CRUfADclinic.org:

where people get well

Gavin Andrews AO MDClinical Research Unit for Anxiety and

Depression (CRUfAD),

UNSW at St Vincent‟s Hospital, Sydney,

Australia.CRUfADclinic is a not for profit initiative of St Vincent‟s Hospital

Depressive & Anxiety Disorders

• 7% of the burden of human disease

• Greater than diabetes + asthma + arthritis

• Principal cause of disability in the world

• Not well treated by SSRIs or FtF CBT

Systematic review

Andrews, Cuijpers, Craske, McEvoy, Titov.

• iCBT or cCBT versus control group

• diagnosed cases of

• major depression,

• social phobia,

• panic disorder,

• GAD.

• 22 Randomized Controlled Trials

• Research quality good

• Follow up duration ~6mo

• Patient adherence and satisfaction high

Group byDisorder

Study name Statistics for each study

Hedges's Lower Upper g limit limit Z-Value p-Value

AMDD Andersson, 2005 0,87 0,43 1,32 3,83 0,00 Blank

AMDD Kessler, 2009 0,61 0,33 0,88 4,30 0,00 BDI

AMDD Perini, 2009 0,56 -0,05 1,17 1,81 0,07 Combined

AMDD Selmi, 1990 1,26 0,40 2,11 2,89 0,00 Blank

AMDD Titov, 2010 0,99 0,55 1,44 4,36 0,00 Combined

AMDD Wright, 2005 1,10 0,35 1,85 2,87 0,00 Blank

AMDD 0,78 0,59 0,96 8,20 0,00

Bpanic Carlbring, 2001 0,97 0,33 1,61 2,99 0,00 Blank

Bpanic Carlbring, 2006 1,13 0,59 1,66 4,10 0,00 Blank

Bpanic Klein, 2001 0,39 -0,41 1,18 0,95 0,34 Blank

Bpanic Klein, 2006 1,49 0,77 2,20 4,07 0,00 Blank

Bpanic Richards, 2006 0,74 -0,12 1,60 1,69 0,09 Blank

Bpanic Wims, 2009 0,28 -0,25 0,81 1,03 0,30 Combined

Bpanic 0,83 0,45 1,21 4,27 0,00

Csocphob Andersson, 2006 0,76 0,26 1,26 2,97 0,00 Blank

Csocphob Berger, 2009 0,64 0,08 1,20 2,23 0,03 Combined

Csocphob Botella, 2009 1,07 0,50 1,64 3,66 0,00 Combined

Csocphob Carlbring, 2007 1,07 0,52 1,61 3,81 0,00 Blank

Csocphob Furmark, 2009 0,67 0,22 1,11 2,92 0,00 Combined

Csocphob Titov, 2008 I 0,94 0,53 1,36 4,48 0,00 Combined

Csocphob Titov, 2008 II 1,18 0,71 1,65 4,95 0,00 Combined

Csocphob Titov, 2008 III 1,02 0,51 1,53 3,91 0,00 Combined

Csocphob 0,92 0,74 1,09 10,28 0,00

GAD Robinson, 2009 1,13 0,70 1,56 5,16 0,00 Combined

GAD Titov, 2009 1,08 0,46 1,69 3,41 0,00 Combined

GAD 1,11 0,76 1,47 6,19 0,00

Overall 0,88 0,76 0,99 15,04 0,00

-2,00 -1,00 0,00 1,00 2,00

Favours control Favours CBT

Results are amazing: NNT~2Andrews, Cuijpers, Craske, McEvoy, Titov.

Disorder N of trials Hedges g NNT

Depression 6 0.78 2.4

Social Phobia 8 0.92 2.1

Panic

Disorder

6 0.83 2.3

GAD 2 1.12 1.8

All Studies 22 0.88 2.2

In Sydney, Australia

• National TV assessed the course for depression

• www.ABC.net.au/Catalyst [virtualclinic]

Efficacy: virtualclinic.org.au

14 Trials: depression=3, social phobia=7, panic=2, GAD=2

• Patients as severe as patients in our face to face specialist clinic

• make the same or better progress (mean ES=0.9)

• progress is better at the six month follow up.

• little clinician time involved, (practice nurses spend 40 minutes).

• 80% of people complete their course, say they are satisfied,

Internet therapy in these four disorders is effective, efficient and acceptable to the patient.

Depression: ¾ recover (Completers n=66)

PHQ-9None(0-9)

PHQ-9Mild (10-14)

PHQ-9Moderate (15-19)

PHQ-9Severe (20-27)

Before

treatment

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After treatment

10 weeks later

73% recovered

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CRUfADclinic: Roll out to clinicians

CRUfADclinic course design:

• Each course has 6 lessons

• „Cartoon‟ story of a person with the disorder who

recovers with advice

• Written instructions for patients to download to

reinforce the advice

• Testimonials from patients

• Relapse prevention is always lesson 6

Panic: Confronting fears

Roll out of CRUfADclinic.org to all rural

physicians in Australia

• Patients approve

• “I was sceptical of an online program as opposed to

an actual clinic. I found the first session great.

• CRUfADclinic has a very professional feel about it

• After spending years explaining my symptoms to

Doctors and Psychologists it is a relief to find help

where I can get on with fixing the problem.”

iCBT = face to face CBT. Efficiency 13:1

CRUfADclinic.org is good science

It treats patients with respect

It is simple to use

Requires little staff time

Most people like it and do well

Roll out to the world

• Negotiating with US, Canada, New Zealand

• With WHO, aiming at the BRIC countries

• Simple to translate for the E U

• Talk to me if you‟re interested• gavina@unsw.edu.au

• Else just purchase a prescription book• www.crufadclinic.org

• $100 buys 20 prescriptions