qualitative research.

Note:
Funding declaration: No funding was obtained for this research.

Conflict of Interests: The authors declare no conflict of interest.

Ethical Approval: Due to the nature of the study, the need for ethical approval was waived by the Medical Ethics Committee of Leiden – Delft – Den Haag (G20.200 dd 19 Feb 2021).

Keywords: Psychotherapy, Anxiety disorder, Depressive disorder, Online therapy, Specialized mental health care, Personalized care