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Paul Ritvo



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    OS24 - Evolving Approaches to Patient Care (ID 29)

    • Event: e-Health 2017 Virtual Meeting
    • Type: Oral Session
    • Track: Clinical and Executive
    • Presentations: 1
    • Coordinates: 6/07/2017, 10:30 AM - 12:00 PM, Room 201CD
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      OS24.03 - Mental Health Coaching Using Cloud-Based Education and Behavioural Monitoring  (ID 376)

      Paul Ritvo, Kinesiology and Health Sciences, York University; Toronto/CA

      • Abstract
      • Slides

      Purpose/Objectives: Seventy percent of mental health problems appear before the age of 25 years. When untreated, these disorders become long-standing and significant, impairing all life domains. Although the problem is especially acute for youth from Indigenous and First Nations backgrounds, it is acute for all Canadian youth as 15-25 years is the most likely age-span for diagnosable mental health problems substance dependencies and suicide. For example, substance dependency and suicide are the 1st and 2nd most frequent causes of college and university student mortality. Cognitive behavioural therapy (CBT) is the best-validated psychotherapy, with proven effectiveness resulting in CBT being offered free-of-charge by the United Kingdom National Health Services. In recent years, CBT has been integrated with mindfulness meditation (e.g. mindfulness-based CBT), with strong evidence supporting its effectiveness. Research undertaken with student populations by our group has demonstrated psychometrically and neurophysiologically assessed benefits in web-based Randomized Controlled Trials of CBT-Mindfulness interventions. This RCT assesses Cognitive Behavioural Therapy (CBT) combined with Mindfulness Meditation (MM) with youth subjects (18 – 25 yrs) diagnosed with major depressive disorder.

      Methodology/Approach: Two treatment groups (youth of Indigenous-First Nations background, youth of all other ethnic backgrounds) will be compared with wait list controls (50% Indigenous- First Nation, 50% other background) at baseline, 3 months (mid-intervention) & 6 months (post-intervention), using valid, standard self report outcome measures. Experimental subjects will receive additional intervention consisting of a mindfulness-based CBT online software program workbook (in collaboration with NexJ Health Inc.). Exposure to and interaction with the online workbook is combined with health coaching (duration of 24 hours) primarly delivered in phone/software interactions. Participants and health coaches will plan one face-to-face session per month. Content builds on two prior successful web-based CBT-mindfulness RCTs with students (Radhu et al., 2012 Arpin-Cribbie et al., 2012) and methods demonstrated effective in prior RCTs in other countries (Boettcher et al. 2014, Carlbring et al., 2013, Lappaleinen et al., 2014). The online workbook content consists of 24 chapters that cover multiple topics (e.g. Living By Your Truths, Overcoming Wired-ness and Tired-ness, Mindfulness and Relationships, Loss and Grief, and Resilience, Befriending Ourselves, Befriending Your Body with Exercise, Body Image and Mindfulness, Intimacy, Forgiveness, Overcoming Procrastination, Dealing with Negative Moods, Stress Resilience, Overcoming Performance Anxiety, Cultivating Inspiration) which are covered in sequence on a weekly basis with the health coach (over 24 weeks).

      Finding/Results: Hypothesis: CBT-MM online intervention will be associated with statistically and clinically significant between-group differences (benefits) when treatment groups and control group are compared, using both intention-to-treat and per protocol analyses. Costs and cost-effectiveness of CBT-MM online intervention will compare favorably with office-based CBT services. Outcome Measures: Primary outcomes: Beck Depression Inventory; Secondary outcomes: Anxiety (Beck Anxiety Inventory), depression (Quick Inventory of Depressive Symptomatology) (QIDS), mindfulness (Five-Facet Mindfulness Questionnaire), pain (Brief Pain Inventory).

      Conclusion/Implication/Recommendations: If significant differences are obtained, this will be a substantial advancement in our ability to offer high quality interventions without geographic restriction.

      140 Character Summary: This RCT assesses Cognitive Behavioural Therapy (CBT) combined with Mindfulness Meditation (MM) for youth diagnosed with major depressive disorder.

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