Accepted for/Published in: JMIR Formative Research
Date Submitted: Jun 17, 2019
Date Accepted: Sep 7, 2020
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Problems with sleep, sexual functioning, energy, and appetite among patients accessing transdiagnostic Internet-delivered cognitive behaviour therapy for anxiety and depression: A qualitative analysis
ABSTRACT
Background:
Transdiagnostic Internet-delivered Cognitive Behaviour Therapy (T-ICBT) is an effective treatment for anxiety and depression and there is now interest in exploring ways to optimize T-ICBT in routine care. T-ICBT programs are designed to address the primary cognitive-affective and behavioural symptoms of anxiety and depression (e.g., low mood, worry, anhedonia, avoidance) and treatment also has the potential to resolve many other symptom concerns (e.g., sleep disruption, sexual dysfunction, lack of energy, and appetite/weight changes).
Objective:
The goal of this exploratory study was to better understand the symptom concerns of T-ICBT clients seeking treatment for depression and anxiety. A qualitative analytic approach was used to identify themes in the symptom concerns reported by patients in the areas of sleep, sexual functioning, energy, and appetite at the time of enrollment. Results were then compared to patient responses on related items from screening measures for anxiety and depression to provide an estimate of how common these symptoms are among T-ICBT patients.
Methods:
Patients in routine care who applied for a T-ICBT program for depression and anxiety over a 1-year period were included in the current study. As part of the application and screening process, participants completed depression and anxiety symptom measures (i.e., Patient Health Questionnaire-9 Item; Generalized Anxiety Disorder-7 Item). Subsequently, they were asked if they were experiencing any problems with sleep, sexual activity, energy, or appetite [yes/no]. If their response was yes, they were presented with an open-ended comment box that asked them to describe the problems they had been having in those areas.
Results:
462 patients were admitted to T-ICBT during the study period, of which 438 endorsed the yes/no item and subsequently responded to the open-ended problems question. In total, 73.4% of patients reported sleep problems (e.g., difficulty initiating or maintaining sleep), 69.3% of patients reported problems with energy or motivation (e.g., tiredness; low motivation), 57.4% of patients reported appetite or body weight concerns (e.g., changes in appetite, weight loss/gain), and 30.1% of patients described concerns with sexual functioning (e.g., loss of interest in sex, difficulty with arousal). Item analysis of symptom measures demonstrated that T-ICBT produced improvements in sleep, energy, and appetite in eight weeks. Sexual dysfunction and weight changes were not represented in the screening measures, so it remains unclear what effect T-ICBT has on these symptoms.
Conclusions:
Sleep disruption, lack of energy, appetite/weight changes, and sexual dysfunction are common concerns reported by clients enrolled in T-ICBT in routine practice. The results of the current study allowed us to identify several areas where T-ICBT outcomes measures could be improved to better understand how effective T-ICBT is in treating these common symptoms related to depression and anxiety.
Citation
