ENACT: Exploiting social Networks to Augment Cognitive behavioural Therapy

The work in this Healthcare Partnerships project - termed ENACT - aims to improve the uptake, adherence and completion rates of those referred to Computerised Cognitive Behavioural Therapy (CCBT) interventions using the engaging power of online social network (OSN) platforms, social computer games and mobile technology. Recent research has demonstrated that many common mental health conditions, such as depression, anxiety and insomnia, can be treated successfully with CBT, a form of therapy that addresses styles of thinking and behavioural habits that maintain or exacerbate psychological symptoms. Improving access to psychological therapy is now an explicit NHS policy; integral to this policy is the greater accessibility of computerised CBT (CCBT). However, while the efficacy, effectiveness and cost-effectiveness of CCBT programmes have been comprehensively demonstrated, there remain challenges in terms of user uptake, engagement and completion.As an interactive computer-based activity, the perceived value of, and user engagement with, CCBT will be influenced by factors common to other forms of interactive communications and computer-based media. Indeed, we believe that a major deficiency of existing CCBT programmes is that they merely replicate the structure of face-to-face CBT and do not reflect the way people currently use emerging online and social technologies. Existing CCBT programmes typically consist of passive, weekly, hour-long therapy sessions, with no social contact between the user and either a therapist or fellow treatment users, and also little or no feedback provided to the user on their performance of essential daily homework tasks. Conversely, online social technologies, which appear to be very good at engendering user uptake and regular use, are typically engaged with by users a number of times daily, are very interactive, and are based primarily on social contact.The primary hypothesis of the ENACT project is that CCBT programmes which replicate the interactive structure of online social media will be more effective at engendering user uptake and engagement than CCBT programmes that replicate the structure of traditional one-to-one therapy sessions. In order to examine the effects of enhancing CCBT with elements of online social technology, ENACT will concentrate on the development and enhancement of a CCBT 'package' for the treatment of insomnia(CCBT-I). Users of the final application will 1) be able to interact confidentially with and receive support from other users of the service, 2) be able report completion of daily activities via Online Social Networking and mobile phone applications, 3) receive feedback in an engaging manner on targets set and met, and 4) will generally be supported in their completion of the treatment package in a manner that reflects their usage of online social technology, and which fits conveniently into their daily liefstyle. ENACT is a timely response to the recent emphasis placed, by the DoH, on CCBT as a means of achieving improved access to effective psychological therapies,combined with a continuing need to offer patients with insomnia effective alternatives to often inappropriate hypnotic medication.

WHO We have identified three groups who will directly benefit: (i) patients with common mental health problems, (ii) NHS healthcare providers, and (iii) commercial producers of computer-delivered healthcare products. It should be emphasised that while CCBT for insomnia has been selected as an 'exemplar' computerised therapy, our findings will address an important and unmet healthcare need: the widespread availability of effective, non-pharmacological treatments for chronic insomnia. Untreated insomnia degrades quality of life, increases accident risks, is an independent risk factor for depression, and is consistently associated with impaired occupational performance. Improvements in the clinical management of insomnia, therefore, can be expected not only to improve public health and wellbeing, but also to improve occupational productivity, job satisfaction, and ultimately the UK economy. HOW Despite the success of CCBT in clinical trials and the approval of CCBT by the National Institute for Health and Clinical Excellence (NICE), patient uptake of, and adherence to CCBT has been disappointing. By addressing and overcoming barriers to uptake and adherence, the proposed project has the potential to immediately: increase patient use of an effective therapy; improve patient outcomes among those who take up this approach to therapy; and foster a patient population more amenable to effective computerised therapies in the future. The 'stepped care model' has been widely adopted in UK mental health services. Within this model CCBT is designated 'low intensity' treatment, suitable for lower tiers and, when effective, offsetting the need to deploy more specialised levels of care. The wider and more effective use of CCBT within NHS mental health services would immediately release specialised practitioner time and reduce service costs.Given the proven clinical benefits of CCBT across a range of conditions, the continued endorsement of CCBT products by NICE and NHS service providers, the satisfaction expressed by patients who complete existing CCBT packages, and the growing demand for web-based resources to address health care needs, appropriately packaged computerised psychological therapies certainly have a future. IPR agreements within the proposed project will ensure the exploitation of the project deliverables by a leading UK based SME. While the CCBT-I package will be immediately exploitable as a therapeutic response to a prevalent healthcare need, the enhancement software and concepts will serve to stimulate the development of a range of existing computer-delivered healthcare products within the UK. WHAT The consortium includes representation from all three identified beneficiaries. Patients will be directly represented by two members of the existing service user panel established in Lincolnshire as part of the 'Resources for Effective Sleep' (REST) project. NHS service provision will be represented within the project by CI NS, and Dr Maureen Tomeny, a Consultant Clinical Psychologist and Director of 'Improving Access to Psychological Therapies' (IAPT) services for Nottinghamshire. Finally, industry will be represented by the tightly coupled involvement of the commercial partner, Ultrasis Ltd. The inclusion of the Ultrasis not only provides a clear and explicit route to exploitation, but also means we have a partner who has been through the process of development, evaluation, clinical trial and commercial exploitation of CCBT. Access to this knowledge and experience represents important added value, and will be used to steer the development of the project. Ultrasis will, as a result, take an active management role within the project, providing advice, access, software, and CCBT materials as required.