Fighting anxiety and depression
It is a statistic that Professor Nick Titov and Dr Blake Dear find alarming. Although one in five people experience anxiety or depression in any given year, less than 35 per cent of those affected will seek treatment for their condition.
There can be a number of reasons why people do not seek help, when they need it most. The cost of treatment can be a barrier, as can the distance to the nearest town – patients in regional and remote areas can find it very difficult to access psychological assessment and care.
In their search for a solution to the problem, Professor Titov and Dr Dear have developed two internet-based platforms for the provision and validation of treatment for anxiety and depression: the eCentreClinic and the MindSpot Clinic.
“The eCentreClinic is a research clinic focused on developing and testing new treatments,” explains Dr Dear. “Once we have sufficient evidence for a treatment and we know it is effective, we move it over to the MindSpot Clinic, which is a national assessment and treatment service for Australians with anxiety and depression.”
Professor Titov and Dr Dear joined Macquarie University in 2011 to establish the internet-based clinics and worked closely with colleagues in the Department of Psychology and the Centre for Emotional Health.
Professor Titov was appointed Associate Professor and had a wealth of research expertise regarding the treatment of anxiety and depressive disorders. Dr Dear was trained as a clinical psychologist with a specific interest in helping patients struggling with challenging health conditions such as chronic pain. The pair worked as a team, sharing a common interest in wanting to improve access to treatment by people with anxiety and depression using internet-based platforms.
Thousands of Australians now access treatment online
“There is a culture of innovation here at Macquarie. The eCentreClinic and the MindSpot Clinics are good examples of how that culture promotes and nurtures paradigm shifts,” says Professor Titov. “We developed an innovative model which challenges multiple paradigms: how psychological therapy should work; the duration of the therapy; and the relationship with patients. In some cases we have a lot of contact with patients, in other cases very little, particularly if they are socially anxious.”
“The culture at Macquarie gives permission to explore research questions at multiple levels providing they’re informed by evidence and they’re safe. I think that’s rare at a university, there’s something very special about Macquarie.”
As Co-Directors of the eCentreClinic, Professor Titov and Dr Dear developed evidence-based treatments for a range of conditions, including social anxiety disorder; panic disorder; generalised anxiety disorder; and major depression.
“Internationally, we’ve contributed to innovation in the development of trans-diagnostic interventions,” says Professor Titov. “Clinicians and patients struggle with the fact that different disorders of anxiety and depression can occur at the same time.”
“Our programmes work across different age groups. They also work effectively across different disorders.”
Since the eCentreClinic was established in 2011, it has grown from an innovative psychological assessment and treatment model into a fully-fledged website, supported by national and international collaboration. From the beginning, its mission was clear – the team wanted to help more people to access treatment for anxiety and depression.
“We’re motivated to improve access for patients to evidence-based care. We really want to address the burden of untreated depression and anxiety in the community,” says Professor Titov. “We knew that our internet-based interventions had potential, but we needed to develop a research programme with quality assurance.”
“We needed clinical trials with a very large number of people and we knew it was a challenge. But we’re always up for a big challenge.”
To test the treatment models they developed, the eCentreCinic carried out more than 20 clinical trials in its first two years of operation, involving more than 2,000 participants across Australia. Soon after, 12 separate treatment programmes had been developed and the MindSpot Clinic was launched.
Proven to be as effective as traditional face-to-face treatments, the programmes are also designed to be delivered at a fraction of the cost of existing services. Designed to be relevant and practical, the programmes use techniques derived from interpersonal and cognitive behavioural therapy to support patients in the short and long term. Importantly, the treatments have received a resounding endorsement from consumers who find them both effective and engaging.
Since 2012, selected eCentreClinic treatment courses have been offered through the MindSpot Clinic, which is funded by the Australian Government until June 2015. Over three years, the internet clinic will provide assessment and treatment to 50,000 Australians, offering care to thousands of people who are unable or unwilling to receive support elsewhere.
“We accept referrals from health providers around Australia but in reality the majority of patients who come to us self-refer,” explains Professor Titov. “They hear about our website, they see references to us in articles or online ads and they initiate an assessment without going to a health professional. So we’re making a difference in reducing some of the barriers that prevent people from seeking help.”
Research is continuing into the uptake and acceptance of internet-based care. Professor Titov and Dr Dear are keen to find out more about those who benefit and those who do not, and to continue to develop treatment programmes, particularly for people struggling with other challenging health conditions such as chronic pain. While clinical results have been “outstanding”, the pair is dedicated to reaching even more Australians who need treatment.
“We’ve been struck by the sheer number of Australians who have never been taught the fundamental skills and strategies that support psychological wellbeing,” says Professor Titov. “I’m sure it is the same story elsewhere in the world. The internet interventions that we are developing can support people to recover from anxiety and depression.”
“We have a platform and a model for public health that can have a massive impact on the well-being of a nation. It is an enormous opportunity and an enormous responsibility.”
Hear from Associate Professor Nickolai Titov
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