title: MindSpot Clinic: An Accessible, Efficient, and Effective Online Treatment Service for Anxiety and Depression.
abstract: OBJECTIVE
  The main objective of this study was to report the feasibility of delivering online cognitive-behavioral therapy (iCBT) treatments for anxiety and depression in a national public mental health service.
  
  
  METHODS
  A prospective noncontrolled cohort study was conducted of all patients who began assessment or treatment at the MindSpot Clinic from January through December 2013. Clinic services were used by a representative cross-section of the Australian population. Mean age at assessment was 36.4±13.0 years, and age range was 18-86 years. Patients completed one of four online courses over eight weeks, during which they received weekly support from a therapist via telephone or secure e-mail. Primary outcome measures were the nine-item Patient Health Questionnaire (PHQ-9) and the seven-item Generalized Anxiety Disorder scale (GAD-7) administered at posttreatment and three months posttreatment.
  
  
  RESULTS
  A total of 10,293 adults who self-identified as having problems with anxiety or depression commenced assessment, and 7,172 completed the assessment and were eligible for analysis. Of these, 2,049 enrolled in a course and 1,471 completed the course, for a course completion rate of 71.8%. Moderate to large noncontrolled effect sizes (Cohen's d=.67-1.66, 95% confidence interval=.08-2.07) were found from assessment to three-month follow-up. At posttreatment and follow-up, reliable recovery ranged from 46.7% to 51.1%, and deterioration ranged from 1.9% to 3.8%. Mean total therapist time per patient was 111.8±61.6 minutes.
  
  
  CONCLUSIONS
  The MindSpot Clinic produced treatment outcomes that were comparable to results from published clinical trials of iCBT. This model of service delivery represents an innovative method of providing accessible, low-cost, effective, and acceptable mental health services to many people who currently are not receiving care.
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Nickolai
authors.initials: N
authors.lastname: Titov
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Blake F
authors.initials: BF
authors.lastname: Dear
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Lauren G
authors.initials: LG
authors.lastname: Staples
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: James
authors.initials: J
authors.lastname: Bennett-Levy
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Britt
authors.initials: B
authors.lastname: Klein
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Rapee
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Clare
authors.initials: C
authors.lastname: Shann
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: David
authors.initials: D
authors.lastname: Richards
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Lee
authors.initials: L
authors.lastname: Ritterband
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Carol
authors.initials: C
authors.lastname: Purtell
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Greg
authors.initials: G
authors.lastname: Bezuidenhout
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Luke
authors.initials: L
authors.lastname: Johnston
authors.affiliation: Dr. Titov, Dr. Dear, Dr. Staples, Dr. Rapee, and Dr. Johnston are with the Department of Psychology, Macquarie University, Sydney, Australia (e-mail: nick.titov@mq.edu.au ). They are also with the MindSpot Clinic, Sydney, where Ms. Purtell, Mr. Bezuidenhout, and Dr. Nielssen are affiliated. Dr. Bennett-Levy is with the School of Public Health, University of Sydney, Sydney, Australia. Dr. Klein is with the Faculty of Health, Federation University, Victoria, Australia. Ms. Shann is with the Movember Foundation, Melbourne, Australia. Dr. Richards is with the Department of Psychology, University of Exeter, Exeter, United Kingdom. Dr. Andersson is with the Department of Behavioral Sciences and Learning, Linköping University, Linköping, Sweden. Dr. Ritterband is with the Department of Psychiatry and Neurobehavioral Sciences, University of Virginia, Charlottesville.
authors.forename: Olav B
authors.initials: OB
authors.lastname: Nielssen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D001008:Anxiety Disorders / Q000628:therapy*; D001315:Australia; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003866:Depressive Disorder / Q000628:therapy*; D034742:Electronic Mail; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008605:Mental Health Services / Q000191:economics*; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D017216:Telemedicine; D016896:Treatment Outcome; D055815:Young Adult