The efficacy and experience of MoodGroup, an online group cognitive behavioural-based intervention for the treatment of depression in Australian adults.

Abstract

Depression is a serious mental health condition affecting approximately 4.1% of Australian adults. Group cognitive behavioural therapy (gCBT) delivered online can potentially provide affordable, accessible, and efficacious treatment to individuals with depression. Online gCBT is an emerging treatment modality and there is a need to broaden the literature regarding its utility and efficacy. Controlled trials are needed to determine the efficacy of online gCBT for depression. This thesis aimed to examine the efficacy, onset of response, group processes, usability, and key stakeholder perspectives of MoodGroup, an online synchronous gCBT intervention for the treatment of clinical depression in Australian adults. In total 92 Australian adults (73 female and 19 male) with a depressive disorder were assigned to either a treatment or wait-list control (WLC) group. Provisional psychologists delivered the treatment intervention with groups of up to eight participants at a time. MoodGroups were hosted in synchronous virtual therapeutic rooms and ran for two hours a week for nine weeks. Participants completed weekly readings and homework activities. They also completed fortnightly outcome measures assessing their depressive symptoms, psychological distress, quality of life (QoL) and group climate perceptions. The usability of the intervention was assessed using weekly online session evaluation questionnaires. A mixed-method approach including linear mixed modelling and thematic content analysis assessed the efficacy and usability of MoodGroup. Additionally, focus groups and interviews were conducted with the MoodGroup facilitators and clinical supervisor to obtain their perspectives on the strengths and limitations of the intervention and recommendations for improvement. The findings of the efficacy trial demonstrated effect sizes favouring the treatment over the control group for all variables, with strong effects (d = 0.65-0.74) noted for measures of depression, psychological distress, anxiety and dysfunctional thoughts. Compared to the WLC, QoL was significantly improved in MoodGroup recipients. Treatment effects were largely maintained over time. The group processes displayed in the MoodGroup intervention were similar to those observed in successful face-to-face gCBT interventions. Furthermore, group climate variables predicted outcome at post-treatment and six-month follow-up. Similar to face-to-face groups, the majority of symptom improvement occurred in the early stages of the MoodGroup intervention. Additionally, early improvement and response to treatment was predictive of treatment gains at the conclusion of the MoodGroup intervention and at six-month follow-up. The usability analysis demonstrated the high usability and acceptability of the intervention. Additionally, valuable insights obtained from the MoodGroup facilitators and clinical supervisor will guide changes to future versions of the intervention and recommendations for group online interventions in general. The major limitations of this research included the small sample size, high rate of attrition and reliance on self-reported data. In conclusion, MoodGroup demonstrated good usability and efficacy. Findings from this thesis contribute to the emerging literature surrounding online group therapy interventions and guide recommendations for future group-based online interventions