Les TCC meilleures que le mindfulness pour traiter les insomnies

September 18, 2015

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A clinical trial proves the effectiveness and cost-effectiveness of a cognitive behavioral therapy over the Internet in people with social anxiety.

A Swedish randomized controlled trial Hedman and colleagues, published in the journal Behaviour Research and Therapy in 2011, compares the effectiveness and economic impact of cognitive behavioral therapy over the Internet to a cognitive behavioral therapy group at the patients with social anxiety disorder. The results show that the internet psychotherapy has better cost-effectiveness and cost-utility than that made in groups.

The Study Rationale

The disorder becomes chronic social anxiety for the majority of sufferers who are not treated. It has the effect of school failure and increased risk of unemployment. This disease costs $ 385 million a year in Swedish society. The main costs of this disease are indirect and relate unemployment and lower productivity.

Cognitive-behavioral group therapy is effective in 66% of cases of people treated for social anxiety disorder. However, the cognitive behavioral therapy group are scarce due to a lack of trained therapists and the high price of the sessions. In recent years, cognitive behavioral therapies have shown their effectiveness internet in the treatment of social anxiety disorder. To date, no studies have evaluated the economic impact and cost effectiveness of cognitive behavioral therapy group and by internet from a societal perspective.

The Question

The cost effectiveness of cognitive behavioral therapy via internet it is higher than that of cognitive behavioral therapy group?

The Method

Swedish randomized controlled trial Hedman and his collaborators analyze the cost-effectiveness of both cognitive behavioral therapy techniques. The study focused on 126 people diagnosed with SAD using the DSM-IV. Participants are randomly assigned to two groups, the cognitive behavioral therapy group (n = 62) and cognitive behavioral therapy group over the Internet (n = 64).

Social anxiety is measured from the scale Liebowitz Social Anxiety Scale (LSAS). It assesses the fear and avoidance in social situations 24. Quality of life was assessed using the EQ-5D questionnaire. Love and Trimbos Institute of Medical Technology Assessment Questionnaire for Cost Psychiatrist (ICT-P) evaluates medical costs and indirect costs (lost productivity, unemployment, work stoppages) of each person. All measurements are performed before and after surgery and at 6 months follow-up.

The Non-Pharmacological Intervention (NPI) assessed

Cognitive behavioral therapy internet: patients had access to 15 incremental modules with specific themes such as exposure and cognitive restructuring. They had for each module of exercises to perform at home. The duration of surgery was 15 weeks. The participants communicated with their therapist via a secure messaging system. The discussion time was limited to 10 minutes per week maximum.

Cognitive behavioral therapy group: the intervention included January 1 individual session and 14 in group sessions, all for 15 weeks. Individual session was to prepare participants for group sessions. Each session lasted 50 minutes with 15 minutes break. The groups consisted of 6 to 7 persons.

The speakers were professional psychotherapists trained in cognitive behavioral therapy for social anxiety disorder.

Main Results

End of treatment, 55% of participants of psychotherapy on the internet reduced their anxiety symptoms compared with 34% of participants of group psychotherapy. This difference between the two groups was not statistically significant.

The total cost and cost per domain (medicines, doctors, unemployment duration) are reduced for both groups six months after surgery. The average cost per patient response is 464 dollars for cognitive behavioral therapy online and 2687 dollars for the cognitive behavioral therapy group. At 6 months, improvement of symptoms generated a societal gain 7046 dollars to the group via the internet.

The quality of life is improved similarly to the end of surgery and six months for both groups compared with the beginning of the intervention. The cost-benefit shows a societal gain of 17.8 dollars per patient with same efficiency on the quality of life for cognitive behavioral therapy online.

What it means for Patients

Cognitive behavioral therapies internet and group have the same benefits on improving the quality of life and symptoms of social phobia. Interestingly, cognitive behavioral therapy Internet costs less than a cognitive behavioral therapy group for an equivalent benefit.

What it means for Healthcare Professionals

Cognitive behavioral therapy Internet costs less than a cognitive-behavioral group therapy for people suffering from social phobia. They are therefore more accessible. This cost difference is explained by the time invested by psychotherapists every week for 50 minutes and 10 minutes a group via the internet.

What it means for Researchers

This study is probably the first to assess the economic impact of cognitive behavioral therapy in internet compared to a group of patients suffering from social anxiety disorder. The results of the cost-effectiveness analyzes show the medical and economic interests of CBT directed by internet. Upcoming randomized controlled trials should assess the longer term benefits (at least one year after psychotherapy). It would also be useful to compare the response to placebo on the internet, other methods of psychotherapy and anti-anxiety medications.

What it means for Policymakers

The randomized controlled trial shows the economic benefit to achieve a type of psychotherapy internet CBT for patients with social anxiety. The savings to society are substantial, 7046 dollars for the 51 patients treated with internet compared with 50 treated group psychotherapy. An analysis of the adjusted survival to the quality of life through QALYs shows a profit of 17.8 dollars for psychotherapy internet.

The Reference

Hedman E, Andersson E, Ljotsson B, Andersson G, Rück C, Lindefors N (2011). Cost-effectiveness of internet-based cognitive behavior therapy vs. cognitive behavioral group therapy for social anxiety disorder: results from a randomized controlled trial. Behaviour Research and Therapy, 49, 729-736.