| Notes |
Internet-enabled Cognitive Behavioural Therapy is a type of high-intensity online therapy offered by Ieso Digital Health, where patients receive weekly one-to-one NICE-compliant CBT therapy with a BABCP accredited therapist, delivered remotely via synchronous written conversation (instant messaging) in a secure online meeting room. Under the Ieso model the patient can self-refer directly to the service online, avoiding the stigma and embarrassment often associated with having to see a GP, or informing employers to take time off work to attend assessments and appointments.
At registration, the patient is asked to complete a self-assessment questionnaire, describing the problem and the impact their mental health problems have on their daily life. The patient is then assigned a therapist and goes through an online 30-minute assessment. The patient and therapist agree to subsequent appointment times via an online appointment planning system. Communication during sessions is via synchronous free text typed into the computer with messages sent instantaneously. In between sessions it is possible for the therapist and patient to communicate with each other via asynchronous messaging. This is often used for the therapist to share documents and information between sessions and to remind the patient of any homework assignments.
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Patients use the asynchronous messaging system to ask questions between sessions. Homework tasks, goal tracking and outcome questionnaire completion are all conducted via the online system. Verbatim transcripts of therapy sessions are also stored. These are used by therapists to support planning for future sessions. Patients are encouraged to review transcripts between therapy sessions to reinforce key learning points established.
Session frequency and interval between sessions are agreed between individual patients and therapists online, with no other media or means of communication used in order to retain the online disinhibition effect. The one-to-one nature of internet-enabled CBT makes it similar to face-to-face programmes, whilst retaining the advantages of online services, including accessibility and convenience, increased disclosure and shorter waiting times. The method is especially suitable for patients living in remote rural areas where it is extremely costly and challenging to get patients to assessment appointments, let alone weekly treatment sessions.
Ieso has been commissioned in the English IAPT programme since 2013. Access is now available in 35 of 211 Clinical Commissioning Group areas in England. Ieso currently receives 1,400 referrals per month and has no waiting list. Referrals are growing at a rate of 70% per annum.
Clinical efficacy with higher engagement rates
The clinical efficacy of Ieso’s method of internet-enabled CBT has been demonstrated in a randomised clinical trial published in 2009 by Kessler and colleagues (Kessler et al. 2009). Recent analyses on more than 15,000 patients completing a course of treatment with Ieso show consistent increases in Ieso’s recovery rates, year upon year, with recovery rates in 2017 reaching 55%, with circa 80% of Ieso’s patient cohort at Step 3 (Figure 1). Comparatively, IAPT services report a recovery rate of 48% in 2016, with only 50% of the patient cohort at Step 3 (data for 2017 not publicly available at the closing date for this call for evidence). Recovery rates are generally expected to be significantly higher for Step 2 than Step3. |